摘要
目的探讨孕期不同体重指数(BMI)增长幅度(ΔBMI)变化对妊娠糖尿病(GDM)合并高血压患者妊娠结局的影响,及其胰岛功能的变化。方法回顾性选取2021年1月至2022年12月在唐山市妇幼保健院进行产检及分娩的GDM合并高血压患者200例作为研究对象,根据ΔBMI变化量将其分成BMI增长不足组(ΔBMI<4 kg/m^(2),n=51)、BMI增长正常组(4 kg/m^(2)≤ΔBMI≤6 kg/m^(2),n=87)、BMI增长过多组(ΔBMI>6 kg/m^(2),n=62),并根据母婴结局不同将患者分为母婴结局不良组(n=60)与母婴结局正常组(n=140)。比较BMI增长不足组、BMI增长正常组、BMI增长过多组的临床资料(年龄、孕前BMI、糖尿病家族病史、文化程度、居住地、分娩方式、新生儿结局、产妇并发症)、孕期胰岛功能[胰岛素抵抗指数(HOMA-IR)及胰岛β细胞功能指数(HOMA-β)]、血压、ΔBMI的差异;分析ΔBMI与母婴不良结局的相关性;比较不同母婴结局产妇临床特征及孕期ΔBMI的差异;采用多因素Logistic回归分析对影响GDM合并高血压发生母婴结局不良的因素进行分析。结果(1)3组分娩方式比较,差异有统计学意义(P<0.05),BMI增长过多组与BMI增长不足组以剖宫产为主,BMI增长正常组以经阴道分娩为主。BMI增长过多组产妇并发症总发生率、新生儿结局不良总发生率均高于BMI增长不足组和BMI增长正常组,差异均有统计学意义(P<0.05)。(2)BMI增长过多组的孕期HOMA-IR与24 h平均收缩压、24 h平均舒张压、孕期ΔBMI均高于BMI增长不足组和BMI增长正常组,孕期HOMA-β低于BMI增长不足组和BMI增长正常组,差异均有统计学意义(P<0.05)。(3)孕期ΔBMI与产妇不良妊娠结局呈正相关(P<0.05),与新生儿不良结局呈正相关(P<0.05);孕期ΔBMI与HOMA-IR、24 h平均收缩压、24 h平均舒张压呈正相关(P<0.05),与孕期HOMA-β呈负相关(P<0.05)。(4)母婴结局不良组孕期ΔBMI、HOMA-IR、24 h平均收缩压、24 h平均舒张压均高于母婴结局正常组,孕期HOMA-β低于母婴结局正常组,差异均有统计学意义(P<0.05)。(5)多因素Logistic回归分析结果显示:孕期ΔBMI>5.83、HOMA-IR>4.92、HOMA-β<162.65、24 h平均收缩压>141.15 mmHg、24 h平均舒张压>90.88 mmHg是母婴结局不良的危险因素(P<0.05)。结论孕期ΔBMI增长过多或不足,可导致GDM合并高血压产妇出现胰岛素抵抗增加,β细胞功能降低,血压异常的现象。孕期ΔBMI与GDM合并高血压产妇母婴结局不良呈正相关,ΔBMI增高会增加母婴结局的不良发生率,孕期应监测患者的体重变化。
Objective To explore the impact of changes in body mass index(BMI)growth rate(ΔBMI)during pregnancy on pregnancy outcomes in pregnant women with GDM and hypertension,as well as changes of pancreatic islet function.Methods A total of 200 pregnant women with GDM and hypertension who underwent prenatal examination and delivery at Tangshan Maternal and Child Health Hospital from January 2021 to December 2022 were retrospectively selected as the research subjects,and they were divided into the BMI insufficient growth group(ΔBMI<4 kg/m^(2),n=51),normal BMI growth group(4 kg/m^(2)≤ΔBMI≤6 kg/m^(2),n=87),excessive BMI growth group(ΔBMI>6 kg/m^(2),n=62)according to the change inΔBMI;and patients were divided into the poor maternal and infant outcomes group(n=60)and the normal maternal and infant outcomes group(n=140)based on different maternal and infant outcomes.The clinical data of the insufficient BMI growth group,the normal BMI growth group,and the excessive BMI growth group(age,pre-pregnancy BMI classification,diabetes family medical history,education level,place of residence,mode of delivery,neonatal outcomes,maternal complications)were compared,the differences in pancreatic islet function[Homeostasis model insulin resistance(HOMA-IR),pancreaticβcell function index(HOMA-β)],blood pressure,andΔBMI during pregnancy between the three groups were compared,and the correlation between BMI and adverse maternal and infant outcomes was analyzed;the clinical characteristics and differences inΔBMI during pregnancy among mothers with different maternal and infant outcomes were analyzed,and the differences inΔBMI during pregnancy among mothers with GDM and hypertension were compared.The factors affecting the adverse maternal and infant outcomes of GDM combined with hypertension were analyzed using multivariate Logistic regression analysis.Results(1)The difference in delivery methods among the three groups was statistically significant(P<0.05).The excessive BMI growth group and insufficient BMI growth group mainly underwent cesarean section,while the normal BMI growth group mainly underwent vaginal delivery.The overall indidence of and total incidence of maternal complications adverse neonatal outcomes in the excessive BMI growth group were higher than those in the insufficient BMI growth group and normal BMI growth group,and the differences were statistically significant(P<0.05).(2)The HOMA-IR and 24-hour mean systolic blood pressure,24-hour mean diastolic blood pressure,andΔBMI during pregnancy in the excessive BMI growth group were higher than those in the insufficient BMI growth group and the normal BMI growth group,and HOMA during pregnancy was lower than that in the insufficient BMI growth group and normal BMI growth group,and the differences were statistically significant(P<0.05).(3)ΔBMI during pregnancy was positively correlated with adverse maternal pregnancy outcomes(P<0.05),and positively correlated with adverse neonatal outcomes(P<0.05);ΔBMI was positively correlated with HOMA-IR,24 h average systolic blood pressure,and 24 h average diastolic blood pressure during pregnancy(P<0.05),and was negatively correlated with HOMA-βduring pregnancy(P<0.05).(4)TheΔBMI,HOMA-IR,24-hour average systolic blood pressure,and 24-hour average diastolic blood pressure during pregnancy in the poor maternal and infant outcomes group were higher than those in the normal maternal and infant outcomes group,and the pregnancy HOMA-βwere lower than that in the normal maternal and infant outcomes group,the difference were statistically significant(P<0.05).(5)Multivariate Logistic regression analysis showed that:ΔBMI>5.83,HOMA-IR>4.92,HOMA-β<162.65,24-hour average systolic blood pressure>141.15 mmHg,and 24-hour average diastolic blood pressure>90.88 mmHg during pregnancy were risk factors associated with poor maternal and fetal outcomes(P<0.05).Conclusion IfΔBMI increases excessively or insufficiently during pregnancy,parturients with GDM and hypertension may experience increased insulin resistance,decreasedβ-cell function,and abnormal blood pressure.ΔBMI during pregnancy were positively correlated with adverse maternal and infant outcomes for GDM and hypertensive mothers.IncreasedΔBMI will increase the incidence of adverse maternal and infant outcomes and should be monitored during pregnancy.Weight changes in pregnant women.
作者
杜瑞娟
袁乐
黄娜
孙莉莉
王苓
王雪梅
周静
于增荣
DU Rui-juan;YUAN Le;HUANG Na(Department of Obstetrics and Gynecology,Tangshan Maternal and Child Health Hospital,Tangshan Hebei 063000,China)
出处
《临床和实验医学杂志》
2024年第9期968-972,共5页
Journal of Clinical and Experimental Medicine
基金
河北省2024年度医学科学研究课题计划(编号:20242186)。
关键词
妊娠期糖尿病
妊娠高血压
体重指数
母婴结局
Gestational diabetes
Gestational hypertension
BMI
Maternal and fetal outcomes
