妊娠期糖尿病患者孕前体重指数及孕期体重增加量与妊娠结局及产科并发症关系研究  

Relationship of pre-pregnancy body mass index and gestational weight gain with obstetric complications and pregnancy outcome in patients with gestational diabetes mellitus

作　　者：王雪影[1] 周莉[1] WANG Xue-ying;ZHOU Li(Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院产二科,北京100026

出　　处：《中国实用妇科与产科杂志》2020年第8期757-761,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：首都临床特色应用研究与成果推广(Z151100004015182)。

摘　　要：目的探讨妊娠期糖尿病(GDM)患者孕前体重指数(BMI)、孕期体重增加量与妊娠结局及产科并发症的关系。方法收集2014年8月1日至2017年9月30日于首都医科大学附属北京妇产医院住院分娩的足月、头先露、单胎确诊GDM孕产妇共1641例。按孕前BMI分为低BMI组(BMI<18.5)128例(7.80%)、正常BMI组(BMI 18.5~25.0)1180例(71.91%)、超重及肥胖组(BMI>25.0)333例(20.29%);按孕期体重增加量分组,分为体重增加不足组375例(22.85%)、体重增加适宜组626例(38.15%)、体重增加过多组640例(39.00%)。探讨不同孕前BMI和不同孕期体重增加量GDM患者的妊娠结局以及并发症的发生情况。结果(1)超重及肥胖是妊娠期高血压疾病的一个危险因素,孕前BMI越大,妊娠期高血压疾病风险预测越高(RR>1),且孕妇妊娠期高血压疾病的危险性与孕期增重也有关系,发病率与增重成正相关(χ^2=5.24,P<0.05)。(2)孕前超重及肥胖组的GDM患者总产程(18.56±2.43)h、新生儿出生体重(3520±480)g均大于正常BMI组(13.88±2.04)h、(3430±450)g及低BMI组(14.21±2.16)h、(3250±450)g(P<0.01),体重增加过多组的GDM孕妇总产程(15.32±2.34)h、新生儿出生体重(3550±450)g均高于体重增加不足组(14.78±2.05)h、(3250±450)g及体重增加适宜组(15.17±2.07)h、(3420±440)g(P<0.05)。(3)孕前超重及肥胖组的GDM患者产程停滞(7.51%)、剖宫产率(31.83%)、产后出血(21.02%)、胎儿窘迫(13.81%)、巨大儿发生率(15.62%)、阴道助产率(8.71%)明显高于低BMI组(0.78%、11.72%、14.06%、8.59%、2.34%、4.69%)及正常BMI组(5.34%、23.98%、15.93%、11.10%、9.41%、6.10%)(P<0.01),同时转新生儿重症监护室(NICU)发生率(3.30%)也普遍增高(1.56%、2.97%)(P<0.05)。(4)孕期总体重增加过多组产程停滞(6.88%)、剖宫产率(29.53%)、产后出血(18.44%)、胎儿窘迫(13.75%)、巨大儿发生率(15.00%)、阴道助产率(8.44%)明显高于体重增加不足组(4.00%、17.07%、15.73%、8.80%、3.20%、5.60Objective To investigate the relationship of pre-pregnancy body mass index(BMI)and gestational weight gain with obstetric complications and pregnancy outcome in patients with gestational diabetes mellitus(GDM).Methods A total of 1641 pregnant women with gestational diabetes mellitus,singleton pregnancy and cephalic presentation,who was admitted to Beijing Obstetrics and Gynecology Hospital,Capital Medical University from August 1 st,2014 to September 30 th,2017,were recruited.According to BMI classification criteria and the pre-pregnancy BMI,the1641 GDM women were divided into three groups,128 cases(7.80%)in low BMI group(BMI<18.5),1180 cases(71.91%)in normal BMI group(BMI 18.5-25.0),and 333 cases(20.29%)in over weight and obesity group(BMI>25.0).According to the weight gain during pregnancy,they were divided into three groups,the inadequate gestational weight gain(GWG)group(375 cases,22.85%),the appropriate GWG group(626 cases,38.15%),and the excessive GWG group(640 cases,39.00%).Investigate the pregnancy outcomes and complications of gestational diabetes patients with different pre-pregnancy BMI and different gestational weight gains.Results(1)Overweight and obesity were risk factors for hypertensive disorders of pregnancy.The higher the pre-pregnancy BMI,the higher the risk of hypertensive disorders of pregnancy(RR>1),and the risk of hypertensive disorders of pregnancy was also related to gestational weight gain,and incidence rate was positively correlated with weight gain(χ^2=5.24,P<0.05).(2)Compared with those with normal BMI[(13.88±2.04)h,(3430±450)g]and low BMI group[(14.21±2.16)h,(3250±450)g],the overweight and obese group had a higher total labor time[(18.56±2.43)h]and a larger neonatal birth weight[(3520±480)g](P<0.01).Compared with those with the inadequate GWG[(14.78±2.05)h,(3250±450)g]and the appropriate GWG group[(15.17±2.07)h,(3420±440)g],the excessive GWG group had a higher total labor time[(15.32±2.34)h]and a larger neonatal birth weight[(3550±450)g](P<0.05).(3)The labor stagnation r

关 键 词：妊娠期糖尿病 体重指数 体重增长 肥胖 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]