孕前BMI、孕期随机空腹血糖最高值、孕期增重对28周后妊娠期糖尿病孕妇分娩巨大儿风险的评估价值  

The value of pre-pregnancy BMI,gestational maximum fasting blood glucose and weight gain during pregnancy to evaluate fetal macrosomia after 28 weeks of gestational diabetes mellitus

作　　者：李丹[1] 宋灏哲 黄宗耀 杨楚琪 王世军[1] Li Dan;Song Haozhe;Huang Zongyao;Yang Chuqi;Wang Shijun(Department of Obstetrics and Gynecology,Xuanwu Hospital of Caitiial Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院妇产科,北京100053

出　　处：《中国医师杂志》2021年第7期1054-1057,共4页Journal of Chinese Physician

摘　　要：目的分析28周后妊娠期糖成病(妊糖症)孕产妇孕前BMI、孕期随机空腹血糖最高值、孕期增重与分娩巨大儿之间的关系。方法回顾性分析2014年首都医科大学宣武医院产科接受孕期检查及分娩的310例确沴28周后妊糖症孕产妇临床资料,依据新生儿体重分为分娩巨大儿的观察组(96例)及分娩正常体重儿的对照组(214例),分析两组孕妇孕前BMI、孕期随机空腹血糖最高值、孕期增重之间的差异。结果巨大儿组孕产妇的孕前BMI、孕期随机空腹血糖最高值、孕期增重等因素均明显大于非巨大儿组,差异有统计学意义(P<0.05);且其预测孕28周后妊娠期糖尿病孕妇分娩巨大儿的最佳截断点分别为22.077kg/m^(2)、4.965mmol/L、17.400kg,曲线下面积(AUC)分别为0.646、0.595、0.699。在矫正混杂因素后,孕前BMI(OR=1.238,95%CI:1.132,1.354,P<0.001)、孕期增重(OR=1.189,95%CI:1.120,1.262,P<0.001)是孕28周后妊娠期糖尿病孕妇分娩巨大儿的危险因素(P<O.05):结论孕前BMI>22.077 kg/m^(2)、孕期随机空腹血糖最高值>4.965 mmol/L、孕期增重>17.400 kg均为28周后妊娠期糖尿病孕妇分娩巨大儿的高危因素,对于妊糖症孕妇,通过积极的孕前干预及健康管理对于降低巨大儿发生风险有重要意义。Objective To analyze the relationship between pre-pregnancy body mass index(BMI),gestational random fasting glucose maximum,weight gain during pregnancy,and the occurrence of macrosomia in pregnant women diagnosed with gestational diabetes after 28 weeks gestation.Methods The clinical data of 310 pregnant women with gestational diabetes after 28 weeks of diagnosis in Xuanwu Hospital of Capital Medical University in 2014 were retrospectively analyzed.They were divided into observation group(96 cases)with macrosomia and control group(214 cases)with normal birth weight according to the weight of newborn.The differences of BMI before pregnancy,ihe highest value of fasting blood glucose during pregnancy and weight gain during pregnancy between the two groups were analyzed.Results The pre-pregnancy BMI,the highest value of random fasting blood glucose and weight gain during pregnancy in macrosomia group were significantly higher than those in non macrosomia group(P<0.05);And the best cut-off point for predicting the delivery of macrosomia in pregnant women with gestational diabetes after 28 weeks of pregnancy was 22.077 kg/m^(2),4.965 mmol/L and 17.400kg,respectively.Fhe area under the curve(AUC)was 0.646,0.595 and 0.699 respectively.After correction of confounding factors,the BMI(OR=1.238,95%CI:1.132,1.354,P<0.001)and weight gain during pregnancy(OR=1.189,95%CI:1.120,1.262,P<0.001)were risk factors for macrosomia in gestational diabetes mellitus after 28 weeks of gestation(P<0.05).Conclusions Pre-pregnancy BMI>22.077 kg/m^(2),gestational maximum fasting blood glucose>4.965 mmol/L and gestational weight gain>17.400 kg were all high risk factors for gestational diabetes mellitus pregnant women after 28 weeks.For pregnant women with gestational diabetes,active prenatal intervention and health management are of great significance in reducing the risk of macrosomia.

关 键 词：糖尿病 妊娠 巨大胎儿 人体质量指数 血糖 体重增长 

分 类 号：R714.256[医药卫生—妇产科学]