孕期增重对妊娠糖尿病患者糖代谢及妊娠结局的影响  

Effect of gestational weight gain on glucose metabolism and pregnancy outcomes in patients with gestational diabetes mellitus

作　　者：沈梦尘 钟建容 王曦[3,4] 陈蕾 Shen Meng-Chen;Zhong Jian-Rong;Wang Xi;Chen Lei(Navy Clinical Medical College of Anhui Medical University,Beijing 100048,China;The Fifth School of Clinical Medicine,Anhui Medical University,Hefei,Anhui 230032,China;Department of Obstetrics and Gynecology,the Sixth Medical Center of Chinese PLA General Hospital,Beijing 100048,China;School of Medicine,South China University of Technology,Guangzhou,Guangdong 510006,China)

机构地区：[1]安徽医科大学海军临床医学院,北京100048 [2]安徽医科大学第五临床医学院,安徽合肥230032 [3]解放军总医院第六医学中心妇产科,北京100048 [4]华南理工大学医学院,广东广州510006

出　　处：《解放军医学杂志》2023年第4期451-455,共5页Medical Journal of Chinese People's Liberation Army

基　　金：首都卫生发展科研专项(首发2020-1-5112)。

摘　　要：目的探讨孕期增重(GWG)对妊娠糖尿病(GDM)患者糖代谢和妊娠结局的影响。方法收集2019年1月-2021年12月在解放军总医院第六医学中心妇产科门诊确诊的1667例单胎GDM孕妇的临床资料进行回顾性分析。根据孕期增重程度将GDM孕妇分为GWG过少组(n=882)、GWG适宜组(n=566)、GWG过量组(n=219),比较3组患者孕期糖化血红蛋白(HbA1c)、空腹血糖(FPG)、空腹胰岛素(FIN)、稳态模式胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)、新生儿出生体重,并采用logistic回归分析孕期增重程度与不良妊娠结局的相关性。结果GWG过量组的HbA1c、FPG、FIN、HOMA-IR、HOMA-β水平均明显高于GWG过少组和GWG适宜组(P<0.05),而GWG过少组的FIN、HOMA-IR、HOMA-β水平明显低于GWG适宜组(P<0.05)。GWG过量组的新生儿出生体重明显高于GWG过少组和GWG适宜组(P<0.05),而GWG过少组的新生儿出生体重明显低于GWG适宜组(P<0.05)。Logistic回归分析结果显示,GWG过量及GWG过少均是妊娠期高血压疾病、巨大儿和大于胎龄儿的独立影响因素(P<0.05)。结论孕期不合理增重可增加GDM患者孕期糖代谢紊乱和不良妊娠结局的发生风险。Objective To observe the effect of gestational weight gain(GWG)on glucose metabolism and pregnancy outcomes in patients with gestational diabetes mellitus(GDM).Methods The clinical data of 1667 single pregnant women with GDM diagnosed in the Department of Obstetrics and Gynecology of the Sixth Medical Center of Chinese PLA General Hospital from January 2019 to December 2021 were collected and retrospectively analyzed.According to the degree of GWG,all the GDM pregnant women were divided into three groups:little weight gain group(n=882),moderate weight gain group(n=566)and excessive weight gain group(n=219).The levels of glycosylated hemoglobin(HbA1c),fasting plasma glucose(FPG),fasting insulin(FIN),Homeostatic Model Assessment of Insulin Resistance(HOMA-IR),homeostasis model assessmentβcell function(HOMA-β)and neonatal birth weight were compared among the three groups.Logistic regression was used to analyze the correlation between GWG and adverse pregnancy outcomes.Results The levels of HbA1c,FPG,FIN,HOMA-IR and HOMA-βin excessive weight gain group were significantly higher than those in little weight gain group and moderate weight gain group(P<0.05),and the levels of FIN,HOMA-IR and HOMA-βin little weight gain group were significantly lower than those in moderate weight gain group(P<0.05).The neonatal birth weight in excessive weight gain group was significantly higher than that in little weight gain group and moderate weight gain group(P<0.05),and the neonatal birth weight in little weight gain group was significantly lower than that in moderate weight gain group(P<0.05).Logistic regression analysis showed that both excessive weight gain and little weight gain were independent factors of hypertensive disorders of pregnancy(HDP),macrosomia and large for gestational age(LGA)(P<0.05).Conclusion Irrational weight gain during pregnancy may increase the incidence of glucose metabolism disorders and adverse pregnancy outcomes in pregnant women with GDM.

关 键 词：妊娠糖尿病 孕期增重 糖代谢 妊娠结局 

分 类 号：R714.1[医药卫生—妇产科学]