1型糖尿病患者妊娠期体重增加对妊娠结局影响的前瞻性队列研究  

Effects of gestational weight gain on pregnancy outcomes in patients with type 1 diabetes mellitus:a prospective cohort study

作　　者：王沁 龚一昕 魏甜 李先铭 王璟 骆斯慧 刘昱婕 郑雪瑛 翁建平 CARNATION课题组 Wang Qin;Gong Yixin;Wei Tian;Li Xianming;Wang Jing;Luo Sihui;Liu Yujie;Zheng Xueying;Weng Jianping;CARNATION Study Group(Department of Endocrinology,Institute of Endocrine and Metabolic Diseases,First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China;Department of Endocrinology,Chinese University Hospital Affiliated to Southeast University,Institute of Diabetes,Southeast University,Nanjing 210009,China;Department of Obstetrics and Gynecology,First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China;不详)

机构地区：[1]中国科学技术大学附属第一医院内分泌科、中国科学技术大学生命科学与医学院内分泌与代谢病研究所,合肥230001 [2]东南大学附属中大医院内分泌科、东南大学糖尿病研究所,南京210009 [3]中国科学技术大学附属第一医院妇产科,合肥230001 [4]不详

出　　处：《中华糖尿病杂志》2023年第6期502-508,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：安徽省博士后基金(2019B373)。

摘　　要：目的探讨1型糖尿病(T1DM)患者妊娠期体重增加(GWG)对妊娠结局的影响。方法为多中心、前瞻性、观察性队列研究。纳入2015年1月至2017年12月在全国11家中心登记的T1DM合并妊娠患者。收集基线人口学资料、全孕程体格检查指标[身高、体重、体重指数(BMI)、腰臀比等]和实验室检查指标[糖化血红蛋白(HbA_(1c))、血红蛋白(Hb)等],记录妊娠结局(子代出生体重、出生身长和巨大儿等)。根据孕前体重和分娩前体重计算GWG,并将受试者分为GWG不足组、GWG适当组和GWG过度组。采用方差分析、非参数检验、χ^(2)检验比较组间差异,采用Pearson相关分析法分析GWG与临床指标的相关性,采用线性回归法分析胎儿出生体重的独立影响因素。结果纳入96例T1DM患者,其中GWG不足组17例(17.71%),GWG适当组47例(48.96%),GWG过度组32例(33.33%)。与GWG适当组相比,GWG过度组巨大儿发生率显著增加[分别为18.75%(6/32)和6.38%(3/47),P=0.038]。Pearson相关分析结果显示,GWG与孕妇分娩前体重、分娩前BMI、子代出生体重、出生身长呈正相关(r值分别为0.381、0.380、0.356、0.303,均P<0.01),与腰臀比、孕前体重、孕前BMI呈负相关(r值分别为-0.398、-0.285、-0.342,均P<0.01)。多元线性回归模型结果显示,以出生体重为因变量,校正孕前/孕早期HbA_(1c)、孕早期Hb、孕前BMI后,GWG与出生体重显著相关(β=0.388,P<0.01);校正分娩前HbA_(1c)、孕晚期Hb、分娩前BMI后,GWG与出生体重显著相关(β=0.264,P<0.05)。结论孕期过度增重与T1DM患者胎儿过度生长风险增加有关。Objective To investigate the effects of gestational weight gain(GWG)on pregnancy outcomes in type 1 diabetes mellitus(T1DM).Methods This study was a multicenter,prospective,observational cohort study.Pregnant women with T1DM who registered in 11 participating centers nationwide from January 2015 to December 2017 were enrolled.Maternal baseline characteristics,physical examination[height,body mass,body mass index(BMI),waist-to-hip ratio,etc.],and laboratory index[glycated hemoglobin A1c(HbA_(1c)),hemoglobin(Hb),etc.]were collected throughout the whole pregnancy,and pregnancy outcomes(neonatal birth weight,birth length and macrosomia,etc.)were recorded.GWG was calculated and categorized into insufficient GWG group,adequate GWG group,and excessive GWG group according to recorded pre-pregnancy weight and antepartum weight.Analysis of variance,non‐parametric test,χ^(2) test were used to compare the differences among groups.Pearson correlation analysis was used to explore factors associated with GWG.Linear regression analysis was used to determine the independent influencing factors of fetal birth weight.Results A total of 96 pregnant women with T1DM were included in the study.There were 17 cases(17.71%)in the insufficient GWG group,47 cases(48.96%)in the appropriate GWG group,and 32 cases(33.33%)in the excessive GWG group.The incidence of macrosomia in the excessive GWG group was significantly higher than that in the adequate GWG group[18.75%(6/32)vs.6.38%(3/47),P=0.038].Pearson correlation analysis showed that GWG was positively correlated with antepartum weight,antepartum BMI,neonatal birth weight,and birth length(r=0.381,0.380,0.356,0.303,all P<0.01)and negatively correlated with waist-to-hip ratio,pre-pregnancy weight and pre-pregnancy BMI(r=-0.398,-0.285,-0.342,all P<0.01).After adjusting for preconception/1st trimester HbA_(1c),Hb in the 1^(st) trimester and pre-pregnancy BMI,GWG was significantly correlated with birth weight in the multiple linear regression(β=0.388,P<0.01).After adjusting for antepartum Hb

关 键 词：糖尿病 1型 妊娠期体重增加 胎儿过度生长 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]