不同体重指数对妊娠糖尿病合并高血压患者妊娠结局的影响及胰岛功能的变化  

Analysis of the impact of different body mass index on pregnancy outcomes and changes in pancreatic islet function in pregnant women with gestational diabetes and hypertension

作　　者：杜瑞娟 袁乐 黄娜 孙莉莉 王苓 王雪梅[1] 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)

机构地区：[1]唐山市妇幼保健院妇产科,河北唐山063000

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)。

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�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 un

关 键 词：妊娠期糖尿病 妊娠高血压 体重指数 母婴结局 

分 类 号：R714.256[医药卫生—妇产科学] R714.246[医药卫生—临床医学]