孕前正常BMI孕妇孕早期体成分与妊娠期糖尿病关系的研究  

The Relationship between Body Composition in Early Pregnancy and Gestational Diabetes Mellitus in a Population of Normal BMI Pregnant Women

作　　者：徐丽丽 郑薇 袁仙仙 马恺文 张浦杨 李光辉[1] XU Lili;ZHENG Wei;YUAN Xianxian;MA Kaiwen;ZHANG Puyang;LI Guanghui(Division of Endocrinology and Metabolism,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围产内分泌代谢科,北京市100026

出　　处：《中国全科医学》2024年第29期3602-3607,3615,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(82301916,82171671);北京市卫生健康委员会高层次公共卫生技术人才建设项目培养计划(领军人才-02-02)。

摘　　要：背景妊娠期糖尿病(GDM)对母儿的近远期健康造成影响。孕前BMI与GDM密切相关,但BMI无法评估脂肪与脂肪分布情况,因此仅用其评估肥胖存在一定缺陷。隐性肥胖人群[BMI正常但体脂百分比(PBF)>30%]及正常体质量伴中心性肥胖人群[BMI正常但内脏脂肪面积(VFA)≥80 cm^(2)]存在着不同程度的代谢异常,然而在临床中此部分人群常被忽视,关于其与GDM关系的研究相对缺乏。目的分析孕前正常BMI孕妇孕早期体成分与GDM的相关性并探讨脂肪分布情况与GDM的关系。方法本研究纳入2018年10月—2022年10月于首都医科大学附属北京妇产医院产科门诊建档,孕早期自愿接受营养评价并定期产前检查至妊娠24~28周的单胎孕妇1938例。研究对象于孕早期(6~16周)进行人体成分检测、妊娠24~28周行口服葡萄糖耐量试验(OGTT)。根据OGTT结果,将研究对象分为GDM组(n=382)和正常组(n=1556)。采用二元Logistic回归分析探究孕早期体成分及体脂分布与GDM的关系。结果GDM组孕妇体脂量(BFM)、VFA、PBF、脂肪质量指数(FMI)均高于正常组(P<0.05)。二元Logistic回归分析结果显示,孕早期BFM、VFA、PBF、FMI升高(OR=1.044,95%CI=1.012~1.078;OR=1.007,95%CI=1.002~1.012;OR=1.041,95%CI=1.012~1.070;OR=1.138,95%CI=1.043~1.241)(P<0.05)和中心性肥胖即VFA≥80 cm^(2)(OR=1.396,95%CI=1.101~1.770,P<0.05)是GDM发生的危险因素。Spearman秩相关分析显示,BFM、VFA、PBF、FMI与OGTT各时点血糖呈正相关(P<0.05)。结论在孕前正常BMI孕妇中,孕早期BFM、VFA、PBF、FMI是GDM发生的危险因素,中心性肥胖即VFA≥80 cm^(2)可以独立预测GDM的发生。产检时需要关注孕妇的脂肪分布,对于中心性肥胖人群加强孕期管理。Background Gestational diabetes mellitus(GDM)is closely related to the short-term and long-term health outcomes of the mothers and offspring.Pre-pregnancy BMI is strongly associated with GDM,nevertheless,it does not distinguish between body fat content and fat distribution.Only using it to assess obesity is flawed.Normal weight obesity(normal BMI but body fat percentage above 30%)and normal weight with central obesity(normal BMI but visceral fat area above 80 cm^(2))show different degree of metabolic dysregulation.However,those population are usually overlooked in clinical practice and there is a paucity of research on those population and GDM.Objective To explore the correlation between body composition in early pregnancy and GDM in a population of normal pre-pregnancy BMI,and to investigate the relationship between fat distribution and GDM.Methods We performed a study that included 1938 singleton pregnant women registered in the obstetric out-patient clinic of Beijing Obstetrics and Gynecology Hospital,Capital Medical University from October 2018 to October 2022.They voluntarily underwent nutritional assessment in early pregnancy and had regular pregnancy check-ups until 24-28 weeks of gestation,who underwent body composition testing in early pregnancy(6-16 weeks)and oral glucose tolerance test(OGTT)at 24-28 weeks.According to the OGTT results,the study population were divided into the GDM group(n=382)and the normal group(n=1556).We estimated the relationship between body composition and fat distribution with GDM in early pregnancy with binary Logistic regression.Results Body fat mass(BFM),visceral fat area(VFA),percentage body fat(PBF),and fat mass index(FMI)in the GDM group were higher than in the normal group(P<0.05).BFM,VFA,PBF,FMI(OR=1.044,95%CI=1.012-1.078;OR=1.007,95%CI=1.002-1.012;OR=1.041,95%CI=1.012-1.070;OR=1.138,95%CI=1.043-1.241)(P<0.05)and central obesity(VFA≥80 cm^(2))(OR=1.396,95%CI=1.101-1.770,P<0.05)associated with a significant increased risk for GDM with binary Logistic regression analysis

关 键 词：妊娠期糖尿病 妊娠初期 体成分 体脂百分比 内脏脂肪面积 中心性肥胖 影响因素分析 

分 类 号：R714.256[医药卫生—妇产科学]