2型糖尿病患者妊娠期体质量增长与妊娠结局关系的研究  

The Relationship between Gestational Weight Gain and Pregnancy Outcomes in Patients with Type 2 Diabetes

作　　者：贾建瑞 严欣 张黎锐 郑薇 李光辉[1] JIA Jianrui;YAN Xin;ZHANG Lirui;ZHENG Wei;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3608-3615,共8页Chinese General Practice

基　　金：国家自然科学基金资助项目(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);北京市医院管理中心青年人才培养“青苗”计划(QML20231401)。

摘　　要：背景鉴于2型糖尿病孕妇不良妊娠结局风险增加,除了控制血糖,了解妊娠期体质量增加与不良妊娠结局的关系非常重要。目的探讨2型糖尿病孕妇妊娠期增重情况及其与妊娠结局的关系。方法回顾性选取在首都医科大学附属北京妇产医院2012—2020年建档并分娩的691例2型糖尿病妇女,根据中国《妊娠期妇女体重增长推荐值标准》进行分类,分为增重不足组(n=143)、增重适宜组(n=289)、增重过多组(n=259)。比较三组人群的妊娠期增重特点、母体结局、新生儿结局。采用多因素Logistic回归分析探讨妊娠期增重对妊娠结局的影响。结果多因素Logistic回归分析结果显示,与增重适宜组相比,增重过多组增加剖宫产(aOR=1.626,95%CI=1.110~2.382)、子痫前期(aOR=1.997,95%CI=1.071~3.677)、巨大儿(aOR=1.948,95%CI=1.175~3.230)及大于胎龄儿(LGA)(aOR=2.090,95%CI=1.321~3.306)的发生风险,降低阴道顺产率(aOR=0.617,95%CI=0.415~0.918);增重不足组降低LGA的发生风险(aOR=0.497,95%CI=0.255~0.970),但对小于胎龄儿(SGA)的发生无影响(P>0.05)。进一步分层分析显示,孕前BMI≥24.0 kg/m^(2)的增重过多组剖宫产、子痫前期、LGA的发生风险增加[aOR及95%CI分别为:1.673(1.082~2.587)、1.961(1.022~3.761)、2.031(1.221~3.379)],阴道顺产率降低(aOR=0.589,95%CI=0.372~0.933);孕前BMI≥24.0 kg/m^(2)的增重不足组LGA的发生风险降低(aOR=0.487,95%CI=0.237~0.999)。孕早期、中期、晚期增重过多是巨大儿[aOR(95%CI)分别为1.07(1.00~1.15)、1.16(1.03~1.31)、1.16(1.06~1.27)]和LGA[aOR(95%CI)分别为1.08(1.01~1.16)、1.13(1.02~1.26)、1.16(1.07~1.26)]的危险因素;孕晚期增重过多是妊娠期高血压、子痫前期的危险因素(aOR=1.13,95%CI=1.02~1.24;aOR=1.14,95%CI=1.03~1.26),孕中期、晚期增重过多是剖宫产的危险因素(aOR=1.11,95%CI=1.02~1.21;aOR=1.09,95%CI=1.02~1.17)。结论妊娠期增重过多增加了2型糖尿病孕妇发生LGA、巨大儿、子痫前期、剖宫Background Given the increased risk of adverse pregnancy outcomes in pregnant women with type 2 diabetes,in addition to glycemic control,it is crucial to understand the relationship between gestational weight gain and adverse pregnancy outcomes.Objective To investigate the gestational weight gain in pregnant women with type 2 diabetes and its relationship with pregnancy outcomes.Methods A retrospective analysis was conducted on 691 cases of pregnant women with type 2 diabetes who underwent prenatal care and delivery at Beijing Obstetrics and Gynecology Hospital,Capital Medical University,from 2012 to 2020.According to the Chinese"Standard of Recommendation for Weight Gain during Pregnancy Period",the participants were categorized into the inadequate weight gain group(n=143),appropriate weight gain group(n=289),and excessive weight gain group(n=259).The gestational weight gain characteristics,maternal outcomes,and neonatal outcomes were compared among the three groups.Multivariate Logistic regression analysis was employed to explore the impact of gestational weight gain on pregnancy outcomes.Results The results of multivariate Logistic regression analysis showed that compared to the appropriate weight gain group,the excessive weight gain group had increased risks of cesarean section(aOR=1.626,95%CI=1.110-2.382),preeclampsia(aOR=1.997,95%CI=1.071-3.677),macrosomia(aOR=1.948,95%CI=1.175-3.230),and large for gestational age(LGA)(aOR=2.090,95%CI=1.321-3.306),while reducing the rate of vaginal delivery(aOR=0.617,95%CI=0.415-0.918).The inadequate weight gain group was associated with a reduced risk of delivering LGA(aOR=0.497,95%CI=0.255-0.970),with no impact on small for gestational age(SGA)(P>0.05).Further stratified analysis revealed that excessive weight gain group with pre-pregnancy BMI≥24.0 kg/m^(2) increased the risks of cesarean section,preeclampsia,LGA[aOR and 95%CI were 1.673(1.082-2.587),1.961(1.022-3.761),2.031(1.221-3.379),respectively],while reducing the rate of vaginal delivery(aOR=0.589,95%CI=0.372-0.9

关 键 词：糖尿病 2型 妊娠期 妊娠期体质量增长 妊娠结局 

分 类 号：R587.1[医药卫生—内分泌] R714.14[医药卫生—内科学]