不同孕前BMI孕妇孕早期增重对妊娠期糖尿病的影响

目的探讨不同孕前身体质量指数(BMI)孕妇孕早期增重与妊娠期糖尿病(GDM)的关系。方法采用前瞻性队列研究,选取2017年12月至2019年12月在湖北医药学院附属国药东风总医院建档产检孕妇491例,专人记录孕妇的身高、年龄、孕前体重、BMI、孕早中期体重、分娩结局等一般信息,采用Logistic回归分析不同孕前BMI的孕妇孕早期体重增长与GDM的关系。结果孕早期增重不足、适宜及过多的孕妇GDM发病率比较差异有统计学意义(χ²=8.417,P<0.05),而孕中期不同的体重增长情况,孕妇GDM发病率差异无统计学意义(χ²=0.951,P>0.05)。孕早期增重按不同孕前BMI进行分组,Logistic回归分析显示:孕前BMI为18.5~24.9kg/m²的孕妇,孕早期增重过多,GDM发病风险增至1.913倍(OR=1.913,95%CI:1.033~3.543);孕前BMI≥25.0kg/m²的孕妇,孕早期增重适宜、过多,GDM的发病风险分别增至4.900倍(OR=4.900,95%CI:1.179~20.373)和5.444倍(OR=5.444,95%CI:1.290~22.976)。孕前BMI<18.5kg/m²的孕妇,孕早期增重不足、适宜、过多,妊娠期高血压疾病(χ²=118.600)、羊水异常(χ²=6.750)及剖宫产(χ²=6.166)的发生差异有统计学意义(均P<0.05);孕前BMI≥25.0kg/m²的孕妇,孕早期增重不足、适宜、过多,巨大儿发生率差异有统计学意义(χ²=19.372,P<0.05);孕前BMI=18.5~24.9kg/m²的孕妇,孕早期不同增重情况,其不良妊娠结局差异无统计学意义(均P>0.05)。结论孕前体重正常和孕前超重肥胖者,孕早期体重增长过多增加了GDM发生风险;而孕前低体重者,孕早期体重增长增加了妊娠期高血压疾病、羊水异常及剖宫产的发生风险,并不增加GDM的发生风险。

The effect of weight gain in the first trimester of pregnancy in women with different BMI before pregnancy on gestational diabetes mellitus

Objective To explore the relationship between weight gain in early pregnancy and gestational diabetes mellitus(GDM)in women with different pre-pregnant body mass index(BMI).Methods 491 healthy pregnant women,that established record and performed prenatal examination in Sinopharm Dongfeng General Hospital Affiliated to Hubei University of Medicine from December 2017 to December 2019 were selected in the prospective cohort study.The basic information of participants was recorded by specially assigned medical workers,including height,age,pre-pregnant weight,BMI,the weight in the first and second trimester of pregnancy,delivery outcomes and so on.Logistic regression model was adopted to analyze the relationship between the weight gain in the first trimester of pregnancy and GDM for pregnant women with different pre-pregnant BMI.Results There was statistically significant difference in the incidence of GDM among pregnant women with insufficient,appropriate and excessive weight gain in the first trimester of pregnancy(χ²=8.417,P<0.05).However,there was no statistically significant difference in the incidence of GDM among pregnant women with different weight gain in the second trimester of pregnancy(χ²=0.951,P>0.05).We divided the study population into three groups based on pre-pregnant BMI,the Logistic regression analysis showed that:in the group of the pre-pregnant BMI range from 18.5 kg/m²to 24.9 kg/m²,the risk of GDM increased to 1.913 times for pregnant women with excessive weight gain in the first trimester of pregnancy(OR=1.913,95%CI:1.033-3.543).In the group of the pre-pregnant BMI≥25 kg/m²,the risk of GDM increased to 4.900 times(OR=4.900,95%CI:1.179-20.373)and 5.444 times(OR=5.444,95%CI:1.290-22.976)for pregnant women with appropriate and excessive weight gain in the first trimester of pregnancy,respectively.In the group of the pre-pregnant BMI<18.5 kg/m²,there was statistical difference in the occurrence of the hypertension disorders of pregnancy,abnormal amniotic fluid volume and cesarean section,among the pregnant women with insufficient,appropriate and excessive weight gain in the first trimester of pregnancy(χ²=118.600,6.750,and 6.166,respectively,all P<0.05).In the group of the pre-pregnant BMI≥25 kg/m²,there were significant differences of the incidence of macrosomia among the pregnant women with insufficient,appropriate and excessive weight gain in the first trimester of pregnancy(χ²=19.372,P<0.01).However,in the group of the pre-pregnant BMI range from 18.5 kg/m²to 24.9 kg/m²,there was no significant difference in the adverse pregnancy outcomes among the pregnant women with different weight gain in the first trimester of pregnancy(all P>0.05).Conclusion For the pregnant women with normal weight and overweight women before pregnancy,excessive weight gain in the first trimester of pregnancy will increase the occurrence risk of GDM,for the pregnant women with low weight before pregnancy,weight gain in the first trimester of pregnancy will increase the occurrence risk of hypertension disorders of pregnancy,abnormal amniotic fluid volume and cesarean section,but not the occurrence risk of GDM.