母亲孕早期代谢性危险因素与巨大儿发生风险的关联分析

目的 了解江苏省昆山市孕妇孕早期代谢综合征（MS）的患病情况并探讨其各组分对巨大儿发生的影响。方法 在江苏省昆山市妇幼保健所围产期保健监测平台上，收集2009至2010年常规围产期保健数据，筛选并分析在孕早期（孕20周以内）行初次产检且体格测量数据完整(包括孕妇体重、身高和血压），同时采集孕早期血糖、血脂等实验室检测数据。根据国际糖尿病联盟（IDF）2005年有关MS的标准进行分组，其中超重/肥胖采用BMI≥24 kg·m-2作为标准。采用多因素Logistics逐步回归分析母亲孕早期MS及其各组分对巨大儿发生的影响。结果 共有1 405名孕妇围产期信息进入数据分析。孕妇初次产检时平均年龄为（26.5±3.2）岁，平均BMI（20.8±2.7）kg·m-2，平均收缩压和舒张压分别为（107.7±10.0）和（69.3±7.0）mmHg。孕早期平均甘油三酯（TG）、高密度脂蛋白（HDL-C）和空腹血糖（FPG）分别为（2.4±1.0）、（2.0±0.4）和（4.5±0.5）mmol·L-1。共有25名（1.8％）孕妇符合MS的诊断标准，其中超重/肥胖、高TG、低HDL-C、高血压和高FPG的患病率分别为12.0%、76.2%、2.8%、2.6%和2.3%。孕妇分娩时平均孕周为（39.0±1.4）周，新生儿出生体重为（3 365.0±418.6）g，其中巨大儿的发生率为7.0%。497名具完整的孕早期和出生结局数据，行多因素Logistic逐步回归分析显示，孕妇孕早期超重/肥胖是巨大儿发生的危险因素（OR=2.4, 95%CI: 1.0~5.5）。结论 昆山市2009至2010年孕妇孕早期MS患病率为1.8%，其最主要的两个组分是超重/肥胖和高TG，并且孕早期超重/肥胖是巨大儿发生的危险因素。提示对孕妇应考虑进行更早期的孕期代谢性危险因素的管理，有望减少不良妊娠结局的发生。

Analysis of the correlation between metabolic risk factors in early pregnancy and neonatal macrosomia

Objective The prevalence of obesity and related cardiometabolic comorbidities increased dramatically in Chinese populations at all ages. This study aimed at investigating the prevalence of metabolic syndrome （MS） and components among pregnant women in early gestation and evaluating the associations with macrosomia.Methods A population-based routine data from Kunshan Maternal and Child Health Care Hospital from 2009 to 2010 were retrospectively analyzed. The prenatal informations were analyzed among pregnant women who received the first prenatal examination less than 20 gestation weeks, including maternal anthropometrics and blood pressure at the first prenatal visit, fasting plasma glucose and serum lipids examined in the first trimester. Birth weight and gestational age were obtained from neonates＇ medical records in the hospital. MS was defined according to the International Diabetes Federation （IDF） criteria 2005. Owing to waist circumferences during pregnancy was imprecise, body mass index （BMI） ≥24 kg·m-2 in first prenatal visit was used to define overweight.Results Statistical analyses were performed among 1 405 subjects with complete prenatal data. The mean of maternal age and BMI at the first prenatal visit was （26.5±3.2） years and （20.8±2.7） kg·m-2, respectively. The mean of triglyceride, HDL-C and fasting glucose was （2.4±1.0）, （2.0±0.4） and （4.5±0.5） mmol·L-1, respectively. The mean of SBP and DBP was （107.7±10.0） and （69.3±7.0） mmHg. The overall prevalence of MS, overweight, elevated triglyceride, reduced HDL-C, raised blood pressure and raised glucose among pregnant women in early gestation was 1.8%, 12.0%, 76.2%, 2.8%, 2.6% and 2.3%, respectively. The mean of the birth weight and gestational age was （3 365.0±418.6） g and （39.0±1.4） weeks with the incidence of macrosomia being 7.0%. Stepwise multiple logistic regressions for 497 subjects with the first prenatal visit within 20 gestational weeks and complete prenatal and neonatal birth weight showed in early gestation maternal overweight/obesity （OR=2.4, 95%CI： 1.0~5.5） significantly increased the risk of macrosomia. There was no significant difference in the proportion of maternal overweight in early gestation between analyzed subjects and those missing birth weight data by using Person＇s chi-square tests.Conclusions About 1.8% of Chinese pregnant women met the criteria of MS in early gestation. The commonest components of MS including raised triglyceride （76.2%） and overweight （12.0%）, were the most important risk factors for macrosomia. The findings call for the urgent need for early and throughout management of metabolic risks among pregnant women in order to control the adverse gestation outcomes.