基于孕前体质指数探索妊娠期糖尿病孕妇适宜孕期增重的研究

Exploration of appropriate gestational weight gain for pregnant women with GDM based on their pre-pregnancy BMI

摘要

目的 根据妊娠期糖尿病(GDM)孕妇不良妊娠结局的发生情况,探讨GDM孕妇适宜的孕期增重(GWG)范围。方法 选取2015年1月至2018年12月在西安纵向母子队列(XAMC)中招募的单胎妊娠GDM孕妇作为研究对象(n=12712).根据孕前体质指数(BMI)将研究对象分为体重不足组(<18.5kg/m²)(n=1180)、体重正常组(18.5~23.9kg/m²)(n=8139)、超重组(24.0~27.9kg/m²)(n=2674)和肥胖组(≥28.0kg/m²)(n=719).通过Logistic回归分析各孕前BMI组中不同GWG分组与任意不良结局的关联性,最终确定各孕前BMI组孕妇的适宜GWG范围。结果 不同孕前BMI组中,体重不足组、体重正常组、超重组和肥胖组的任意不良结局发生率逐渐升高(χ²=210.592,P<0.05).妊娠期高血压和子痫前期的发生率亦随孕前BMI升高而显著增加(χ²分别为132.745、162.438,P<0.05).超重和肥胖组的剖宫产率显著高于体重不足组和正常组(χ²=379.604,P<0.05).大于胎龄儿(LGA)及巨大儿的发生率随孕前BMI升高而显著增加(χ²分别为239.117、161.254,P<0.05),而小于胎龄儿(SGA)的发生率随孕前BMI升高逐渐降低(χ²=30.645,P<0.001).低出生体重(LBW)的发生率在各组间差异无统计学意义(χ²=1.826,P=0.609).多因素logistic回归分析显示,不同孕前BMI组孕妇孕期适宜的GWG范围分别为:体重不足组为14.0~15.9kg(AOR=0.689,95%CI:0.515~0.920);体重正常组为6.0~11.9kg[GWG在6.0~7.9kg、8.0~9.9kg、10.0~11.9kg时,AOR及其95%CI分别为0.712(0.563~0.901)、0.679(0.563~0.818)和0.804(0.714~0.904)];超重组为4.0~5.9kg(AOR=0.662,95%CI:0.441~0.994);肥胖组为≤3.9kg(AOR=0.471,95%CI:0.223~0.997)。结论 将孕期增重控制在本研究得到的妊娠期糖尿病孕妇适宜孕期增重范围内,有助于降低妊娠期糖尿病孕妇发生任意不良结局的风险.

Abstract

Objective To determine an appropriate gestational weight gain (GWG) range for pregnant women with gestational diabetes mellitus (GDM) in light of incidence of adverse pregnancy outcomes. Methods A total of 12712 women with singleton pregnancy complicated with GDM who were recruited in Xi′an longitudinal mother-child cohort (XAMC) from January 2015 to December 2018 were selected as study subjects. Participants were categorized according to their pre-pregnancy body mass index (BMI) into four groups: underweight group (<18.5kg/m², n=1180), normal weight group (18.5-23.9kg/m², n=8139), overweight group (24.0-27.9kg/m ², n=2674) and obese group (≥28.0kg/m², n=719). Logistic regression analysis was applied to analyze associations between different GWG categories and any adverse outcomes in each BMI group, and in final determine an appropriate GWG range for these pregnant women with GDM. Results The incidences of any adverse outcomes increased gradually across the underweight group, the normal weight group, the overweight group, and the obese group in order (χ²=210.592, P<0.05). The incidence rates of gestational hypertension and preeclampsia also increased significantly with increase in pre-pregnancy BMI (χ²=132.745 and 162.438 respectively, both P<0.05). The cesarean rates in the overweight group and the obese group were significantly higher than those in the underweight group and the normal weight group (χ²=379.604, P<0.05). The incidences of large-for-gestational-age (LGA) infant and macrosomia increased significantly with increase in pre-pregnancy BMI (χ²=239.117 and 161.254 respectively, both P<0.05), whereas the incidence of small-for-gestational-age (SGA) infant decreased progressively with increase in pre-pregnancy BMI (χ²=30.645, P<0.001). There was no significant difference in incidence of low birth weight (LBW) among different pre-pregnancy BMI groups (χ²=1.826, P=0.609). Multivariate Logistic regression showed that the optimal GWG ranges for different pre-prgnancy BMI categories: GWG 14.0-15.9kg for the underweight women (AOR=0.689, 95%CI: 0.515-0.920); GWG 6.0-11.9kg for the normal weight women (GWG 6.0-7.9kg: AOR=0.712, 95%CI: 0.563-0.901; GWG 8.0-9.9kg: AOR=0.679, 95%CI: 0.563-0.818 and GWG 10.0-11.9kg: AOR=0.804, 95%CI: 0.714-0.904); GWG 4.0-5.9kg for the overweight women (AOR=0.662, 95%CI: 0.441-0.994) and GWG ≤3.9kg for the obese women (AOR=0.471, 95%CI: 0.223-0.997). Conclusion Maintaining GWG within appropriate ranges determined in this study may help reduce risks for any adverse outcomes of these pregnant women with GDM.

关键词

妊娠期糖尿病 / 孕前体质指数 / 孕期增重 / 不良妊娠结局

Key words

gestational diabetes mellitus / pre-pregnancy body mass index / gestational weight gain / adverse pregnancy outcome

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基金资助

重点产业创新链社会发展领域(2021ZDLSF01-14)