孕前體重指數與孕期體重改變對妊娠期糖尿病孕婦妊娠結局的影響

黃英

[摘要]目的 探討孕前體重指數（BMI）與孕期體重改變對妊娠期糖尿病（GDM）孕婦妊娠結局的影響。方法 選取2016年3月～2018年4月在我院就診及分娩的242例GDM孕婦作為研究對象，根據孕婦孕前BMI將其分為體重不足組（39例）、標準體重組（158例）、超重肥胖組（45例）;根據孕期體重增加情況將其分為增重不足組（22例）、增重正常組（90例）、增重過多組（130例）。記錄孕婦的血糖水平、分娩方式和妊娠結局。結果 超重肥胖組孕婦的空腹血糖和餐后1 h血糖均高于體重不足組和標準體重組，差異有統計學意義（P<0.05）;標準體重組孕婦的空腹血糖高于體重不足組，差異有統計學意義（P<0.05）。超重肥胖組、標準體重組、體重不足組孕婦的剖宮產、巨大兒、低體重兒、新生兒窒息、胎兒窘迫、產后出血和早產發生率比較，差異有統計學意義（P<0.05）。增重不足組、增重正常組和增重過多組孕婦的剖宮產、巨大兒、低體重兒、新生兒窒息、胎兒窘迫、產后出血和早產發生率比較，差異有統計學意義（P<0.05）。結論 孕前BMI可影響GDM孕婦孕期的血糖水平，在空腹血糖和餐后1 h血糖方面尤為明顯，孕前BMI以及孕期增重情況是GDM孕婦妊娠結局的影響因素之一，GDM孕婦在妊娠期間應注重體重的合理管理。

[關鍵詞]妊娠期糖尿病;體重指數;孕期體重增長;妊娠結局;血糖

[中圖分類號] R714.14? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1674-4721（2020）2（a）-0139-04

Effect of pre-pregnancy body mass index and weight change during pregnancy on pregnancy outcomes of pregnant women with gestational diabetes mellitus

HUANG Ying

Huizhou Maternal and Child Health Family Planning Service Center， Guangdong Province， Huizhou? 516000， China

[Abstract] Objective To investigate the effect of pre-pregnancy body mass index （BMI） and weight changes during pregnancy on pregnancy outcomes in pregnant women with gestational diabetes mellitus （GDM）. Methods A total of 242 pregnant women with GDM who were admitted and delivered in our hospital from March 2016 to April 2018 were enrolled as subjects. According to the pre-pregnancy BMI， the pregnant women were divided into underweight group （n=39）， standard-weight group （n=158）， overweight-obese group （n=45）. In addition， according to the weight gain during pregnancy， all the participants were divided into insufficient weight gain group （n=22）， normal weight gain group （n=90）， excess weight gain group （n=130）. The blood glucose level， delivery mode and pregnancy outcomes of the 242 pregnant women were recorded. Results Fasting blood glucose and 1-hour postprandial blood glucose in the overweight-obese group were higher than those in the underweight group and standard-weight group， with statistically significant differences （P<0.05）. The fasting blood glucose in the standard-weight group was higher than that in the underweight group， with statistically significant difference （P<0.05）. There were statistically significant differences in the incidence rates of cesarean section， giant infants， low-birth-weight infants， neonatal asphyxia， fetal distress， postpartum hemorrhage and preterm birth in the overweight-obese group， standard-weight group， and underweight group （P<0.05）. There were statistically significant differences in the incidence rates of cesarean section， giant infants， low-birth-weight infants， neonatal asphyxia， fetal distress， postpartum hemorrhage and preterm birth in the insufficient weight gain group， normal weight gain group， and excess weight gain group （P<0.05）. Conclusion Pre-pregnancy BMI can affect the blood glucose level of pregnant women during GDM， especially in fasting blood glucose and 1-hour postprandial blood glucose. The influencing factors of GDM pregnant women′s pregnancy outcome might be pre-pregnancy BMI and pregnancy weight gain. Pregnant women with GDM should pay attention to reasonable weight management during pregnancy.

[Key words] Gestational diabetes mellitus; Body mass index; Weight gain during pregnancy; Pregnancy outcome; Blood glucose

妊娠期糖尿病（gestational diabetes mellitus，GDM）是指在妊娠期間首次發現或發生的糖代謝異常，GDM在目前妊娠期孕婦中發病率較高，是孕期特有且最常見并發癥之一[1-2]，GDM對孕產婦和新生兒的健康皆存在不良影響。隨著當前社會經濟水平的發展、孕婦在妊娠期飲食結構的變化，育齡女性孕前肥胖以及孕期體重增長過多的發生率呈上升趨勢[3]。有臨床研究顯示，孕前體重指數（body mass index，BMI）和孕期體重變化是妊娠結局影響因素[4]，孕前肥胖孕婦相關并發癥（GDM、妊娠期高血壓等）發病率較高，而良好的孕期體重管理可降低不良妊娠結局的風險，孕期體重的控制對孕婦以及胎兒的健康均具有重要的意義。本研究選取于我院就診的242例GDM孕婦作為研究對象，探討孕前BMI與孕期體重改變對GDM孕婦妊娠結局的影響，以期為GDM的預防以及圍生護理提供臨床依據，現報道如下。……