妊娠糖尿病患者孕前身体质量指数、孕期增重及血脂水平对妊娠结局的影响

目的：探讨妊娠糖尿病（GDM）孕妇及非GDM孕妇孕前身体质量指数（BMI）、孕期增重及孕期血脂水平对妊娠结局的影响。方法：选取2018年1月至2019年4月在浙江大学医学院附属妇产科医院产检并分娩的单胎、孕前无糖尿病、高血压疾病的12?650名孕妇，按照孕妇是否有GDM分为GDM组（2381例）和非GDM组（10?269例），再根据孕前BMI、孕期增重分亚组。各组间比较临床资料及妊娠结局，分析影响妊娠结局的相关因素。结果：在GDM和非GDM孕妇中，孕前超重和孕期增重过多均是大于胎龄儿、小于胎龄儿、初次剖宫产的独立相关因素（P<0.01或P<0.05），孕期增重过多亦是子痫前期的独立影响因素（P<0.05）。孕中期甘油三酯水平与大于胎龄儿、子痫前期、初次剖宫产、早产等不良妊娠结局独立相关（均P<0.01）。结论：控制孕期增重可以减少大于胎龄儿发生率，但孕期增重过少可能导致小于胎龄儿的发生；孕前控制BMI在正常范围可以有效减少大于胎龄儿、子痫前期及初次剖宫产的发生率；非GDM孕妇孕中期血脂水平异常可能与多个不良妊娠结局相关，需要积极的饮食指导或干预。

Impact of pre-pregnancy body mass index,weight gain and blood lipid level during pregnancy on pregnancy outcome in patients with gestational diabetes mellitus

Objective:To explore the effects of pre-pregnancy body mass index (BMI), weight gain and blood lipid level during pregnancy on pregnancy outcome in patients with and without gestational diabetes mellitus(GDM). Methods:A total of 12 650 singleton pregnant women without history of hypertension and diabetes who were admitted at Women’s Hospital, Zhejiang University School of Medicine for delivery from January 2018 to April 2019 were enrolled in the study. There were 2381 cases complicated with gestational diabetes (GDM group) and 10 269 cases without GDM (non-GDM group). The pre-pregnancy BMI and weight gain during pregnancy were documented in two groups. The factors related to perinatal outcome were analyzed. Results: In both GDM and non-GDM pregnant women, pre-pregnancy overweight and excessive weight gain during pregnancy were independent factors of large for gestational age infant (LGA), small for gestational age infant (SGA) and first cesarean section (P<0.01 orP<0.05). Excessive weight gain during pregnancy was also an independent risk factor of preeclampsia (P<0.05). Triglyceride levels in the second trimester were independently associated with multiple adverse pregnancy outcomes, such as LGA, preeclampsia, initial cesarean delivery, premature delivery.Conclusions: Controlling excessive or insufficient weight gain during pregnancy can significantly reduce the incidence of LGA and SGA. And controlling BMI before pregnancy can effectively reduce the incidence of LGA, preeclampsia and the first cesarean section. For non-GDM pregnant women, abnormal blood lipid levels in the second trimester may be closely related to multiple adverse pregnancy outcomes, and active dietary guidance or treatment is also required.