Yogev Yariv, Langer Oded
Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital Center, University Hospital of Columbia University, New York, NY 10019, USA.
Eur J Obstet Gynecol Reprod Biol. 2008 Mar;137(1):21-6. doi: 10.1016/j.ejogrb.2007.03.022. Epub 2007 May 22.
We sought to determine whether pregnancy outcome differs between obese and morbidly obese GDM patients and to assess pregnancy outcome in association with mode of treatment and level of glycemic control.
A cohort study of 4,830 patients with gestational diabetes (GDM), treated in the same center using the same diabetic protocol, was performed. Obesity was defined as prepregnancy BMI >30 and <35 kg/m(2); morbid obesity was defined as prepregnancy BMI >or=35 kg/m(2). Well-controlled GDM was defined as mean blood glucose <105 mg/dl. Pregnancy outcome measures included the rates of large for gestational age (LGA) and macrosomic babies, metabolic complications, the need for NICU admission and/or respiratory support, rate of shoulder dystocia, and the rate of cesarean section.
Among the GDM patients, the rates of obesity and morbid obesity were 15.7% (760 out of 4830, BMI: 32.4+/-1.6 kg/m(2)) and 11.6% (559 out of 4830, BMI: 42.6+/-2.2 kg/m(2)), respectively. No differences were found with regard to maternal age, ethnicity, gestational age at delivery or oral glucose tolerance test (OGTT) results. Moreover, similar rates of cesarean section, fetal macrosomia, shoulder dystocia, composite outcome, and metabolic complications were noted. Insulin treatment was initiated for 62% of the obese and 73% of the morbidly obese GDM patients (P<0.002). Similar rates of obese and morbidly obese patients achieved desired levels of glycemic control (63% versus 61%, respectively). In both obese and morbidly obese patients who achieved a desired level of glycemic control (<105 mg/dl), no difference was found in pregnancy outcome except that both neonatal metabolic complications and composite outcomes were more prevalent in diet-treated subjects in comparison to insulin-treated GDM patients.
In obese women with GDM, pregnancy outcome is compromised regardless of the level of obesity or treatment modality.
我们试图确定肥胖和病态肥胖的妊娠期糖尿病（GDM）患者的妊娠结局是否存在差异，并评估与治疗方式和血糖控制水平相关的妊娠结局。
对4830例妊娠期糖尿病患者进行队列研究，这些患者在同一中心采用相同的糖尿病治疗方案。肥胖定义为孕前体重指数（BMI）>30且<35kg/m²；病态肥胖定义为孕前BMI≥35kg/m²。血糖控制良好的GDM定义为平均血糖<105mg/dl。妊娠结局指标包括大于胎龄（LGA）儿和巨大儿的发生率、代谢并发症、入住新生儿重症监护病房（NICU）和/或呼吸支持的需求、肩难产发生率以及剖宫产率。
在GDM患者中，肥胖和病态肥胖的发生率分别为15.7%（4830例中的760例，BMI：32.4±1.6kg/m²）和11.6%（4830例中的559例，BMI：42.6±2.2kg/m²）。在产妇年龄、种族、分娩孕周或口服葡萄糖耐量试验（OGTT）结果方面未发现差异。此外，剖宫产、胎儿巨大、肩难产、综合结局和代谢并发症的发生率相似。62%的肥胖GDM患者和73%的病态肥胖GDM患者开始使用胰岛素治疗（P<0.002）。肥胖和病态肥胖患者达到理想血糖控制水平的比例相似（分别为63%和61%）。在达到理想血糖控制水平（<105mg/dl）的肥胖和病态肥胖患者中，除了与胰岛素治疗的GDM患者相比，饮食治疗的受试者中新生儿代谢并发症和综合结局更普遍外，妊娠结局没有差异。
在患有GDM的肥胖女性中，无论肥胖程度或治疗方式如何，妊娠结局都会受到影响。
