Hillier Teresa A, Pedula Kathryn L, Vesco Kimberly K, Schmidt Mark M, Mullen Judith A, LeBlanc Erin S, Pettitt David J
Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon 97227, USA.
Obstet Gynecol. 2008 Nov;112(5):1007-14. doi: 10.1097/AOG.0b013e31818a9779.
To estimate how maternal weight gain and maternal glucose relate to fetal macrosomia risk (greater than 4,000 g) among a population universally screened for gestational diabetes mellitus (GDM).
Between 1995 and 2003, 41,540 pregnant women in two regions (Northwest/Hawaii) of a large U.S. health plan had GDM screening using the 50-g glucose challenge test; 6,397 also underwent a 3-hour, 100-g oral glucose tolerance test. We assessed the relationship between level of maternal glucose with glucose screening and fetal macrosomia risk after adjustment for potential confounders, including maternal age, parity, and ethnicity and sex of the newborn. We stratified by maternal weight gain (40 lb or fewer compared with more than 40 lb) because excessive maternal weight gain modified results.
Among women with both normal and abnormal GDM screenings, increasing level of maternal glucose was linearly related to macrosomia risk (P<.001 for trend in all groups). Women with excessive weight gain (more than 40 lb) had nearly double the risk of fetal macrosomia for each level of maternal glucose compared with those with gestational weight gain of 40 lb or fewer. For example, among women with normal post-glucose challenge test glucose levels (less than 95 mg/dL) and excessive weight gain, 16.5% had macrosomic newborns compared with 9.3% of women who gained 40 lb or fewer. Moreover, nearly one third of women (29.3%) with GDM who gained more than 40 lb had a macrosomic newborn compared with only 13.5% of women with GDM who gained 40 lb or fewer during pregnancy (P=.018).
Excessive pregnancy weight gain nearly doubles the risk of fetal macrosomia with each increasing level of maternal glucose, even among women with GDM.
II.
在对妊娠期糖尿病（GDM）进行普遍筛查的人群中，评估孕妇体重增加及孕妇血糖与巨大儿风险（大于4000g）之间的关系。
1995年至2003年期间，美国一家大型医疗保健计划的两个地区（西北部/夏威夷）的41540名孕妇采用50g葡萄糖耐量试验进行GDM筛查；其中6397名孕妇还接受了3小时、100g口服葡萄糖耐量试验。在对包括孕妇年龄、产次、种族及新生儿性别等潜在混杂因素进行校正后，我们评估了葡萄糖筛查时孕妇血糖水平与巨大儿风险之间的关系。我们根据孕妇体重增加情况（40磅及以下与超过40磅）进行分层，因为孕妇体重过度增加会改变结果。
在GDM筛查正常和异常的女性中，孕妇血糖水平升高与巨大儿风险呈线性相关（所有组趋势P<0.001）。与孕期体重增加40磅及以下的女性相比，体重过度增加（超过40磅）的女性，每增加一级孕妇血糖水平，胎儿患巨大儿的风险几乎增加一倍。例如，在葡萄糖耐量试验后血糖水平正常（低于95mg/dL）且体重过度增加的女性中，16.5%生育了巨大儿，而体重增加40磅及以下的女性这一比例为9.3%。此外，孕期体重增加超过40磅的GDM女性中，近三分之一（29.3%）生育了巨大儿，而孕期体重增加40磅及以下的GDM女性中这一比例仅为13.5%（P = 0.018）。
即使在GDM女性中，孕期体重过度增加也会使随着孕妇血糖水平升高胎儿患巨大儿的风险几乎增加一倍。
II级。
