Cheng Yvonne W, Chung Judith H, Kurbisch-Block Ingrid, Inturrisi Maribeth, Shafer Sherri, Caughey Aaron B
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California 94143-0132, USA.
Obstet Gynecol. 2008 Nov;112(5):1015-22. doi: 10.1097/AOG.0b013e31818b5dd9.
To examine the association between gestational weight gain and perinatal outcome in women with gestational diabetes mellitus (GDM).
This is a retrospective cohort study of women with nonanomalous singleton pregnancies with GDM enrolled in the Sweet Success California Diabetes and Pregnancy Program between 2001 and 2004. Gestational weight gain, calculated from prepregnancy weight and weight at last prenatal Sweet Success visit, was subgrouped into below, within, and above the Institute of Medicine (IOM) weight-gain guidelines. Perinatal outcomes were examined using chi2 test and multivariable regression analysis with 15-35-lb weight gain as the reference group.
There were 31,074 women meeting study criteria. Compared with women with gestational weight gain within the IOM guidelines, women who gained above the guidelines had higher odds of having large for gestational age neonates (adjusted odds ratio [aOR] 1.72, 95% confidence interval [CI] 1.53-1.93, number needed to harm 10), preterm delivery (aOR 1.30, 95% CI 1.14-1.48, number needed to harm 32), and primary cesarean delivery (aOR 1.52, 95% CI 1.26-1.83, number needed to harm 10). Women who gained below the guidelines had higher odds of having small for gestational age neonates (aOR 1.39, 95% CI 1.01-1.90) and maintaining diet-controlled GDM (aOR 1.47, 95% CI 1.34-1.63) and lower odds of having large for gestational age neonates (aOR 0.60, 95% CI 0.52-0.67).
Women diagnosed with GDM who had gestational weight gain above the IOM guidelines have higher risk of undesirable outcomes, including preterm delivery, having macrosomic neonates, and cesarean delivery. Women who gained below guidelines are more likely to remain on diet control but have small for gestational age neonates.
II.
探讨妊娠期糖尿病（GDM）女性孕期体重增加与围产期结局之间的关联。
这是一项对2001年至2004年参加加利福尼亚州糖尿病与妊娠甜蜜成功项目的非畸形单胎妊娠GDM女性进行的回顾性队列研究。根据孕前体重和孕期最后一次甜蜜成功项目访视时的体重计算孕期体重增加量，并将其分为低于、符合和高于美国医学研究所（IOM）体重增加指南三类。采用卡方检验和多变量回归分析评估围产期结局，以体重增加15 - 35磅的组作为参照组。
共有31,074名女性符合研究标准。与孕期体重增加符合IOM指南的女性相比，体重增加高于指南的女性发生大于胎龄儿的几率更高（校正比值比[aOR]为1.72，95%置信区间[CI]为1.53 - 1.93，危害所需人数为10）、早产几率更高（aOR为1.30，95% CI为1.14 - 1.48，危害所需人数为32）以及首次剖宫产几率更高（aOR为1.52，95% CI为1.26 - 1.83，危害所需人数为10）。体重增加低于指南的女性发生小于胎龄儿的几率更高（aOR为1.39，95% CI为1.01 - 1.90）、维持饮食控制的GDM几率更高（aOR为1.47，95% CI为1.34 - 1.63），而发生大于胎龄儿的几率更低（aOR为0.60，95% CI为0.52 - 0.67）。
被诊断为GDM且孕期体重增加高于IOM指南的女性出现不良结局的风险更高，包括早产、巨大儿和剖宫产。孕期体重增加低于指南的女性更有可能继续进行饮食控制，但会出现小于胎龄儿。
II级
