Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
J Perinatol. 2011 Nov;31(11):717-21. doi: 10.1038/jp.2011.15. Epub 2011 Mar 3.
To determine whether women with gestational diabetes mellitus (GDM) whose weight gain exceeded the 2009 Institute of Medicine (IOM) recommendations were more likely to have macrosomia.
Retrospective cohort study of the association of weight gain in women with Class A1 GDM, with term (≥37 weeks) singleton liveborns and macrosomia (birthweight ≥4000 g). Multivariate logistic regression models were used to adjust for covariates and test for interactions.
Of 1502 women studied, pre-pregnancy body mass index (BMI) categories were: normal (39.6%), overweight (28.5%) and obese (31.9%). The mean (±standard deviation ) weight gain (lbs) for these groups was: 27.6±10.9, 24.2±13.0 and 18.8±16.3 (P<0.0001), whereas the occurrence of macrosomia was 7.4, 11.4 and 19.0%, respectively. Women with an obese BMI were twice as likely to have a macrosomic infant compared with women in the normal BMI group (odds ratio, OR 2.0; 95% CI 1.4-3.0; P=0.0005). Independently, women who exceeded the IOM guidelines were three times more likely to have a macrosomic infant (OR 3.0, 95% CI 2.2-4.2, P<0.0001).
Maternal pre-pregnancy weight and weight gain during pregnancy appear to be significant and independent risk factors for macrosomia in women with GDM.
确定体重增加超过 2009 年美国医学研究所 (IOM) 建议的妊娠糖尿病 (GDM) 女性更有可能出现巨大儿。
对 A1 级 GDM 女性体重增加与足月（≥37 周）单胎活产儿和巨大儿（出生体重≥4000g）之间关联的回顾性队列研究。使用多变量逻辑回归模型调整协变量并检验交互作用。
在 1502 名研究对象中，孕前体重指数 (BMI) 类别为：正常（39.6%）、超重（28.5%）和肥胖（31.9%）。这些组的平均（±标准差）体重增加（磅）分别为：27.6±10.9、24.2±13.0 和 18.8±16.3（P<0.0001），而巨大儿的发生率分别为 7.4%、11.4%和 19.0%。肥胖 BMI 的女性发生巨大儿的可能性是正常 BMI 组女性的两倍（比值比，OR 2.0；95%置信区间 1.4-3.0；P=0.0005）。独立地，超出 IOM 指南的女性发生巨大儿的可能性是其三倍（OR 3.0，95%置信区间 2.2-4.2，P<0.0001）。
孕妇孕前体重和孕期体重增加似乎是 GDM 女性发生巨大儿的重要且独立的危险因素。
