孕前体重指数与1型糖尿病孕妇不良结局风险：一项基于人群的队列研究。
Pre-pregnancy body mass index and the risk of adverse outcome in type 1 diabetic pregnancies: a population-based cohort study.
作者信息
Persson Martina, Pasupathy Dharmintra, Hanson Ulf, Westgren Magnus, Norman Mikael
机构信息
Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
出版信息
BMJ Open. 2012 Feb 14;2(1):e000601. doi: 10.1136/bmjopen-2011-000601. Print 2012.
OBJECTIVE
To assess the risk of perinatal complications in overweight and obese women with and without type 1 diabetes (T1DM).
DESIGN
Prospective population-based cohort study.
SETTING
This study was based on data from the Swedish Medical Birth Registry from 1998 to 2007.
PARTICIPANTS
3457 T1DM and 764 498 non-diabetic pregnancies were included. T1DM was identified based on ICD code O24.0. Mothers were categorised according to pre-pregnancy body mass index (BMI: weight in kilograms per height in square metres) as normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9) or obese (BMI ≥30). Only women with singleton pregnancies and with data on BMI were included. PRIMARY/SECONDARY OUTCOMES: The primary outcome was large for gestational age (LGA: birth weight >90th percentile) infants. Secondary outcomes were major malformations, pre-eclampsia (PE), preterm delivery, perinatal mortality, delivery by Caesarean section and neonatal overweight. Logistic regression analysis was performed with normal weight non-diabetic women as the reference category and also within the diabetic cohort with normal weight type 1 diabetic women as the reference. The ORs were adjusted for ethnicity, maternal age, height, parity, smoking and chronic hypertension.
RESULTS
35% of women with T1DM were overweight and 18% were obese, as compared with 26% and 11%, respectively, in non-diabetic pregnancies. The incidences of adverse outcome increased with greater BMI category. As compared with non-diabetic normal weight women, the adjusted OR for obese T1DM for LGA was 13.26 (95% CI 11.27 to 15.59), major malformations 4.11 (95% CI 2.99 to 5.65) and PE 14.19 (95% CI 11.50 to 17.50). T1DM was a significant effect modifier of the association between BMI and LGA, major malformations and PE (p<0.001).
CONCLUSION
High pre-pregnancy BMI is an important risk factor for adverse outcome in type 1 diabetic pregnancies. The combined effect of both T1DM and overweight or obesity constitutes the greatest risk. It seems prudent to strive towards normal pre-pregnancy BMI in women with T1DM.
目的
评估患有和未患有1型糖尿病（T1DM）的超重及肥胖女性发生围产期并发症的风险。
设计
基于人群的前瞻性队列研究。
背景
本研究基于瑞典医学出生登记处1998年至2007年的数据。
参与者
纳入3457例1型糖尿病孕妇和764498例非糖尿病孕妇。1型糖尿病根据国际疾病分类代码O24.0确定。母亲们根据孕前体重指数（BMI：体重千克数除以身高米数的平方）分为正常体重（BMI 18.5 - 24.9）、超重（BMI 25 - 29.9）或肥胖（BMI≥30）。仅纳入单胎妊娠且有BMI数据的女性。
主要/次要结局：主要结局为大于胎龄儿（LGA：出生体重>第90百分位数）。次要结局为严重畸形、子痫前期（PE）、早产、围产期死亡、剖宫产分娩及新生儿超重。以正常体重非糖尿病女性为参照组进行逻辑回归分析，在糖尿病队列中则以正常体重1型糖尿病女性为参照。对种族、母亲年龄、身高、产次、吸烟及慢性高血压进行了OR值调整。
结果
1型糖尿病女性中35%超重，18%肥胖，相比之下，非糖尿病妊娠女性中这一比例分别为26%和11%。不良结局的发生率随BMI类别增加而升高。与非糖尿病正常体重女性相比，肥胖的1型糖尿病女性发生大于胎龄儿的校正OR值为13.26（95%可信区间11.27至15.59），严重畸形为4.11（95%可信区间2.99至5.65），子痫前期为14.19（95%可信区间11.50至17.50）。1型糖尿病是BMI与大于胎龄儿、严重畸形及子痫前期之间关联的显著效应修饰因素（p<0.001）。
结论
孕前BMI高是1型糖尿病妊娠不良结局的重要危险因素。1型糖尿病与超重或肥胖的联合作用构成最大风险。对于1型糖尿病女性，努力实现孕前BMI正常似乎是明智的。
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