Sugiyama Takashi, Nagao Kenji, Metoki Hirohito, Nishigori Hidekazu, Saito Masatoshi, Tokunaga Hideki, Nagase Satoru, Sugawara Junichi, Watanabe Yoh, Yaegashi Nobuo, Sagawa Norimasa, Sanaka Mayumi, Akazawa Shoichi, Anazawa Sonoko, Waguri Masako, Sameshima Hiroshi, Hiramatsu Yuji, Toyoda Nagayasu
Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan.
Endocr J. 2014;61(4):373-80. doi: 10.1507/endocrj.ej13-0541. Epub 2014 Jan 30.
The aim of this study was to determine the effects of pre-gestational body mass index on pregnancy outcomes of women with gestational diabetes in Japan. A multi-institutional retrospective study was performed. We examined pregnant women who met the former criteria for gestational diabetes in Japan, receiving dietary intervention with self-monitoring of blood glucose with or without insulin therapy. Women with gestational diabetes were divided into three groups according to pre-gestational body mass index: body mass index <25 (control group), 25 ≤ body mass index <30 (overweight group), body mass index ≥30 (obese group). Data from a total of 1,758 eligible women were collected from 40 institutions. Participants included 960 controls, 426 overweight women, and 372 obese women with gestational diabetes. Gestational weight gain was highest in the control and lowest in the obese group. The prevalences of chronic hypertension and pregnancy induced hypertension were higher in the overweight and obese groups than in the control group. Multiple logistic regression analysis revealed pre-gestational body mass index, gestational weight gain, chronic hypertension, and nulliparity to be associated with the onset of pregnancy induced hypertension, while the 75-g OGTT results were unrelated to pregnancy induced hypertension. The prevalence of large-for-gestational age was lower in infants born to obese women than in those born to overweight or control women. The present results suggest that medical interventions for obese women with gestational diabetes may contribute to reducing the prevalence of large-for-gestational age but would not achieve marked reductions in maternal complications.
本研究的目的是确定孕前体重指数对日本妊娠期糖尿病女性妊娠结局的影响。进行了一项多机构回顾性研究。我们调查了符合日本妊娠期糖尿病既往标准的孕妇，她们接受了饮食干预，并进行血糖自我监测，部分接受胰岛素治疗。妊娠期糖尿病女性根据孕前体重指数分为三组：体重指数<25（对照组），25≤体重指数<30（超重组），体重指数≥30（肥胖组）。从40个机构收集了总共1758名符合条件女性的数据。参与者包括960名对照组、426名超重女性和372名患有妊娠期糖尿病的肥胖女性。妊娠期体重增加在对照组中最高，在肥胖组中最低。超重和肥胖组慢性高血压和妊娠期高血压的患病率高于对照组。多因素logistic回归分析显示，孕前体重指数、妊娠期体重增加、慢性高血压和初产与妊娠期高血压的发生有关，而75克口服葡萄糖耐量试验结果与妊娠期高血压无关。肥胖女性所生婴儿大于胎龄儿的患病率低于超重或对照组女性所生婴儿。目前的结果表明，对患有妊娠期糖尿病的肥胖女性进行医学干预可能有助于降低大于胎龄儿的患病率，但不会显著降低母体并发症的发生率。
