Department of Food & Nutrition, Hoseo University, Asan, Korea.
Diabetes Metab Res Rev. 2014 Nov;30(8):716-25. doi: 10.1002/dmrr.2540.
We prospectively assessed whether maternal weight gain at 24-28 weeks of gestation (MWG24) influences the risk of developing gestational complications, such as gestational diabetes mellitus (GDM) and other adverse pregnancy outcomes, in pregnant Korean women.
Maternal weight gain from self-reported pre-pregnancy weight until 24-28 weeks of gestation was measured in 731 pregnant women, and an expected MWG24 was determined using the Institute of Medicine 2009 guidelines. Glucose tolerance, insulin resistance, insulin secretory capacity, anthropometric measurements, lipid profiles, nutrient intakes and pregnancy outcomes were evaluated at 24-28 weeks of gestation. The adjusted odds ratios (ORs) for GDM, large-for-gestational-age infants, small-for-gestational-age infants and preterm delivery were determined according to maternal weight gain by logistic regression analysis after adjusting for covariates.
Compared with a normal MWG24, an inadequate MWG24 reduced the OR (0.565) for GDM, but an excessive MWG24 did not affect the OR (0.854). However, ORs for preterm delivery were significantly higher in both inadequate and excessive MWG24 groups in comparison with the normal MWG24. There were no other adverse pregnancy outcomes due to the inadequate MWG24. MWG24 was not associated with a significant increase in ORs for delivering large-for-gestational-age or small-for-gestational-age infants or delivery by caesarean section. Although energy intake was less than the estimated energy requirement in all groups, MWG24 was linearly associated with energy intake such that energy balance was positive in the excessive MWG24 group.
This study suggests that both target weight gain and energy intake recommendations for early pregnancy may not be optimal for Korean women and that race-specific recommendations are needed to decrease the risk of GDM without increasing adverse pregnancy outcomes.
本研究前瞻性评估了妊娠 24-28 周（MWG24）时的母体体重增加（MWG24）是否会增加韩国孕妇发生妊娠并发症的风险，如妊娠期糖尿病（GDM）和其他不良妊娠结局。
在 731 名孕妇中测量了自报的孕前体重至 24-28 周的体重增加，并使用 2009 年美国医学研究所指南确定了预期的 MWG24。在 24-28 周评估了葡萄糖耐量、胰岛素抵抗、胰岛素分泌能力、人体测量学测量、血脂谱、营养素摄入和妊娠结局。通过 logistic 回归分析调整协变量后，根据母体体重增加确定 GDM、巨大儿、小于胎龄儿和早产的调整比值比（OR）。
与正常 MWG24 相比，MWG24 不足降低了 GDM 的 OR（0.565），但 MWG24 过多并不影响 OR（0.854）。然而，与正常 MWG24 相比，MWG24 不足和过多组的早产 OR 均显著升高。MWG24 不足与不良妊娠结局无关。MWG24 与巨大儿或小于胎龄儿分娩或剖宫产的 OR 无显著增加无关。尽管所有组的能量摄入均低于估计的能量需求，但 MWG24 与能量摄入呈线性相关，使得 MWG24 过多组的能量平衡为正。
本研究表明，对于韩国女性，早期妊娠的目标体重增加和能量摄入建议可能并不理想，需要制定特定种族的建议，以降低 GDM 的风险而不增加不良妊娠结局。
