Martin Kate E, Grivell Rosalie M, Yelland Lisa N, Dodd Jodie M
The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia; Discipline of Obstetrics & Gynaecology, Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, SA, Australia.
The University of Adelaide, Robinson Institute, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide 5006, SA, Australia; Discipline of Obstetrics & Gynaecology, Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, SA, Australia.
Diabetes Res Clin Pract. 2015 Jun;108(3):508-13. doi: 10.1016/j.diabres.2014.12.015. Epub 2015 Feb 23.
To evaluate the effect of maternal body mass index (BMI) on gestational diabetes (GDM) and the risk of adverse pregnancy outcomes in women who are overweight or obese.
A prospective cohort study nested within the LIMIT randomised controlled trial. A total of 1030 women were recruited between 10 and 20 weeks' gestation, with a BMI≥25 kg/m(2), and were grouped into BMI subclasses utilising World Health Organisation criteria. Women underwent a fasting oral glucose tolerance test at 26-28 weeks' gestation, and a diagnosis of GDM was made if fasting blood glucose was ≥5.5 mmol/L or ≥7.8 mmol/L after 2h. Maternal and neonatal health outcomes were evaluated.
The prevalence of GDM increased with increasing maternal BMI (6.74% overweight vs 13.42% obese subclass 1 vs 12.79% obese subclass 2 vs 20.00% obese subclass 3). Women who were diagnosed with GDM were significantly less likely to give birth to an infant with birth weight above 4 kg (RR 0.60; 95% CI 0.36 to 1.00; p=0.05). The need for caesarean delivery (RR 1.27; 95% CI 1.07 to 1.50; p=0.006) and incidence of birth weight >90% (RR 1.38; 95% CI 1.07 to 1.77; p=0.01) was significantly increased in women who were obese, independent of GDM.
Increasing maternal BMI is a significant risk factor for the development of GDM, and our findings demonstrate a considerably higher prevalence than has been previously described. Raised maternal BMI is a risk factor for high infant birth weight, which may be modified by lifestyle intervention.
评估孕妇体重指数（BMI）对超重或肥胖女性妊娠期糖尿病（GDM）及不良妊娠结局风险的影响。
一项前瞻性队列研究嵌套于LIMIT随机对照试验中。共招募了1030名妊娠10至20周、BMI≥25 kg/m²的女性，并根据世界卫生组织标准将其分为BMI亚组。女性在妊娠26至28周时接受空腹口服葡萄糖耐量试验，若空腹血糖≥5.5 mmol/L或2小时后≥7.8 mmol/L，则诊断为GDM。评估母婴健康结局。
GDM的患病率随孕妇BMI的增加而升高（超重者为6.74%，肥胖亚组1为13.42%，肥胖亚组2为%12.79，肥胖亚组3为20.00%）。被诊断为GDM的女性生出出生体重超过4 kg婴儿的可能性显著降低（风险比0.60；95%置信区间0.36至1.00；p=0.05）。肥胖女性剖宫产的需求（风险比1.27；95%置信区间1.07至1.50；p=0.00）和出生体重>90%的发生率（风险比1.38；95%置信区间1.07至1.77；p=0.01）显著增加，与GDM无关。
孕妇BMI增加是GDM发生的重要危险因素，我们的研究结果显示其患病率比先前描述的要高得多。孕妇BMI升高是婴儿出生体重高的危险因素，可通过生活方式干预加以改善。
