Siegel Anne M, Tita Alan, Biggio Joseph R, Harper Lorie M
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
Am J Obstet Gynecol. 2015 Oct;213(4):563.e1-5. doi: 10.1016/j.ajog.2015.07.030. Epub 2015 Jul 26.
The Institute of Medicine (IOM) does not provide recommendations for gestational weight gain (GWG) specific to women with pregestational diabetes. We aimed to assess the impact of GWG outside the IOM recommendations on perinatal outcomes.
We performed a retrospective cohort study of all singletons with pregestational diabetes from 2008 through 2013. Women were classified as GWG within, less than, or greater than IOM recommendations for body mass index per week of pregnancy. Maternal outcomes examined were cesarean delivery, preeclampsia, and percentage of visits with glycemic control (>50% blood sugars at goal). Neonatal outcomes were birthweight, small for gestational age (<10th percentile), large for gestational age (LGA) (>90th percentile), macrosomia (>4000 g), preterm delivery (<37 weeks), and birth injury (shoulder dystocia, fracture, brachial plexus injury, cephalohematoma). Groups were compared using analysis of variance and χ(2) test, as appropriate. Backwards stepwise logistic regression was used to adjust for confounding factors.
Of 340 subjects, 37 (10.9%) were within, 64 (18.8%) less than, and 239 (70.3%) greater than IOM recommendations. The incidence of cesarean delivery, preeclampsia, glycemic control, preterm delivery, and birth injury were not significantly different between GWG groups. The incidence of LGA and macrosomia increased as GWG category increased (adjusted odds ratio [AOR], 3.08; 95% confidence interval [CI], 1.13-8.39 and AOR, 4.02; 95% CI, 1.16-13.9, respectively) without decreasing the incidence of small for gestational age (AOR, 0.34; 95% CI, 0.10-1.19). Increases in the risk in LGA and macrosomia were not explained by differences in glycemic control by GWG groups.
Women with pregestational diabetes mellitus should be counseled to gain within the IOM recommendations to avoid LGA and macrosomic newborns.
美国医学研究所（IOM）未针对孕前糖尿病女性给出特定的孕期体重增加（GWG）建议。我们旨在评估GWG超出IOM建议范围对围产期结局的影响。
我们对2008年至2013年所有患有孕前糖尿病的单胎妊娠女性进行了一项回顾性队列研究。根据孕期每周体重指数，将女性分为GWG符合IOM建议、低于IOM建议或高于IOM建议。所检查的孕产妇结局包括剖宫产、先兆子痫以及血糖控制良好的就诊百分比（血糖达标率>50%）。新生儿结局包括出生体重、小于胎龄儿（<第10百分位数）、大于胎龄儿（LGA，>第90百分位数）、巨大儿（>4000 g）、早产（<37周）以及出生损伤（肩难产、骨折、臂丛神经损伤、头颅血肿）。根据情况，使用方差分析和χ²检验对各组进行比较。采用向后逐步逻辑回归分析来调整混杂因素。
在340名受试者中，37名（10.9%）符合IOM建议，64名（18.8%）低于IOM建议，239名（70.3%）高于IOM建议。GWG各组之间剖宫产、先兆子痫、血糖控制、早产和出生损伤的发生率无显著差异。随着GWG类别增加，LGA和巨大儿的发生率升高（校正比值比[AOR]分别为3.08；95%置信区间[CI]为1.13 - 8.39和AOR为4.02；95% CI为1.16 - 13.9），而小于胎龄儿的发生率未降低（AOR为0.34；95% CI为0.10 - 1.19）。GWG各组血糖控制差异并不能解释LGA和巨大儿风险的增加。
应建议患有孕前糖尿病的女性按照IOM建议增加体重，以避免新生儿为LGA和巨大儿。
