Ogonowski J, Miazgowski T
Outpatient Clinic for Diabetic Pregnant Women, Provincial Hospital, Szczecin, Poland; Department of Civilization Diseases, Pomeranian Medical University, Szczecin, Poland.
Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland.
Eur J Obstet Gynecol Reprod Biol. 2015 Dec;195:113-116. doi: 10.1016/j.ejogrb.2015.10.002. Epub 2015 Oct 20.
It has been suggested that neonatal macrosomia may contribute to increased risk of obesity and type 2 diabetes in later life. Much less is known about the association between maternal birth weight (MBW) and offspring birth weight (OBW). This retrospective study evaluated the prevalence of macrosomia in women with treated gestational diabetes mellitus (GDM) and normal glucose tolerance during pregnancy. The study also investigated associations between MBW and OBW.
Medical records of 519 pregnant women with treated GDM and 766 women with normal glucose tolerance, referred to the Gestational Diabetes Outpatient Clinic in Szczecin, Poland, were analyzed. The following data were assessed: maternal age, pregravid body weight, height, gestational weight gain, prior GDM, prior macrosomia, MBW and OBW. Birth weight was classified as small for gestational age (SGA), appropriate for gestational age (AGA), large for gestational age (LGA) and macrosomia (≥4000g). OBW was obtained from birth certificates, and MBW was obtained from birth certificates or self-report.
The overall prevalence of macrosomia was 8.1%, and was comparable in subgroups of women with and without GDM (7.7% and 8.4%, respectively; p=0.905). The frequencies of SGA, AGA and LGA did not differ between study groups. A positive correlation was found between MBW and OBW in women with treated GDM (r=0.211, p<0.001) and in women with normal glucose tolerance (r=0.220, p<0.001). Regardless of glucose tolerance status during pregnancy, the greatest proportion of macrosomic babies were born to mothers who were themselves born macrosomic (26.5% in mothers with GDM and 20.0% in mothers with normal glucose tolerance; p=0.631). On logistic regression, MBW was found to be a robust predictor of macrosomia in offspring [odds ratio (OR) 1.64, 95% confidence interval (CI) 1.15-2.36 in women with treated GDM; OR 1.35, 95% CI 1.07-1.76 in women with normal glucose tolerance). Other independent predictors of fetal macrosomia were gestational weight gain, prior macrosomia and pregravid body mass index (BMI).
MBW, prior macrosomia, pregravid BMI and gestational weight gain were predictors of macrosomia in offspring, but GDM was not. High MBW seems to contribute to intergenerational transmission of macrosomia.
有人提出新生儿巨大儿可能会增加日后肥胖和2型糖尿病的风险。关于母亲出生体重（MBW）与子代出生体重（OBW）之间的关联，人们了解得要少得多。这项回顾性研究评估了孕期接受治疗的妊娠期糖尿病（GDM）女性和糖耐量正常女性中巨大儿的患病率。该研究还调查了MBW与OBW之间的关联。
分析了波兰什切青妊娠期糖尿病门诊收治的519例接受治疗的GDM孕妇和766例糖耐量正常女性的病历。评估了以下数据：母亲年龄、孕前体重、身高、孕期体重增加、既往GDM史、既往巨大儿史、MBW和OBW。出生体重分为小于胎龄儿（SGA）、适于胎龄儿（AGA）、大于胎龄儿（LGA）和巨大儿（≥4000g）。OBW从出生证明中获取，MBW从出生证明或自我报告中获取。
巨大儿的总体患病率为8.1%，在有GDM和无GDM的女性亚组中相当（分别为7.7%和8.4%；p = 0.905）。研究组之间SGA、AGA和LGA的发生率没有差异。在接受治疗的GDM女性（r = 0.211，p < 0.001）和糖耐量正常的女性（r = 0.220，p < 0.001）中，发现MBW与OBW呈正相关。无论孕期糖耐量状态如何，最大比例的巨大儿出生于自身出生时为巨大儿的母亲（GDM母亲中为26.5%，糖耐量正常母亲中为20.0%；p = 0.631）。在逻辑回归分析中，发现MBW是子代巨大儿的有力预测因素[接受治疗的GDM女性中优势比（OR）为1.64，95%置信区间（CI）为1.15 - 2.36；糖耐量正常女性中OR为1.35，95% CI为1.07 - 1.76]。胎儿巨大儿的其他独立预测因素为孕期体重增加、既往巨大儿史和孕前体重指数（BMI）。
MBW（母亲出生体重）、既往巨大儿史、孕前BMI和孕期体重增加是子代巨大儿的预测因素，但GDM不是。高MBW似乎有助于巨大儿的代际传递。
