Ganer Herman Hadas, Dekalo Ann, Jubran Lora, Schreiber Letizia, Bar Jacob, Kovo Michal
a Department of Obstetrics and Gynecology , the Edith Wolfson Medical Center , Holon , Israel.
b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.
J Matern Fetal Neonatal Med. 2019 May;32(10):1682-1687. doi: 10.1080/14767058.2017.1416078. Epub 2018 Feb 5.
We assessed clinical outcomes and placental pathology among pregnancies complicated with gestational diabetes mellitus (GDM) according to their pregestational body mass index (BMI) and weight gain during pregnancy.
Pregnancy outcome and placental pathological reports of all GDM deliveries, during 2009-2015, were reviewed. We compared women with pregestational BMI > 30 and or gestational weight gain >20 kg (high-BMI group), and women with pregestational BMI < 30 and weight gain less than 20 kg (normal BMI group).
Out of the 429 women with GDM, 221 (51.5%) were in the high-BMI group and 208 (48.3%) were in the normal BMI group. As compared to the normal BMI group, the high-BMI group displayed a higher rate of GDMA2 41.6 versus 30.2%, p = .01, higher birth weight, 3475 ± 508 g versus 3242 ± 503 g, p < .001, more large for gestational age neonates, 33.1 versus 13.9%, p < .001, and a trend for more cesarean deliveries (CD), 49.3 versus 40.8%, p = .07, respectively. By logistic regression analysis, past CD and high BMI were independently associated with CD, while GDM type and birth weight were nonsignificant. Pathological reports were available for 143 of these patients. Placental weight was increased among the high-BMI group, but did not retain significance after adjustment for birth weight, and GDM type. No differences were demonstrated in other placental histological findings.
GDM pregnancies accompanied by increased weight gain or elevated pregestational BMI are associated with adverse obstetric outcomes, despite similar placental findings. Patient should be advised accordingly, as gestational weight gain may determine delivery mode.
我们根据孕前体重指数（BMI）和孕期体重增加情况，评估了妊娠合并妊娠期糖尿病（GDM）患者的临床结局和胎盘病理学情况。
回顾了2009年至2015年期间所有GDM分娩的妊娠结局和胎盘病理报告。我们比较了孕前BMI＞30且/或孕期体重增加＞20kg的女性（高BMI组）和孕前BMI＜30且体重增加少于20kg的女性（正常BMI组）。
在429例GDM女性中，221例（51.5%）属于高BMI组，208例（48.3%）属于正常BMI组。与正常BMI组相比，高BMI组的GDM A2发生率更高，分别为41.6%和30.2%，p = 0.01；出生体重更高，分别为3475±508g和3242±503g，p＜0.001；大于胎龄儿更多，分别为33.1%和13.9%，p＜0.001；剖宫产（CD）率有升高趋势，分别为49.3%和40.8%，p = 0.07。通过逻辑回归分析，既往CD史和高BMI与CD独立相关，而GDM类型和出生体重无统计学意义。其中143例患者有病理报告。高BMI组胎盘重量增加，但在调整出生体重和GDM类型后无统计学意义。其他胎盘组织学检查结果无差异。
尽管胎盘表现相似，但伴有体重增加或孕前BMI升高的GDM妊娠与不良产科结局相关。应相应地告知患者，因为孕期体重增加可能决定分娩方式。
