Huet Justin, Beucher Gael, Rod Anne, Morello Remy, Dreyfus Michel
CHU de Caen, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Cote de Nacre, France.
CHU de Caen, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Cote de Nacre, France.
J Gynecol Obstet Hum Reprod. 2018 Nov;47(9):469-476. doi: 10.1016/j.jogoh.2018.08.003. Epub 2018 Aug 25.
Gestational diabetes and obesity are independent risk factors for obstetric and neonatal complications. The purpose of our study was to evaluate the impact of their association on pregnancy outcomes.
Monocentric retrospective cohort study including patients with obesity and gestational diabetes (GDM), those with GD without obesity, and those with obesity without GDM, who gave birth between 01 January 2012 and 31 December 2014, and whose GDM was exclusively monitored at our centre. The diagnostic criteria and management modalities of GDM were based on the 2010 CNGOF (Collège National des Gynécologues et Obstétriciens Français [French national college of obstetricians and gynaecologists]) Clinical Practice Recommendations. Obesity was defined as having a body mass index ≥30 Kg/m.
A total of 1,484 patients were included, 259 with GDM and obesity, 549 with GDM without obesity, 676 with obesity without GDM. In the GDM + obesity group, GDM was treated earlier and was more uncontrolled and more often treated with insulin in relation to non-obese women with GDM. These patients also presented a higher risk of caesarean section (OR 2.92, CI 95% 2.04-4.16, P<0.001), preeclampsia (OR 4.62, CI 95% 1.31-16.32, P=0.017), maternal morbidity (OR 2.05, CI 95% 1.37-3.04, P<0.001) and large foetus for gestational age (OR 1.91, CI 95% 1.26-2.88, P=0.002). Obesity alone was a risk factor in its own right for preeclampsia (OR 7.32, CI 95% 2.50-21.45, P<0.001) and macrosomia (OR 3.55, IC 95% 2.24-5.62, P<0.001), compared to non-obese patients with GDM. Uncontrolled GDM was associated independently of obesity with the risk of induced labour and large foetus for gestational age.
Obesity on its own is a risk factor for obstetric complications and its association with GDM strongly impacts on pregnancy outcomes.
妊娠期糖尿病和肥胖是产科及新生儿并发症的独立危险因素。我们研究的目的是评估它们之间的关联对妊娠结局的影响。
单中心回顾性队列研究，纳入2012年1月1日至2014年12月31日期间分娩、且妊娠期糖尿病（GDM）仅在我们中心监测的肥胖合并GDM患者、单纯GDM患者以及单纯肥胖患者。GDM的诊断标准和管理模式基于2010年法国国家妇产科医师学会（CNGOF）的临床实践建议。肥胖定义为体重指数≥30 Kg/m²。
共纳入1484例患者，259例肥胖合并GDM患者，549例单纯GDM患者，676例单纯肥胖患者。在GDM合并肥胖组中，与非肥胖的GDM女性相比，GDM的治疗更早开始，控制情况更差，且更多使用胰岛素治疗。这些患者剖宫产（比值比[OR] 2.92，95%置信区间[CI] 2.04 - 4.16，P < 0.001）、子痫前期（OR 4.62，95% CI 1.31 - 16.32，P = 0.017）、孕产妇发病率（OR 2.05，95% CI 1.37 - 3.04，P < 0.001）及大于胎龄儿（OR 1.91，95% CI 1.26 - 2.88，P = 0.002）的风险更高。与非肥胖的GDM患者相比，单纯肥胖本身就是子痫前期（OR 7.32，95% CI 2.50 - 21.45，P < 0.001）和巨大儿（OR 3.55，95% CI 2.24 - 5.62，P < 0.001）的危险因素。未控制的GDM独立于肥胖与引产风险及大于胎龄儿相关。
单纯肥胖是产科并发症的危险因素，其与GDM的关联对妊娠结局有强烈影响。
