Endocr Pract. 2019 Nov;25(11):1137-1150. doi: 10.4158/EP-2019-0011. Epub 2019 Aug 15.
To explore the association of excessive gestational weight gain (GWG) defined by the Institute of Medicine (IOM) targets and adverse perinatal outcomes in gestational diabetes mellitus (GDM) pregnancies, and whether a modified target might be related to a lower rate of adverse perinatal outcomes for GDM. This retrospective cohort study involved 1,138 women of normal glucose tolerance (NGT) and 1,200 women with GDM. Based on the IOM target, pregnancies were classified to appropriate GWG (aGWG), inadequate GWG, and excessive GWG (eGWG). Modified GWG targets included: upper limit of IOM target minus 1 kg (IOM-1) or 2 kg (IOM-2), both upper and lower targets minus 1 kg (IOM-1-1) or 2 kg (IOM-2-2). The proportions of women achieving eGWG were 26.3% in NGT and 31.2% in GDM ( = .036); in comparison, for aGWG NGT, the risks of large for gestational age (LGA) were significantly higher in eGWG NGT (adjusted odds ratio [OR] 1.47; 95% confidence interval [CI] 1.02 to 2.13), aGWG GDM (adjusted OR 1.42; 95% CI 1.03 to 1.95), and eGWG GDM (adjusted OR 2.70; 95% CI 1.92 to 3.70). GDM pregnancies gaining aGWG based on the modified GWG targets (IOM-2, IOM-1-1, and IOM-2-2) had a lower prevalence of LGA and macrosomia delivery than that for similar pregnancies using the original IOM target (all <.05). For aGWG GDM according to the IOM target, adhering to a more stringent weight control was associated with decreased adverse outcomes. A tighter IOM target might help to reduce the prevalence of adverse pregnancy outcomes. = appropriate gestational weight gain; = blood glucose; = body mass index; = confidence interval; = excessive gestational weight gain; = gestational diabetes mellitus; = gestational weeks; = gestational weight gain; = hemoglobin A1c; = inadequate gestational weight gain; = Institute of Medicine; = large for gestational age; = normal glucose tolerance; = neonatal intensive care unit; = oral glucose tolerance test; = odds ratio; = partial population attributable risks; = small for gestational age.
探讨美国医学研究所 (IOM) 目标定义的妊娠期体重过度增加 (GWG) 与妊娠期糖尿病 (GDM) 围产期不良结局的关系，以及修改后的目标是否与 GDM 的围产期不良结局发生率降低有关。本回顾性队列研究纳入了 1138 例糖耐量正常 (NGT) 孕妇和 1200 例 GDM 孕妇。根据 IOM 目标，将妊娠分为适当 GWG (aGWG)、GWG 不足和 GWG 过度 (eGWG)。修改后的 GWG 目标包括：IOM 目标减去 1kg（IOM-1）或 2kg（IOM-2），上下限均减去 1kg（IOM-1-1）或 2kg（IOM-2-2）。NGT 中达到 eGWG 的女性比例为 26.3%，GDM 中为 31.2%（=0.036）；相比之下，对于 aGWG，NGT 中 eGWG 的巨大儿 (LGA) 风险明显更高（校正优势比 [OR] 1.47；95%置信区间 [CI] 1.02 至 2.13），aGWG GDM（校正 OR 1.42；95%CI 1.03 至 1.95）和 eGWG GDM（校正 OR 2.70；95%CI 1.92 至 3.70）。基于修改后的 GWG 目标（IOM-2、IOM-1-1 和 IOM-2-2），GDM 孕妇获得 aGWG 后，LGA 和巨大儿分娩的发生率低于使用原始 IOM 目标的类似妊娠（均<.05）。根据 IOM 目标，对于 aGWG GDM，坚持更严格的体重控制与不良结局减少相关。更严格的 IOM 目标可能有助于降低不良妊娠结局的发生率。
