Meghelli Leila, Vambergue Anne, Drumez Elodie, Deruelle Philippe
Univ. Lille, CHU Lille, EA 4489 - Environnement Périnatal et Santé, F-59000, Lille, France.
Pôle médico-chirurgical, Hôpital Huriez, CHRU de Lille, France/EGID-UMR 8199, Univ. Lille, France.
J Gynecol Obstet Hum Reprod. 2020 Jan;49(1):101628. doi: 10.1016/j.jogoh.2019.101628. Epub 2019 Sep 6.
The synergistic role of severe obesity and gestational diabetes mellitus (GDM) on pregnancy complications has been poorly studied. We aim to analyze the impact of GDM on pregnancy complications in women with class III obesity.
we performed a retrospective monocentric study including women with a pregestational BMI≥40kg/m2 with a singleton pregnancy from January 1996 to December 2014. We compared the risks of maternal, fetal and neonatal complications between patients with GDM and those without GDM.
We included 354 patients, 121 (34.3%) had GDM and 63 needed insulin treatment (52.9% of the GDM women). Patients with GDM were older (30.4±5.1 vs 28.9±4.8 years,p=0.008) and had more frequently a history of GDM (24.8% vs 6.1%; p<0.0001). Patients with GDM were more often hospitalized (47.8% vs 29.8%, p=0.001) and were more likely to have premature birth (11.7% vs. 5.3%, p=0.031). Neonates from mothers with GDM were more frequently large for gestational age (31.6% vs 19.4%, p=0.011), and had a higher rate of transfers to neonatal intensive unit (9.2% vs 4.0%, p=0.047). There was no difference for preeclampsia, C-section, shoulder dystocia, neonatal hypoglycemia or postpartum complications. Outcomes were comparable in women with or without insulin therapy.
The rate of GDM is particularly high in class III obese women. Morbidly obese women with GDM were more at risk for complications and needed more often insulin therapy. Our results suggest to pay a particular attention in this high-risk population.
严重肥胖与妊娠期糖尿病（GDM）对妊娠并发症的协同作用研究较少。我们旨在分析GDM对III级肥胖女性妊娠并发症的影响。
我们进行了一项回顾性单中心研究，纳入了1996年1月至2014年12月期间孕前体重指数（BMI）≥40kg/m²的单胎妊娠女性。我们比较了GDM患者和非GDM患者的孕产妇、胎儿和新生儿并发症风险。
我们纳入了354例患者，其中121例（34.3%）患有GDM，63例需要胰岛素治疗（占GDM女性的52.9%）。GDM患者年龄较大（30.4±5.1岁 vs 28.9±4.8岁，p = 0.008），且既往患GDM的病史更常见（24.8% vs 6.1%；p < 0.0001）。GDM患者住院频率更高（47.8% vs 29.8%，p = 0.001），早产可能性更大（11.7% vs. 5.3%，p = 0.031）。GDM母亲的新生儿大于胎龄的频率更高（31.6% vs 19.4%，p = 0.011），转入新生儿重症监护病房的比例更高（9.2% vs 4.0%，p = 0.047）。子痫前期、剖宫产、肩难产、新生儿低血糖或产后并发症方面无差异。接受或未接受胰岛素治疗的女性结局相当。
III级肥胖女性中GDM的发生率特别高。患有GDM的病态肥胖女性并发症风险更高，且更常需要胰岛素治疗。我们的结果提示应对这一高危人群给予特别关注。
