Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil.
Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Medicina Social, Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil.
J Pediatr (Rio J). 2021 Mar-Apr;97(2):167-176. doi: 10.1016/j.jped.2020.02.004. Epub 2020 Apr 10.
This study aimed to evaluate gestational weight gain and birth weight in women with gestational diabetes mellitus of two Brazilian cohorts enrolled three decades apart.
The authors compared data of 2362 women from the Lifestyle INtervention for Diabetes Prevention After Pregnancy study (LINDA-Brasil, 2014-2017) to those of 359 women from the Estudo Brasileiro de Diabetes Gestacional study (EBDG, 1991-1995). Gestational weight gain was classified by the 2009 Institute of Medicine criteria; large and small for gestational age newborns, by the Intergrowth-21 chart. Differences in birth weight means between pregestational BMI and gestational weight gain categories were evaluated by ANOVA; the associations of gestational weight gain and birth weight, through multivariable Poisson regression.
In LINDA-Brasil, women presented higher pregestational body mass index (30.3±6.5 vs. 24.6±4.4kg/m) and were frequently obese (46.4 vs. 11.1%) compared to those of the EBDG. In the EBDG, gestational weight gain was larger (11.3±6.1 vs. 9.2±7.6kg) and rates of small for gestational age higher (7.5 vs. 4.5%) compared to LINDA-Brasil. In LINDA-Brasil, excessive gestational weight gain was associated to macrosomia (adjusted relative risk [aRR]: 1.59, 95% CI 1.08-2.35) and large for gestational age (aRR: 1.40; 95% CI 1.05-1.86); less gain increased the risk of low birth weight (aRR: 1.66; 95% CI 1.05-2.62) and small for gestational age (aRR: 1.79; 95% CI 1.03-3.11). These associations were similar in the EBDG, although not statistically significant.
Improvements in gestational weight gain and rates of small for gestational age occurred over time in gestational diabetes mellitus pregnancies, accompanied by a worsening in maternal weight profile. This highlights the nutritional transition during this period and the importance of avoiding excessive gestational weight gain as well as promoting adequate weight before conception.
本研究旨在评估两个巴西队列中 30 年间登记的妊娠糖尿病女性的妊娠体重增加和出生体重。
作者比较了 Lifestyle INtervention for Diabetes Prevention After Pregnancy 研究（LINDA-Brasil，2014-2017 年）的 2362 名女性和 Estudo Brasileiro de Diabetes Gestacional 研究（EBDG，1991-1995 年）的 359 名女性的数据。妊娠体重增加按照 2009 年美国医学研究所的标准进行分类；通过 Intergrowth-21 图表评估巨大儿和小于胎龄儿的新生儿。通过方差分析评估孕前 BMI 和妊娠体重增加类别之间的出生体重均值差异；通过多变量泊松回归评估妊娠体重增加与出生体重的关系。
与 EBDG 组相比，LINDA-Brasil 组女性的孕前体重指数（30.3±6.5 与 24.6±4.4kg/m）更高，且肥胖更为常见（46.4% 与 11.1%）。在 EBDG 组中，妊娠体重增加更多（11.3±6.1 与 9.2±7.6kg），小于胎龄儿的发生率更高（7.5% 与 4.5%）。在 LINDA-Brasil 组中，妊娠体重过度增加与巨大儿（调整后的相对风险[aRR]：1.59，95%置信区间[CI]：1.08-2.35）和大于胎龄儿（aRR：1.40；95%CI：1.05-1.86）有关；体重增加不足会增加低出生体重（aRR：1.66；95%CI：1.05-2.62）和小于胎龄儿（aRR：1.79；95%CI：1.03-3.11）的风险。这些关联在 EBDG 中也相似，尽管没有统计学意义。
随着时间的推移，妊娠糖尿病女性的妊娠体重增加和小于胎龄儿的发生率有所改善，同时母体体重状况恶化。这突出了这一时期的营养转型以及避免妊娠体重过度增加和促进孕前适当体重的重要性。
