Department of Healthcare, Fujian Maternity and Child Health Hospital, Fuzhou, China.
Department of Obstetrics, Fujian Maternity and Child Health Hospital, Fuzhou, China.
Front Endocrinol (Lausanne). 2022 Jul 7;13:942271. doi: 10.3389/fendo.2022.942271. eCollection 2022.
To examine the combined effect of pre-pregnancy overweight or obesity, excessive gestational weight gain, and glucose tolerance status on the incidence of adverse pregnancy outcomes among women with gestational diabetes mellitus.
A observational study including 5529 gestational diabetes mellitus patients was performed. Logistic regression were used to assess the independent and multiplicative interactions of overweight or obese, excessive gestational weight gain, abnormal items of oral glucose tolerance test and adverse pregnancy outcomes. Additive interactions were calculated using an Excel sheet developed by Anderson to calculate relative excess risk.
Overall 1076(19.46%) study subject were overweight or obese and 1858(33.60%) women gained weight above recommended. Based on IADPSG criteria, more than one-third women with two, or three abnormal glucose values. Preconception overweight or obesity, above recommended gestational weight gain, and two or more abnormal items of oral glucose tolerance test parameters significantly increased the risk of adverse pregnancy outcomes, separately. After accounting for confounders, each two of overweight or obesity, excessive gestational weight gain, two or more abnormal items of OGTT parameters, the pairwise interactions on adverse pregnancy outcomes appear to be multiplicative. Coexistence of preconception overweight or obesity, above recommended gestational weight gain and two or more abnormal items of oral glucose tolerance test parameters increased the highest risk for adverse pregnancy outcomes. No additive interaction was found.
Pre-pregnancy overweight or obesity, excessive gestational weight gain, two or more abnormal items of OGTT parameters contribute to adverse pregnancy outcomes independently among women with gestational diabetes mellitus. Additionally, the combined effect between these three factors and adverse pregnancy outcomes appear to be multiplicative. Interventions focus on maternal overweight or obesity and gestational weight gain should be offered to improve pregnancy outcomes.
探讨孕前超重或肥胖、孕期体重过度增加以及糖代谢状态对妊娠期糖尿病患者不良妊娠结局的综合影响。
本研究为观察性研究，纳入了 5529 例妊娠期糖尿病患者。采用 logistic 回归分析评估超重或肥胖、孕期体重过度增加、口服葡萄糖耐量试验异常项目与不良妊娠结局的独立和相乘交互作用。采用 Anderson 开发的 Excel 表格计算相对超额危险度来评估相加交互作用。
总体而言，1076 名（19.46%）研究对象超重或肥胖，1858 名（33.60%）女性孕期体重增加超过推荐值。根据 IADPSG 标准，超过三分之一的女性有两项或三项血糖异常。孕前超重或肥胖、孕期体重增加超过推荐值以及两项或以上口服葡萄糖耐量试验参数异常均显著增加不良妊娠结局的风险。在调整混杂因素后，超重或肥胖、孕期体重过度增加、两项或以上 OGTT 参数异常两两之间对不良妊娠结局的交互作用呈相乘模式。孕前超重或肥胖、孕期体重过度增加以及两项或以上口服葡萄糖耐量试验参数异常同时存在时，发生不良妊娠结局的风险最高。未发现相加交互作用。
孕前超重或肥胖、孕期体重过度增加、两项或以上 OGTT 参数异常均独立增加妊娠期糖尿病患者不良妊娠结局的风险。此外，这三个因素的综合作用与不良妊娠结局之间呈相乘模式。干预措施应侧重于超重或肥胖的孕产妇，并应关注孕期体重增加，以改善妊娠结局。
