Wuhan University School of Nursing, Wuhan University, Wuhan, China.
Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA.
J Obstet Gynaecol Res. 2023 Jan;49(1):182-193. doi: 10.1111/jog.15448. Epub 2022 Oct 2.
To examine the optimal gestational weight gain (GWG) for Chinese pregnant women with gestational diabetes mellitus (GDM) based on the Chinese-specific body mass index (BMI) classification.
A retrospective cohort study was conducted using the 2017-2020 data from pregnant women with GDM in a tertiary hospital. A quadratic function model and the total predicted probability of adverse pregnancy outcomes were developed to obtain the optimal GWG. Differences in the incidence of adverse pregnancy outcomes between our optimal GWG recommendations and the Institute of Medicine (IOM) 2009 GWG guidelines were also analyzed.
A total of 8103 pregnant women with GDM were analyzed. Based on the Chinese-specific BMI classification, the optimal GWG range was 11.0-17.5 kg for underweight women, 3.7-9.7 kg for normal-weight women, -0.6 to 4.8 kg for overweight women, and - 9.8 to 4.2 kg for obese women. Excessive GWG had a higher risk of large for gestational age (LGA) (OR: 2.99, 95% CI: 2.42-3.70), macrosomia (OR: 2.35, 95% CI: 1.77-3.12), pre-eclampsia (OR: 1.91, 95% CI: 1.37-2.65), gestational hypertension (OR: 1.65, 95% CI: 1.24-2.19), cesarean section (OR: 1.29, 95% CI: 1.15-1.44), postpartum hemorrhage (OR: 1.29, 95% CI: 1.02-1.64); insufficient GWG had a higher risk of small for gestational age (OR: 1.82, 95% CI: 1.20-2.75). Compared to the IOM 2009 GWG guidelines, the prevalence of macrosomia, LGA, and postpartum hemorrhage were significantly lower in pregnant women following the implementation of our recommended GWG range (p < 0.05).
Compared to the IOM 2009 GWG recommendations, our optimal GWG recommendations for Chinese pregnant women were more sensitive.
基于中国人特有的体质指数（BMI）分类，探讨妊娠期糖尿病（GDM）中国孕妇最佳的体重增长（GWG）范围。
采用回顾性队列研究，利用 2017-2020 年三级医院 GDM 孕妇的数据，建立二次函数模型和总预测不良妊娠结局的概率，以获得最佳 GWG。还分析了我们的最佳 GWG 推荐与美国医学研究所（IOM）2009 年 GWG 指南之间不良妊娠结局发生率的差异。
共分析了 8103 例 GDM 孕妇。基于中国人特有的 BMI 分类，体重不足孕妇的最佳 GWG 范围为 11.0-17.5kg，正常体重孕妇为 3.7-9.7kg，超重孕妇为-0.6-4.8kg，肥胖孕妇为-9.8-4.2kg。GWG 过多会增加巨大儿（OR：2.99，95%CI：2.42-3.70）、巨大儿（OR：2.35，95%CI：1.77-3.12）、子痫前期（OR：1.91，95%CI：1.37-2.65）、妊娠期高血压（OR：1.65，95%CI：1.24-2.19）、剖宫产（OR：1.29，95%CI：1.15-1.44）、产后出血（OR：1.29，95%CI：1.02-1.64）的风险；GWG 不足会增加小于胎龄儿（OR：1.82，95%CI：1.20-2.75）的风险。与 IOM 2009 年 GWG 指南相比，实施我们推荐的 GWG 范围后，孕妇巨大儿、巨大儿和产后出血的发生率明显降低（p<0.05）。
与 IOM 2009 年 GWG 建议相比，我们对中国孕妇的最佳 GWG 建议更为敏感。
