Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
Department of Endocrinology & Metabolism, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai Sixth People's Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
BMC Pregnancy Childbirth. 2023 Jun 3;23(1):414. doi: 10.1186/s12884-023-05657-8.
Give the high background risk of adverse pregnancy outcomes (APOs), it is important to understand the associations of maternal pre-pregnancy body mass index (ppBMI), gestational weight gain (GWG) with APOs in women with gestational diabetes mellitus (GDM). We addressed the independent and joint associations of maternal ppBMI and GWG with APOs in Chinese women with GDM.
764 GDM women with singleton delivery were studied and they were stratified into three weight groups by ppBMI (underweight, normal weight and overweight/obesity) following classification standards for Chinese adults and three GWG groups (inadequate, adequate, excessive GWG) by the 2009 Institute of Medicine guidelines, respectively. Univariate and multivariate logistic regression analyses were performed to estimate the odds ratios of APOs.
Maternal overweight/obesity was associated with increased odds of pregnancy-induced hypertension [PIH, adjusted odds ratio (aOR): 2.828, 95% confidence interval (CI) 1.382-5.787], cesarean delivery (CS) (aOR 2.466, 95%CI 1.694-3.590), preterm delivery (aOR 2.466, 95%CI 1.233-4.854), LGA (aOR 1.664, 95%CI 1.120-2.472), macrosomia (aOR 2.682, 95%CI 1.511-4.760) and any pregnancy complication (aOR 2.766, 95%CI 1.840-4.158) compared with healthy weight. Inadequate GWG was less likely to develop PIH (aOR 0.215, 95%CI 0.055-0.835), CS (aOR 0.612, 95%CI 0.421-0.889) and any pregnancy complication (aOR 0.628, 95%CI 0.435-0.907), but had higher risk of preterm birth (aOR 2.261, 95%CI 1.089-4.692), while excessive GWG was more vulnerable to LGA (aOR 1.929, 95%CI 1.272-2.923), macrosomia (aOR 2.753, 95%CI 1.519-4.989) and any pregnancy complication (aOR 1.548, 95%CI 1.006-2.382) as compared to adequate GWG. Furthermore, compared to normal weight mothers with adequate GWG, obese mothers with excessive GWG had the highest risk of any pregnancy complication (aOR 3.064, 95%CI 1.636-5.739).
Maternal overweight/obesity and GWG were associated with APOs in the already high-risk settings of GDM. Obese mothers with excessive GWG may confer the greatest risk of adverse outcomes. It was very helpful to reduce the burden of APOs and benefit GDM women by promoting a healthy pre-pregnancy BMI and GWG.
鉴于不良妊娠结局（APO）的高背景风险，了解患有妊娠期糖尿病（GDM）的女性的母体孕前体重指数（ppBMI）和妊娠增重（GWG）与 APO 的关联非常重要。我们研究了中国患有 GDM 的女性中母体 ppBMI 和 GWG 与 APO 的独立和联合关联。
对 764 名单胎分娩的 GDM 妇女进行了研究，并根据中国成年人的分类标准将她们分为 ppBMI（体重不足、正常体重和超重/肥胖）三个体重组，以及根据 2009 年美国医学研究所指南分为三个 GWG 组（不足、适当、过多 GWG）。分别使用单变量和多变量逻辑回归分析来估计 APO 的优势比。
与健康体重相比，母体超重/肥胖与妊娠高血压（PIH）[调整后的优势比（aOR）：2.828，95%置信区间（CI）1.382-5.787]、剖宫产（CS）（aOR 2.466，95%CI 1.694-3.590）、早产（aOR 2.466，95%CI 1.233-4.854）、巨大儿（aOR 1.664，95%CI 1.120-2.472）、巨大儿（aOR 2.682，95%CI 1.511-4.760）和任何妊娠并发症（aOR 2.766，95%CI 1.840-4.158）的发生风险增加有关。与适当的 GWG 相比，GWG 不足不太可能发生 PIH（aOR 0.215，95%CI 0.055-0.835）、CS（aOR 0.612，95%CI 0.421-0.889）和任何妊娠并发症（aOR 0.628，95%CI 0.435-0.907），但早产风险较高（aOR 2.261，95%CI 1.089-4.692），而 GWG 过多更容易发生巨大儿（aOR 1.929，95%CI 1.272-2.923）、巨大儿（aOR 2.753，95%CI 1.519-4.989）和任何妊娠并发症（aOR 1.548，95%CI 1.006-2.382）。此外，与正常体重、GWG 适当的母亲相比，GWG 过多的肥胖母亲发生任何妊娠并发症的风险最高（aOR 3.064，95%CI 1.636-5.739）。
在已经存在 GDM 的高风险环境中，母体超重/肥胖和 GWG 与 APO 相关。GWG 过多的肥胖母亲可能会带来最大的不良结局风险。通过促进健康的孕前 BMI 和 GWG，可以降低 APO 的负担，使 GDM 女性受益，这非常有帮助。
