Chen Tzu-Ling, Cheng Su-Fen, Kuo Chien-Lin, Huang Chu-Yu, Wu Chia-Hsun
Department of Nurse-Midwifery and Women's Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
BMC Pregnancy Childbirth. 2025 Jan 27;25(1):79. doi: 10.1186/s12884-025-07222-x.
Obesity and excessive gestational weight gain (GWG) have been linked to an increased risk of cesarean section. However, existing literature primarily focuses on weight gain during individual trimesters, lacking a comprehensive assessment of GWG trajectories across all three trimesters. This study aimed to investigate the impact of pre-pregnancy BMI and changes in GWG trajectories from the first to the third trimester on cesarean section in women with confirmed gestational diabetes mellitus (GDM).
This retrospective cohort study enrolled 947 women with GDM who delivered between January 2012 and July 2022 in northern Taiwan. GDM was diagnosed by oral glucose tolerance test (OGTT) during 24-28 weeks of gestation. Body mass index cut-offs were based on Asian-specific guidelines. The weekly GWG rate was based on baseline weight and weight at two follow-up measurements. GWG patterns were identified using group-based trajectory modeling analysis (GBTM).
Gestational weight gain patterns were classified into two groups during the pregnancy period: group 1 (non-rapid excessive weight gain) and group 2 (rapid excessive weight gain), comprising 70.2% and 29.8% of participants, respectively. Our study found that being pre-pregnancy underweight and experiencing rapid excessive weight gain contributed to cesarean section. Binary logistic regression analysis revealed that pre-pregnancy normal body mass index (OR = 2.06; 95% CI: 1.08-3.92) and being overweight/obese (OR = 4.04; 95%CI: 2.12-7.70) were associated with the incidence of cesarean sections. Multiparous women and women with a trajectory of rapid excessive weight gain were more likely to undergo cesarean sections.
Healthcare professionals should provide education on weight management from pre-pregnancy to pregnancy to reduce the incidence of cesarean sections. Particular attention should be paid to women with gestational diabetes mellitus (GDM) who exhibit rapid excessive weight gain to minimize the risk of cesarean delivery.
肥胖和孕期体重过度增加（GWG）与剖宫产风险增加有关。然而，现有文献主要关注孕期各阶段的体重增加情况，缺乏对整个孕期GWG轨迹的全面评估。本研究旨在调查孕前体重指数（BMI）以及孕早期至孕晚期GWG轨迹变化对确诊为妊娠期糖尿病（GDM）的女性剖宫产的影响。
这项回顾性队列研究纳入了2012年1月至2022年7月在台湾北部分娩的947例GDM女性。GDM通过妊娠24 - 28周期间的口服葡萄糖耐量试验（OGTT）进行诊断。体重指数临界值依据亚洲特定指南确定。每周GWG率基于基线体重和两次随访测量时的体重。GWG模式通过基于群体的轨迹建模分析（GBTM）确定。
孕期体重增加模式分为两组：第1组（非快速过度体重增加）和第2组（快速过度体重增加），分别占参与者的70.2%和29.8%。我们的研究发现，孕前体重过轻以及经历快速过度体重增加会导致剖宫产。二元逻辑回归分析显示，孕前正常体重指数（比值比[OR] = 2.06；95%置信区间[CI]：1.08 - 3.92）和超重/肥胖（OR = 4.04；95%CI：2.12 - 7.70）与剖宫产发生率相关。经产妇以及体重快速过度增加轨迹的女性更有可能接受剖宫产。
医疗保健专业人员应提供从孕前到孕期的体重管理教育，以降低剖宫产发生率。对于体重快速过度增加的妊娠期糖尿病（GDM）女性应给予特别关注，以尽量降低剖宫产风险。
