Stogianni Anna, Jönsson Annika, Penna Malin, Lendahls Lena, Alvarsson Michael, Landin-Olsson Mona, Wanby Pär, Thunander Maria
Department of Clinical Sciences, Endocrinology and Diabetes, Lund University, Lund, Sweden.
Department of Endocrinology, Karolinska University Hospital (Huddinge), Stockholm, Sweden.
Acta Obstet Gynecol Scand. 2025 Aug 13. doi: 10.1111/aogs.70040.
Our objective was to evaluate the association of early-pregnancy body mass index (BMI) in women with gestational diabetes mellitus (GDM) with maternal, delivery, and child outcomes, and compare with pregnancies without diabetes in southeastern Sweden, including after a surge of non-European immigration.
A retrospective population-based observational study of all 401 singleton pregnancies with GDM in the Kronoberg and southern Kalmar regions, 2013-2018, and 377 pregnancies without diabetes, matched by date of delivery. Data were collected by chart review. Women with early-pregnancy BMI <30 kg/m/≥30 kg/m were compared. Main outcomes were gestational weight gain (GWG), continuous and dichotomized <8 kg/≥8 kg, preeclampsia, cesarean section (CS), and large-for-gestational-age (LGA). Maternal age, ethnicity, parity, smoking, physical activity, delivery type and week, birthweight, and the APGAR score were also registered.
Obese women with GDM had lower mean GWG (9.2 ± 6.8 vs. 11.7 ± 6.1 kg); fewer reached ≥8 kg (54% vs. 75%), more had preeclampsia (13% vs. 2.6%), and infants weighed 200 g less than those of nonobese women with GDM all p < 0.001 and those of obese women without GDM (11.2 ± 5.8 kg, p < 0.001; 68%, p = 0.05, 3.1%, p = 0.03). APGAR scores were high in all groups, 9.4-9.8. All women with GDM had a higher prevalence of LGA infants than controls without diabetes; obese 24% versus 12% (p = 0.03) and nonobese 11% versus 6% (p = 0.05). Obese women with GDM delivered more LGA infants than nonobese women with GDM, p = 0.001. The combination of GDM and obesity increased risk of LGA, OR 5.3 (2.76-10.1); preeclampsia OR 4.3 (1.83-10.23); and CS OR 1.9 (1.26-2.97) and decreased odds of GWG ≥8 kg, OR 0.25 (0.16-0.38), compared to the reference group of nonobese women without GDM. All results remained unchanged in a sensitivity analysis using the BMI obesity limit ≥27.5 kg/m for Asians, who were overrepresented in the group of women with GDM.
Women with GDM and obesity, especially in combination, had a greater risk for preeclampsia, CS, and delivering LGA infants; their lower GWG and high APGAR scores in all groups, compared to earlier studies, suggested successful care interventions. Efforts to lower the levels of early-pregnancy obesity and strict glucose control in women with GDM are recommended to reduce adverse outcomes.
我们的目的是评估患有妊娠期糖尿病（GDM）的女性的孕早期体重指数（BMI）与孕产妇、分娩及儿童结局之间的关联，并与瑞典东南部无糖尿病的妊娠情况进行比较，包括在非欧洲移民激增之后。
一项基于人群的回顾性观察研究，研究对象为2013年至2018年克吕讷贝里和卡尔马南部地区所有401例单胎妊娠合并GDM的孕妇，以及377例无糖尿病的妊娠孕妇，按分娩日期进行匹配。通过病历审查收集数据。比较孕早期BMI<30 kg/m²和≥30 kg/m²的女性。主要结局包括孕期体重增加（GWG），连续变量及分为<8 kg和≥8 kg的二分变量、子痫前期、剖宫产（CS）以及大于胎龄儿（LGA）。还记录了产妇年龄、种族、产次、吸烟情况、身体活动、分娩类型及孕周、出生体重和阿氏评分。
患有GDM的肥胖女性平均GWG较低（9.2±6.8 vs. 11.7±6.1 kg）；达到≥8 kg的人数较少（54% vs. 75%），子痫前期的发生率更高（13% vs. 2.6%），并且其婴儿体重比未患GDM的非肥胖女性轻200 g（所有p<0.001），也比未患GDM的肥胖女性轻（11.2±5.8 kg，p<0.001；68%，p = 0.05，3.1%，p =（此处原文似乎有误，推测为0.03））。所有组的阿氏评分都很高，为9.4 - 9.8。所有患有GDM的女性中LGA婴儿的患病率均高于无糖尿病的对照组；肥胖女性为24% 对12%（p = 0.03），非肥胖女性为11% 对6%（p = 0.05）。患有GDM的肥胖女性分娩的LGA婴儿比未患GDM的非肥胖女性更多，p = 0.001。与未患GDM的非肥胖女性参考组相比，GDM与肥胖并存增加了LGA的风险，比值比（OR）为5.3（2.76 - 10.）；子痫前期的OR为4.3（1.83 - （此处原文似乎有误，推测为10.23））；剖宫产的OR为1.9（1.26 - 2.97），并且降低了GWG≥8 kg的几率，OR为0.25（0.16 - 0.38）。在一项敏感性分析中，对于在患有GDM的女性群体中占比过高的亚洲人，使用BMI肥胖界限≥27.5 kg/m²时，所有结果均保持不变。
患有GDM和肥胖的女性，尤其是两者并存时，发生子痫前期、剖宫产和分娩LGA婴儿的风险更高；与早期研究相比，她们较低的GWG以及所有组中较高的阿氏评分表明护理干预取得了成功。建议努力降低孕早期肥胖水平并对患有GDM的女性进行严格的血糖控制，以减少不良结局。
