[1]陈 彬,李 青,钱自强,等.妊娠期体重控制与妊娠期糖尿病患者分娩结局的关系[J].医学信息,2021,(24):45-50.[doi:10.3969/j.issn.1006-1959.2021.24.009]
 CHEN Bin,LI Qing,QIAN Zi-qiang,et al.Relationship Between Weight Control During Pregnancy and Delivery Outcome in Patients with Gestational Diabetes Mellitus[J].Medical Information,2021,(24):45-50.[doi:10.3969/j.issn.1006-1959.2021.24.009]
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妊娠期体重控制与妊娠期糖尿病患者分娩结局的关系()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
期数:
2021年24期
页码:
45-50
栏目:
论著
出版日期:
2021-12-15

文章信息/Info

Title:
Relationship Between Weight Control During Pregnancy and Delivery Outcome in Patients with Gestational Diabetes Mellitus
文章编号:
1006-1959(2021)24-0045-06
作者:
陈 彬李 青钱自强
(安徽医科大学附属安庆医院妇产科,安徽 安庆 246000)
Author(s):
CHEN BinLI QingQIAN Zi-qianget al.
(Department of Obstetrics and Gynecology,Anqing Hospital Affiliated to Anhui Medical University,Anqing 246000,Anhui,China)
关键词:
妊娠期糖尿病妊娠期体重增加分娩结局IOM指南
Keywords:
Gestational diabetes mellitusGestational weight gainAdverse pregnancy outcomesIOM Guide
分类号:
R714.256
DOI:
10.3969/j.issn.1006-1959.2021.24.009
文献标志码:
A
摘要:
目的 研究妊娠期糖尿病(GDM)患者妊娠期体重不同增长程度对分娩结局的影响。方法 回顾性分析2019年12月-2020年12月我院产科分娩并在孕期常规检查通过IADPSG 75 g葡萄糖糖耐量实验的孕妇1269例,根据糖耐量是否正常分为GDM组(n=506)和NGT(糖耐量正常)组(n=763)。根据美国医学研究所(IOM)指南,依据妊娠期体重增加(GWG)程度不同分为三组:体重增加过轻组(GWG2)、体重增加正常组(GWG1)、体重增加过度组(GWG3)。根据IOM指南对现有的GWG控制目标进行调整,调整后的GWG分组为:IOM-1(将IOM指南建议的GWG最大数值减少1 kg),IOM-2(将IOM指南建议的GWG最小数值减少2 kg),IOM-1-1(将IOM指南建议的GWG最大及最小数值均减少1 kg),IOM-2-2(将IOM指南建议的GWG最大及最小数值都减少2 kg)。比较采用IOM指南及调整后建议体重增加标准的围产结局。结果 剖宫产风险NGT-GWG2组相比IOM-1、IOM-2、IOM-1-1、IOM-2-2降低,差异有统计学意义(P<0.05);与调整前IOM(9.71%) 相比IOM-1-1(4.92%)巨大儿风险降低,IOM(12.86%)相比IOM-2-2(3.91%)剖宫产风险降低,差异有统计学意义(P<0.05)。结论 采用更为严格的IOM调整方案,可减少不良围产结局发生的概率,GWG过度会增加妊娠不良结局的发生风险。
Abstract:
Objective To study the effects of different growth levels of gestational weight on delivery outcomes in patients with gestational diabetes mellitus (GDM).Methods A retrospective analysis was conducted on 1269 pregnant women who delivered in our hospital from December 2019 to December 2020 and passed IADPSG 75 g glucose tolerance test during pregnancy. They were divided into GDM group (n=506 ) and NGT group (n=763 ) according to whether glucose tolerance was normal. According to the guidelines of the American Institute of Medicine (IOM) and the degree of weight gain during pregnancy (GWG), they were divided into three groups : light weight gain group (GWG2), normal weight gain group (GWG1), and excessive weight gain group (GWG3). The existing GWG control objectives are adjusted according to the IOM guidelines. The adjusted GWGs are grouped as follows : IOM-1 (reducing the maximum value of GWG recommended by the IOM guidelines by 1 kg), IOM-2 (reducing the minimum value of GWG recommended by the IOM guidelines by 2 kg), IOM-1-1 (reducing the maximum and minimum values of GWG recommended by the IOM guidelines by 1 kg), and IOM-2-2 (reducing the maximum and minimum values of GWG recommended by the IOM guidelines by 2 kg). Compare perinatal outcomes using IOM guidelines and adjusted recommended weight gain criteria.Results The risk of cesarean section in the NGT-GWG2 group was lower than that in the IOM-1, IOM-2, IOM-1-1 and IOM-2-2 groups, and the difference was statistically significant (P<0.05). Compared with IOM before adjustment (9.71%), the risk of macrosomia in IOM-1-1 (4.92%) was lower, and the risk of cesarean section in IOM (12.86%) was lower than that in IOM-2-2 (3.91%), the difference was statistically significant (P<0.05).Conclusion The more stringent IOM adjustment scheme can reduce the probability of adverse perinatal outcomes, and excessive GWG will increase the risk of adverse pregnancy outcomes.

参考文献/References:

[1]American Diabetes Association.2.Classication and Diagnosis of Diabetes:Standards of Medical Care in Diabetes-2018[J].Diabetes Care,2018,41(Suppl 1):S13-S27.[2]Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines; Rasmussen KM, Yaktine AL, editors.Weight Gain During Pregnancy: Reexamining the Guidelines[M].Washington (DC):National Academies Press (US):2009.[3]International Association of Diabetes and Pregnancy Study Groups Consensus Panel,Metzger BE,Gabbe SG,et al.International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy[J].Diabetes Care,2010,33(3):676-682.[4]中华医学会妇产科学分会妊娠期高血压疾病学组.妊娠期高血压疾病诊治指南(2020)[J].中华妇产科杂志,2020,55(4):227-238.[5]谢幸,孔北华,段涛.妇产科学[M].第9版.北京:人民卫生出版社,2018:135-137.[6]Obesity: preventing and managing the global epidemic.Report of a WHO consultation[J].World Health Organ Tech Rep Ser,2000(894):i-xii,1-253.[7]Cho NH,Shaw JE,Karuranga S,et al.IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045[J].Diabetes Res Clin Pract,2018,138(2):271-281.[8]Aydin H,Celik O,Yazici D,et al.Prevalence and predictors of gestational diabetes mellitus:a nationwide multicentre prospective study[J].Diabet Med,2019,36(2):221-227.[9]National Collaborating Centre for Women’s and Children’s Health(UK).Diabetes in Pregnancy:Management of Diabetes and Its Complications from Preconception to the Postnatal Period[M].London:National Institute for Health and Care Excellence(UK),2015.[10]Longmore DK,Barr EL,Lee IL,et al.Maternal body mass index, excess gestational weight gain, and diabetes are positively associated with neonatal adiposity in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study[J].Pediatric Obesity,2019,14(4):e12490.[11]Bouthoorn SH,Silva LM,Murray SE,et al.Low-educated women have an increased risk of gestational diabetes mellitus:the Generation R Study[J].Acta Diabetol,2015,52(3):445-452.[12]Choi DJ,Yoon CH,Lee H,et al.The association of family history of premature cardiovascular disease or diabetes mellitus on the occurrence of gestational hypertensive disease and diabetes[J].PLoS One,2016,11(12):e0167528.[13]Weiss JX,Malone FD,Emig D,et al.Obesity, obstetric complications and cesarean delivery rate--a population-based screening study[J].Am J Obstet Gynecol,2004,190(4):1091-1097.[14]Dai L,Deng C,Li Y,et al.Birth weight reference percentiles for Chinese[J].PLoS One,2014,9(8):e104779.[15]Goldstein RF,Abell SK,Ranasinha S,et al.Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis[J].JAMA,2017,317(21):2207-2225.[16]Murphy C,Rashid W,Henderson CE.Gestational Diabetes Mellitus and Frequency of Blood Glucose Monitoring: A Randomized Controlled Trial[J].Obstet Gynecol,2017,130(5):1158.[17]Mayo K,Melamed N,Vandenberghe H,et al.The impact of adoption of the international association of diabetes in pregnancy study group criteria for the screening and diagnosis of gestational diabetes[J].Am J Obstet Gynecol,2015,212(2):224.e1-224.e2249.[18]Schaefer-Graf UM,Kjos SL,Kilavuz O,et al.Determinants of fetal growth at different periods of pregnancies complicated by gestational diabetes mellitus or impaired glucose tolerance [J].Diabetes Care,2003,26(1):193-198.[19]Shi P,Yang W,Yu Q,et al.Overweight, gestational weight gain and elevated fasting plasma glucose and their association with macrosomia in Chinese pregnant women[J].Matern Child Health J,2014,18(1):10-15.[20]Wong T,Barnes RA,Ross GP,et al.Are the institute of medicine weight gain targets applicable in women with gestational diabetes mellitus?[J].Diabetologia,2017,60(3):416-423.

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更新日期/Last Update: 1900-01-01