关键词: 糖尿病, 妊娠；妊娠并发症；巨大胎儿；孕期增重；血脂异常；回顾性研究；影响因素分析

Abstract: Background　Great attention has been paid to lifestyle intervention such as diet and exercise in pregnant women with gestational diabetes mellitus（GDM） clinically. Recent studies have found that glycemic control in pregnant women with GDM is satisfactory，but the incidence of macrosomia has not decreased significantly. Objective　To investigate the effects of GDM on glycolipid levels and macrosomia incidence in the third trimester of pregnancy. Methods　Through the hospital information system of Tongzhou Maternal & Child Health Hospital of Beijing，we retrospectively selected 16 134 women with full-term delivery in the hospital from 2014 to 2018，and divided them into GDM group〔including those with a delivered baby with macrosomia（GM subgroup） and with a delivered baby with normal birth weight（GN subgroup）〕and non-GDM group 〔including those with a delivered baby with macrosomia（NM subgroup） and with a delivered baby with normal birth weight（NN subgroup）〕by GDM prevalence. We compared total cholesterol （TC），triglyceride （TG），high-density lipoprotein cholesterol （HDL-C），low-high lipoprotein cholesterol （LDL-C），and fasting blood glucose（FBG） at the third trimester between GDM and non-GDM groups，GM and GN subgroups，NM and NN subgroups，NM and GM subgroups，and NN and GN subgroups，respectively. Multivariate Logistic regression analysis was used to explore the associated factors of macrosomia. Results　There were 3 834 cases in GDM group（411 in GM subgroup，and 3 423 in GN subgroup），and 12 300 in non-GDM group（898 in NM subgroup，and 11 402 in NN subgroup）. GDM group showed higher mean TG and FBG levels and lower mean TC，HDL-C and LDL-C levels than non-GDM group （P<0.05）. GN subgroup had lower mean TG and FBG levels and higher mean HDL-C level than GM subgroup （P<0.05）. NM subgroup had higher mean TC，HDL-C and LDL-C levels and lower mean TG and FBG levels than GM subgroup （P<0.05）. NN subgroup had higher mean TC，HDL-C and LDL-C levels and lower mean TG and FBG levels than GN subgroup （P<0.05）. NN subgroup had higher mean HDL-C level and lower mean TG and FBG levels than NM subgroup （P<0.05）. Multivariate Logistic regression analysis found that GDM〔OR=1.338，95%CI（1.158，1.547）〕，and pre-pregnancy BMI 〔emaciated：OR=0.476，95%CI（0.361，0.626）；overweight：OR=1.770，95%CI（1.537，2.039）；obesity：OR=2.854，95%CI（2.282，3.568）〕，weight gain during pregnancy 〔OR=1.100，95%CI（1.087，1.113）〕，gestational age at delivery 〔OR=1.728，95%CI（1.622，1.841）〕，TC in late pregnancy 〔OR=0.705，95%CI（0.514，0.966）〕，TG in late pregnancy 〔OR=1.282，95%CI（1.153，1.425）〕，LDL-C in late pregnancy 〔OR=1.487，95%CI（1.094，2.021）〕，and FBG in late pregnancy 〔OR=1.692，95%CI（1.482，1.933）〕 were associated with the delivery of a baby with macrosomia （P<0.05）. Conclusion　Elevated TG and FBG and decreased TC，HDL-C and LDL-C were found in pregnant women with GDM. GDM，blood lipid and blood glucose in late pregnancy may be associated factors of delivering a baby with macrosomia. To reduce macrosomia incidence，it is suggested to strengthen the monitoring of blood lipid and blood glucese（especially TG and FBG levels） as well as weight management in pregnancy.

Key words: Diabetes, gestational；Pregnancy complications；Fetal macrosomia；Gestational weight gain；Dyslipidemias；Retrospective studies；Root cause analysis