Association of Weight Gain Rate in Second and Third Trimesters with Pregnancy Complications and Delivery Outcomes in Women with Gestational Diabetes Mellitus

doi:10.12114/j.issn.1007-9572.2022.0410

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (29): 3621-3626.DOI: 10.12114/j.issn.1007-9572.2022.0410

Special Issue: 内分泌代谢性疾病最新文章合辑；孕产妇健康研究最新文章合辑

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Association of Weight Gain Rate in Second and Third Trimesters with Pregnancy Complications and Delivery Outcomes in Women with Gestational Diabetes Mellitus

1. The Fourth Clinical School of Zhejiang Chinese Medicine University, Hangzhou 310053, China
2. School of Public Health, Hangzhou Normal University Division of Health Sciences, Hangzhou 311121, China
3. Hangzhou Women's Hospital, Hangzhou 310008, China

Received:2022-03-12 Revised:2022-06-20 Published:2022-10-15 Online:2022-07-21
Contact: Wensheng HU
About author:
HUA W, ZHANG L J, LU S, et al. Association of weight gain rate in second and third trimesters with pregnancy complications and delivery outcomes in women with gestational diabetes mellitus[J]. Chinese General Practice, 2022, 25 (29) : 3621-3626.

孕中晚期增重速率对妊娠期糖尿病孕妇妊娠期并发症和分娩结局的影响研究

1．310053　浙江省杭州市，浙江中医药大学第四临床医学院
2．311121　浙江省杭州市，杭州师范大学医学部公共卫生学院
3．310008　浙江省杭州市妇产科医院

通讯作者: 胡文胜
作者简介:
华雯，张丽君，卢莎，等.孕中晚期增重速率对妊娠期糖尿病孕妇妊娠期并发症和分娩结局的影响研究[J].中国全科医学，2022，25（29）：3621-3626. [www.chinagp.net] 作者贡献：华雯进行文章的统计学处理，撰写论文；张丽君、卢莎进行结果的分析与解释；徐佳惠、Nisile Kakongoma进行数据整理；胡文胜进行文章的构思设计、负责文章的质量控制及审校。
基金资助:
国家自然科学基金面上项目(82173530); 国家卫生健康委科学研究基金—浙江省医药卫生重大科技计划项目(WKJ-ZJ-1911); 杭州市卫生科技计划重点项目(ZD20200035)

Abstract

Abstract:

Background

The total gestational weight gain is closely related to the gestational week at delivery. Choosing the gestational weight gain rate (GWGR) as a indicator can reduce the interference of gestational week on the results. Currently, available recommendations regarding GWGR are controversial. Few studies have explored the correlation between GWGR in second and third trimesters and delivery outcomes in women with gestational diabetes mellitus (GDM) .

Objective

To investigate the association of GWGR in second and third trimesters with pregnancy complications and delivery outcomes in women with GDM.

Methods

A total of 370 women with GDM were selected, who had an experience of undergoing delivery in Hangzhou Women's Hospital from March to December 2018, and were included in the Hangzhou Maternal and Offspring Health Cohort Study (clinical trial registration number: ChiCTR1900026149) . According to GWGR in second and third trimesters recommended by the Weight Monitoring and Evaluation during Pregnancy Period of Chinese Women published by the Chinese Nutrition Society in 2021, the subjects were divided into insufficient GWGR group (n=115) , normal GWGR group (n=152) and excessive GWGR group (n=103) . We analyzed the incidence of pregnancy complications and delivery outcomes of the three groups.

Results

Logistic regression analysis demonstrated that excessive GWGR in second and third trimesters was associated with an increased risk of hypertensive disorders of pregnancy〔OR=2.661, 95%CI (1.291, 9.460) 〕, gestational hypothyroidism〔OR=2.288, 95%CI (1.090, 4.805) 〕, gestational hyperlipidemia〔OR=2.085, 95%CI (1.656, 6.630) 〕 and macrosomia〔OR=4.591, 95%CI (1.238, 17.031) 〕 (P<0.05) , and a decreased risk of preterm neonate〔OR=0.117, 95%CI (0.014, 0.959) 〕 (P<0.05) .

Conclusion

Abnormal weight gain in pregnant women is common. Excessive GWGR in second and third trimesters may increase the risk of hypertensive disorders of pregnancy, gestational hypothyroidism, hyperlipidemia and macrosomia, and decrease the risk of preterm neonate in women with GDM.

Key words: Diabetes, gestational, Gestational weight gain rate in the second and third trimesters, Pregnancy complications, Pregnancy outcomes, Cohort studies

摘要：

背景

妊娠期总增重与分娩孕周紧密相连，选择增重速率作为研究指标，可以减少孕周对研究结果的干扰。目前有关妊娠期增重速率的既定建议存在争议且很少有研究探讨孕中晚期增重速率与妊娠期糖尿病（GDM）孕妇母婴结局的相关性。

目的

探讨孕中晚期增重速率对GDM孕妇妊娠期并发症及分娩结局的影响。

方法

选取2018年3—12月在杭州市妇产科医院住院生产并纳入"杭州市母婴健康队列"（注册号：ChiCTR1900026149）的370例GDM孕妇为研究对象。根据2021年中国营养学会发布的《中国妇女妊娠期体重监测与评价》推荐的孕中晚期增重速率，将研究对象分为增重速率过慢组（n=115）、增重速率正常组（n=152）和增重速率过快组（n=103）。分析三组孕妇妊娠期并发症发生情况及分娩结局。

结果

Logistic回归分析结果显示，孕中晚期增重速率过快是GDM孕妇发生妊娠期高血压疾病〔OR=2.661，95%CI（1.291，9.460）〕、妊娠期甲状腺功能减退症〔OR=2.288，95%CI（1.090，4.805）〕、高脂血症〔OR=2.085，95%CI（1.656，6.630）〕及分娩巨大儿〔OR=4.591，95%CI（1.238，17.031）〕的危险因素（P<0.05），孕中晚期增重速率过快是分娩早产儿〔OR=0.117，95%CI（0.014，0.959）〕的保护因素（P<0.05）。

结论

孕妇妊娠期增重不合理现象普遍，孕中晚期增重速率过快增加了GDM孕妇发生妊娠期高血压疾病、妊娠期甲状腺功能减退症、高脂血症及分娩巨大儿的风险，但降低了发生早产的风险。

关键词: 糖尿病，妊娠, 孕中晚期增重速率, 妊娠并发症, 分娩结局, 队列研究

Wen HUA,Lijun ZHANG,Sha LU, et al. Association of Weight Gain Rate in Second and Third Trimesters with Pregnancy Complications and Delivery Outcomes in Women with Gestational Diabetes Mellitus[J]. Chinese General Practice, 2022, 25(29): 3621-3626. DOI: 10.12114/j.issn.1007-9572.2022.0410.
华雯,张丽君,卢莎等. 孕中晚期增重速率对妊娠期糖尿病孕妇妊娠期并发症和分娩结局的影响研究[J]. 中国全科医学, 2022, 25(29): 3621-3626. DOI: 10.12114/j.issn.1007-9572.2022.0410.

Figures/Tables 5

References 38

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妊娠期体质量状况	妊娠前BMI （kg/m²）	总增重范围（kg）	孕中晚期增重速率（kg/周）
低体质量	<18.5	11.0~16.0	0.46（0.37，0.56）
正常体质量	18.5~23.9	8.0~14.0	0.37（0.26，0.46）
超重	24.0~27.9	7.0~11.0	0.30（0.22，0.37）
肥胖	≥28.0	5.0~9.0	0.22（0.15，0.30）

妊娠期体质量状况	妊娠前BMI （kg/m²）	总增重范围（kg）	孕中晚期增重速率（kg/周）
低体质量	<18.5	11.0~16.0	0.46（0.37，0.56）
正常体质量	18.5~23.9	8.0~14.0	0.37（0.26，0.46）
超重	24.0~27.9	7.0~11.0	0.30（0.22，0.37）
肥胖	≥28.0	5.0~9.0	0.22（0.15，0.30）

组别	例数	年龄（岁）	产次（次）	身高（cm）	分娩孕周（周）	妊娠前体质量（kg）	最后一次产检宫高（cm）	最后一次产检腹围（cm）
增重速率过慢组	115	31.7±4.3	1.4±0.5	158.6±5.3	38.3±2.0	55.5±7.9	34.0±2.2	98.9±5.4
增重速率正常组	152	30.6±3.9	1.4±0.5	160.5±4.9^a	38.6±1.6	55.8±7.8	34.1±1.7	99.4±5.3
增重速率过快组	103	30.7±4.7	1.5±0.6	160.9±5.2^a	38.6±1.4	59.6±8.6^ab	35.0±2.4^ab	103.8±6.2^ab
F值		2.183	1.796	6.351	1.644	6.709	8.295	25.394
P值		0.114	0.167	0.002	0.195	0.001	<0.001	<0.001

组别	例数	年龄（岁）	产次（次）	身高（cm）	分娩孕周（周）	妊娠前体质量（kg）	最后一次产检宫高（cm）	最后一次产检腹围（cm）
增重速率过慢组	115	31.7±4.3	1.4±0.5	158.6±5.3	38.3±2.0	55.5±7.9	34.0±2.2	98.9±5.4
增重速率正常组	152	30.6±3.9	1.4±0.5	160.5±4.9^a	38.6±1.6	55.8±7.8	34.1±1.7	99.4±5.3
增重速率过快组	103	30.7±4.7	1.5±0.6	160.9±5.2^a	38.6±1.4	59.6±8.6^ab	35.0±2.4^ab	103.8±6.2^ab
F值		2.183	1.796	6.351	1.644	6.709	8.295	25.394
P值		0.114	0.167	0.002	0.195	0.001	<0.001	<0.001

组别	例数	妊娠期高血压疾病	妊娠期甲状腺功能减退症	妊娠期肝内胆汁淤积症	妊娠期肝功能损害	胎膜早破	羊水异常	高脂血症
增重速率过慢组	115	6（5.3）	14（12.2）	3（2.6）	4（3.5）	25（21.7）	3（2.6）	8（7.0）
增重速率正常组	152	2（1.3）	17（11.2）	6（3.9）	4（2.6）	29（19.1）	7（4.6）	5（3.3）
增重速率过快组	103	9（8.7）^b	24（23.3）^ab	0	4（3.9）	11（10.7）^a	7（6.8）	12（11.7）^b
χ²值		5.844	8.077	4.198	0.489	5.978	2.135	6.052
P值		0.040	0.018	0.119	0.813	0.049	0.342	0.041

Association of Weight Gain Rate in Second and Third Trimesters with Pregnancy Complications and Delivery Outcomes in Women with Gestational Diabetes Mellitus

孕中晚期增重速率对妊娠期糖尿病孕妇妊娠期并发症和分娩结局的影响研究

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组别	例数	出生体质量（±s，g）	巨大儿〔n（%）〕	足月小样儿〔n（%）〕	早产儿〔n（%）〕	胎儿窘迫〔n（%）〕	新生儿窒息〔n（%）〕	胎儿畸形〔n（%）〕
增重速率过慢组	115	3 169±511	3（2.6）	2（1.7）	9（7.8）	9（7.8）	1（0.9）	0
增重速率正常组	152	3 245±460	6（3.9）	0	8（5.3）	8（5.3）	3（2.0）	2（1.3）
增重速率过快组	103	3 485±513^ab	13（12.6）^ab	2（1.9）	1（1.0）^a	4（3.9）	2（1.9）	1（1.0）
χ²（F）值		12.173^c	11.583	3.121	6.004	1.660	0.689	1.396
P值		<0.001	0.003	0.182	0.047	0.452	0.771	0.627

变量	妊娠期高血压疾病		妊娠期甲状腺功能减退症		胎膜早破		高脂血症		巨大儿		早产儿
变量	OR（95%CI）	P值	OR（95%CI）	P值	OR（95%CI）	P值	OR（95%CI）	P值	OR（95%CI）	P值	OR（95%CI）	P值
增重速率过慢	1.354（0.364，5.036）	0.354	0.996（0.450，2.073）	0.474	0.880（0.478，1.621）	0.881	2.082（0.706，6.135）	0.881	1.506（0.363，6.245）	0.664	0.610（0.233，1.669）	0.466
增重速率过快	2.661（1.291，9.460）	0.027	2.288（1.090，4.805）	0.030	0.481（0.221，1.050）	0.177	2.085（1.656，6.630）	0.021	4.591（1.238，17.031）	0.016	0.117（0.014，0.959）	0.042

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