孕前超重和肥胖对孕期糖脂代谢及妊娠结局的影响
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摘要
目的:探讨孕前超重肥胖孕妇的孕期代谢情况及妊娠结局,为科学管理孕前超重和肥胖孕妇,保障母儿安全提供依据。方法:2016年8月—2017年5月,随机选取在航天中心医院产科进行孕期检查的孕前超重或肥胖且无孕前合并症妇女115例进入观察组,同时选取孕前体质量指数正常的孕妇235例进入对照组。比较分析两组孕妇代谢情况及妊娠结局。结果:观察妊娠期高血压、妊娠期糖尿病、产后出血的发生率(13.0%、34.8%、17.4%)高于对照组(6.4%、17.5%、9.3%)(P<0.05),孕晚期血清总胆固醇(5.9±1.0nmol/L)和低密度脂蛋白(2.7±0.7mmol/L)水平低于对照组(6.3±1.1nmol/L)、(3.0±0.8mmol/L)(P<0.05)。巨大儿和新生儿1minApgar评分<10分、新生儿入住NICU的发生率(13.3%、6.1%、5.2%)高于对照组(P<0.05),平均新生儿出生体重[(3507.5±460.7)g]更重(P<0.05)。结论:孕前超重或肥胖的妇女将增加妊娠期高血压、糖尿病等合并症的发生率,并有增加母儿不良妊娠结局的风险。
Objective: To analyze the influence of pre-pregnancy overweight or obesity on glycolipid metabolism of pregnant women and pregnancy outcomes, and to provide evidence for scientific management of pregnant women with pre-pregnancy overweight or obese. Methods: From August 2016 to May 2017, 115 pregnant women with overweight or obese and without other diseases before pregnancy were randomly selected into the observation group, and another 235 pregnant women with normal body mass index(BMI) before pregnancy were selected into the control group during the same period. The glycolipid metabolism of pregnant women and maternal and child outcomes were compared between the two groups. Results: The rates of pregnancy induced hypertension, gestational diabetes, and postpartum hemorrhage of women in the observation group were 13.0%, 34.8%, and 17.4%, respectively, which were significant higher than those(6.4%, 17.5%, and 9.3%, respectively)of women in the control group(P<0.05), and the level of total cholesterol [(5.9±1.0) nmol/L] and low density lipoprotein level [(2.7±0.7) mmol/L] of women in the observation group during the third trimester pregnancy were significant lower than those [(6.3±1.1)nmol/L and(3.0±0.8)mmol/L] of women in the control group(P<0.05). The rates of macrosomia, neonatal Apgar score less than 10 points at 1 minute after born, and newborn transferred to NICU in the observation group was 13.3%, 6.1%, and 5.2%, respectively, which were significant higher than those in the control group(P<0.05), and the average birth weight of newborns in the observation group [(3507.5±460.7)g] was significant heavier than that of newborns in the control group(P<0.05). Conclusion: The women with overweight or obesity before pregnancy have higher rate of pregnancy induced hypertension and GDM than those women with normal weight before pregnancy, which may lead to more risk of adverse pregnancy outcomes.
Objective: To analyze the influence of pre-pregnancy overweight or obesity on glycolipid metabolism of pregnant women and pregnancy outcomes, and to provide evidence for scientific management of pregnant women with pre-pregnancy overweight or obese. Methods: From August 2016 to May 2017, 115 pregnant women with overweight or obese and without other diseases before pregnancy were randomly selected into the observation group, and another 235 pregnant women with normal body mass index(BMI) before pregnancy were selected into the control group during the same period. The glycolipid metabolism of pregnant women and maternal and child outcomes were compared between the two groups. Results: The rates of pregnancy induced hypertension, gestational diabetes, and postpartum hemorrhage of women in the observation group were 13.0%, 34.8%, and 17.4%, respectively, which were significant higher than those(6.4%, 17.5%, and 9.3%, respectively)of women in the control group(P<0.05), and the level of total cholesterol [(5.9±1.0) nmol/L] and low density lipoprotein level [(2.7±0.7) mmol/L] of women in the observation group during the third trimester pregnancy were significant lower than those [(6.3±1.1)nmol/L and(3.0±0.8)mmol/L] of women in the control group(P<0.05). The rates of macrosomia, neonatal Apgar score less than 10 points at 1 minute after born, and newborn transferred to NICU in the observation group was 13.3%, 6.1%, and 5.2%, respectively, which were significant higher than those in the control group(P<0.05), and the average birth weight of newborns in the observation group [(3507.5±460.7)g] was significant heavier than that of newborns in the control group(P<0.05). Conclusion: The women with overweight or obesity before pregnancy have higher rate of pregnancy induced hypertension and GDM than those women with normal weight before pregnancy, which may lead to more risk of adverse pregnancy outcomes.
引文
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[15] Morais JB,Severo JS,Santos LR,et al.Role of Magnesium in Oxidative Stress in Individuals with Obesity[J].Biological Trace Element Research,2017,176(1):20-26.
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[19] Geraghty AA,Alberdi G,O'Sullivan EJ,et al.Maternal Blood Lipid Profile during Pregnancy and Associations with Child Adiposity:Findings from the ROLO Study [EB/OL].PLoS ONE,2016,11(8):e0161206.
[20] Stephenson J,Heslehurst N,Hall J,et al.Before the beginning:nutrition and lifestyle in the preconception period and its importance for future health [J].Lancet,2018,391 (10132):1830-1841.
[2] Ogden CL,Carroll MD,Kit BK,et al.Prevalence of Obesity in the United States,2009-2010.U.S [EB/OL].NCHS Data Brief,2012(82):1-8.
[3] Wang C,Wei YM,Zhang XM,et al.A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women[J].American Journal of Obstetrics & Gynecology,2017(4):340-351.
[4] Feresu SA,Wang Y,Dickinson S.Relationship between maternal obesity and prenatal,metabolic syndrome,obstetrical and perinatal complications of pregnancy in Indiana,2008–2010[J].BMC Pregnancy Childbirth,2015(15):266.
[5] Institute of Medicine,Weight Gain during Pregnancy:Reexamining the Guidelines[R].Washington (DC):National Academies Press (US),2009.
[6] 谢幸 ,孔北华,段涛.妇产科学[M].第9版.北京:人民卫生出版社,2018:70-204.
[7] 董娟.肥胖与妊娠期糖尿病[J].中国计划生育学杂志,2018,26(9):877-878.
[8] Maier JT,Schalinski E,Gauger U,et al.Antenatal body mass index (BMI) and weight gain in pregnancy–its association with pregnancy and birthing complications [J].Journal of Perinatal Medicine,2016,(44):397-404.
[9] Gao X,Yan Y,Xiang S,et al.The mutual effect of pre-pregnancy body mass index,waist circumference and gestational weight gain on obesity-related adverse pregnancy outcomes:A birth cohort study[EB/OL].PLos One,2017,12(6):e0177418.
[10] Maclnnis N,Woolcott CG,McDonald S,et al.Population Attributable Risk Fractions of Maternal Overweight and Obesity for Adverse Perinatal Outcomes[J].Scientific Reports,2016(6):DOI:10.1038/srep22895
[11] Yang Z,Phung H,Freebairn L,et al.Contribution of maternal overweight and obesity to the occurrence of adverse pregnancy outcomes[EB/OL].Australian and New Zealand Journal of Obstetrics and Gynaecology,2018-7-19.DOI:10.1111/ajo.12866.
[12] Fleming TP,Watkins AJ,Velazquez MA,et al.Origins of lifetime health around the time of conception:causes and consequences [J].Lancet,2018,391:1842-52.
[13] Shen H,Liu X,Chen Y,et al.Associations of lipid levels during gestation with hypertensive disorders of pregnancy and gestational diabetes mellitus:a prospective longitudinal cohort study [J].BMJ Open,2016,6(12):e013509.
[14] Geraghty AA,Alberdi G,O'Sullivan EJ,et al.Maternal and fetal blood lipid concentrations during pregnancy differ by maternal body mass index:findings from the ROLO study [J].BMC Pregnancy Childbirth,2017,17(1):360.
[15] Morais JB,Severo JS,Santos LR,et al.Role of Magnesium in Oxidative Stress in Individuals with Obesity[J].Biological Trace Element Research,2017,176(1):20-26.
[16] Luciano-Mateo F,Cabre N,Nadal M,et al.Serum concentrations of trace elements and their relationships with paraoxonase-1 in morbidly obese women[J].Journal of Trace Elements in Medicine and Biology,2018,(48):8-15.
[17] Khatibi A,Brantsaeter AL,Sengpiel V,et al.Prepregnancy maternal body mass index and preterm delivery[J].Am J Obstet Gynecol,2012,207(3):1-7.
[18] Gunatilake RP,Perlow JH.Obesity and pregnancy:clinical management of the obese gravida [J].American Journal of Obstetrics and Gynecology,2011,204(2):106-119.
[19] Geraghty AA,Alberdi G,O'Sullivan EJ,et al.Maternal Blood Lipid Profile during Pregnancy and Associations with Child Adiposity:Findings from the ROLO Study [EB/OL].PLoS ONE,2016,11(8):e0161206.
[20] Stephenson J,Heslehurst N,Hall J,et al.Before the beginning:nutrition and lifestyle in the preconception period and its importance for future health [J].Lancet,2018,391 (10132):1830-1841.