糖代谢异常孕妇体质量及相关因素对新生儿出生体质量的影响
당대사이상잉부체질량급상관인소대신생인출생체질량적영향
Factors relevant to newborn birth weight in pregnancy complicated with abnormal glucose Metabolism
  • 万方数据
    中华妇产科杂志 중화부산과잡지
    CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
    2010年 9期 646-651 ,共6页

    杨延冬%翟桂荣%杨慧霞

    양연동%적계영%양혜하

    葡萄糖代谢障碍%糖尿病,妊娠%体重增长%出生体重%人体质量指数 葡萄糖代謝障礙%糖尿病,妊娠%體重增長%齣生體重%人體質量指數
    포도당대사장애%당뇨병,임신%체중증장%출생체중%인체질량지수
    Glucose metabolism disorders%Diabetes,gestational%Weight gain%Birth weight%Body mass index
    目的 探讨影响糖代谢异常孕妇新生儿出生体质量的相关因素.方法 选择2005年1月-2009年12月在北京大学第一医院分娩的临床资料齐全的妊娠合并糖代谢异常足月单胎孕妇1157例,根据孕前体质指数(BMI)分成4组:53例BMI＜18.5 kg/m2为低体质量组,647例BMI18.5～23.9 kg/m2为理想体质量组,323例BMI 24.0～27.9 kg/m2为超体质量组,134例BMI≥28.0 kg/m2为肥胖组.1157例新生儿按出生体质量分为:出生体质量2500～4000 g为正常体质量儿(987例),其中545例出生体质量3000～3500 g为适宜体质量儿;出生体质量≥4000 g为巨大儿(112例);出生体质量＜2500 g为低体质量儿(58例).记录其孕前体质量、身高、糖代谢异常诊断时间及诊断时体质量、孕期血脂水平、不良产史、糖尿病家族史、分娩孕周、分娩时体质量、新生儿出生体质量.分析孕前BMI、孕期体质量增长(分娩时体质量-孕前体质量)、诊断糖代谢异常的孕周、诊断后孕妇体质量增长(分娩时体质量-诊断糖代谢异常时体质量)、孕期血脂水平、不良产史及糖尿病家族史对新生儿出生体质量的影响及计算孕前不同BMI孕妇分娩适宜体质量儿的孕期体质量适宜增长范围.结果 (1)新生儿平均出生体质量:低体质量组为(3142±333)g,理想体质量组为(3339±476)g,超体质量组为(3381±581)g,肥胖组为(3368±644)g.新生儿出生体质量随孕前BMI增加而增加,低体质量组新生儿平均出生体质量低于其他3组,分别比较,差异均有统计学意义(P＜0.05);但理想体质量组、超体质量组、肥胖组间分别比较,差异均无统计学意义(P＞0.05).(2)分娩正常体质量儿和巨大儿孕妇的孕期体质量增长:分娩正常体质量儿及分娩巨大儿的各组孕妇孕期体质量增长为,理想体质量组分别为(13.5±4.5)及(17.1±5.4)kg,超体质量组分别为(11.6±4.9)及(15.3±6.4)kg,肥胖组分别为(10.3±5.0)及(14.7±7.4)kg,3组分别比较,差异均有统计学意义(P＜0.05);低体质量组分娩巨大儿的孕妇仅1例,无法进行统计学分析.(3)分娩正常体质量儿和巨大儿孕妇的糖代谢异常诊断孕周:理想体质量组分别为(27.8±5.8)及(29.8±5.3)周,超体质量组分别为(26.7±6.8)及(30.2±4.1)周,两者分别组内比较,差异均有统计学意义(P＜0.05);肥胖组分别为(26.2±7.5)及(25.7±9.3)周,差异无统计学意义(P＞0.01);低体质量组分娩巨大儿孕妇例数仅1例,无法进行统计学分析.(4)分娩正常体质量儿与巨大儿孕妇的血脂水平:分娩巨大儿孕妇血清甘油三酯水平[(3.1±1.5)mmol/L]明显高于分娩正常体质量儿的孕妇[(2.7±1.2)mmol/L,P＜0.01];分娩巨大儿孕妇血清高密度脂蛋白胆固醇水平[(1.4±0.3)mmol/L]明显低于分娩正常体质量儿的孕妇[(1.7±0.9)mmol/L,P＜0.05];分娩巨大儿孕妇血清低密度脂蛋白胆固醇及总胆固醇水平[分别为(2.8±0.8)及(5.4±1.1)mmol/L]均低于分娩正常体质量儿的孕妇[分别为(3.0±0.9)及(5.6±1.1)mmol/L],但差异无统计学意义(P＞0.05).(5)影响新生儿出生体质量的相关因素:将年龄、不良产史、糖尿病家族史、孕前BMI、孕期体质量增长、诊断糖代谢异常后孕妇体质量增长、孕期血脂水平、糖代谢异常分类、诊断孕周等因素进行logistic多元回归模型分析,最终进入回归模型的变量中排在前3位的是孕前BMI、孕期体质量增长及高密度脂蛋白胆固醇水平(P＜0.01).结论 妊娠合并糖代谢异常孕妇新生儿出生体质量与孕前BMI、孕期体质量增长、孕期血浆高密度脂蛋白胆固醇水平相关.
    목적 탐토영향당대사이상잉부신생인출생체질량적상관인소.방법 선택2005년1월-2009년12월재북경대학제일의원분면적림상자료제전적임신합병당대사이상족월단태잉부1157례,근거잉전체질지수(BMI)분성4조:53례BMI＜18.5 kg/m2위저체질량조,647례BMI18.5～23.9 kg/m2위이상체질량조,323례BMI 24.0～27.9 kg/m2위초체질량조,134례BMI≥28.0 kg/m2위비반조.1157례신생인안출생체질량분위:출생체질량2500～4000 g위정상체질량인(987례),기중545례출생체질량3000～3500 g위괄의체질량인;출생체질량≥4000 g위거대인(112례);출생체질량＜2500 g위저체질량인(58례).기록기잉전체질량、신고、당대사이상진단시간급진단시체질량、잉기혈지수평、불량산사、당뇨병가족사、분면잉주、분면시체질량、신생인출생체질량.분석잉전BMI、잉기체질량증장(분면시체질량-잉전체질량)、진단당대사이상적잉주、진단후잉부체질량증장(분면시체질량-진단당대사이상시체질량)、잉기혈지수평、불량산사급당뇨병가족사대신생인출생체질량적영향급계산잉전불동BMI잉부분면괄의체질량인적잉기체질량괄의증장범위.결과 (1)신생인평균출생체질량:저체질량조위(3142±333)g,이상체질량조위(3339±476)g,초체질량조위(3381±581)g,비반조위(3368±644)g.신생인출생체질량수잉전BMI증가이증가,저체질량조신생인평균출생체질량저우기타3조,분별비교,차이균유통계학의의(P＜0.05);단이상체질량조、초체질량조、비반조간분별비교,차이균무통계학의의(P＞0.05).(2)분면정상체질량인화거대인잉부적잉기체질량증장:분면정상체질량인급분면거대인적각조잉부잉기체질량증장위,이상체질량조분별위(13.5±4.5)급(17.1±5.4)kg,초체질량조분별위(11.6±4.9)급(15.3±6.4)kg,비반조분별위(10.3±5.0)급(14.7±7.4)kg,3조분별비교,차이균유통계학의의(P＜0.05);저체질량조분면거대인적잉부부1례,무법진행통계학분석.(3)분면정상체질량인화거대인잉부적당대사이상진단잉주:이상체질량조분별위(27.8±5.8)급(29.8±5.3)주,초체질량조분별위(26.7±6.8)급(30.2±4.1)주,량자분별조내비교,차이균유통계학의의(P＜0.05);비반조분별위(26.2±7.5)급(25.7±9.3)주,차이무통계학의의(P＞0.01);저체질량조분면거대인잉부례수부1례,무법진행통계학분석.(4)분면정상체질량인여거대인잉부적혈지수평:분면거대인잉부혈청감유삼지수평[(3.1±1.5)mmol/L]명현고우분면정상체질량인적잉부[(2.7±1.2)mmol/L,P＜0.01];분면거대인잉부혈청고밀도지단백담고순수평[(1.4±0.3)mmol/L]명현저우분면정상체질량인적잉부[(1.7±0.9)mmol/L,P＜0.05];분면거대인잉부혈청저밀도지단백담고순급총담고순수평[분별위(2.8±0.8)급(5.4±1.1)mmol/L]균저우분면정상체질량인적잉부[분별위(3.0±0.9)급(5.6±1.1)mmol/L],단차이무통계학의의(P＞0.05).(5)영향신생인출생체질량적상관인소:장년령、불량산사、당뇨병가족사、잉전BMI、잉기체질량증장、진단당대사이상후잉부체질량증장、잉기혈지수평、당대사이상분류、진단잉주등인소진행logistic다원회귀모형분석,최종진입회귀모형적변량중배재전3위적시잉전BMI、잉기체질량증장급고밀도지단백담고순수평(P＜0.01).결론 임신합병당대사이상잉부신생인출생체질량여잉전BMI、잉기체질량증장、잉기혈장고밀도지단백담고순수평상관.
    Objective To investigate the influencing factors of neonatal birth body mass in women with abnormal glucose metabolism during pregnancy. Methods A study was conducted on 1157 singleton gravidas, who were diagnosed and treated for abnormal glucose metabolism and delivered in the Department of Obstetrics and Gynecology, First Hospital, Peking University from January 2005 to December 2009, by reviewing the medical records. Based on the pre-pregnant body mass index, the selected cases were divided into 4 groups: low body mass group [ body mass index (BMI) ＜ 18.5 kg/m2, n =53], ideal body mass group ( BMI 18.5 - 23.9 kg/m2, n = 647 ), over body mass group ( BMI 24.0 - 27.9 kg/m2, n = 323 ),and obese group (BMI≥28.0 kg/m2, n = 134). 1157 newborns were divided by birth body mass into 3 groups: normal birth body mass group (body mass 2500 -4000 g, n =987), of which 545 cases of birth body mass 3000 -3500 g for the appropriate newborns, macrosomia group (body mass≥4000 g, n = 112);low birth body mass group (body mass ＜ 2500 g, n = 58 ). The following information was collected,including pre-pregnancy body mass, height, gestational age of diagnosis and body mass gain after diagnosis,maternal serum level of cholesterol, history of adverse pregnancy, and family history of diabetes, gestational age, delivering body mass, neonatal birth body mass. The influence of pre-pregnant BMI, body mass gain during pregnancy, gestational age of diagnosis, body mass gain after diagnosis, maternal serum level of cholesterol, family history of diabetes on the newborns' birth body mass was analyzed. The appropriate ranges of gestational body mass gain were calculated in women with abnormal glucose metabolism. Results ( 1 )The average neonatal birth body mass for each group respectively were (3142 ±333) g for low body mass group, (3339 ±476) g for the ideal body mass group, (3381 ±581) g for over body mass group, and (3368 ± 644) g for obese group. The neonatal birth body mass was increasing with maternal pre-pregnant BMI, and average birth body mass of the newborns in low body mass group was lower than other 3 groups,respectively, the difference was statistically significant ( P ＜ 0.05 ). The difference was not statistically significant ( P ＞ 0.05 ), when it was compared among the obese group, ideal weight group and over body mass group. (2)The body mass gain during pregnancy in women delivered normal birth weight newborn and delivered macrosomia for each group respectively were ( 13.5 ±4.5 ) and ( 17.1±5.4) kg for the ideal body mass group, ( 11.6 ± 4.9 ) and ( 15.3 ± 6.4 ) kg for the over body mass group, ( 10.3 ± 5.0) and ( 14.7 ±7.4) kg for the obese group. The difference was statistically significant in 3 groups (P ＜ 0.05 ). The difference of body mass gain during pregnancy in women delivered normal birth weight newborn and delivered macrosomia for low body mass group could not be compared statistically, because of only 1 case delivered macrosomia. (3)The gestational age of diagnosis in women who delivered normal birth weight newborn and macrosomia for the ideal body mass group respectively were ( 27.8 ± 5.8) and ( 29.8 ± 5.3 ) weeks, the difference was statistically significant ( P ＜0.05 ). The gestational age of diagnosis in gravidas who delivered normal birth weight newborn and macrosomia for the over body mass group respectively were ( 26.7 ± 6.8)and (30.2 ± 4.1 ) weeks, the difference was statistically significant ( P ＜ 0.05 ). The gestational age of diagnosis in women who delivered normal birth weight newborn for obese group was (26.2 ± 7.5 )weeks, less than that of pregnant women who delivered macrosomia [ ( 25.7 ± 9.3 ) weeks ], but the difference was not statistically significant (P ＞ 0.05 ). The difference of the diagnosed gestational age for low body mass group could not be compared statistically, because of only 1 case delivered macrosomia. (4)Tbe serum triglyceride (TG) levels of pregnant women who delivered macrosomia was (3.1 ± 1.5) mmol/L, higher than that of pregnant women who delivered normal birth weight newborn [ (2.7 ± 1.2) mmol/L], and the difference was statistically significant (P ＜ 0.01 ). The serum high density lipoprotein cholesterol (HDL-C) levels of pregnant women who delivered macrosomia was ( 1.4 ± 0.3 ) mmol/L, lower than that of pregnant women who delivered normal birth weight newborn [( 1.7 ±0.9) mmol/L], and the difference was statistically significant (P＜0.01). The serum low-density lipoprotein cholesterol (LDL-C) and cholesterol level of pregnant women who delivered macrosomia respectively was ( 2.8 ± 0.8 ) and ( 5.4 ± 1.1 ) mmol/L, less than those of pregnant women who delivered normal birth weight newborn [ (3.0 ±0.9) mmol/L and (5.6 ±1.1) mmol/L], but the difference was not statistically significant (P ＞0.05). (5)The final regression model of variables into the top three were pre-pregnant BMI, body mass gain during pregnancy and maternal serum level of HDL-C, when analyzing the related factors of affecting neonatal birth body mass with multiple logistic regression analysis such as age, history of adverse pregnancy, family history of diabetes, prepregnancy BMI, body mass gain during pregnancy and after diagnosis of abnormal glucose metabolism,maternal serum level of cholesterol, abnormal glucose metabolism categories, gestational age and other factors ( P ＜ 0.01 ). Conclusion Pre-pregnant BMI, body mass gain during pregnancy and maternal serum level of HDL-C may affect the neonatal birth body mass whose mothers were complicated with abnormal glucose metabolism during pregnancy.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문