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浙江大学学报（医学版）
浙江大学学报（医学版）  2021, Vol. 50 Issue (3): 313-319    DOI: 10.3724/zdxbyxb-2020-0013
专题报道     
妊娠糖尿病孕妇孕中期口服葡萄糖耐量试验异常项数及孕期增重与不良妊娠结局的关系
陈云燕1,2(),吴琪1,张丽霞1,陈丹青1,梁朝霞1,*()
1.浙江大学医学院附属妇产科医院产科，浙江 杭州 310006
2.浙江省湖州市妇幼保健院产科，浙江 湖州 313000
Relationship of abnormal mid-term oral glucose tolerance test and maternal weight gain with adverse pregnancy outcomes in women with gestational diabetes mellitus
CHEN Yunyan1,2(),WU Qi1,ZHANG Lixia1,CHEN Danqing1,LIANG Zhaoxia1,*()
1. Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China;
2. Department of Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
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摘要：

目的：探讨妊娠糖尿病（GDM）患者孕中期75g口服葡萄糖耐量试验（OGTT）血糖指标异常项数及孕期增重对妊娠结局的影响。方法：纳入2017年7月1日至2018年6月30日在浙江大学医学院附属妇产科医院定期进行产前检查并分娩的2611例GDM孕妇，根据孕中期OGTT血糖异常项数和孕期体重增长情况进行分组，分析各组的不良妊娠结局及其交互作用。结果：OGTT血糖三项均异常的孕妇妊娠期高血压疾病、早产、巨大胎儿和大于胎龄儿（LGA）的发生率高于一项和二项指标异常的孕妇（均P<0.017）；血糖二项指标异常的孕妇妊娠期高血压疾病和早产发生率也高于一项指标异常的孕妇（均P<0.017）。孕期增重过多孕妇妊娠期高血压疾病、巨大胎儿发生率高于增重不足和增重适宜孕妇，LGA发生率高于增重不足孕妇（均P<0.017）；增重适宜孕妇早产和低体重儿发生率低于增重不足和增重过多孕妇，小于胎龄儿（SGA）发生率低于增重不足孕妇（均P<0.017）。在OGTT血糖一项指标异常的孕妇中，孕期增重不足是发生早产、SGA的危险因素（aOR=1.66，95%CI：1.10～2.52；aOR=2.20，95%CI：1.07～4.53），是LGA的保护因素（aOR=0.40，95%CI：0.27～0.50）；孕期增重过多则是妊娠期高血压疾病、早产、低体重儿的危险因素（aOR=2.15，95%CI：1.35～3.41；aOR=1.80，95%CI：1.20～2.72；aOR=2.18，95%CI：1.10～4.30）。在OGTT血糖二项指标异常的孕妇中，孕期增重不足是巨大胎儿和LGA的保护因素（aOR=0.24，95%CI：0.09～0.67；aOR=0.54，95%CI：0.34～0.86），孕期增重过多则是早产的危险因素（aOR=1.98，95%CI：1.23~3.18）。而在OGTT血糖三项指标异常的孕妇中，孕期增重与不良妊娠结局的发生无明显关联。结论：在GDM孕期管理中，对于OGTT一项或两项血糖升高者，孕期体重合理管理可降低部分不良妊娠结局的发生风险；三项血糖均升高者，除了孕期体重管理，需更严格的血糖监测并进行药物降糖等积极干预措施。
关键词： 妊娠糖尿病;  口服葡萄糖耐量试验;  孕期增重;  妊娠结局;  健康管理    
Abstract:

Objective: To explore the correlation of mid-term oral glucose tolerance test (OGTT) and maternal weight gain with adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM). Methods: A total of 2611 pregnant women with GDM who were examined and delivered in Women’s Hospital, Zhejiang University School of Medicine from July 1st 2017 to 30th June 2018 were enrolled in this study. According to the number of abnormal items of mid-term OGTT results or maternal gestational weight gain (GWG), patients were classified. The incidence of adverse perinatal outcomes in each group and its relation with OGTT results and GWG were analyzed. Results: The incidence of gestational hypertension, premature delivery, macrosomia and large for gestational age infant (LGA) in three abnormal items GDM patients were significantly higher than those in one or two abnormal items GDM patients (all P<0.017). The incidence of gestational hypertension and premature delivery in two abnormal items GDM patients were higher than those in one abnormal item GDM patients (allP<0.017). The incidence of gestational hypertension and macrosomia in excessive GWG patients were significantly higher than those in inadequate and appropriate GWG patients (allP<0.017), and the incidence of LGA were higher than that in inadequate GWG patients (allP<0.017). The incidence of premature delivery and low birth weight infants in appropriate GWG patients were significantly lower than those in inadequate and excessive GWG patients, and the incidence of small for gestational age infant (SGA) were significantly lower than that in inadequate GWG patients (allP<0.017). In one abnormal item GDM patients, inadequate GWG was a risk factor for premature delivery and SGA (aOR=1.66, 95%CI: 1.10–2.52; aOR=2.20, 95%CI: 1.07–4.53), and protective factor for LGA (aOR=0.40, 95%CI: 0.27–0.59). And excessive GWG was a risk factor for gestational hypertension, premature delivery and low birth weight infants (aOR=2.15, 95%CI: 1.35–3.41; aOR=1.80, 95%CI: 1.20–2.72; aOR=2.18, 95%CI: 1.10–4.30).In two abnormal items GDM patients, inadequate GWG was a protective factor for macrosomia and LGA (aOR=0.24, 95%CI: 0.09–0.67; aOR=0.54, 95%CI: 0.34–0.86), while excessive GWG was risk factor for premature delivery (aOR=1.98, 95%CI: 1.23–3.18).In three abnormal items GDM patients, there was no significant relationship between GWG and adverse pregnancy outcomes. Conclusion: For GDM women with one or two items of elevated blood glucose in OGTT, reasonable weight management during pregnancy can reduce the occurrence of adverse pregnancy outcomes. For those with three items of elevated blood glucose in OGTT, more strict blood glucose monitoring and active intervention measures should be taken in addition to weight management during pregnancy.
Key words: Gestational diabetes mellitus    Oral glucose tolerance test    Gestational weight gain    Pregnancy outcome    Health management
收稿日期: 2020-12-20 出版日期: 2021-08-16
CLC:  R714.25  
基金资助: 国家自然科学基金 （81974234）；浙江省重点研发计划 （2018C03010）
通讯作者: 梁朝霞     E-mail: 94510670@qq.com;xiaozaizai@zju.edu.cn
作者简介: 陈云燕，副主任医师，主要从事产科学研究；E-mail：94510670@qq.com；https：//orcid.org/0000-0003-4917-8566
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引用本文:

陈云燕,吴琪,张丽霞,陈丹青,梁朝霞. 妊娠糖尿病孕妇孕中期口服葡萄糖耐量试验异常项数及孕期增重与不良妊娠结局的关系[J]. 浙江大学学报（医学版）, 2021, 50(3): 313-319.

CHEN Yunyan,WU Qi,ZHANG Lixia,CHEN Danqing,LIANG Zhaoxia. Relationship of abnormal mid-term oral glucose tolerance test and maternal weight gain with adverse pregnancy outcomes in women with gestational diabetes mellitus. J Zhejiang Univ (Med Sci), 2021, 50(3): 313-319.

链接本文:

http://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2020-0013    或    http://www.zjujournals.com/med/CN/Y2021/V50/I3/313

异常项数

n

年龄（岁）

孕次（次）

产次

孕前?BMI（kg/m2）

孕前?BMI

初产妇

经产妇

体重过轻

体重正常

体重超重

肥胖

一项

1509

32.1±4.4??

2.3±1.3?

749（49.6）????

760（50.4）???

21.7±3.0???

183（12.1）

1141（75.6）??

167（11.1）????

18（1.2）???

二项

872

32.8±4.7* ?

2.4±1.3?

423（48.5）????

449（51.5）???

21.8±3.1???

111（12.7）

645（74.0）

106（12.2）????

10（1.2）???

三项

230

34.2±4.6*#

2.5±1.3*

?94（40.9）*#

136（59.1）*#

23.7±3.7*#

??15（6.5）*#

???140（60.9）*#

60（26.1）*#

15（6.5）*#

P值

—

<0.01

0.05

<0.05

<0.01

<0.01

异常项数

n

孕周

新生儿体重（g）

孕期增重（kg）

孕期增重

血糖水平（mmol/L）

不足

适宜

过多

空腹

OGTT?1?h

OGTT?2?h

一项

1509

38.3±1.8??

3260±523??

12.6±4.1

677（44.9）

567（37.6）???

265 （17.6）

4.6±0.5

9.4±1.2

8.3±1.1

二项

872

38.1±1.9* ?

3236±547??

12.2±4.1

371（42.6）

362（41.5）???

139 （15.9）

4.7±0.5* ?

10.8±1.0*

9.4±1.1*

三项

230

37.7±1.8*#

3348±615*#

12.2±3.7

104（45.2）

68（29.6）#

58（25.2）*#

5.7±0.7*#

11.9±1.4*#

10.5±1.6*#

P值

—

<0.01

<0.05

>0.05

<0.01

<0.01

<0.01

<0.01
表 1  不同OGTT 异常项数孕妇一般特征比较

异常项数

n

妊娠期高血压疾病

早产

巨大胎儿

低体重儿

大于胎龄儿

小于胎龄儿

一项

1509

103 （6.82）

158 （10.47）

85 （5.63）

103 （6.82）

323 （21.40）

58 （3.84）

二项

872

89 （10.20）*

120 （13.76）*

59 （6.77）

69 （7.91）

194 （22.25）

38 （4.36）

三项

230

41 （17.83）*#

45 （19.57）*#

30 （13.04）*#

20 （8.70）

78 （33.91）*#

6 （2.61）

P值

—

<0.01

<0.01

<0.01

>0.05

<0.01

>0.05
表 2  不同口服葡萄糖耐量试验异常项数孕妇不良妊娠结局比较

孕期增重

n

妊娠期高血压疾病

早产

巨大胎儿

低体重儿

大于胎龄儿

小于胎龄儿

不足

997

59 （5.92）

156 （15.65）

37 （3.71）

99 （9.93）

193 （19.36）

55 （5.52）

适宜

1152

92 （7.99）

105 （9.11）*

71 （6.16）*

61 （5.30）*

233 （20.23）

30 （2.60）*

过多

462

82 （17.75）*#

62 （13.42）#

66 （14.29）*#

32（6.93）#

169 （36.58）*#

17 （3.68）

P值

—

<0.01

<0.01

<0.01

<0.01

<0.01

<0.01
表 3  孕期不同程度增重孕妇不良妊娠结局比较

变量

n

妊娠期高血压疾病

早产

巨大胎儿

低体重儿

大于胎龄儿

小于胎龄儿

aOR

95% CI

aOR

95% CI

aOR

95% CI

aOR

95% CI

aOR

95% CI

aOR

95% CI

一项异常

?

增重不足

567

0.66

0.33~1.32

1.66

1.10~2.52*

0.88

0.51~1.53

2.20

1.07~4.53*

0.40

0.27~0.59*

1.88

1.03~3.43

增重适宜

677

1.00

—

1.00

—

1.00

—

1.00

—

1.00

—

1.00

—

增重过多

265

2.15

1.35~3.41*

1.80

1.20~2.72*

1.47

0.83~2.59

2.18

1.10~4.30*

1.12

0.83~1.51

0.63

0.23~1.75

二项异常

?

增重不足

362

0.55

0.28~1.07

0.89

0.51~1.54

0.24

0.09~0.67*

2.41

0.95~6.10

0.54

0.34~0.86*

1.95

0.93~4.09

增重适宜

371

1.00

—

1.00

—

1.00

—

1.00

—

1.00

—

1.00

—

增重过多

139

1.52

0.88~2.62

1.98

1.23~3.18*

1.94

0.98~3.82

1.72

0.72~4.11

1.36

0.91~2.05

1.06

0.41~2.72

三项异常

?

增重不足

68

0.84

0.31~2.28

1.01

0.39~2.61

0.29

0.64~1.32

0.85

0.22~3.30

0.74

0.34~1.61

1.62

0.16~42.83

增重适宜

104

1.00

—

1.00

—

1.00

—

1.00

—

1.00

—

1.00

—

增重过多

58

1.49

0.71~3.12

1.85

0.90~3.78

1.11

0.49~2.51

1.33

0.49~3.63

1.21

0.61~2.06

6.11

0.67~55.78
表 4  口服葡萄糖血糖试验异常项数及孕期增重与不良妊娠结局叉生分析结果
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