Please wait a minute...
浙江大学学报（医学版）
J Zhejiang Univ (Med Sci)  2021, Vol. 50 Issue (3): 313-319    DOI: 10.3724/zdxbyxb-2020-0013
    
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
Download: HTML( 2 )   PDF(2205KB)
Export: BibTeX | EndNote (RIS)      

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     
Received: 20 December 2020      Published: 16 August 2021
CLC:  R714.25  
Corresponding Authors: LIANG Zhaoxia     E-mail: 94510670@qq.com;xiaozaizai@zju.edu.cn
Service
E-mail this article
Add to my bookshelf
Add to citation manager
E-mail Alert
RSS
Articles by authors
CHEN Yunyan
WU Qi
ZHANG Lixia
CHEN Danqing
LIANG Zhaoxia
Cite this article:

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.

URL:

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


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

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 

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
Table 1 Comparison of general characteristics among pregnant women with different numbers of abnormal blood glucose items in OGTT

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
Table 2 Comparison of adverse pregnancy outcomes among groups with different numbers of abnormal blood glucose items in OGTT

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
Table 3 Comparison of adverse pregnancy outcomes among different gestational weight gain groups

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
Table 4 Cross-proliferation analysis of gestational weight gain and adverse pregnancy outcome among groups of different OGTT blood glucose abnormal items
[2]   METZGERB E, LOWEL P, DYERA R, et al.Hyperglycemia and adverse pregnancy outcomes[J]N Engl J Med, 2008, 358( 19): 1991-2002.
doi: 10.1056/NEJMoa0707943
[4]   LINNENKAMPU, GUARIGUATAL, BEAGLEYJ, et al.The IDF diabetes atlas methodology for estimating global prevalence of hyperglycaemia in pregnancy[J]Diabetes Res Clin Pract, 2014, 103( 2): 186-196.
doi: 10.1016/j.diabres.2013.11.004
[5]   陈海天, 李珠玉, 刘培培, 等. 广州地区妊娠期糖尿病发病情况调查及妊娠结局分析[J]. 中国慢性病预防与控制, 2017, 25(1): 38-41
CHEN Haitian, LI Zhuyu, LIU Peipei, et al. Investigation on the incidence and outcome of gestational diabetes mellitus in Guangzhou[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2017, 25(1): 38-41. (in Chinese)
[6]   陈晓璐, 彭洋颖, 徐雪清. 妊娠不同时期体质量增长与妊娠结局关系的研究[J]. 中华医学杂志, 2018, 98(19): 1493-1497
CHEN Xiaolu, PENG Yangying, XU Xueqing. Study on weight gain in different stages of pregnancy and pregnancy outcomes[J]. National Medical Journal of China, 2018, 98(19): 1493-1497. (in Chinese)
[7]   张亦奇, 兰茜, 张琚, 等. 孕期总增重与不良妊娠结局关系的前瞻性研究[J]. 中华流行病学杂志,2018, 39(12): 1626-1629
ZHANG Yiqi, LAN Qian, ZHANG Ju, et al. Association between gestational weight gain and adverse pregnancy outcomes: a prospective study[J]. Chinese Journal of Epidemiology, 2018, 39(12): 1626-1629. (in Chinese)
[8]   中华医学会妇产科学分会产科学组, 中华医学会围产医学分会妊娠合并糖尿病协作组. 妊娠合并糖尿病诊治指南 (2014)[J]. 中华围产医学杂志, 2014, 17(8): 537?545
Obstetrics Division, Obstetrics and Gynecology Branch, Chinese Medical Association, Cooperative Group of Pregnancy with Diabetes, Chinese Society of Perinatology. Guidelines for the management of gestational diabetes mellitus(2014)[J]. Chinese Journal of Perinatal Medicine, 2014, 17(8): 537?545. (in Chinese)
[9]   Institute of Medicine and National Research Council Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines[M]. Washington: National Academies Press, 2009
[10]   谢幸, 孔北华, 段涛, 等. 妇产科学[M]. 9 版. 北京: 人民卫生出版社, 2018: 83-137
XIE Xing, KONG Beihua, DUAN Tao, et al. Obstetrics and gynecology[M]. 9th ed. Beijing: People’s Medical Publishing House, 2018: 83-137. (in Chinese)
[11]   ZHU W W, YANG H X, WEI YM, et al. Evaluation of the value of fasting plasma glucose in the first prenatal visit to diagnose gestational diabetes mellitus in China[J]. Diabetes Care, 2013, 36(3): 586?590
[12]   FENGH, ZHUW W, YANGH X, et al.Relationship between oral glucose tolerance test charactedstics and adverse pregnancy outcomes among women with gestational diabetes mellitus[J]Chin Med J (Engl), 2017, 130( 9): 1012-1018.
doi: 10.4103/0366-6999.204928
[13]   ZHOUJ L, XINGJ, LIUC H, et al.Effects of abnormal 75?g oral glucose tolerance test at different time points on neonatal complications and neurobehavioral development in the pregnant women with gestational diabetes mellitus (a STROBE-compliant article)[J/OL]Medicine (Baltimore), 2018, 97( 21): e10743.
doi: 10.1097/MD.0000000000010743
[14]   高云鹤, 郑海清, 殷彩欣, 等. 妊娠期糖尿病患者糖化血红蛋白及血糖指标异常与妊娠结局的相关性[J]. 实用妇产科杂志, 2019, 35(3): 228-233
GAO Yunhe, ZHENG Haiqing, YIN Caixin, et al. The association between mid-pregnancy glucose levels and pregnancy outcome mellitus[J]. Journal of Practical Obstetrics and Gynecology, 2019, 35(3): 228-233. (in Chinese)
[15]   梁一, 李丹婷, 陈梦雪, 等. 中国西南地区妇女孕前体质量指数、孕期增重与妊娠期糖尿病关系的前瞻性队列研究[J]. 四川大学学报(医学版), 2019, 50(1): 83-87
LIANG Yi, LI Danting, CHEN Mengxue, et al. Associations of pre-pregnancy body mass index and gestationaI weight gain with gestational diabetes meIlitus: a cohort study in southwest China[J]. Journal of Sichuan University(Medical Science Edition), 2019, 50(1): 83-87. (in Chinese)
[17]   王雪影, 周莉. 妊娠期糖尿病患者孕前体重指数及孕期体重增加量与妊娠结局及产科并发症关系研究[J]. 中国实用妇科与产科杂志, 2020, 36(8): 757-761
WANG Xueying, ZHOU Li. Relationship of pre-pregnancy body mass index and gestational weight gain with obstetric complications and pregnancy outcome in patients with gestational diabetes mellitus[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2020, 36(8): 757-761. (in Chinese)
[18]   GOLDSTEINR F, ABELLS K, RANASINHAS, et al.Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis[J]JAMA, 2017, 317( 21): 2207-2225.
doi: 10.1001/jama.2017.3635
[19]   MASTELLA L S, WEINERT L S, GNIELKA V, et al. Influence of maternal weightgain birthweight: agestational diabetes cohort[J]. , 2018, 62(1): 55-63
[20]   HUY, WUQ, HANL, et al.Association between maternal gestational weight gain and preterm birth according to body mass index and maternal age in Quzhou, China[J]Sci Rep, 2020, 10( 1): 15863.
doi: 10.1038/s41598-020-72949-w
[21]   张丹丹, 谈迪心, 王斌, 等. 孕期增重与早产关联的流行病学分析[J]. 中华流行病学杂志, 2016, 37(7): 1012-1016
ZHANG Dandan, TAN Dixin, WANG Bin, et al. Association between gestational weight gain and preterm birth: a retrospective epidemiological analysis in Wuhan[J]. Chinese Journal of Epidemiology, 2016, 37(7): 1012-1016. (in Chinese)
[22]   李艳华, 陈小梅, 陈水仙, 等. 孕前体重和孕期增重对新生儿出生结局及孕产妇围产结局的影响[J]. 中华流行病学杂志, 2014, 35(6): 635-640
LI Yanhua, CHEN Xiaomei, CHEN Shuixian, et al. A cohort study on the impacts of pre-pregnancy maternal body mass index, gestational weight gain on neonate birth status and perinatal outcomes in Fujian province[J]. Chinese Journal of Epidemiology, 2014, 35(6): 635-640. (in Chinese)
[1] YANG Lindong,BAO Fang,WU Yuanzhe,SUN Lizhou. Relationship of group B streptococcus colonization in late pregnancy with perinatal outcomes[J]. J Zhejiang Univ (Med Sci), 2020, 49(3): 389-396.
[2] CHEN Xu,LI Yang,WANG Jinxi,CAI Hongliu,CAO Hongcui,SHENG Jifang. Pregnant women complicated with COVID-19: a clinical analysis of 3 cases[J]. J Zhejiang Univ (Med Sci), 2020, 49(2): 240-244.
[3] LIN Xiaoxiao,SUN Daifei,FU Jun,ZHONG Huizhen. Outcome of re-pregnancy in women with uterine artery embolization for postpartum hemorrhage[J]. J Zhejiang Univ (Med Sci), 2019, 48(5): 540-545.
[4] MEI Jin,LIU Jiao,WANG Min,ZHANG Wen,WANG Hao,LU Sha,HE Chaying,JIN Chunlei. Prenatal diagnosis and pregnancy outcomes of 22q11.2 duplication syndrome: analysis of 8 cases[J]. J Zhejiang Univ (Med Sci), 2019, 48(4): 429-433.
[5] SUN Ting,XU Mingjuan. Body weight and gestational outcomes in women with high normotension during pregnancy[J]. J Zhejiang Univ (Med Sci), 2019, 48(2): 174-179.
[6] LI Enshu, YE Xiaoqun, FANG Li, YE Yinghui. Effect of oxygen concentration on outcome of in-vitro fertilization-embryo transfer[J]. J Zhejiang Univ (Med Sci), 2017, 46(3): 290-294.
[7] SHI Biwei, CUI Long, YE Xiaoqun, YE Yinghui. Effects of embryo cryopreservation and thawing on clinical outcomes of transplantable embryos after cleavage-stage preimplantation genetic diagnosis or screening[J]. J Zhejiang Univ (Med Sci), 2017, 46(3): 295-299.
[8] ZHANG Jian-zhen, HE Jing. Risk factors of recurrent preeclampsia and its relation to maternal and offspring outcome[J]. J Zhejiang Univ (Med Sci), 2015, 44(3): 258-263.
[9] SHEN Qin-qin, ZHANG Tan. Research advances on prenatal maternal serum markers for screening adverse pregnancy outcomes[J]. J Zhejiang Univ (Med Sci), 2015, 44(3): 339-343.
[10] LI Miao, ZHU Yi-Min . Impact of hepatitis B virus on sperm parameters and outcome of assisted reproductive technology[J]. J Zhejiang Univ (Med Sci), 2013, 42(2): 237-241.