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目的 探讨妊娠期糖尿病(gestational diabetes mellitus, GDM)孕妇不同时间点糖代谢异常及孕期增重与新生儿不良结局的关联。方法 回顾性分析医院定期产前检查并分娩的1 359例妊娠期糖尿病孕妇资料。根据口服葡萄糖耐量试验(oral glucose tolerance test, OGTT)血糖异常时间点分为空腹血糖异常组(A组)、服糖后血糖异常组(B组)、两者均异常组(C组)。分析各组的不良妊娠结局及OGTT不同时间点糖代谢异常、孕期增重与新生儿不良结局的交互作用。结果 C组发生早产儿、大于胎龄儿(large for gestational age infant, LGA)风险高于A组和B组(均P<0.05);Logistic回归分析与叉生分析显示：A组仅孕期增重不足是LGA的保护因素(OR=0.69,95%CI:0.31～1.53);B组中，孕期增重不足是LGA的保护因素(OR=0.45,95%CI:0.32～0.62),是小于胎龄儿(small for gestational age infant, SGA)及转新生儿重症监护室(neonatal intensive care unit, NICU)的危险因素(OR=1.94,95%CI:1.17～3.19;OR=2.29,95%CI:1.24～4.22);增重过多是早产儿、SGA及转NICU发生的危险因素(OR=1.82,95%CI:1.28～2.58;OR=1.42,95%CI:1.10～1.84;OR=2.36,95%CI:1.33～4.20)。C组中，孕期增重过多是早产儿、新生儿窒息发生的危险因素(OR=1.71,95%CI:0.94～3.09;OR=1.85,95%CI:1.05～3.28)。结论 对于不同血糖代谢异常的GDM孕妇，需要为其孕期增重提供不同的建议，尤其在服糖后血糖异常的GDM孕妇中，孕期增重与新生儿不良结局的相关性更密切，更需要重视孕期体重管理。
Abstract：Objective To investigate the association between abnormal glucose metabolism at different time points during pregnancy, pregnancy weight gain, and adverse neonatal outcomes in pregnant women with gestational diabetes mellitus(GDM). Methods A retrospective analysis was conducted on data from 1 359 pregnant women with GDM who received regular prenatal check-ups and delivered at the hospital. Based on the timing of abnormal blood glucose levels during the oral glucose tolerance test(OGTT), participants were divided into three groups: fasting blood glucose abnormal group(Group A), post-glucose administration blood glucose abnormal group(Group B), and both abnormal groups(Group C). The study analyzed the adverse pregnancy outcomes and the interaction between abnormal glucose metabolism at different time points during OGTT, pregnancy weight gain, and adverse neonatal outcomes.Results The risks of preterm birth and large for gestational age(LGA) infants were significantly higher in Group C compared with Groups A and B(both P<0.05). Logistic regression and interaction analyses showed that in Group A, insufficient GWG was a protective factor against LGA(OR=0.69,95% CI: 0.31-1.53). In Group B, insufficient GWG was also a protective factor for LGA(OR=0.45,95% CI: 0.32-0.62), but it was a risk factor for small for gestational age(SGA) infants and neonatal intensive care unit(NICU) admission(OR=1.94,95% CI: 1.17-3.19; OR=2.29,95% CI: 1.24-4.22). Excessive GWG was associated with increased risks of preterm birth, SGA, and NICU admission in Group B(OR=1.82,95% CI: 1.28-2.58; OR=1.42,95% CI: 1.10-1.84; OR=2.36,95% CI: 1.33-4.20). In Group C, excessive GWG was a risk factor for preterm birth and neonatal asphyxia(OR=1.71,95% CI: 0.94-3.09; OR=1.85,95% CI: 1.05-3.28). Conclusions For GDM pregnant women with different patterns of abnormal glucose metabolism, individualized recommendations for pregnancy weight gain should be provided. Particularly for those with abnormal post-glucose administration blood glucose levels, the correlation between pregnancy weight gain and adverse neonatal outcomes is closer, necessitating more attention to weight management during pregnancy.
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基本信息:
DOI：10.19890/j.cnki.issn1674-6449.2025.04.019
中图分类号:R714.256
引用信息:
[1]陈云燕,胡丽红,杨燕婷.妊娠期糖尿病孕妇糖代谢异常与体重增长对新生儿结局的影响[J].健康研究,2025,45(04):471-475.DOI:10.19890/j.cnki.issn1674-6449.2025.04.019.
基金信息:
湖州市公益性应用研究项目(2023GY41)
2025-08-15
2025-08-15