正常孕妇妊娠期增重和糖脂代谢与巨大儿发生风险的关系

doi:10.12280/gjfckx.20230346

摘要/Abstract

摘要：

目的： 分析妊娠期体质量和糖脂水平在分娩巨大儿的无妊娠合并症/并发症、非肥胖、非高龄的正常孕妇中的变化特点，探讨其对巨大儿发生风险的影响。方法： 选取2020年9—12月在上海交通大学医学院附属国际和平妇幼保健院定期产检的正常孕妇，根据是否分娩巨大儿分为巨大儿组（104例）和对照组（258例），比较2组基本情况和妊娠期糖脂水平，并采用Logistic回归分析正常孕妇分娩巨大儿的影响因素。结果： 相较于正常对照组，巨大儿组妊娠期空腹血糖、妊娠早晚期三酰甘油（triglyceride，TG）水平更高，妊娠早晚期高密度脂蛋白（high density lipoprotein，HDL）水平更低，且巨大儿组妊娠期TG变化差值更大、HDL变化差值更小（均P<0.05）。与妊娠期增重适宜的正常孕妇相比，增重过多的正常孕妇分娩巨大儿的风险升高142%（OR=2.42，95%CI：1.34~4.39），增重不足的正常孕妇分娩巨大儿的风险降低73%（OR=0.27，95%CI：0.10~0.77）；妊娠晚期HDL每升高1 mmol/L，分娩巨大儿风险下降79%（OR=0.21，95%CI：0.08~0.57）。结论： 正常孕妇群体仍需严格控制妊娠期体质量以降低巨大儿的发生风险，并且仍需关注血脂代谢，其中妊娠晚期HDL的水平及变化情况或可辅助筛查隐匿性巨大儿。

关键词: 巨大胎儿, 妊娠, 血糖, 脂类, 孕期体重增长

Abstract:

Objective: To analyze the pregnancy weight gain and glycolipid levels during pregnancy in normal pregnant women who delivered macrosomia without pregnancy complications, obesity, and advanced age, and explore their influence on the risk of macrosomia. Methods: Normal pregnant women who underwent regular prenatal examination were selected as the research object in the International Peace Maternal and Child Health Hospital from September 2020 to December 2020, and divided into macrosomia group (104 cases) and normal control group (258 cases) according to neonatal weight. The difference of basic situation and the levels of glucose and lipid metabolism were compared, and Logistic regression models were adopted to explore the risk factors of macrosomia in normal pregnant women. Results: Compared with the normal control group, the macrosomia group had higher levels of fasting blood glucose, triglyceride (TG) and lower levels of high density lipoprotein (HDL) at all stages of pregnancy (P<0.05), there are lager difference of TG level and smaller difference of HDL level in macrosomia group (both P<0.05). Compared with those who gained proper weight during pregnancy, those who gained too much weight had 142% increased risk of delivery of macrosomia (OR=2.42, 95%CI: 1.34-4.39) and those who had adequate weight gain had 73% decreased risk of delivery of macrosomia (OR=0.27, 95%CI: 0.10-0.77). For every 1 mmol/L increase in HDL in late pregnancy, the risk of delivery of macrosomia decreased by 79% (OR=0.21, 95%CI: 0.08-0.57). Conclusions: Normal pregnant women should control their weight gain strictly during pregnancy to reduce the risk of macrosomia, and lipid metabolism needs to be paid attention to, in which the level and change of HDL in late pregnancy may assist in the screening of cryptogenic macrosomia.

Key words: Fetal macrosomia, Pregnancy, Blood glucose, Lipids, Gestational weight gain

高婧, 秦飞, 陈超, 熊姚西, 程蔚蔚. 正常孕妇妊娠期增重和糖脂代谢与巨大儿发生风险的关系[J]. 国际妇产科学杂志, 2024, 51(2): 176-180.

GAO Jing, QIN Fei, CHEN Chao, XIONG Yao-xi, CHENG Wei-wei. Analysis of Macrosomia Risk between Pregnancy Weight Gain and Glycolipid Metabolism among Normal Pregnant Women[J]. Journal of International Obstetrics and Gynecology, 2024, 51(2): 176-180.

图/表 5

参考文献 21

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组别	n	年龄（岁）		妊娠前BMI （kg/m²）			妊娠期增重（kg）		分娩孕周（周）			新生儿出生体质量（g）		男胎			FPG（mmol/L）
组别	n	年龄（岁）		妊娠前BMI （kg/m²）			妊娠期增重（kg）		分娩孕周（周）			新生儿出生体质量（g）		男胎			妊娠早期	妊娠中期		妊娠晚期
巨大儿组	104	29.7±2.9		21.4±2.1			17.1±4.2		39.8±0.8			4 171.4±175.9		75（72.1）			4.7±0.4	4.2±0.4		4.5±0.5
对照组	258	29.4±2.6		20.6±1.6			14.2±4.4		39.4±1.0			3 236.7±307.2		114（44.2）			4.6±0.4	4.0±0.3		4.4±0.5
t或χ²或H		1.049		4.107			5.722		3.946			29.149		23.173			2.173	5.033		2.285
P		0.294		<0.001			<0.001		<0.001			<0.001		<0.001			0.031	<0.001		0.023
组别	妊娠早期血脂（mmol/L）							妊娠晚期血脂（mmol/L）							妊娠期血脂变化（mmol/L）
组别	TC		TG		HDL	LDL		TC		TG	HDL		LDL		△TC	△TG			△HDL		△LDL
巨大儿组	4.4±0.6		1.4±0.7		1.8±0.4	2.3±0.6		6.3±1.1		3.1±1.3	1.9±0.4		3.7±1.1		1.8±0.9	1.6（1.1，2.2）			0.1±0.3		1.4±1.0
对照组	4.4±0.8		1.2±0.5		2.0±0.3	2.3±0.6		6.5±1.0		2.7±0.9	2.2±0.4		3.7±1.0		2.0±0.8	1.4（0.9，1.8）			0.2±0.3		1.5±0.7
t或χ²或H	0.100		2.447		3.652	0.728		1.520		3.276	5.857		0.316		2.409	7.713			3.256		0.985
P	0.906		0.015		<0.001	0.469		0.130		0.001	<0.001		0.757		0.064	0.006			0.001		0.326

组别	n	年龄（岁）		妊娠前BMI （kg/m²）			妊娠期增重（kg）		分娩孕周（周）			新生儿出生体质量（g）		男胎			FPG（mmol/L）
组别	n	年龄（岁）		妊娠前BMI （kg/m²）			妊娠期增重（kg）		分娩孕周（周）			新生儿出生体质量（g）		男胎			妊娠早期	妊娠中期		妊娠晚期
巨大儿组	104	29.7±2.9		21.4±2.1			17.1±4.2		39.8±0.8			4 171.4±175.9		75（72.1）			4.7±0.4	4.2±0.4		4.5±0.5
对照组	258	29.4±2.6		20.6±1.6			14.2±4.4		39.4±1.0			3 236.7±307.2		114（44.2）			4.6±0.4	4.0±0.3		4.4±0.5
t或χ²或H		1.049		4.107			5.722		3.946			29.149		23.173			2.173	5.033		2.285
P		0.294		<0.001			<0.001		<0.001			<0.001		<0.001			0.031	<0.001		0.023
组别	妊娠早期血脂（mmol/L）							妊娠晚期血脂（mmol/L）							妊娠期血脂变化（mmol/L）
组别	TC		TG		HDL	LDL		TC		TG	HDL		LDL		△TC	△TG			△HDL		△LDL
巨大儿组	4.4±0.6		1.4±0.7		1.8±0.4	2.3±0.6		6.3±1.1		3.1±1.3	1.9±0.4		3.7±1.1		1.8±0.9	1.6（1.1，2.2）			0.1±0.3		1.4±1.0
对照组	4.4±0.8		1.2±0.5		2.0±0.3	2.3±0.6		6.5±1.0		2.7±0.9	2.2±0.4		3.7±1.0		2.0±0.8	1.4（0.9，1.8）			0.2±0.3		1.5±0.7
t或χ²或H	0.100		2.447		3.652	0.728		1.520		3.276	5.857		0.316		2.409	7.713			3.256		0.985
P	0.906		0.015		<0.001	0.469		0.130		0.001	<0.001		0.757		0.064	0.006			0.001		0.326

组别	n	FPG（mmol/L）			妊娠早期血脂（mmol/L）				妊娠晚期血脂（mmol/L）				妊娠期血脂变化（mmol/L）
组别	n	妊娠早期	妊娠中期	妊娠晚期	TC	TG	HDL	LDL	TC	TG	HDL	LDL	△TC	△TG	△HDL	△LDL
巨大儿组	8	4.7±0.3	4.4±0.4	4.4±0.4	4.7±0.7	1.5±0.7	1.9±0.3	2.5±0.5	6.6±1.0	3.2±1.1	2.0±0.4	3.9±0.6	1.8±0.6	1.7±0.7	0.0±0.1	1.3±0.6
对照组	59	4.7±0.4	3.9±0.4	4.3±0.4	4.5±0.6	1.2±0.4	2.0±0.3	2.3±0.5	6.6±1.0	2.6±0.8	2.2±0.4	3.8±1.0	2.1±0.8	1.3±0.6	0.3±0.3	1.5±0.7
t		0.245	2.893	0.663	0.819	1.418	0.707	0.883	0.010	1.718	1.814	0.120	0.794	1.709	2.254	0.600
P		0.807	0.015	0.512	0.416	0.161	0.484	0.382	0.992	0.091	0.075	0.905	0.430	0.093	0.028	0.552

组别	n	FPG（mmol/L）			妊娠早期血脂（mmol/L）				妊娠晚期血脂（mmol/L）				妊娠期血脂变化（mmol/L）
组别	n	妊娠早期	妊娠中期	妊娠晚期	TC	TG	HDL	LDL	TC	TG	HDL	LDL	△TC	△TG	△HDL	△LDL
巨大儿组	8	4.7±0.3	4.4±0.4	4.4±0.4	4.7±0.7	1.5±0.7	1.9±0.3	2.5±0.5	6.6±1.0	3.2±1.1	2.0±0.4	3.9±0.6	1.8±0.6	1.7±0.7	0.0±0.1	1.3±0.6
对照组	59	4.7±0.4	3.9±0.4	4.3±0.4	4.5±0.6	1.2±0.4	2.0±0.3	2.3±0.5	6.6±1.0	2.6±0.8	2.2±0.4	3.8±1.0	2.1±0.8	1.3±0.6	0.3±0.3	1.5±0.7
t		0.245	2.893	0.663	0.819	1.418	0.707	0.883	0.010	1.718	1.814	0.120	0.794	1.709	2.254	0.600
P		0.807	0.015	0.512	0.416	0.161	0.484	0.382	0.992	0.091	0.075	0.905	0.430	0.093	0.028	0.552

组别	n	FPG（mmol/L）			妊娠早期血脂（mmol/L）				妊娠晚期血脂（mmol/L）				妊娠期血脂变化（mmol/L）
组别	n	妊娠早期	妊娠中期	妊娠晚期	TC	TG	HDL	LDL	TC	TG	HDL	LDL	△TC	△TG	△HDL	△LDL
巨大儿组	36	4.7±0.5	4.1±0.4	4.4±0.7	4.6±0.7	1.4±0.6	1.9±0.4	2.5±0.6	6.5±1.2	2.9±0.8	2.0±0.4	3.9±1.0	1.9±0.9	1.5（1.2，2.1）	0.1±0.3	1.5±0.9
对照组	117	4.6±0.3	4.0±0.3	4.4±0.4	4.4±0.8	1.2±0.5	2.0±0.4	2.3±0.6	6.5±1.0	2.7±1.0	2.2±0.4	3.8±1.0	2.0±0.7	1.3（0.9，1.8）	0.2±0.3	1.5±0.7
t或H		1.523	2.076	0.624	1.054	1.175	1.947	1.497	0.060	1.095	2.914	0.632	0.995	1.856	1.187	0.436
P		0.130	0.061	0.531	0.294	0.242	0.054	0.137	0.952	0.276	0.004	0.527	0.320	0.609	0.238	0.664