Diabetes Care：孕妇超重且高血糖可增加新生儿患病风险

一般来说，血糖适度升高的过重孕妇绝对不会给她们的治疗医生敲响健康的警钟，但是对于过度肥胖或者有妊娠糖尿病的妇女来说，对于自身或者婴儿都会引起一系列的健康风险。但是近日的一项研究显示，刚刚超过体重和血糖标准的妇女却有不良的妊娠风险，事实上，这组妇女比肥胖但血糖正常的妇女或者仅仅有糖尿病的妇女存在更高的风险。

研究者表示，我们必须将过重和血糖结合起来一起考虑，研究中，既肥胖又患糖尿病的妇女比例为6%，仅仅肥胖的妇女占到了16%，而仅仅患糖尿病的占到了13.7%。这项研究同样证实了患有两项疾病的妇女相比只有一种疾病的妇女来说，不良妊娠风险更高。相关研究刊登在了近日的杂志Diabetes Care上，这项研究包含了来自九个国家的23316名妇女。肥胖而且患糖尿病的孕妇容易产出较大号的婴儿，这种婴儿会存在脂肪积累，在分娩的过程中容易增加受伤的风险，而且容易增加剖腹产生产的可能性。而且研究显示，这种孕妇生出的婴儿体重在340克左右；过重并且伴有血糖水平升高的孕妇，生出孩子的体重为214克；正常体重但是伴有妊娠糖尿病的孕妇生出的孩子为164克；肥胖但是血糖水平正常的孕妇生出的孩子为174克。

孕妇高的血糖水平和体重会导致新生儿胰岛素水平升高以及血糖水平降低，这种影响有可能在孩子早期阶段引发肥胖和糖尿病。研究者Metzger表示，在孕妇怀孕期间，必须注意营养的均衡以及饮食的健康，这样才能使后代的发病几率降低。

（生物谷：T.Shen编译）

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doi:10.2337/dc11-1790
PMC:
PMID:

The Hyperglycemia and Adverse Pregnancy Outcome Study Associations of GDM and obesity with pregnancy outcomes

Patrick M. Catalano, MD1, H. David McIntyre, MD2, J. Kennedy Cruickshank, MD3, David R. McCance, MD4, Alan R. Dyer, PHD5, Boyd E. Metzger, MD6⇓, Lynn P. Lowe, PHD5, Elisabeth R. Trimble, MD7, Donald R. Coustan, MD8, David R. Hadden, MD4, Bengt Persson, MD, PHD9, Moshe Hod, MD10, Jeremy J.N. Oats, MD11 and for the HAPO Study Cooperative Research Group

OBJECTIVE To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study.

RESEARCH DESIGN AND METHODS Participants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide >90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes.

RESULTS Mean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m2), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight >90th percentile for GDM alone was 2.19 (1.93–2.47), for obesity alone 1.73 (1.50–2.00), and for both GDM and obesity 3.62 (3.04–4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat >90th percentiles were similar. Odds for birth weight >90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women).

CONCLUSIONS Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.