The Study Of The Correlation Between Prepregnancy BMI、Gestational Weight Gain And Gestational Metabolic Syndrome

Metabolic syndrome (MS) is a cluster of multiple metabolic diseases withcommon pathological and physiological basis of central obesity, diabetes or impairedglucose regulation, hypertension, dyslipidemia and insulin resistance. In recent yearsthe incidences of gestational diabetes mellitus (GDM) and hypertensive disordercomplicating pregnancy (HDCP) have been rising. As more and more researcheresindicating that: GDM and HDCP patients are all in the state of varing degree oflipid metabolic disorder and insulin resistance and have common high riskfactor-obesity, there are certain correlation in the pathogenesis of them and their risksof long-term cardiovascular disease and type2diabetes mellitus are significantlyincreased, some scholars have put forward a new opinion that referring to GDM andHDCP as gestational metabolic diseases collectively and some severe cases may evenprogress to GMS. Then gestational metabolic syndrome (GMS) is the cluster ofprepregnancy overweight or obesity, abnormal glucose metabolism, hypertension,dyslipidemia during pregnancy.The particularity of GMS is that the pregnant women are in the state of a certainderee of IR and hyperlipidemia as the special pregnancy hormone circumstance andphysiological characteristics to meet the needs of the fetal growth and development,which is also called physiological metabolic syndrome by some people. Therefore the guideline for the prevention of cardiovascular disease in women published byAmerica Heart Assoiciation (AHA) in2011pointed out that pregnancy as a stress testoffers a unique opportunity to assess female lifetime risk of cardiovascular andmetabolic diseases. So GMS should be endowed with special diagnostic criteria forthe special metabolic environment. Some MS diagnostic criterias are adjustedaccording to the pregnancy metabolic environment to be used as GMS diagnosticcriterias. But whether MS or GMS all can raise the risk rate of long-termcardiovascular and type2diabetes mellitus. So diagnosing GMS timely is veryimportant for making timely therapy and intervention measures to improve thepregnancy outcomes and to reduce the incidence of long-term adverse outcomes.The studies on risk factors of metabolic syndrome showed that obesity is theinitial factor of it; Body mass index as one of indicators of obesity has positivelycorrelation with TG, LDL, TC, VLDL levels respectively.In addition, obesity mayinduce IR through adipocytokines such as Aiponectin, Leptin, Resistin etc, which asthe core link thus induce the happening of glucose intolerance, hypertension anddyslipidemia.In view of the above findings: pregnancy and obesity all can induce a certaindegree of IR and dislipidemia. Then if the two factors coincided-obesity womengetting pregnancy or excessive intake of nutrition during pregnancy leading topregnancy obesity, the degree of insulin resistance and dyslipidemia would beaggravated and then develop to pathological glucolipid metabolic disorders whichfurther cause vascular endothelial injury and low-grade inflammatory and oxidativestress state etc to induce the occurring of GDM and HDCP, and the aggregateion ofthese risk factors is likely to become gestational metabolic syndrome.ObjectiveThrough analyzing the correlation between prepregnancy BMI/gestationalweight gain and the incidences of the metabolic syndrome compositions(hypertension, hyperlipidemia and hyperglycemia) in late pregnancy to furtherexplore the affects of prepregnancy obesity and maternal overnutrition on the incidence of GMS, which can provide theoretical basis for the prevention andtreatment of GMS.Methods1Study ObjectThe280singletons33-36weeks pregnant women who have came to the thirdaffiliated hospital of zhengzhou university for therapy or perinatal care from Januaryto December2013were object, of which61cases with GDM (group A),79caseswith HDCP (group B),33patients with GDM and HDCP (group C) are theexperimental groups and the107cases (group D) normal pregnant women withfamiliar gestation week for perinatal care at the same time is the control group. Therewere98cases of obese or overweight with pre-pregnancy BMI≥24kg/m2and102cases of non obese and overweight with pre-pregnancy BMI＜24kg/m2of them.2Diagnostic Criteria2.1GDM:(1) Fasting plasma glucose (FPG) dedected for the first time≥5.1mmol/L, but＜7mmol/L as the diagnosis of GDM;(2)FPG≥4.4mmol/L, but＜5.1mmol/L, then make oral glucose tolerance test (OGTT) in24-28weeks of pregnancy: FPG≥5.1mmol/L,1h≥10.0mmol/L,2h≥8.5mmol/L. More than one reached orexceeded the criteria as diagnosis of GDM.2.2HDCP: Include gestational hypertension, preeclampsia (PE), eclampsia,preeclampsia superposed opon chronic hypertension,chronic hypertensioncimplicating pregnancy and the specific diagnostic criteria of them according toObstetrics and Gynecology which was the seventh edition (People’s MedicalPublishing House).2.3GMS:(1) Prepregnancy overweight and (or) obesity, BMI＞25kg/m2;(2)Hyperglycemia: diagnosed as GDM;(3) Hypertention:BP≥140/90mmHg(1mmHg=0.133kPa);(4) Dislipidemia: TG≥3.23mmol/L. Having three of the above items orall can be diagnosed as GMS. Exclusion criteria: prepregnancy complicated withmetabolic syndrome, cardiovascular disease, thyroid disease, blood disease andpolycystic ovary syndrome, infection during pregnancy, multiple pregnancy and pregnancy via assisted reproductive technology.2.4The normal BMI is (18.5-23.9) kg/m2;Overweight BMI is (24.0-27.9)kg/m2, Obesity BMI is greater than or equal to28kg/m2.3Methods3.1Enquire study object their general information about age, gestational week,parity and pregnancy weight and measure their blood pressure correctly. Thenprohibit them from drinking and eating after12:00pm that night and in next morningmeasure their fasting body weight and height, retain the clean middle urine toexamine urine routin（e24h urinary quantitativtity protein for suspicious preeclampsiapregnant women）and extract5ml fasting elbow venous blood to send to thelaboratory to detect the levels of FPG, TC, TG, HDL and LDL.3.2Detection methods: The levels of FPG and TC, TG, HDL, LDL weredetected by using automatic biochemical analyzer.4Statistical methodsAn α of0.05was used for all statistical tests. Analyses were done by using SPSS17.0soft-ware.Results1The comparison of general datasThere is no statistical significance in maternal age, gestational weeks, parity ofthe four groups (P>0.05).2The comparison of TG/TC/LDL/HDL/pre-pregnancy BMI/gestational weightgain level in three experimental groups and the control groupThe prepregnancy BMI, gestational weight gain、FPG and TG levels of the threeexperimental groups were higher than the control group(P＜0.05) and the LDL andTC levels of the HDCPgroup and HDCP with GDM group were also higher than thecontrol group, while the HDL level were lower than the control group all withsignificant differences (P <0.01).3Correlation between prepregnancy overweight or obesity and othercompositions of GMS The incidences of other GMS compositions of the overweight or obesity groupwere significantly higher than the non overweight or obesity group, and thedifferences were statistically significant (P<0.05).4Relativity of gestational weight gain and the level of glucose andlipid levelsExcluding the influence of gestational week and pre-pregnancy BMI, Gestationalweight gain was positively correlated with TG level in third trimester (r=0.796, P <0.05).5The incidences of GMS in the four groups and the analyzes of its riskfactorsThe incidences of GMS in HDCP, GDM, HDCP with GDM and control groupwere respectively20.25%(16/79),11.48%(7/61),75.76%(25/33) and0. Then makeGMS as the dependent variable, pre-pregnancy BMI and gestational weight gain asdependent variables. Use bivariate binomial Logistic regression model to analyze therisk factors of GMS. The results showed that prepregnancy BMI and gestationalweight gain both are risk factors of GMS (OR=1.42,95%CI1.24~1.67, P <0.05;OR=1.27,95%CI1.11~1.45, P <0.05).ConclusionsPrepregnancy BMI and gestational weight gain are both risk factors of GMS.