Prediction Of Macrosomia Based On Metabolic Status Of Glucose And Lipids During Pregnancy

Objective:The purpose of this study was to investigate the effects and predictive value of related indicators on macrosomia in pregnant women based on glucose and lipid metabolism disorders.Methods:This study was designed based on a prospective cohort of non-matched nested case-control studies.A prospective cohort study was conducted including the singleton pregnancies who taked prenatal routine clinic examination and delivered in Tongling Maternal and Child Health Hospital.All the subjects who obtained informed consent underwent oral glucose tolerance test(OGTT)during 24-28 gestation weeks and then divided into two groups,normal group and GDM group,according to the inclusion criteria.All the subjiects were followed up until fetal births.Demographics and physical measurements data of pregnant and neonatal were taken during pregnancy and during childbirth,while maternal blood in the trimesters and umbilical cord blood were collected for testing.The newborns were grouped according to pregnancy outcomes while the neonates with macrosomia were defined as the case group and non-macrosomia as the control group.Laboratory analysis of blood samples collected while collate and fill data at the same time.The relevant factors in trimesters were analyed by univariate analysis first,and the significant varibles from univariate analysis were analyed by stepwise multivariate non-conditional Logistic regression analysis,established of Logistic regression models finaly,evaluate the models goodness-of-fit test and its accuracy.Results:(1)The study was followed up by a total of 674 pregnant women,including 216 cases of GDM group and 458 cases of normal group pregnant.There were 28 cases of macrosomia and 188 cases of non-macrosomia in the GDM group and the incidence of macrosomia was 13%.While there were 37 cases of macrosomia and 421 non-macrosomia in the normal group,and the incidence of macrosomia was 8.1%.There was a significant difference between the two groups(P<0.05).Body measurements in the macrosomia were all greater than those in non-macrosomia,with significant differences between the two groups(P <0.05).(2)The pre-pregnancy BMI and gestational weight gain in the macrosomia group were greater than those in the non-macrosomia group,and there was significant difference between the two groups(P <0.05)both in the GDM group and normal group pregnant.(3)The Postprandial 2h-OGTT value in the macrosomia group was higher than non-macrosomia group and the difference between the two groups was statistically significant(P<0.05)in the GDM group pregnant,other glucose and lipid metabolism was no significant difference between the groups(P>0.05).(4)The pre-pregnancy BMI and the gestational weight gain in the early pragnancy were the independent risk factors for themacrosomia in the first trimester(OR=1.164[1.068,1.269],OR=1.110 [1.034,1.193];The pre-pregnancy BMI,the gestational weight gain in the middle pragnancy and the postprandial 2h-OGTT were the independent risk factors for the macrosomia(OR=1.234 [1.114-1.367],OR=1.151 [1.077,1.229],OR=1.320[1.076,1.621],The mild physical activity and the above physical activity was the protective factor for macrosomia(OR=0.936 [0.866,1.012],OR=0.767 [0.620,0.949])in the second trimester;The pre-pregnancy BMI,the gestational weight gain in the late pragnancy and the GDM group were the independent risk factors for the macrosomia the third trimester(OR=1.204[1.098-1.320],OR=1.100 [1.055-1.147],OR=1.581 [0.918-2.725]).The predictive value of the second trimester were the best(AUC=0.756 [0.688-0.824]),which is great then the third trimester(AUC=0.714 [0.651-0.778])and the first trimester(AUC=0.672 [0.607-0.738])according to the ROC analysed.(5)The levels of TG in the trimesters were positively correlated with the birth weight(?=0.080,P =0.046;?=2.182,P =0.030;?=3.917,P =<0.001).Conclusions: The risk of delivery macrosomia with gestational diabetes mellitus pregnant is significantly higher than the normal.The macrosomia may be related to the pre-pregnancy BMI,weight gain in the first trimester;related to the pre-pregnancy BMI,weight gain,2hOGTT and physical activity in second trimester;related to the pre-pregnancy BMI,weight gain and GDM in third trimester.By analyzing the predictive value of pregnancy related indicators on the macrosomia,we found that the predictive value of the second trimester is the best,followed by the third trimester,and the last is in the first trimester by establishing predictive models.It is necessary to monitor the indicators of glucose and lipid metabolism during pregnancy,and to manage weight during pregnancy and even before pregnancy.With a view to ultimately reducing the incidence of adverse pregnancy outcomes of maternal and child.