| Objective:This study attempts to explore the adverse effects of BMI and weight gain on the outcome of pregnant women with gestational diabetes mellitus(GDM),and provide basis for weight management before and during pregnancy.Method: Through the medical record browser of our hospital,we retrospectively collected gestational diabetes mellitus patients who received routine prenatal examination and delivered in hospital in three obstetric wards of the Affiliated Hospital of Yan’an University from January 2018 to December 2020.According to the inclusion and exclusion criteria,877 eligible subjects were included.According to pre pregnancy BMI,they were divided into low body weight group(BMI<18.5),23 cases,(2.62%),normal weight group(18.5≤BMI<24),509 cases,(58.04%),overweight group(24≤BMI<28),257 cases,(29.31%)and obesity group(BMI≥28),88 cases,(10.03%);According to the corresponding range of weight gain in pregnancy formulated by the Institute of Medicine(IOM)for different pre pregnancy body mass index in 2009,the weight gain during pregnancy was divided into three groups,namely,insufficient weight gain,suitable weight gain and excessive weight gain.The weight gain range of low weight pregnant women before pregnancy is 12.5-18.0kg,that of normal pregnant women is 11.5-16.0kg,overweight pregnant women is 7.0-11.5kg,obese pregnant women is 5.0-9.0kg.In this range,it is called the appropriate weight gain during pregnancy,and the weight gain less than the recommended range is insufficient weight gain in pregnancy,which is greater than excessive weight gain,which can be divided into206 cases(23.49%)in the group with insufficient weight gain in pregnancy There were328 cases(37.40%)in the appropriate weight gain group and 343 cases(39.11%)in the excessive weight gain group.Through the medical record browser,the general clinical data of pregnant women,such as age,parity,height,weight before delivery,mother’s mode of delivery and pregnancy complications(Premature rupture of membranes,postpartum hemorrhage,fetal distress),adverse outcomes of offspring(including macrosomia,full-term low birth weight infants,premature infants and transfer to NICU)were recorded in detail.All data were analyzed by spss25.0 statistical software.If there is difference between the four groups(three groups),the comparison between the two groups is performed.Results: 1.877 pregnant women with GDM were included in this study.According to the pre pregnancy BMI,there were 23 low body weight group,accounting for 2.62%;509 normal body weight group,accounting for 58.04%;257 overweight group,accounting for 29.31%;88 obese group,accounting for 10.03%.According to the weight gain during pregnancy,there were 206 people in the group of insufficient weight gain during pregnancy,accounting for 23.49%;328 people in the group of suitable weight gain during pregnancy,accounting for 37.40%;343 people in the group of excessive weight gain during pregnancy,accounting for 39.11%.See Figure 1-2.2.There was no significant difference in the incidence of premature rupture of membranes,postpartum hemorrhage and fetal distress among the four groups.There were 7 cases of premature rupture of membranes in low body weight group,with the highest incidence of 30.4%.The mode of delivery(cesarean section)among the four groups was statistically significant(P=0.000).The cesarean section rate of overweight and obesity group was higher than that of low weight group(P =0.000,0.000).The cesarean section rate of overweight and obesity group was higher than that of normal weight group(P=0.000,0.000).See Table 3.3.The incidence of giant infants(P=0.000)was found in GDM patients before pregnancy,and the difference was statistically significant.The results of further comparison showed that the incidence of megalopia in the hyperrecombination and obesity groups was higher than that of the normal weight group(P=0.000,0.001).The incidence of premature infants(P=0.003)was statistically significant(P<0.05).The results showed that the incidence of low body weight group was higher than that of normal weight group(P=0.001).There was no statistical difference between the four groups(P>0.05),but the rate of NICU transfer increased with the increase of BMI before pregnancy.See Table 4.4.The incidence of cesarean section in the overweight group was 63.3%,which was the highest among the three groups.There was statistical difference among the three groups(P=0.000).Further comparison between the two groups showed that there were significant differences between the excessive weight gain group,the appropriate weight gain group and the insufficient weight gain group(P=0.000,0.000),while there were no significant differences among the other groups.There was no significant difference in the incidence of premature rupture of membranes,postpartum hemorrhage and fetal distress among the three groups(P>0.05).See Table 5.5.The incidence rate of pregnancy in group GDM was different from that in group A,and the incidence of macrosomia in overweight group was 18.1%,the highest in three groups.There was a significant difference between the three groups(P=0.000).The results of the two comparisons showed that there was significant difference between the overweight group and the insufficient weight gain group and the appropriate group(P=0.000,0.000).The incidence rate of full-term low birth weight in the underweight group was 3%,the highest in the three groups and statistically significant(P=0.016).The results of the two comparisons showed that there was significant difference between the group with insufficient weight gain,the suitable group and the overweight group(P=0.002,0.001).The incidence rate of premature infants with low weight gain was 10.7%,the highest in the three groups,and there was a significant difference(P=0.003).The results of the two comparisons showed that there was significant difference between the group with insufficient weight gain,the suitable group and the overweight group(P=0.007,0.002).There was no significant difference in the incidence of neonatal transfer into NICU between groups(P>0.05),but it was found that the incidence of neonatal transfer into NICU increased with the increase of pregnancy weight.See Table 6.Conclusions: 1.Pre pregnancy overweight,obesity and excessive weight gain during pregnancy in patients with gestational diabetes mellitus have a significant impact on the mode of delivery of pregnant women,and can lead to the occurrence of adverse neonatal outcomes,and the incidence of transferring to NICU increases.2.Appropriate weight gain during gestational diabetes mellitus can reduce the incidence of full-term low birth weight infants.Low weight before pregnancy and low weight gain during pregnancy will increase the incidence of premature infants.Therefore,weight management before and during pregnancy should be guided to reduce the risk of premature infants. |
PDF Full Text Request