孕中期血糖水平与新生儿出生体重的队列研究

黄三唤; 徐叶清; 陈茂林; 黄锟; 潘维君; 葛星; 严双琴; 毛雷婧; 牛影童; 世庐; 陶芳标

文章摘要

黄三唤,徐叶清,陈茂林,黄锟,潘维君,葛星,严双琴,毛雷婧,牛影童,世庐,陶芳标.孕中期血糖水平与新生儿出生体重的队列研究[J].中华流行病学杂志,2016,37(1):45-49

孕中期血糖水平与新生儿出生体重的队列研究

Mid-gestational glucose levels and newborn birth weight: birth cohort study

收稿日期:2015-05-25 出版日期:2016-01-12

DOI：10.3760/cma.j.issn.0254-6450.2016.01.009

中文关键词: 孕期血糖出生体重大于胎龄儿小于胎龄儿

英文关键词: Maternal glucose Birth weight Large for gestational age Small for gestational age

基金项目:国家自然科学基金(81330068,81373012);马鞍山市卫生局科教专项资金

作者	单位	E-mail
黄三唤	230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级实验室
徐叶清	243000 安徽省马鞍山市妇幼保健院院部
陈茂林	243000 安徽省马鞍山市妇幼保健院妇产科
黄锟	230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级实验室
潘维君	243000 安徽省马鞍山市妇幼保健院妇产科
葛星	230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级实验室
严双琴	243000 安徽省马鞍山市妇幼保健院保健部
毛雷婧	230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级实验室
牛影童	230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级实验室
世庐	230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级实验室	s.tong@qut.edu.au
陶芳标	230032 合肥, 安徽医科大学公共卫生学院儿少卫生与妇幼保健学系安徽人口健康与优生省级实验室

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中文摘要:

目的探讨孕中期孕妇75 g口服糖耐量试验(OGTT)的3项血糖值与出生体重的关系。方法参与前瞻性队列研究的3 081名孕妇于孕≤14周时收集基础人口统计学信息,在孕24～28周行75 g OGTT,利用多项logistic回归法分析新生儿出生体重的影响因素及孕中期FPG和OGTT-1 h、OGTT-2 h值四分位分组的大于胎龄儿(LGA)发生风险,以多元线性回归法分析血糖值与新生儿出生体重的关系。结果孕前超重(24.0 kg/m²≤BMI <28.0 kg/m²)(OR=1.4,95%CI:1.0～2.0,P=0.029)、妊娠期糖尿病(OR=2.4,95%CI:1.8～3.2,P <0.001)是LGA发生的危险因素;孕前消瘦(BMI <18.5 kg/m²)(OR=1.6,95%CI:1.2～2.2,P=0.003)、子痫前期(OR=4.0,95%CI:1.9～8.4,P <0.001)可增加小于胎龄儿出生的风险。多元线性回归分析调整孕前BMI、产次、高血压情况、新生儿性别后,FPG、OGTT-1 h和OGTT-2 h均与新生儿出生体重呈正相关关系(β 值分别为91.99、33.60、32.00,P值均 <0.001)。随着孕妇3项血糖水平四分位升高各组出生体重呈增大趋势,且LGA发生风险逐渐增大。结论孕中期血糖水平与子代出生体重呈正相关。随着血糖水平升高,新生儿出生体重增大,LGA发生风险升高,但小于胎龄儿与血糖无关联。FPG值对发生LGA有很好的预测作用。

英文摘要:

Objective To understand the association between the blood glucose levels of pregnant women in second trimester detected by 75 gram oral glucose tolerance test (OGTT) and the birth weight of neonates. Methods Demographic information collection and OGTT were conducted for 3 081 pregnant women at ≤14 gestational weeks and 24-28 gestational weeks respectively. Multiple logistic regression analysis was done to identify the factors associated with the birth weight and the risks of large for gestational age (LGA) in three levels (FPG, OGTT-1 h and OGTT-2 h) of OGTT percentile group, multiple linear regression analysis was used to evaluate the relationships between maternal glucose levels and neonate birth weight. Results Pre-pregnancy obesity (24.0 kg/m²≤ BMI <28.0 kg/m²) (OR=1.4, 95%CI:1.0-2.0, P=0.029) and gestational diabetes mellitus (OR=2.4, 95%CI: 1.8-3.2, P <0.001) were the risk factors. Pre-pregnancy underweight (BMI <18.5 kg/m²) (OR=1.6, 95%CI: 1.2-2.2, P=0.003), preeclampsia (OR=4.0, 95%CI: 1.9-8.4, P <0.001) increased the risk for small for gestational age (SGA). Multiple linear regression analysis showed neonate birth weight was positive correlated with maternal glucose levels (β were 91.99, 33.60, 32.00, respectively, P <0.001). Percentile groups of each OGTT level was linearly positive associated with increased mean value of neonate birth weight, and so with the risk of LGA. Conclusions There were positive correlations between maternal glucose levels and neonate birth weight. The risk of LGA increased with the maternal glucose levels, but there was no statistical association between SGA and maternal glucose levels. FPG level is one of the predictors of LGA. Active surveillance and control of maternal glucose level can effectively reduce the risk of LGA.

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