The Effect Of Pregravid Body Mass Index、Gestational Weight Gain And Blood Lipid Levels To The Pregnancy Adverse Outcomes In GDM

Background:Gestational diabetes mellitus (GDM) is defined as degree of glucose intolerance with onset of first recognition during pregnancy, with changes of glucose and lipid metabolism, and is associated with a couple of adverse outcomes during pregnancy. In recent years, with the improvement of life standards and the adjustment of child birth policy, In our country, the population of overweight and obesity were gradually expanded and the age of pregnant women increased, while the weight of pregnant women increased significantly during the period of pregnancy in our country. Studies have shown that gestational diabetes, pre pregnancy overweight or obesity, gestational weight gain and maternal serum lipid levels have interactive effects on pregnancy outcome, but the conclusion is not unified, while they are mainly to foreign study population. Through this study, we make analysis of prepregnancy body mass index (BMI), Gestational weight gain (GWG), trimester biochemical index and pregnancy outcome in women with or without GDM, in order to further illustrate the influence of these factors on pregnancy outcome and reduce the occurrence of adverse pregnancy outcome.Methods:Clinical datas of pregnant women delivered singleton baby after 28 gestational weeks in Women’s Hospital School of Medicine Zhejiang University from January 2014 to April 2014 were collected, excluding those pregravid diabetes or hypertension. A total go 3764 women were taken into this research and were classified according to GDM、 pregestational body mass index (BMI; normal range:18.5-24.9kg/m2) and GWG (determined according to pregravid BMI status as pro- posed by the Institute of Medicine (IOM)). The biochemical indexes include triglyceride(TG)、total cholesterol(TC)、high density lipoprotein(HDL)、low density lipoprotein(LDL) and the OGTT levels during the second trimester. Main outcome measures were large/small for gestational age (LGA/SGA), caesarean section, preeclampsia, preterm delivery, fetal distress, neonatal asphyxia and postpartum hemorrhage.Result:1. Comparison of general information between GDM and no GDM groups shows the age, parity, gravidity, pre-pregnancy BMI and family history of diabetes have no significant difference(P< 0.05). In women with or without GDM, the pre pregnancy BMI is significantly associated with the age and parity(P<0.05). In GDM women, the proportion of family history of diabetes increase in overweight group, while in women without GDM, the proportion of multipara increased and the GWG decreased, they are all significantly different(P< 0.05).2. In women with or without GDM, with the increase of pregravid BMI, the rate of LGA and caesarean section both increase significantly, while there is no difference in the rate of SGA. In women with GDM, the pregravid BMI is associated with preeclampsia and fetal distress. Whether women have GDM or note, the GWG is positively associated with LGA, preeclampsia and caesarean section, and negatively with SGA.3. In women with GDM, among different GWG groups, there is no difference of blood lipid levels during second trimester, but according to blood lipid levels during the third trimester, TC and LDL level are lower in women with excess GWG (P< 0.05), but the TG and HDL level have no significant difference. In women without GDM, among different GWG groups, there is no difference of blood lipid levels during second trimester, but the level of TC, TG and LDL are all significantly different among different GWG groups.4. In women without GDM, with the increase of pregravid BMI, the fasting glucose, 1h glucose and 2h glucose all significantly increase(P< 0.05). In GDM women, with the increase of abnormal numbers of the three indexes in the OGTT test, the Incidence of LGA and caesarean section were rising(p< 0.05), but there was no significant difference in SGA and preeclampsia.5. Through binary logistic regression analysis, we found regardless of whether GDM, the GWG is always the independent influent factors of LGA, SGA, preeclampsia and caesarean section, while pregravid BMI is independently associated with LGA and caesarean section. Only in women with GDM, the pregravid BMI is the independent influent factor of preeclampsia, fetal distress and SGA. In women without GDM, the LDL level during the second trimester is independently associated with LGA and caesarean section, while the TG level during the second trimester is associated with preeclampsia and caesarean section.ConclusionGestational diabetes mellitus, pre-pregnancy overweight or obese and excess GWG all are important influent factors of LGA, preeclampsia and caesarean section. Through controlling weight gain during pregnancy, the incidence of LGA will significantly decrease. However, the gestational weight gain could not increase too little, or may lead to SGA. At the same time, pre-pregnancy BMI has independent influence on the outcomes, therefore, in addition to control weight during pregnancy, we should control the body mass index in normal range before pregnancy, which can effectively reduce the incidence of LGA, preeclampsia, cesarean section and fetal distress. In addition, for non GDM pregnant women, the level of blood lipids in the second trimester of pregnancy may be closely related to LGA, preeclampsia and cesarean section, which means these women also need to carry out a positive diet guidance or treatment.