Correlation Analysis Of Prepregnancy Body Mass Index And Quality Growth With Gestational Diabetes Mellitus

ObjectiveExplore the pregnant women pregnant body mass index,28 weeks pregnancy,body weight growth and age factors and the correlation of gestational diabetes,the influence to the pregnancy outcome and neonatal weight,according to the suitable range of weight gain during pregnancy,aims to further analyzing the risk factors of gestational diabetes,provide scientific basis for pregnancy weight controlling and instruction.MethodsFrom January 2015 to December 2017,412 gestational diabetes patients from 20 to 40 years old who had normal birth examination and delivery and met the criteria were selected;all of them were single fetuses.OGTT test was conducted on the 24th-28th week.Meanwhile,413 normal OGTT women who met the criteria in the same time with normal body examination were selected as the control group.Using retrospective analysis,record the age of pregnant women,production time,gestational age,height,BMI,body mass in the 28th week,delivery quality,neonatal birth weight and neonatal score,value of OGTT and merge gestational hypertension,postpartum hemorrhage and macrosomia,premature occurrence parameters and so on,divided the 825 cases according to maternal pregnancy Body mass index(BMI)and the body mass growth in the 28th week and overall body mass growth during pregnancy(gestational weight gain,GWG)into four groups which are the light weight group,the healthy weight group,the over weight group and the obesity group.They were divided into groups according to whether the body mass of pregnancy met the standards of IOM(Institute of Medicine).Which are the too little growth,too much growth and appropriate growth.They were divided into four groups according to their ages:those who were less than or equal to 24 years old,those who were 25 to 29 years old,and those who were 30 to 34 years old,or greater than or equal to 35 years old.SPSS21.0 was used for statistical analysis,independent sample t was used for comparison between two groups,and variance analysis was used for comparison of data between three groups and above.Grade data were tested by K-W non-parametric test.The calculation data are represented by frequency and percentage,and the comparison between groups is performed by x 2 test.Logistic multivariate regression was used to analyze whether excessive growth of body mass index and body mass before pregnancy would increase the risk of diabetes,as well as the impact on pregnancy outcome and neonatal weight,and to analyze the relationship between neonatal birth weight and OGTT.Gestational weight gain during pregnancy is often occurring before the 28th week of pregnancy.Therefore,it is necessary to study the relationship between gestational weight change and GDM before the 28th week of pregnancy.In this study,the effect of prepregnancy BMI and changes in the overall quality of pregnancy before the 28th week and pregnancy on the delivery mode and outcome of pregnant women with gestational diabetes during pregnancy was studied to analyze the risk factors of GDM and reduce the risk of pregnancy.Relevant factors include prepregnancy BMI,gestational weight gain,gestational week,OGTT value,age,neonatal birth weight,delivery method,neonatal score,postpartum hemorrhage,gestational diabetes complicated with gestational hypertension,and amniotic fluid status.Results1.The differences in gestational age and height between the GDM group and the control group were not statistically significant,and the data were comparable.The age,weight,BMI and birth order of the GDM group were all higher than the control group,and the difference was statistically significant(P<0.05).2.In the GDM group,pre-pregnancy weight,gestational weight at the 28th week and pre-birth weight of each group were gradually increased,showing significant differences(P<0.05).Weight gain at the 28th week and total weight gain during pregnancy were the most in the normal BMI group before pregnancy,and the least in the obese group(P<0.05).3.Grouping by BMI,the incidence of diabetes in the overweight and obese group before pregnancy was high,with significant difference(P<0.05).4.According to the BMI,the incidence of giant infants in the overweight and obese group before pregnancy was higher than that in the normal group and the low-weight group,and the incidence of giant infants in each group was significantly different(P<0.05).There was no significant difference(P>0.05).However,the overweight group mild asphyxia rate was 3.88%(5/129),which was significantly higher than the normal weight group(1.66%(9/543))and the low weight group(0.78%(1/128)).There were significant differences in the incidence of cesarean section in each group(P<0.05).5.Pregnancy body mass increase less is too little GWG group,the pregnancy body mass increase appropriately for GWG is normal group and the body mass growth too much is over increase group,and growing at the 28th week pregnancy body quality recommended value to group,according to the calculation of the 28th week of gestation suitable scope of weight gain,body 28th week of gestation diabetes incidence of high quality growth too much group,the incidence of low growth suitable group,with significant difference(P<0.05).There were significant differences in the incidence of macrosomia between groups(p<0.05).There were significant differences in cesarean section rate in each group(p<0.05).6.According to the different BMI classification before pregnancy and the appropriate range of weight growth for each group,Logistic regression was used to analyze the relationship between BMI and body mass growth during pregnancy and gestational diabetes.Low prepregnancy BMI is a protective factor for gestational diabetes,while overweight and obesity in pregnancy are independent risk factors for gestational diabetes,showing statistical significance(p<0.05).The risk of developing GDM after overweight before pregnancy is 2.15 times of normal weight before pregnancy(ORFI2.15,95%CI:1.44-3.22);The risk of developing GDM in pre-pregnancy obesity is 4.35 times higher than that of normal weight before pregnancy(OR=4.35,95%CI:1.61-11.77).The risk of developing GDM was 0.63 times that of normal weight before pregnancy(OR=0.63,95%CI:0.42-0.94).7.Logistic regression analysis of pre-pregnancy BMI and GWG and pregnancy outcome showed that there was no statistically significant relationship between maternal BMI before pregnancy and low birth weight and macrosomia(P>0.05).The higher GWG growth rate was 2.73 times of the risk of occurrence of macrosomia in the GWG growth fit group(OR=2.73,95%CI:1.52-4.92),but the risk of occurrence of macrosomia in the GWG growth fit group was not different from that in the GWG growth fit group.The risk of cesarean delivery was 3.81 times in the obese group(OR=3.81,95%CI:1.69-8.59),while the risk of cesarean delivery in the group with too little GWG was 0.55 times in the group with too little GWG(OR=0.55,95%CI:0.34-0.89),which was the protective factor for cesarean delivery(P<0.05).8.According to different age groups,the incidence of pregnant women over 35 years old is the highest,followed by those is between 25 and 34 years old.The incidence of gestational diabetes is proportional to age,showing a significant difference(p<0.05).9.Fasting blood glucose level in pregnant women with gestational diabetes is positively correlated with neonatal weight(p<0.05).Conclusions1.High BMI before pregnancy,excessive increase in body mass during pregnancy,and significantly increased risk of gestational diabetes,suggesting that excessive increase in BMI and body mass during pregnancy are risk factors for gestational diabetes.2.High BMI before pregnancy,excessive increase in body mass during pregnancy is closely related to pregnancy outcome,and the incidence of adverse pregnancy outcome such as gestational hypertension,postpartum hemorrhage,amniotic fluid pollution,cesarean section,etc.3.The BMI before pregnancy,pregnancy body mass growth,OGTT value associated with birth weight,resulting in abnormal birth weight,increase the incidence of macrosomia,overweight obesity group of neonatal asphyxia rate also increased,especially pay attention to are closely associated with neonatal weight,fasting glucose women before pregnancy and pregnancy weight control should be strengthened,pregnancy,blood sugar control,to enhance the publicity on pregnancy,rational intervention of potential risk factors.4.Older women have abnormal glucose metabolism and high risk of gestational diabetes.5.Weight management during pregnancy should be strengthened.The pre-pregnancy counseling and health education were conducted,and the per-pregnancy BMI was determined to be reasonable directly with the pregnant women’s weight growth range in China,and the pre-pregnancy BMI should be controlled below 24 kg/m2 during pregnancy.Develop a personalized diet plan ac cording to the physical quality of pregnancy,appropriate exercise therapy,self-weight monitoring,and maintain a reasonable weight range.This study has a small sample size,and the appropriate range of weight gain in pregnancy is not clear.The basis of weight gain grading management in pregnancy needs further study.Therefore,the incidence of gestational diabetes,macrosomia and cesarean section rate are reduced.