| Gestational diabetes mellitus(GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy.It's a common complication of pregnancy,the morbidity is 5%-6%and is increasing recently.The level of blood glucose of most gestational diabetes patients will restore normal,but some long term follow-up research finding gestational diabetes patients will become high-risk group of type-2 diabetes mellitus.Some scholars even think GDM is early stages of type 2 diabetes,it will change the metabolism of intra-uterine environment and cause the recently perinatal morbidity and mortality significantly higher than the general population,also affect the mental development in long-term,and increase the morbidity of adolescent obesity.So more and more scholars begin to pay attention to this disease.Pregnancy is associated with increased tissue resistance to insulin,resulting in increased levels of blood insulin as well as glucose and triglycerides.Gestational diabetes has a serious impact on mother and fetus,the major impact on pregnant women including:Increasing the incidence of spontaneous abortion at early pregnancy, especially in patients with bad blood glucose control;Increasing the morbidity of pre-eclampsia.In particular,pregnant women complicated with diabetic renal vascular lesions,the incidence of pre-eclampsia will up to more than 50%;The rates of infection, polyhydramnios,macrosomia,DKA are higher than that in normal pregnant women. The major impact on fetus including:Increasing the incidence of neonatal respiratory distress syndrome and neonatal hypoglycemia.Study shows that obesity is one of the high risk factors of gestational diabetes. Articles also reported that pro-pregnancy obesity and excessive weight gain during pregnancy will have a negative impact on pregnancy outcome.In this study,we want to estimate the effect of matemal pre-pregnancy body mass index(BMI) and BMI gain during pregnancy on obstetric outcomes of gestational diabetes mellitus(GDM) women.MethodsThis study is a register-based prospective cohort study.238 pregnant women diagnosed with GDM at our institution between 2006 and 2007 were enrolled,all the women were instructed in the use of diet therapy to achieved targeted levels of glycemic control.Perinatal outcomes were observed and analyzed according to maternal prepregnancy body mass index(BMI,kg/m~2) categories(normal weight group, overweight group,obese group) and BMI gain during pregnancy categories:A group(BMI gain＜4),B group(4≤BMI gain≤6),C group(BMI gain＞6).Results1,The rates of preeclampsia and preterm delivery in obese group(26.0%,32.7%) were significantly higher than that in normal weight group(11.9%,8.3%) and obese group (10.8%,3.7%)(P＜0.05).2,There was no significant differences about polyhydramnios and premature rupture of membrane in three groups(P＞0.05).The normal weight group have less fetus distress(8.3%)than overweight group(23.5%)and obese group(23.1%)(P＜0.05).3,In B group,there was significantly more preeclampsia(10.4%),polyhydramnios (10.4%),premature rupture of membrane(10.4%),fetus distress(11.3%), preterm delivery(8.0%) compared with the C group(22.2%,23.8%,25.3%, 30.2%,30.2%).4,The rates of fetal macrosomia in C group(25.4%) were higher than that in A (6.0%) and B group(12.0%)(P<0.05).The newborn of C group(28.6%) have more hypoglycemia than B group(16.0%)(P<0.05).Among the A,B and C groups, the rates of neonatal distress,jaundice and wet lung had no statistical differences (P>0.05).ConclusionThe obese GDM women with BMI≥25 and BMI gain>6 during pregnancy would have higher risk of adverse prenatal outcome such as preterm delivery,preeclampsia and fetus distress.The BMI gain during pregnancy of GDM women should be suitably controlled,then the prenatal outcome would be enhanced.
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