| PartⅠObesity during pregnancyObjective:The objective of the present study was to investigate the relationship between different body mass index (BMI) in the last trimester of gestation and obstetric complications, to evaluate the appropriate criterion of the obesity in the last trimester of gestation, in order to analyze the difference of clinical and biochemical and obstetric complications between obesity and non obesity gravidas.Methods:A total of 1046 gravidas from the Maternal and Child Care Service Centre of Hunan with singleton and termpregnancy from January 2006 to November 2010 were collected. The women whose height, weight, abdominal circumference, fundal height, blood pressure, blood glucose, triglycercide, family history of diabetes and hypertension, cesarean delivery, neonatal birth weight and obstetric complications were recorded. Study the relationship between obesity during pregnancy and obstetric complications.Results:1. These gravidas were divided into five groups according to their third-trimester BMI:group A(BMI<25 kg/m2), group B(25 kg/m2≤BMI < 28 kg/m2), group C(28 kg/m2≤BMI< 30 kg/m2), group D(30 kg/m2≤BMI<35 kg/m2) and group E(BMI≥35 kg/m2). In the normal gravidas, gestational diabetes mellitus(GDM) or impaired glucose tolerance(GIGT) and pregnancy-induced hypertension, age, heart rate, systolic blood pressure, diastolic blood pressure, abdominal circumference, fundal height, and hospital stays were gradually raised along with the increase of BMI, blood sugar and level of TG were gradually raised, the rate of cesarean, complications of mother were also increased. Gravidas in group C were at high risk for complications of mother (OR=2.350; 95%CI:1.439-3.837; P=0.001), in group D were 2.119 (95%CI:1.289-3.484; P=0.003), in group E were 3.467 (95%CI: 1.457-8.250; P=0.003). Neonatal birth weight and complications of fetal were gradually increased. Gravidas in group C were at high risk for complications of fetal (OR=2.482; 95%CI:1.359-4.533; P=0.002), in group D were 5.293 (95%CI:2.986-9.381; P=0.000), in group E were 6.307 (95%CI:2.518-15.801; P=0.000).2. Explore the cutoff point of pregnancy obesity with BMI of 28 kg/m2,29 kg/m2 and 30 kg/m2. The results showed that when BMI of 28 kg/m2,29 kg/m2 and 30 kg/m2 in third-trimester, the clinical and biochemical indicators in third-trimester had changed. Gravidas in group of BMI>28kg/m2 were high risk for complications of mother and fetal (OR=2.846,95%CI,2.201-3.679; p=0.000), in group of BMI≥29kg/m2 (OR=3.155,95%CI,2.412-4.127; p=0.000), in group of BMI>30kg/m2 (OR=2.933 (95%CI,2.186-3.936; p=0.000). Complications of mother and fetal were significant added when the BMI of 29kg/m2. BMI of 29kg/m2 will as the relative cutoff point to pregnancy obesity.Conclusions:1. In the normal gravidas, GDM/GIGT and hypertension and gravidas, the age, heart rate, systolic blood pressure, diastolic blood pressure, abdominal circumference, fundal height, and hospital stays in gravidas had gradually increased, blood sugar and level of TG were also gradually elevated along with the increase of third-trimester BMI.2. The metabolic disturbance and the obstetric complications were increased while third-trimester gravidas in BMI of 29kg/m2, therefore BMI of 29kg/m2 may as the cutpoint of pregnancy obesity.Part II Lipid abnormalities during pregnancyObjective:To explore the lipid changes in normal gravidas GDM/GIGT and ypertension gravidas. With the level of TG 3.76 mmol/L as the cutpoint in high triglycerides (TG), gravidas were divided into two groups, one group of lipid abnormalities and the other group of lipid normal. Analyze the difference of clinical and biochemical indicators between lipid abnormalities and normal ones to explore the impact of lipid abnormalities on mother and fetal, and to discuss whether lipid abnormalities in gestational will be prone to merges with components of other metabolic syndrome (MS).Methods:514 gravidas with singleton and termpregnancy who were hospitalized in the Maternal and Child Care Service Centre of Hunan from January 2006 to November 2010 were collected.291 cases were diagnosed with GDM/GIGT,91 cases diagnosed with pregnancy-induced hypertension,132 cases of normal group. These women whose height, weight, abdominal circumference, fundal height, blood pressure, blood glucose, TG, family history of diabetes and hypertension, cesarean delivery, neonatal birth weight and obstetric complications were recorded. The relationship between lipid abnormalities in gestational and delivery outcome were investigated.Results:1. The level of TG was increased in group of GDM/GIGT than in group of normal gravidas (P<0.05).2. The level of TG was increased in group of pregnancy-induced hypertension than in group of normal gravidas (P<0.05).3. With TG of 3.76 mmol/L for cutpoint, the fetal birth weight, macrosomia, rate of cesarean, rate of complications to mother were increased in group TG≥3.76 mmol/L than in group TG< 3.76 mmol/L (P< 0.05). The levels of abdominal circumference, fundal height, BMI, blood sugar were increased (P< 0.05). The incidence of obesity and GDM/GIGT were increased in group TG≥3.76 mmol/L than in group TG < 3.76 mmol/L (P< 0.05).4. In group with lipid abnormalities, the proportion of obesity, high blood pressure and GDM/GIGT were 29.00%,16.02% and 64.07% separately.Conclusions:1. The level of TG was higher in GDM and hypertension than that in normal gravidas.2. Lipid abnormalities in pregnancy were prone to combined with obesity and GDM/GIGT.Part III Metabolic syndrome in pregnancyObjective:To explore MS in gestation, and compare the difference of mother and fetal complications between patients with MS and those without MS, analyze the impact of MS on mother and fetal in gravidas with different numbers of MS components. Methods:514 gravidas with singleton and termpregnancy who were hospitalized in Maternal and Child Care Service Centre of Hunan from January 2006 to November 2010 were collected.291 cases diagnosed with GDM/GIGT,91 cases diagnosed with pregnancy-induced hypertension,132 cases of normal. These women whose height, weight, abdominal circumference, fundal height, blood pressure, blood glucose, triglycercide, family history of diabetes and hypertension, cesarean delivery, neonatal birth weight and obstetric complications were recorded. According to documents and our research results, MS in pregnancy was defined with three or more in the following,①pregnancy obesity (BMI>29kg/m2 in third trimester)②pregnancy-induced hypertension (after weeks 20 of gestation, first discovered the blood pressure>140/90mmHg)③Glucose metabolism during pregnancy (after 24 weeks of gestation, with 75g OGTT test, after fasting and take sugar 1 hour,2 hours,3 hours for blood sugar with 5.6 mmol/L,10.3 mmol/L,8.6 mmol/L and 6.7 mmol/L, as there is a point reach or exceed normal)④Lipid abnormalities (level of TG≥3.76 mmol/L in third-trimester).Results:1. Compared with normal gravidas, the proportion of combined obesity (36.43% vs 17.42%) and high TG (50.86% vs 34.09%) in GDM/GIGT women were increased (P< 0.05).2. Compared with normal gravidas, the proportion of combined obesity (48.35% vs 17.42%) in pregnancy-induced hypertension were increased (P< 0.05).3. Gravidas with one component of MS were at high risk for obstetric complications (OR=2.293,95%CI,1.084-4.849; P=0.027), those with two components of MS were with higher risk of obstetric complications (OR=4.471,95%CI,2.149-9.299; P=0.000) and those with MS were with the highest risk of obstetric complications (OR=7.714,95%CI, 3.531-16.854; P=0.000).Conclusions:1. MS was also exist during gestation, and the components of MS were abnormal in gestation.2. The obstetric complications were more happen with MS than without MS in gestation and more number of components of MS, higher risk of obstetric and fetal complications. |
PDF Full Text Request