| By prospectively observing, to explore changing characteristic of pregnancy body composition(fat free mass, body fat mass, total body water,extracellular water etal) among the normal pregnant women and to summarize their reference range in different stages of pregnancy, and analyze their effects on pregnancy outcome, then to explore the association between variation of pregnancy body composition and last trimester visfatin(in maternal blood, cord blood, placenta) and gestational diabetes mellitus(GDM), and to analyze visfatin effects on pregnancy outcome and relationship with body composition.The major methods: 1.selected normal pregnant women( 2006 cases) without any complications as research object, who had documented in obstetrics of The Air Force General Hospital and kept appointments in February 2014 to November 2015. First,those pregnant women were divided into 4 groups according to progestational BMI(body mass index): normal-weight(18.5Kg/m2 ?BMI<23 Kg/m2), underweight(BMI<18.5 Kg/m2), overweight(23 Kg/m2?BMI<25 Kg/m2),obesity(BMI? 25 Kg/m2), in order to observe the body compositional feature under different bases of progestational BMI and summarize the reference range of pregnancy body composition in normalprogestational weight women. Then, those pregnant were divided into 4groups again according to pregnant weeks : 11-13 pregnant weeks,17-20 pregnant weeks, 24-28 pregnant weeks and 32-36 pregnant weeks,analyzed characteristic of body composition in different pregnancy. In the final, analysis the effects of body composition on pregnancy outcome among different pre-pregnancy BMI pregnant women during pregnancy. 2.in addition, selected normal and only merged GDM pregnant women(60 in each) as the experimental group and control group respectively, who had documented in our Hospital in May 2015 to November 2015, monitored changes of two groups in pregnancy body compositional and visfatin,then explored their relationship with GDM, analysed effects of visfatin on pregnancy outcom and its connection with body composition. Through analysed the study results, discoveried that each index of pregnancy body composition appeared gradually rising trend with the increase of progestational BMI and gestational weeks for normal pregnant, differences are statistically significant(P<0.05); reference range of pregnancy body composition(lean body mass, body fat percentage, total body water,extracellular water) among normal- progestational weight women were :(11-13 pregnant weeks), 37.20±3.29 Kg,24.69±4.15%,29.10±2.87 L,13.02±1.22 L,(17-20 pregnant weeks), 38.31±3.24 Kg,25.79±4.00%,29.93±2.57 L,13.44±1.17 L,(24-28 pregnant weeks), 39.89±3.33 Kg,28.71±3.71%, 31.17±2.67 L, 14.05±1.28 L,(32-36 pregnant weeks),43.08±3.74 Kg, 31.43±9.36%, 33.66±2.96 L, 15.17±1.34 L. Logistic regression analysis to body composition that changing relatively great for pregnant women with different pregnancy BMI and pregnancy outcome,indicated that: ?1 For normal pre-pregnancy BMI pregnant, increase of fat free mass and fat mass were main factors affecting on their pregnancy outcome, such as, fat free mass in 11-13 pregnant weeks, 17-20 pregnant weeks, 24-28 pregnant weeks(OR=0.71?0.84?0.85,95%IC 0.63~0.82?0.77~0.92?0.77~0.93)had negative correlation with occurrence of the premature rupture of membranes, they were protective factors; fat mass in24-28 pregnant weeks and 32-36 pregnant weeks(OR=0.93?0.93,95%IC0.87~0.98?0.88~0.99)were negatively correlated with occurrence of postpartum hemorrhage, they were protective factors; fat free mass in four pregnancy stages(OR=1.14?1.15?1.36?1.12,95%IC 1.07~1.22?1.01~1.23?1.19~1.56?1.07~1.17)were positively correlated with occurrence of macrosomia,they were risk fators. ?2 For underweight pregnant, fat free mass was main factor affecting on their pregnancy outcome, such as, fat free mass in 17-20,24-28 pregnant weeks(OR=0.67?0.76,95%IC 0.41~0.98?0.59~0.96)were negatively correlated with occurrence of premature labour, they were protective factors. ?3 For overweight pregnant, changs of fat mass were main factor affecting on their pregnancy outcome, such as, fat mass in 11-13 pregnant weeks(OR=1.25,95%IC 1.02 ~ 1.52) was positively correlated with occurrence of macrosomia, it was risk factor; body fat percentage in 32-36 pregnant weeks( OR=0.20, 95%IC 0.01 ~ 3.25) was negatively correlated with occurrence of placental abruption, it was protective factor; ?4 For obesity pregnant, the changes of fat mass and lean body mass were main factor affecting on their pregnancy outcome, such as, fat mass in 11-13 pregnant weeks( OR=0.72, 95%IC 0.55 ~ 0.94) was negatively correlated with occurrence of placental abruption, it was protective factor; lean body mass in 11-13 pregnant weeks and 17-20 pregnant weeks were negatively correlated with occurrence of premature rupture of membranes(OR=0.67,95%IC 0.48~0.96)and postpartum hemorrhage(OR=0.80;95%IC 0.66~0.98) respectively, they were protective factor. Similarly, from stepwise regression analysis between body composition changing much greatly in each groups and neonatal birth weight, we found : ?1 For normal pre-pregnant weight : fat free mass, fat mass in 11-13 pregnant weeks and32-36 pregnant weeks, fat mass in 17-20 pregnant weeks and 24-28 pregnant weeks, were the main factors affecting the neonatal birth weight;?2 For underweight pregnant, fat free mass, fat mass in 11-13 pregnant weeks, fat free mass, body fat percentage in 17-20 pregnant weeks and32-36 pregnant weeks, body fat percentage in 24-28 pregnant weeks, were the main factors affecting the neonatal birth weight; ?3 For overweight pregnant, fat mass in 11-13 pregnant weeks, 17-20 pregnant weeks,and32-36 pregnant weeks, fat free mass, body fat percentage in 24-28 pregnant weeks were the main factors affecting the neonatal birth weight; ?4 For obesity pregnant, total body water in 17-20 pregnant weeks and 24-28 pregnant weeks, lean body mass in 32-36 pregnant weeks were the main factors affecting the neonatal birth weight. In addition, study results for body composition and vasfatin of GDM indicated that: except intracellular water in 11-13 pregnant weeks, almost all the body composition index of GDM group exceeded control group while 11-13 pregnant weeks, 17-20 pregnant weeks and 24-28 pregnant weeks(P<0.05), but there were no obvious differences at 32-36 pregnant weeks(P>0.05), besides total body water, body fat percentage, extracellular water; Compared with other index,the fasting blood-glucose(FPG) in 11-13 pregnant weeks and FPG of OGTT in 24-28 weeks had closer connection with fat mass in 11-13 pregnant weeks(r=0.354, 0.491,P <0.01); visfatin level of GDM in maternal blood were below to control group(P<0.05), but there were no obvious differences to cord blood and placenta(P>0.05). Correlation analysis revealed that visfatin level in maternal blood positively related to cord blood and placenta, especially cord blood(r =0.922,P<0.01); visfatin may not be relevant to pregnancy outcom(P>0.05); moreover, there were negative correlation among visfatin level in maternal blood and some of body composition in last trimester, such as : fat free mass, lean body mass,total body water, extracellular water during 32-36 pregnant weeks(r=-0.225,-0.221,-0.223,-0.214;P<0.05). Therefore, the research consider that the increase of pregnancy body composition along with the increase of pregnancy BMI and pregnant weeks; pregnancy body composition of different pre-pregnancy BMI of pregnant women has different effects on pregnancy outcome; the variation of pregnancy body composition and visfatin maybe have a certain relationship with occurrence and development of GDM. |
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