Pregnancy outcome in obese and morbidly obese gestational diabetic women
Pregnancy outcome in obese and morbidly obese gestational diabetic women
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DOI：
10.1016/j.ejogrb.2007.03.022
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发表时间：
2008-03-01
影响因子：
2.6
通讯作者：
Langer, Oded
中科院分区：
文献类型：
--
作者：
Yogev, Yariv;Langer, Oded
目的：我们试图确定肥胖和病态肥胖GDM患者的妊娠结局是否不同，并评估妊娠结局与治疗模式和血糖控制水平的关系。方法：对4830例妊娠期糖尿病（GDM）患者进行队列研究，这些患者在同一中心采用相同的糖尿病治疗方案。肥胖定义为孕前BMI为bbb30和= 35 kg/m(2)。控制良好的GDM定义为平均血糖< 105 mg/dl。妊娠结局指标包括大胎龄儿（LGA）和巨大儿的发生率、代谢并发症、NICU入院和/或呼吸支持的需要、肩难产率和剖宫产率。结果：GDM患者中肥胖率为15.7% (760 / 4830,BMI: 32.4 +/- 1.6 kg/m(2))，病态肥胖率为11.6% （559 / 4830,BMI: 42.6 +/- 2.2 kg/m(2)）。在产妇年龄、种族、分娩胎龄或口服葡萄糖耐量试验（OGTT）结果方面没有发现差异。此外，剖宫产、巨大儿、肩难产、复合结局和代谢并发症的发生率相似。62%的肥胖和73%的病态肥胖GDM患者开始胰岛素治疗（P < 0.002）。肥胖和病态肥胖患者达到预期血糖控制水平的比例相似（分别为63%和61%）。在达到理想血糖控制水平（< 105 mg/dl）的肥胖和病态肥胖患者中，妊娠结局没有发现差异，除了饮食治疗的受试者与胰岛素治疗的GDM患者相比，新生儿代谢并发症和综合结局更普遍。结论：在患有GDM的肥胖妇女中，无论肥胖程度或治疗方式如何，妊娠结局都会受到影响。(c)爱思唯尔爱尔兰有限公司2007年出版
Objective: We sought to determine whether pregnancy outcome differs between obese and morbidly obese GDM patients and to assess pregnancy outcome in association with mode of treatment and level of glycemic control.Methods: A cohort study of 4830 patients with gestational diabetes (GDM), treated in the same center using the same diabetic protocol, was performed. Obesity was defined as prepregnancy BMI > 30 and = 35 kg/m(2). Well-controlled GDM was defined as mean blood glucose < 105 mg/dl. Pregnancy outcome measures included the rates of large for gestational age (LGA) and macrosomic babies, metabolic complications, the need for NICU admission and/or respiratory support, rate of shoulder dystocia, and the rate of cesarean section.Results: Among the GDM patients, the rates of obesity and morbid obesity were 15.7% (760 out of 4830, BMI: 32.4 +/- 1.6 kg/m(2)) and 11.6% (559 out of 4830, BMI: 42.6 +/- 2.2 kg/m(2)), respectively. No differences were found with regard to maternal age, ethnicity, gestational age at delivery or oral glucose tolerance test (OGTT) results. Moreover, similar rates of cesarean section, fetal macrosomia, shoulder dystocia, composite outcome, and metabolic complications were noted. Insulin treatment was initiated for 62% of the obese and 73% of the morbidly obese GDM patients (P < 0.002). Similar rates of obese and morbidly obese patients achieved desired levels of glycemic control (63% versus 61%, respectively). In both obese and morbidly obese patients who achieved a desired level of glycemic control (< 105 mg/dl), no difference was found in pregnancy outcome except that both neonatal metabolic complications and composite outcomes were more prevalent in diet-treated subjects in comparison to insulin-treated GDM patients.Conclusion: In obese women with GDM, pregnancy outcome is compromised regardless of the level of obesity or treatment modality. (c) 2007 Published by Elsevier Ireland Ltd.