The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth.
The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth.
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DOI：
10.2337/dc12-0741
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发表时间：
2013-01
期刊：
影响因子：
16.2
通讯作者：
Lawrence JM
中科院分区：
文献类型：
--
作者：
Black MH;Sacks DA;Xiang AH;Lawrence JM
国际妊娠期糖尿病研究组协会（IADPSG）诊断妊娠期糖尿病（GDM）的标准确定了有不良结局风险的妇女和婴儿，这些不良结局也与母亲超重、肥胖和妊娠期体重过度增加密切相关。我们对9，835名妊娠≥20周分娩的妇女进行了回顾性研究;进行了产前2小时75克口服葡萄糖耐量试验;并且在妊娠期间未接受饮食，运动或抗糖尿病药物治疗。根据IADPSG标准将女性分为GDM，并将其分为6个相互排斥的孕前BMI/GDM组：正常体重± GDM，超重± GDM和肥胖± GDM。总体而言，5，851名（59.5%）女性超重或肥胖，1，892名（19.2%）患有GDM。在GDM患者中，1，443人（76.3%）超重或肥胖。与正常体重的对照组相比，超重和肥胖的非GDM妇女的大于胎龄儿（LGA）的患病率明显更高。在没有GDM的妇女中，21.6%的LGA婴儿归因于母亲超重和肥胖，超重或肥胖和GDM的组合占LGA婴儿的23.3%。在所有组中，妊娠期体重增加与LGA的患病率较高相关。孕前超重和肥胖占LGA的比例很高，即使没有GDM。干预措施，重点是产妇超重/肥胖和妊娠期体重增加，无论GDM状态，有可能达到更多的妇女有一个LGA婴儿的风险。
The International Association of Diabetes in Pregnancy Study Groups (IADPSG) criteria for diagnosis of gestational diabetes mellitus (GDM) identifies women and infants at risk for adverse outcomes, which are also strongly associated with maternal overweight, obesity, and excess gestational weight gain. We conducted a retrospective study of 9,835 women who delivered at ≥20 weeks’ gestation; had a prenatal, 2-h, 75-g oral glucose tolerance test; and were not treated with diet, exercise, or antidiabetic medications during pregnancy. Women were classified as having GDM based on IADPSG criteria and were categorized into six mutually exclusive prepregnancy BMI/GDM groups: normal weight ± GDM, overweight ± GDM, and obese ± GDM. Overall, 5,851 (59.5%) women were overweight or obese and 1,892 (19.2%) had GDM. Of those with GDM, 1,443 (76.3%) were overweight or obese. The prevalence of large-for-gestational-age (LGA) infants was significantly higher for overweight and obese women without GDM compared with their normal-weight counterparts. Among women without GDM, 21.6% of LGA infants were attributable to maternal overweight and obesity, and the combination of being overweight or obese and having GDM accounted for 23.3% of LGA infants. Increasing gestational weight gain was associated with a higher prevalence of LGA in all groups. Prepregnancy overweight and obesity account for a high proportion of LGA, even in the absence of GDM. Interventions that focus on maternal overweight/obesity and gestational weight gain, regardless of GDM status, have the potential to reach far more women at risk for having an LGA infant.