背景:在患有妊娠期糖尿病(GDM)的孕妇中,最佳妊娠期体重变化(GWC)鲜为人知。
目的:本研究旨在探索GDM女性的最佳GWC范围,并与医学研究所(IOM)指南相比验证这些范围。
方法:一项基于人群的队列研究使用美国国家卫生统计中心(NCHS)的出生数据,包括2014年至2020年的1,338,460对GDM母婴。使用Poisson回归模型来确定与严重程度加权复合结局(包括早产(PTB)<37周)的可接受风险(<10%增加)相关的GWC范围(GDM目标)。胎龄大(LGA,出生体重>90百分位数)和小于胎龄(SGA,出生体重<10%)。这些目标在包括PTB在内的个体结果中得到了验证,LGA,SGA,妊娠高血压疾病,新生儿重症监护病房入院率和新生儿呼吸道发病率,并使用逻辑回归模型与IOM指南进行比较,计算了人口归因分数(PAF)。
结果:严重程度加权综合结局与体重指数(BMI)类别的GWC呈U形或J形关系。GDM目标为14.1-20.3kg,9.0-17.0kg,4.8-13.8kg,-0.8-10.8千克,-2.4-8.2kg,和-8.3-6.0公斤体重,正常体重,超重,1类肥胖,2类肥胖,和3级肥胖,分别。在验证分析中,GDM或IOM目标以外的GWC与不良围产期结局增加相关。PAF表明,与GDM目标相比,IOM指南降低了GDM女性的不良围产期结局的比例相似或更高。除了2级和3级肥胖的人。
结论:IOM指南通常适用于GDM患者,除了中度和重度肥胖的女性。GDM和中度至重度肥胖女性的最佳GWC范围可能低于IOM指南。
BACKGROUND: Optimal gestational weight change (GWC) is little known among pregnant women with gestational diabetes mellitus (GDM).
OBJECTIVE: This study aimed to explore the optimal GWC ranges for women with GDM and validate these ranges compared with the Institute of Medicine (IOM) guidelines.
METHODS: A population-based cohort study using natality data from the National Center for Health Statistics in the United States included 1,338,460 mother-infant pairs with GDM from 2014 to 2020. Poisson regression models were performed to identify GWC ranges (GDM targets) associated with acceptable risks (<10% increase) for a severity-weighted composite outcome including preterm birth (PTB) <37 wk, large for gestational age (LGA, birthweight >90th percentile) and small for gestational age (SGA, birthweight <10th percentile). These targets were validated in individual outcomes including PTB, LGA, SGA, hypertensive disorders of pregnancy, neonatal intensive care unit admission, and neonatal respiratory morbidity, and compared with the IOM guidelines using logistic regression models with population-attributable fractions (PAFs) calculated.
RESULTS: The severity-weighted composite outcome had a U-shaped or a J-shaped relationship with GWC across body mass index categories. The GDM targets were 14.1 to 20.3 kg, 9.0 to 17.0 kg, 4.8 to 13.8 kg, -0.8 to 10.8 kg, -2.4 to 8.2 kg, and -8.3 to 6.0 kg for underweight, normal weight, overweight, class 1 obesity, class 2 obesity, and class 3 obesity, respectively. GWC outside the GDM or the IOM targets was associated with increased adverse perinatal outcomes in validation analyses. PAFs indicated that the IOM guidelines reduced a similar or higher proportion of adverse perinatal outcomes compared with the GDM targets for women with GDM, except for those with class 2 and 3 obesity.
CONCLUSIONS: The IOM guidelines are generally applicable for women with GDM, except for women with moderate and severe obesity. The optimal GWC ranges for women with GDM and moderate to severe obesity may be lower than the IOM guidelines.