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目的了解江苏省昆山市孕妇孕早期代谢综合征(MS)的患病情况并探讨其各组分对巨大儿发生的影响。方法在江苏省昆山市妇幼保健所围产期保健监测平台上,收集2009至2010年常规围产期保健数据,筛选并分析在孕早期(孕20周以内)行初次产检且体格测量数据完整(包括孕妇体重、身高和血压),同时采集孕早期血糖、血脂等实验室检测数据。根据国际糖尿病联盟(IDF)2005年有关MS的标准进行分组,其中超重/肥胖采用BMI≥24kg·m-2作为标准。采用多因素Logistics逐步回归分析母亲孕早期MS及其各组分对巨大儿发生的影响。结果共有1405名孕妇围产期信息进入数据分析。孕妇初次产检时平均年龄为(26.5±3.2)岁,平均BMI(20.8±2.7)kg·m-2,平均收缩压和舒张压分别为(107.7±10.0)和(69.3±7.0)mmHg。孕早期平均甘油三酯(TG)、高密度脂蛋白(HDL-C)和空腹血糖(FPG)分别为(2.4±1.0)、(2.0±0.4)和(4.5±0.5)mmol·L-1。共有25名(1.8%)孕妇符合MS的诊断标准,其中超重/肥胖、高TG、低HDL-C、高血压和高FPG的患病率分别为12.0%、76.2%、2.8%、2.6%和2.3%。孕妇分娩时平均孕周为(39.0±1.4)周,新生儿出生体重为(3365.0±418.6)g,其中巨大儿的发生率为7.0%。497名具完整的孕早期和出生结局数据,行多因素Logistic逐步回归分析显示,孕妇孕早期超重/肥胖是巨大儿发生的危险因素(OR=2.4,95%CI:1.0～5.5)。结论昆山市2009至2010年孕妇孕早期MS患病率为1.8%,其最主要的两个组分是超重/肥胖和高TG,并且孕早期超重/肥胖是巨大儿发生的危险因素。提示对孕妇应考虑进行更早期的孕期代谢性危险因素的管理,有望减少不良妊娠结局的发生。
Objective To understand the prevalence of metabolic syndrome (MS) in pregnant women in Kunshan, Jiangsu Province and to explore the impact of each component on the occurrence of macrosomia in pregnant women. Methods The data of routine perinatal period from 2009 to 2010 were collected on the monitoring platform of perinatal care in Maternal and Child Health Care Hospital of Kunshan City, Jiangsu Province. Screening and analysis of the first antenatal examination and complete physical measurement data during the first trimester (within 20 weeks of pregnancy) Pregnant women body weight, height and blood pressure), while collecting early pregnancy blood glucose, blood lipids and other laboratory test data. According to the International Diabetes Federation (IDF) 2005 MS-related criteria for grouping, including overweight / obesity with BMI ≥ 24kg · m-2 as a standard. The multifactor Logistics stepwise regression analysis of maternal pregnancy in early pregnancy MS and its components on the occurrence of macrosomia in children. Results A total of 1405 pregnant women perinatal information into the data analysis. The mean age at first checkup was (26.5 ± 3.2) years old with mean BMI (20.8 ± 2.7) kg · m-2. Mean systolic and diastolic blood pressure were (107.7 ± 10.0) and (69.3 ± 7.0) mmHg, respectively. The mean triglyceride (TG), high density lipoprotein (HDL-C) and fasting plasma glucose (FPG) in early pregnancy were (2.4 ± 1.0), (2.0 ± 0.4) and (4.5 ± 0.5) mmol·L-1, respectively. A total of 25 pregnant women (1.8%) met the diagnostic criteria of MS. The prevalence rates of overweight / obesity, high TG, low HDL-C, high blood pressure and high FPG were 12.0%, 76.2%, 2.8%, 2.6% and 2.3%. The average gestational age of pregnant women during delivery was (39.0 ± 1.4) weeks, and the birth weight of newborns was (3365.0 ± 418.6) g, of which the incidence of macrosomia was 7.0%. 497 patients with complete early pregnancy and birth outcomes, multivariate Logistic stepwise regression analysis showed that pregnant women overweight / obesity during early pregnancy was a risk factor for macrosomia (OR = 2.4,95% CI: 1.0-5.5). Conclusion The prevalence of MS in pregnant women in Kunshan during the first trimester was 1.8% during the first trimester of pregnancy in Kunshan City. The two major components were overweight / obesity / high TG, and the overweight / obesity in early pregnancy was the risk factor for macrosomia. Suggesting that pregnant women should consider the management of metabolic risk factors of earlier pregnancy, is expected to reduce the incidence of adverse pregnancy outcomes.