摘要
目的探讨孕前不同体重指数（body mass index，BMI）孕妇孕早期及晚期血脂水平的变化，以及孕期体重增长对血脂水平的影响。方法采用系统整群抽样的方法，选取北京市15家医院于2013年6月20日至11月30日住院分娩，且行孕早期（〈14孕周）和晚期（≥28孕周）血脂检测的2 593例单胎孕妇为研究对象。通过问卷的方式收集孕妇的人口学信息及临床资料。根据美国医学研究院推荐的成人肥胖和超重诊断标准，将入组孕妇分为孕前体重正常组（孕前BMI〈25）与孕前超重与肥胖组（BMI≥25），并进一步依据其推荐的孕期体重正常增长范围，将入组孕妇分为孕期体重增长正常组、孕期体重增长超重组。比较孕前BMI〈25与BMI≥25孕妇孕早期与晚期的血脂水平和增幅差值（孕晚期血脂水平－孕早期血脂水平）。采用两独立样本t检验及χ2检验进行统计学分析。结果（1）孕前BMI〈25的孕妇孕晚期总胆固醇（total cholesterol，TC）、甘油三酯（triglycerides，TG）、高密度脂蛋白胆固醇（high density lipoprotein-cholesterol，HDL-C）和低密度脂蛋白胆固醇（low density lipoprotein-cholesterol，LDL-C）水平分别为（6.47±1.17）、（3.14±1.19）、（1.94±0.44）和（3.56±1.00）mmol/L，高于孕早期[分别为（4.63±0.80）、（1.22±0.70）、（1.85±0.49）和（2.29±0.67）mmol/L]（t值分别为－61.250、－65.909、－6.448和－49.952，P值均〈0.01）；孕前BMI≥25孕妇孕晚期TC、TG、HDL-C和LDL-C水平分别为（6.20±1.14）、（3.31±1.20）、（1.86±0.44）和（3.30±0.89） mmol/L，高于孕早期[分别为（4.75±0.88）、（1.44±0.70）、（1.65±0.37）和（2.51±0.82） mmol/L]（t值分别为－18.756、－25.165、－6.905和－12.191，P值均〈0.01）。孕前BMI≥25和BMI〈25孕妇孕早期及孕晚期TC、TG、LDL-C及HDL-C水平比较差异均有统计学意义（P值均〈0.05）。（2）孕前BMI≥25的孕妇相比孕前BMI〈25者TC增幅差值降低[（1.45±1.01）与（1.84±1.02）mmol/L，t=6.664]，HDL-C增幅差值升高[（0.21±0.39）与（0.09±0.51）mmol/L，t=－4.301]（P值均〈0.01）。（3）孕前BMI〈25孕期体重增长超重与孕期体重增长正常孕妇相比，孕早期至孕晚期TC增幅差值[（1.77±0.96）与（1.89±1.05） mmo/L，t=－2.802]和HDL-C增幅差值[（0.06±0.41）与（0.12±0.58） mmo/L，t=－2.588]降低，TG增幅差值升高[（2.00±1.07）与（1.86±1.18）mmo/L，t=3.015]（P值均〈0.05）。孕前BMI≥25孕期体重增长超重与孕期体重增长正常孕妇相比，HDL-C增幅差值降低[（0.17±0.35）与（0.29±0.44） mmo/L]（t=－2.664，P〈0.01）。结论孕晚期血脂水平较孕早期明显升高，孕前BMI相比孕期体重增长更能影响孕期血脂变化，而孕期体重增长是否超重主要影响孕前BMI〈25孕妇的血脂变化。
Objective To investigate the influence of pre-pregnancy body mass index （BMI） and gestational weight gain （GWG） on lipid variations of first and third trimester. Methods A retrospective analysis was conducted on 2 593 singleton pregnant women without diabetes from 15 hospitals in Reijing from June 20 to November 30 in 2013. Serum lipid levels were determined in all of these women at the first trimester （〈14 weeks） and the third trimester （≥ 28 weeks）. Demographic data and medical information were collected individually through questionnaires. The recruited gravidas were divided into normal pre-pregnant BMI group （BMI〈25） and pre-pregnant overweight and obese group （BMI ≥25） according to recommendations of the Institute of Medicine （IOM）. Based on the same recommendations on normal GWG, the pregnant women in the two groups were further assigned to two subgroups including normal GWG and over GWG group. The serum lipid levels in both first and third trimester and the increases from first to third trimester were compared between the normal and abnormal BMI groups with two independent sample t-test. Results （1） The levels of total cholesterol （TC）, triglyceride （TG）, high density lipoprotein-cholesterol （HDL-C） and low density lipoprotein-cholesterol （LDL-C） in the third trimester were all significantly higher than those in the first trimester in the normal BMI group [（6.47±1.17） vs （4.63 ±0.80）, （3.14±1.19） vs （1.22±0.70）, （1.94±0.44） vs （1.85±0.49） and （3.56± 1.00） vs （2.29±0.67） mmol/L, t=- - 61.250, - 65.909, - 6.448 and - 49.952, all P〈0.01]. And the same results were shown in the abnormal BMI group [（6.20±1.14） vs （4.75±0.88）, （3.31±1.20） vs （1.44±0.70）, （1.86±0.44） vs （1.65±0.37） and （3.30±0.89） vs （2.51 ±0.82） mmol/L, t=- - 18.756, - 25.165, - 6.905 and - 12.191, all P〈0.01]. Significant differences were identified between the normal and abnormal pre-pregnant BMI groups both in first and third trimester （all P〈0.05）. （2） The increases of TC from early to late pregnancy in the abnormal BMI group was lower than that in the normal BMI group [（1.45±1.01） vs （1.84±1.02） mmol/L, t=6.664, P〈0.01], but the increase of HDL-C was higher [（0.21 ±0.39） vs （0.09±0.51） retool/L, t= - 4.301, P〈0.01]. （3） In the normal BM1 group, the increase of TC and HDL-C between the third and the first trimester was lower in the over GWG subgroups than in the normal GWG subgroups [（1.77±0.96） vs （1.89±1,05） mmo/L, t= - 2.802, P=0.005; （0.06±0.41） vs （0.12±0.58） mmo/L, t= - 2.588, P=0.010], but the increase of TG was higher [（2.00±1.07） vs （1.86±1.18） mmo/L, t=3.015, P=0.003]. While in the abnormal BMI group, smaller increase of HDL-C was found in the over GWG subgroup than in the normal GWG subgroup [（0.17± 0.35） vs （0.29±0.44） mmo/L, t= - 2.664, P=0.008]. Conclusions The lipid levels during pregnancy are significantly higher in late pregnancy than in early pregnancy. Pre-pregnancy BMI has much more effect on lipid variations during pregnancy than GWG, which primarily affect the lipid levels of women with normal pre-pregnancy BMI.
出处
《中华围产医学杂志》
CAS
CSCD
2016年第1期56-61,共6页
Chinese Journal of Perinatal Medicine
基金
世界糖尿病基金（WDF10-517、WDF14-908）
国家科技支撑计划（2015BAI13B00）
妊娠合并糖尿病母胎医学研究北京重点实验室
关键词
人体质量指数
超重
体重增长
妊娠
脂类
Body mass index
Overweight
Weight gain
Pregnancy
Lipids
