Nooria Atta, Anuli Ezeoke, Clive J Petry, Laura C Kusinski, Claire L Meek
{"title":"高体重指数和妊娠体重增加过多与 1 型糖尿病妇女妊娠结局的关系：系统回顾与元分析》。","authors":"Nooria Atta, Anuli Ezeoke, Clive J Petry, Laura C Kusinski, Claire L Meek","doi":"10.2337/dc24-0725","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The increased risk of pregnancy complications in type 1 diabetes is mainly attributed to maternal hyperglycemia. However, it is unclear whether other potentially modifiable factors also contribute to risk in this population.</p><p><strong>Purpose: </strong>We sought to assess whether high BMI and excessive gestational weight gain (GWG) are associated with perinatal complications in type 1 diabetes.</p><p><strong>Data sources: </strong>We searched Medline, Embase, PubMed, Scopus, Web of Science, and Cochrane databases to January 2024.</p><p><strong>Study selection: </strong>Studies examining associations between periconception BMI or GWG and perinatal complications in type 1 diabetes were included.</p><p><strong>Data extraction: </strong>We used a predesigned data extraction template to extract study data including year, country, sample size, participants' characteristics, exposure, and outcomes.</p><p><strong>Data synthesis: </strong>We included 29 studies (18,965 pregnancies; 1978-2019) in the meta-analysis. A 1 kg/m2/1 kg increase in preconception BMI or GWG was associated with a 3% and 11% increase, respectively, in perinatal complications (BMI odds ratio [OR] 1.03 [95% CI 1.01-1.06]; GWG OR 1.11 [95% CI 1.04-1.18]). Preconception BMI ≥ 25 kg/m2 or excessive GWG was associated with a 22% and 50% increase, respectively, in perinatal complications (BMI OR 1.22 [95% CI 1.11-1.34]; GWG OR 1.50 [95% CI 1.31-1.73]). BMI was associated with congenital malformation, preeclampsia, and neonatal intensive care unit admission. Excessive GWG was associated with preeclampsia, cesarean delivery, large for gestational age, and macrosomia.</p><p><strong>Limitations: </strong>Limitations included retrospective study design, variable measurement for exposures and outcomes, small number of studies for some outcomes, and no data from Asia and Africa.</p><p><strong>Conclusions: </strong>Addressing maternal BMI prepregnancy and preventing excessive GWG should be key clinical priorities to improve outcomes in pregnant women with type 1 diabetes.</p>","PeriodicalId":93979,"journal":{"name":"Diabetes care","volume":" ","pages":"1855-1868"},"PeriodicalIF":0.0000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Associations of High BMI and Excessive Gestational Weight Gain With Pregnancy Outcomes in Women With Type 1 Diabetes: A Systematic Review and Meta-analysis.\",\"authors\":\"Nooria Atta, Anuli Ezeoke, Clive J Petry, Laura C Kusinski, Claire L Meek\",\"doi\":\"10.2337/dc24-0725\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The increased risk of pregnancy complications in type 1 diabetes is mainly attributed to maternal hyperglycemia. However, it is unclear whether other potentially modifiable factors also contribute to risk in this population.</p><p><strong>Purpose: </strong>We sought to assess whether high BMI and excessive gestational weight gain (GWG) are associated with perinatal complications in type 1 diabetes.</p><p><strong>Data sources: </strong>We searched Medline, Embase, PubMed, Scopus, Web of Science, and Cochrane databases to January 2024.</p><p><strong>Study selection: </strong>Studies examining associations between periconception BMI or GWG and perinatal complications in type 1 diabetes were included.</p><p><strong>Data extraction: </strong>We used a predesigned data extraction template to extract study data including year, country, sample size, participants' characteristics, exposure, and outcomes.</p><p><strong>Data synthesis: </strong>We included 29 studies (18,965 pregnancies; 1978-2019) in the meta-analysis. A 1 kg/m2/1 kg increase in preconception BMI or GWG was associated with a 3% and 11% increase, respectively, in perinatal complications (BMI odds ratio [OR] 1.03 [95% CI 1.01-1.06]; GWG OR 1.11 [95% CI 1.04-1.18]). Preconception BMI ≥ 25 kg/m2 or excessive GWG was associated with a 22% and 50% increase, respectively, in perinatal complications (BMI OR 1.22 [95% CI 1.11-1.34]; GWG OR 1.50 [95% CI 1.31-1.73]). BMI was associated with congenital malformation, preeclampsia, and neonatal intensive care unit admission. 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引用次数: 0
摘要
目的：1 型糖尿病患者妊娠并发症风险增加的主要原因是母体高血糖。然而，目前还不清楚其他潜在的可调节因素是否也会导致这一人群的风险。我们试图评估高体重指数（BMI）和妊娠体重增加过多（GWG）是否与 1 型糖尿病围产期并发症有关：我们检索了截至 2024 年 1 月的 Medline、Embase、PubMed、Scopus、Web of Science 和 Cochrane 数据库。纳入了研究 1 型糖尿病患者围孕期体重指数或 GWG 与围产期并发症之间关系的研究。我们使用预先设计的数据提取模板提取研究数据，包括年份、国家、样本大小、参与者特征、暴露和结果。我们在荟萃分析中纳入了 29 项研究（18965 例妊娠；1978-2019 年）：孕前 BMI 或 GWG 每增加 1 kg/m2/1 kg，围产期并发症的发生率分别增加 3% 和 11%（BMI 机率比 [OR] 1.03 [95% CI 1.01-1.06]；GWG 机率比 1.11 [95% CI 1.04-1.18]）。孕前体重指数（BMI）≥ 25 kg/m2 或 GWG 过高分别与围产期并发症增加 22% 和 50%有关（BMI OR 1.22 [95% CI 1.11-1.34]；GWG OR 1.50 [95% CI 1.31-1.73]）。体重指数与先天性畸形、子痫前期和新生儿重症监护室入院有关。GWG 过高与子痫前期、剖宫产、胎龄过大和巨大儿有关：结论：解决孕产妇孕前体重指数（BMI）问题和防止 GWG 过高应成为改善 1 型糖尿病孕妇预后的临床重点。
Associations of High BMI and Excessive Gestational Weight Gain With Pregnancy Outcomes in Women With Type 1 Diabetes: A Systematic Review and Meta-analysis.
Background: The increased risk of pregnancy complications in type 1 diabetes is mainly attributed to maternal hyperglycemia. However, it is unclear whether other potentially modifiable factors also contribute to risk in this population.
Purpose: We sought to assess whether high BMI and excessive gestational weight gain (GWG) are associated with perinatal complications in type 1 diabetes.
Data sources: We searched Medline, Embase, PubMed, Scopus, Web of Science, and Cochrane databases to January 2024.
Study selection: Studies examining associations between periconception BMI or GWG and perinatal complications in type 1 diabetes were included.
Data extraction: We used a predesigned data extraction template to extract study data including year, country, sample size, participants' characteristics, exposure, and outcomes.
Data synthesis: We included 29 studies (18,965 pregnancies; 1978-2019) in the meta-analysis. A 1 kg/m2/1 kg increase in preconception BMI or GWG was associated with a 3% and 11% increase, respectively, in perinatal complications (BMI odds ratio [OR] 1.03 [95% CI 1.01-1.06]; GWG OR 1.11 [95% CI 1.04-1.18]). Preconception BMI ≥ 25 kg/m2 or excessive GWG was associated with a 22% and 50% increase, respectively, in perinatal complications (BMI OR 1.22 [95% CI 1.11-1.34]; GWG OR 1.50 [95% CI 1.31-1.73]). BMI was associated with congenital malformation, preeclampsia, and neonatal intensive care unit admission. Excessive GWG was associated with preeclampsia, cesarean delivery, large for gestational age, and macrosomia.
Limitations: Limitations included retrospective study design, variable measurement for exposures and outcomes, small number of studies for some outcomes, and no data from Asia and Africa.
Conclusions: Addressing maternal BMI prepregnancy and preventing excessive GWG should be key clinical priorities to improve outcomes in pregnant women with type 1 diabetes.
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