摘要目的 探究妊娠期规律运动对孕前高体重指数产妇的远期影响. 方法 本课题组2014年12月至2016年7月开展了一项自孕早期起规律运动对预防孕前高体重指数无合并症孕妇发生妊娠期糖尿病的作用的随机对照试验,共入组265例孕前高体重指数[body mass index (BMI)≥24.0 kg/m2]孕妇,随机分为运动组(132例)及对照组(133例).本研究于2016年3月至2017年8月对该队列入组产妇在产后1年进行随访,比较随访时体重、体脂、75 g口服葡萄糖耐量试验(oral glucose tolerance test, OGTT)中空腹及服糖后2 h血糖、稳态模型胰岛素抵抗指数和血脂水平;采用国际体力活动问卷(International Physical Activity Questionnaire, IPAQ)对产妇产后1年体力活动水平进行评价,采用改良的成人饮食行为评价量表对产妇产后1年饮食习惯进行评价,采用产后抑郁筛查量表(Postpartum Depression Screen Scale, PDSS)对产妇进行抑郁分级.统计学分析采用两独立样本t检验、Mann-Whitney U检验和χ2检验. 结果 2组产妇产后1年的总随访率为51.7%(137/265),其中运动组为64.4%(85/132),对照组为39.1%(52/133).运动组与对照组相比,随访时的体重回降程度、体脂百分率、75 g OGTT服糖后2 h血糖、糖耐量异常比例、稳态模型胰岛素抵抗指数[分别为1.0(－1.3~4.7)与2.3(－6.0~5.0) kg、(37.51± 4.90)% 与(38.04±4.54)%、(7.32±1.61)与(7.30±2.80) mmol/L、28.8%(17/59)与 30.0% (9/30)、2.86±1.92与2.92±1.77]比较差异均无统计学意义(t、Z或χ2值分别为－0.940,0.312, 3.415,0.005,1.743,P值均＞0.05),75 g OGTT空腹血糖[分别为(5.28±0.43)与(5.53± 0.92) mmol/L]差异有统计学意义(t=9.268,P=0.003).运动组与对照组产妇产后1年的总体力活动水平、饮食习惯总分和PDSS评分[分别为219(99~504)与195(99~351)、79.00(72.50~87.50)与 76.00(70.00~82.00)分、55.00(41.00~77.00)与 70.00(46.25~84.75)分 ] 比较差异亦无统计学意义(Z值分别为－0.808,－1.822,－1.620,P值均＞0.05);随访时血甘油三酯、总胆固醇、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇水平 [分别为(1.25±1.04)与(1.42± 0.85) mmol/L、(4.56±0.71)与(4.40±0.67) mmol/L、(1.32±0.29)与(1.22±0.21) mmol/L、(2.67±0.56)与(2.55±0.52) mmol/L]比较差异均无统计学意义(t值分别为0.001,0.020,3.255, 0.303,P值均＞0.05). 结论 孕前高体重指数的产妇在产后失去生活方式强化干预,妊娠期运动干预的作用将难以持续,除空腹血糖外,其他各项指标与未干预者相近.因此,产后随访及产后继续加强健康生活方式指导应被重视.

abstractsObjective To investigate the long-term effects of regular exercise during pregnancy on overweight and obese gravidas. Methods This study was based on a previous randomized controlled trial (RCT) regarding Effect of Regular Exercise Commenced in Early Pregnancy on the Incidence of Gestational Diabetes Mellitus in Overweight and Obese Pregnant Women conducted at Peking University First Hospital from December 2014 to July 2016. Totally 265 women whose prepregnant body mass index (BMI) ≥24.0 kg/m2 were enrolled in the RCT and were randomly assigned to exercise group (n=132) and control group (n=133). This study was a follow-up of all the participants at one year after delivery from March 2016 to August 2017. Body weight, body fat, fasting and 2 h glucose level in 75 g oral glucose tolerance test (OGTT), insulin resistance index and lipid profiles were compared. We also evaluated their physical activities with International Physical Activity Questionnaire (IPAQ), their dietary habits with modified Adult Dietary Behavior Assessment Scale and depression condition with Postpartum Depression Screen Scale (PDSS). Two independent samples t-test, Mann-Whitney U test and Chi-square test were used for statistical analysis. ResuLts The overall follow-up rate was 51.7% (137/265), while 64.4% (85/132) in the exercise group and 39.1% (52/133) in the control group. No significant difference in body weight loss [2.3 ( － 6.0 to 5.0) vs 1.0 ( － 1.3 to 4.7) kg], body fat percentage [(38.04±4.54)% vs (37.51±4.90) %], 2 h glucose level in 75 g OGTT [(7.30±2.80) vs (7.32±1.61) mmol/L], abnormal glucose tolerance ratio [30.0% (9/30) vs 28.8% (17/59)] or insulin resistance index (2.92±1.77 vs 2.86±1.92) was found between the control and exercise group (t or Z= － 0.940, 0.312, 3.415, 0.005, 1.743, all P>0.05). However, the fasting blood glucose in 75 g OGTT was higher in the control group [(5.53±0.92) vs (5.28±0.43) mmol/L, t=9.268, P=0.003]. The two groups showed no significant difference (exercise group vs control group) in physical activity level [219 (99-504) vs 195 (99-351)], total score of dietary habits [79.00 (72.50-87.50) vs 76.00 (70.00-82.00)] or PDSS score of depression [55.00 (41.00-77.00) vs 70.00 (46.25-84.75)] at follow-up (Z=－0.808, －1.822, －1.620, all P>0.05). Moreover, there was no significant difference in the level of serum triglyceride [(1.25±1.04) vs (1.42±0.85) mmol/L], total cholesterol [(4.56±0.71) vs (4.40±0.67) mmol/L], high density lipoprotein-cholesterol [(1.32±0.29) vs (1.22±0.21) mmol/L] or low density lipoprotein-cholesterol [(2.67±0.56) vs (2.55±0.52) mmol/L] between the exercise and control group (t=0.001, 0.020, 3.255, 0.303, all P>0.05). ConcLusions Regular exercise during pregnancy has no long-term effect on maternal health in the absence of continuing lifestyle intervention after delivery. Therefore, postpartum follow-up and continued education on healthy lifestyle should be emphasized.