孕前体重指数及孕期增重对围生结局的影响

doi:10.11852/zgetbjzz2019-0407

摘要/Abstract

摘要： 目的分析孕前体重指数(BMI)及孕期体重增长对围生结局的影响,为孕期保健、孕前和孕期体重管理提供依据。方法采用历史性队列研究方法,将深圳市龙岗区2014-2017年26家助产医院95 849例单胎足月产妇按孕前BMI及孕期增重情况分组,观察各组围生结局。结果 95 849例孕妇平均孕前BMI为(20.49±2.83) kg/m²,平均孕期增重(14.49±5.89) kg。相比孕前正常BMI 和孕期增重适宜的孕妇,孕前消瘦(BMI<18.5kg/m²)和孕期增重不足是低出生体重儿发生的危险因素,OR值(95%CI)分别为1.80(1.61~2.00)、1.83(1.63~2.05);孕前超重(BMI≥24 kg/m²)是妊娠期糖尿病(GDM)、妊娠期高血压、子痫前期/子痫、巨大儿、剖宫产、出生窒息发生的危险因素,OR值(95%CI)分别为1.84(1.68~2.02)、2.40(1.90~3.04)、3.07(2.39~3.96)、2.70(2.49~2.92)、1.89(1.81~1.97)及1.33(1.05~1.67);孕期增重过度是巨大儿、剖宫产、妊娠期高血压、子痫前期/子痫、胎膜早破、产后出血发生的危险因素,OR值(95%CI)分别为2.59(2.40~2.79)、1.45(1.40~1.50)、2.83(2.21~3.62)、2.18(1.69~2.81)、1.26(1.13~1.40)及1.26(1.07~1.48)。结论孕前BMI和孕期增重均是剖宫产、妊娠期高血压、子痫前期/子痫、低出生体重和巨大儿发生的影响因素,因此将孕前BMI、孕期增重控制在合理范围有利于获得良好的围生结局。

关键词: 孕前体重指数, 孕期增重, 妊娠并发症, 低出生体重, 巨大儿

Abstract: Objective To investigate the effects of pre-pregnancy body mass index (BMI) and gestational weight gain on pregnancy outcomes,in order to provide evidence for pregnancy health care and prenatal weight management. Method A historical cohort study of 95 849 single full-term pregnant women from 26 midwifery hospitals in Longgang District of Shenzhen City from 2014 to 2017 was conducted on the influence of pre-pregnancy BMI and gestational weight gain on perinatal outcomes. Results The average pre-pregnancy BMI was (20.49±2.83) kg/m² in 95 849 pregnant women,the average gestational weight gain was (14.49 ±5.89) kg.Compared with pregnant women with normal BMI and suitable weight gain during pregnancy,the emaciation (BMI<18.5 kg/m²) (OR=1.80,95%CI: 1.61-2.00) and insufficient gestational weight gain (OR=1.83,95%CI: 1.63-2.05) were risk factors for low birth weight infants.Pre-pregnancy overweight (BMI≥24 kg/m²) was a risk factor for gestational diabetes mellitus (GDM) (OR=1.84,95%CI: 1.68-2.02),gestational hypertension(OR=2.40,95%CI: 1.90-3.04),preeclampsia/eclampsia(OR=3.07,95%CI: 2.39-3.96),macrosomia(OR=2.70,95%CI: 2.49-2.92),cesarean section(OR=1.89,95%CI: 1.81-1.97),birth asphyxia(OR=1.33,95%CI: 1.05-1.67).Excessive weight gain during pregnancy was a risk factor for macrosomia (OR=2.59,95%CI: 2.40-2.79),cesarean section(OR=1.45,95%CI: 1.40-1.50),pregnancy hypertension (OR=2.83,95%CI: 2.21-3.62),preeclampsia/eclampsia(OR=2.18,95%CI: 1.69-2.81),premature rupture of membranes(OR=1.26,95%CI: 1.13-1.40) and postpartum hemorrhage(OR=1.26,95%CI: 1.07-1.48). Conclusionss Pre-pregnancy BMI and pregnancy weight gain are the influencing factors of cesarean section,gestational hypertension,preeclampsia/eclampsia,low birth weight and macrosomia.Therefore,it will be conducive to a good pregnancy outcome by controlling pre-pregnancy BMI and gestational weight gain.

Key words: pre-pregnancy body mass, gestational weight gain, pregnancy complications, low birth weight, macrosomia

中图分类号:

R714.14

邢萌萌, 卫国, 王志隆, 任路忠. 孕前体重指数及孕期增重对围生结局的影响[J]. 中国儿童保健杂志, 2020, 28(4): 389-394.

XING Meng-meng, WEI Guo, WANG Zhi-long, REN Lu-zhong. Effect of pre-pregnancy body mass index and gestational weight gain on perinatal outcomes[J]. journal1, 2020, 28(4): 389-394.

参考文献

[1] Barker DJ,Eriksson JG,Forsén T,et al.Fetal origins of adult disease:strength of effects and biological basis [J].Int J Epidemiol,2002,31(6):1235-1239.
[2] 陈春明,国际生命科学学会中国办事处中国肥胖问题工作组联合数据汇总分析协作组.中国成人体质指数分类的推荐意见简介[J].中华预防医学杂志,2001,35(5):349-350.
[3] Rasmussen KM, Yaktine AL. Weight gain during pregnancy: reexamining the guidelines[M].Washington, DC: The National Academies Press, 2009: 254-255.
[4] Schumann NL,Brinsden H,Lobstein T.A review of national health policies and professional guidelines on maternal obesity and weight gain in pregnancy[J].Clin Obes,2014,4(4):197-208.
[5] 林友结,蔡倩莹,徐云云,等.母亲孕前体质指数和孕期体重增加及其交互作用对新生儿出生体重的影响[J].中华流行病学杂志,2018,39(6):770-775.
[6] 李丹婷,梁一,龚云辉,等.西南3省妇女孕前体质指数和孕期增重对新生儿出生体重影响的前瞻性队列研究[J].中华流行病学杂志,2018,39(10):1319-1323.
[7] 冒志琴,汪之顼.孕前体质指数、孕期增重对新生儿出生体重的影响[J].江苏预防医学,2013,24(5):29-31.
[8] Vinturache A,Moledina N,Mcdonald S,et al.Pre-pregnancy Body Mass Index(BMI) and delivery outcomes in a Canadian population[J].BMC Pregnancy Childbirth,2014,14:422.
[9] Yao R,Ananth CV,Park BY.Obesity and the risk of stillbirth:a population-based cohort study[ J ].Am J Obstet Gynecol,2014,9378(14):132-135.
[10] Schummers L,Hutcheon JA,Bodnar LM,et al.Risk of adve rse pregnancy outcomes by prepregnancy body mass index:a population-based study to inform prepregnancy weight loss counseling[J].Obstet Gynecol,2015,125(1):133-143.
[11] Balsells M,García-Patterson A,Corcoy R.Systematic revie-w and meta-analysis on the association of prepregnancy underweight and miscarriage [J].Eur J Obstet Gynecol Reprod Biol,2016,207:73-79.
[12] Schummers L,Hutcheon JA,Bodnar LM,et al.Risk of adverse pregnancy outcomes by prepregnancy body mass index:a population-based study to inform prepregnancy weight loss counseling[J].Obstet Gynecol,2015,125(1):133-143.
[13] Murai U,Nomura K,Kido M,et al.Pre-pregnancy body ma-ss index as a predictor of low birth weight infants in Japan[J].Asia Pac J Clin Nutr,2017,26(3):434-437.
[14] Fujiwara K,Aoki S,Kurasawa K,et al.Associations of maternal pre-pregnancy underweight with small-for-gestational-age and spontaneous preterm birth,and optimal gestational weight gain in Japanese women[J].J Obstet Gynaecol Res,2014,40(4):988-994.
[15] 陈芳芳,王文鹏,滕红红,等.1996至2010年北京市活产出生体重变化趋势及其影响因素[J].中国循证儿科杂志,2012,7(6):418-423.
[16] Munim S,Maheen H.Association of gestational weight gain and pre-pregnancy body mass index with adverse pregnancy outcome[J].J Coll Physicians Surg Pak,2012,22(11):694-698.
[17] 梁嬛,张为远,李笑天.基于巨大儿发生率的中国孕妇孕期体质量增加的参考范围—多中心横断面研究[J].中华妇产科杂志,2017,52(3):147-152.
[18] Hung TH,Hsieh TT.Pregestational body mass index,gestational weight gain,and risks for adverse pregnancy outcomes among Taiwanese women:a retrospective cohort study[J].Taiwan J Obstet Gynecol,2016,55(4):575-581.
[19] Artal R,Lockwood CJ,Brown HL.Weight gain recommendations in pregnancy and the obesity epidemic [ J].Obstet Gynecol,2010,115(1):152-155.
[20] Chung JG,Taylor RS,Thompson JM,et al.Gestational weight gain and adverse pregnancy outcomes in a nulliparous cohort [ J ].Eur J Obstet Gynecol Reprod Biol,2013,167 (2):149-153.
[21] Wen T,Lv Y.Inadequate gestational weight gain and adverse pregnancy outcomes among normal weight women in China[J].Int J Clin Exp Med,2015,8(2):2881-2886.