孕前体重指数及孕期体重变化与妊娠结局的相关性研究

发布时间：2018-07-10 04:07

本文选题：孕前体重 + 孕期体重管理　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:探讨孕前体重指数及孕期体重变化对妊娠结局的影响。方法:选择3924例单胎妊娠孕妇,分析妊娠并发症发生情况(妊娠期糖尿病、妊娠高血压病、妊娠胆汁淤积症、胎膜早破、胎盘早剥、产后出血、产褥感染)、不良妊娠结局发生情况(胎儿窘迫、早产、死胎)、分娩方式、及新生儿健康总体状况(Apgar评分、体重、身长、巨大儿、低体重儿、入住NICU),按孕前BMI分为BMI正常组(n=3126),高BMI组(n=434)及低BMI组(n=364),比较各组妊娠并发症发生情况、不良妊娠结局发生情况、分娩方式和新生儿情况,其中3126名孕前BMI正常组孕妇按孕期体重增长情况分为增长正常组(n=2426),增长不足组(n=107)及增长过多组(n=593),比较各组妊娠并发症发生情况、不良妊娠结局发生情况、分娩方式和新生儿情况。结果:3924例孕妇妊娠高血压发病率为4.46%(175/3924)妊娠期糖尿病发病率10.19%(400/3924),妊娠胆汁淤积症发病率为0.94%(37/3924)。胎膜早破发生率为4.13%(162/3924);胎盘早剥发生率为1.12%(44/3924),产后出血3.62%,产褥感染发生率0.87%(140/3924)。胎儿窘迫发生率为1.73%(68/3924),早产发生率2.70%(106/3924),死胎发生率为0.17%(7/3924)。剖宫产率为51.38%(2016/3924);3924名新生儿Apgar评分(9.90±0.36),体重平均(3312±51.75)g,身长(50.56±1.24)cm,巨大儿比例为6.75%(265),低体重儿比例为1.34%(53/3924),入住NICU比例为3.16%(124/3924)。低BMI组与BMI正常组妊娠高血压病发病率无显著差异(X~2=3.104,p=0.078),高BMI组妊娠高血压发病率高于BMI正常组(X~2=20.394,p=0.000)及低BMI组组(X~2=16.458,p=0.000);低BMI组妊娠糖尿病发病率低于BMI正常组(X~2=31.507,p=0.000)及BMI增高组(X~2=65.195,p=0.000),高BMI组妊娠糖尿病发病率高于BMI正常组(X~2=30.186,p=0.000);低BMI组妊娠胆汁淤积症发病率与BMI正常组(X~2=0.038,p=0.845)及高BMI组(X~2=0.214,p=0.643)无显著差异。高BMI组妊娠胆汁淤积症发病率与BMI正常组无显著差异(X~2=0.203,p=0.652);低BMI组与BMI正常组妊胎膜早破发生率无显著差异(X~2=0.086,p=0.769),高BMI组胎膜早破发生率高于BMI正常组(X~2=149.128,p=0.000)及低BMI组(X~2=40.034,p=0.000);低BMI组胎盘早剥发病率同BMI正常组无显著差异(X~2=0.006,p=0.938),高BMI组胎盘早剥发病率高于低BMI组(X~2=5.227,p=0.022)及BMI正常组(X~2=18.677,p=0.000);低BMI组产后出血发生率同BMI正常组无显著差异(X~2=0.710,p=0.400),同高BMI组无显著差异(X~2=0.063,p=0.802),高BMI组同BMI正常组产后出血发生率无显著差异(X~2=1.845,p=0.174);低BMI组产褥感染发生率同BMI正常组无显著差异(X~2=0.450,p=0.502),低于高BMI组(X~2=5.477,p=0.019),高BMI组产褥感染发生率高于BMI正常组(X~2=31.713,p=0.0000);低BMI组胎儿窘迫发病率同BMI正常组无显著差异(X~2=0.387,p=0.531),高BMI组胎儿窘迫发病率高于低BMI组(X~2=15.296,p=0.000)及BMI正常组(X~2=82.088,p=0.000);低BMI组早产发生率同BMI正常组无显著差异(X~2=0.001,p=0.987),高BMI组早产发病率高于低BMI组(X~2=28.680,p=0.000)及BMI正常组(X~2=130.228,p=0.000);低BMI组死胎发生率与BMI正常组(X~2=0.487,p=0.485)及高BMI组(X~2=0.185,p=0.667)无显著差异。高BMI组死胎发生率与BMI正常组无显著差异(X~2=2.510,p=0.113);低BMI组剖宫产率高于BMI正常组(X~2=4.887,p=0.027),与高BMI组无显著差异(X~2=1.553,p=0.213),高BMI组剖宫产率高于对BMI正常组(X~2=16.780,p=0.000);BMI正常组新生儿Apgar评分高于低BMI组(t=7.146,p=0.014)及高BMI组(t=7.615,p=0.010),低BMI组Apgar评分同高BMI组无明显差异(t=0.064,p=0.816);BMI正常组新生儿体重小于高BMI组(t=5.296,p=0.009),高于低BMI组(t=9.174,p=0.003);BMI正常组新生儿身长与低BMI组(t=2.176,p=0.062)及高BMI组无显著差异(t=1.205,p=0.147),高BMI组新生儿身长高于低BMI组(t=4.286,p=0.029)。BMI正常组巨大儿发生率高于低BMI组(X~2=8.296,p=0.004),低于高BMI组(X~2=37.277,p=0.000),高BMI组巨大儿发生率高于低BMI组(X~2=34.083,p=0.000);BMI正常组低体重儿发生率低于低BMI组(X~2=32.527,p=0.000),与高BMI组无显著差异(X~2=0.098,p=0.754),高BMI组低体重儿发生率低于低BMI组(X~2=9.140,p=0.003);BMI正常组新生儿入住NICU率低于低BMI组(X~2=4.193,p=0.041)及高BMI组(X~2=5.697,p=0.017),低BMI组与高BMI组新生儿入住NICU发生率无显著差异(X~2=0.012,p=0.911)。增长不足组与增长正常组妊娠高血压病发病率无显著差异(X~2=0.442,p=0.506),增长过多组妊娠高血压发病率高于增长正常组(X~2=71.543,p=0.000)及增长不足组(X~2=4.090,p=0.027);增长不足组妊娠糖尿病发病率低于增长正常组(X~2=8.802,p=0.003)及增长过多组(X~2=28.535,p=0.000),增长过多组妊娠糖尿病发病率高于增长正常组(X~2=102.065,p=0.000);增长不足组妊娠胆汁淤积症发病率与增长正常组(X~2=0.006,p=0.940)及增长过多组(X~2=0.048,p=0.826)无显著差异,增长过多组妊娠胆汁淤积症发病率与增长正常组无显著差异(X~2=0.514,p=0.473);增长正常组胎膜早破发生率低于增长不足组(X~2=18.711,p=0.000)与增长过多组(X~2=13.997,p=0.000),增长不足组与增长过多组胎膜早破发生率无显著差异(X~2=2.465,p=0.116);增长正常组胎盘早剥发生率低于增长不足组(X~2=11.501,p=0.001)与增长过多组(X~2=6.909,p=0.009),增长不足组与增长过多组胎盘早剥发生率无显著差异(X~2=1.533,p=0.216);增长正常组产后出血发生率低于增长不足组(X~2=20.750,p=0.000),增长过多组产后出血发生率高于增长不足组(X~2=6.710,p=0.010)及增长正常组(X~2=11.800,p=0.001);增长正常组产褥感染发生率低于于增长不足组(X~2=21.964,p=0.001)及增长过多组(X~2=21.964,p=0.001),增长不足组与增长过多组产褥感染发生率无显著差异(X~2=0.890,p=0.346)。增长正常组胎儿窘迫发生率低于增长不足组(X~2=124.859,p=0.000)与增长过多组(X~2=17.907,p=0.000),增长不足组与增长过多组胎儿窘迫发生率无显著差异(X~2=1.835,p=0.176);增长正常组早产发生率低于增长不足组(X~2=10.994,p=0.001)与增长过多组(X~2=6.057,p=0.014),增长不足组与增长过多早产发生率无显著差异(X~2=1.520,p=0.218);增长正常组死胎发生同增长不足组(X~2=0.132,p=0.176)及增长过多组(X~2=0.073,p=0.787)无显著差别;增长正常组剖宫产率同增长不足组无显著差异(X~2=0.021,p=0.555),增长过多组剖宫产率高于增长不足组(X~2=6.710,p=0.010)及增长正常组(X~2=37.874,p=0.000);增长正常组新生儿Apgar评分高于增长不足组(t=5.296,p=0.017)及增长过多组(t=6.545,p=0.010),增长不足组Apgarp评分同增长过多组无明显差异(t=0.217,p=0.658);增长正常组新生儿体重高于增长不足组(t=8.076,p=0.008),低于增长过多组(t=9.142,p=0.002);增长正常组新生儿身长高于增长不足组(t=3.179,p=0.012),低于增长过多组(t=4.576,p=0.008);增长正常组巨大儿发生率高于增长不足组(X~2=5.604,p=0.018),低于增长过多组(X~2=42.494,p=0.000);增长正常组低体重儿发生率同增长过多组无显著差异(X~2=0.024,p=0.877);低于增长不足组(X~2=109.119,p=0.000)。增长正常组入住NICU率低于增长不足组(X~2=23.925,p=0.000)及增长过多组(X~2=36.794,p=0.000)。结论:孕前BMI异常以及孕期体重增长异常增加产妇妊娠中晚期并发症风险,影响胎儿的健康发育,也是不良妊娠结局的原因之一,并影响新生儿的健康,在妊娠前要合理控制体重,孕期科学营养,进行孕期体重管理,降低妊娠风险,改善妊娠质量。
[Abstract]:Objective: To investigate the effect of pre pregnancy body mass index and pregnancy weight on pregnancy outcome. Methods: 3924 pregnant women with single pregnancy were selected to analyze pregnancy complications (gestational diabetes, pregnancy induced hypertension, pregnancy cholestasis, premature rupture of membranes, placental abruption, postpartum hemorrhage, puerperal infection), pregnancy outcome (fetus). Fetal distress, preterm birth, stillbirth), mode of delivery, and the overall health of the newborn (Apgar score, weight, length, gigantic, low weight, NICU), BMI divided into normal BMI group (n=3126), high BMI group (n=434) and low BMI group (n=364), compare the occurrence of complications of pregnancy, adverse pregnancy outcome, delivery mode and new birth. In the case of 3126 pre pregnancy BMI normal groups, pregnant women were divided into normal group (n=2426), inadequate growth group (n=107) and increasing group (n=593) according to the weight growth of pregnancy, compared with each group of pregnancy complications, adverse pregnancy outcome, childbirth formula and newborns. Results: the incidence of pregnancy hypertension in 3924 pregnant women. The incidence of gestational diabetes was 10.19% (400/3924) for 4.46% (175/3924). The incidence of pregnancy cholestasis was 0.94% (37/3924). The incidence of premature rupture of membranes was 4.13% (162/3924), placental abruption was 1.12% (44/3924), postpartum hemorrhage was 3.62%, puerperal infection was 0.87% (140/3924). The incidence of fetal distress was 1.73% (68/3924), and the incidence of premature birth was 2. .70% (106/3924), the incidence of stillbirth was 0.17% (7/3924). The cesarean section rate was 51.38% (2016/3924); 3924 newborn Apgar scores (9.90 + 0.36), weight average (3312 + 51.75) g, length (50.56 + 1.24) cm, 6.75% (265), low weight infant ratio 1.34% (53/3924), and NICU ratio was 3.16% (124/3924). Low BMI group and normal BMI group pregnancy There was no significant difference in the incidence of hypertension (X~2=3.104, p=0.078). The incidence of hypertension in high BMI group was higher than that of normal BMI group (X~2=20.394, p=0.000) and low BMI group (X~2=16.458, p=0.000), and the incidence of gestational diabetes in low BMI group was lower than that of BMI normal group (X~2=31.507, 0) and higher group. There was no significant difference in the incidence of cholestasis between the low BMI group and the normal group of BMI (X~2=0.038, p=0.845) and the high BMI group (X~2=0.214, p=0.643). The incidence of pregnancy cholestasis in the high BMI group was not significantly different from that of the normal group of BMI (X~2=0.214, p=0.643). There was no significant difference (X~2=0.086, p=0.769). The incidence of premature rupture of membranes in high BMI group was higher than that in normal BMI group (X~2=149.128, p=0.000) and low BMI group (X~2=40.034, p=0.000). The incidence of placental abruption in low BMI group was not significantly different from that of BMI normal group (X~2=0.006,), and the incidence of placental abruption was higher than that of low BMI group and normal group. (X~2=18.677, p=0.000), the incidence of postpartum hemorrhage in the low BMI group was not significantly different from that of the normal BMI group (X~2=0.710, p=0.400), and there was no significant difference in the same high BMI group (X~2=0.063, p=0.802). There was no significant difference in the incidence of postpartum hemorrhage between the high BMI group and the BMI normal group (X~2=1.845,), and there was no significant difference in the incidence of puerperal infection in the low group. P=0.502), the incidence of puerperal infection in the high BMI group was higher than that of the high BMI group (X~2=5.477, p=0.019), and the incidence of puerperal infection in the high BMI group was higher than that of the normal BMI group (X~2=31.713, p=0.0000), and the incidence of fetal distress in the low BMI group was not significantly different from that of the BMI normal group (X~2=0.387, p=0.531). The incidence of preterm labor in group MI was not significantly different from that in normal BMI group (X~2=0.001, p=0.987). The incidence of premature birth in high BMI group was higher than that in low BMI group (X~2=28.680, p=0.000) and normal BMI group (X~2=130.228, p=0.000). There was no significant difference in the normal group of MI (X~2=2.510, p=0.113), and the rate of caesarean section in the low BMI group was higher than that of the normal BMI group (X~2=4.887, p=0.027), and there was no significant difference between the high BMI group (X~2=1.553, p=0.213), and the caesarean section in the high BMI group was higher than that of the normal BMI group. The Apgar score in the low BMI group was not significantly different from that in the high BMI group (t=0.064, p=0.816), and the weight of the newborn in the normal BMI group was less than the high BMI group (t=5.296, p=0.009), higher than the low BMI group (t=9.174, Apgar). The incidence of giant infants in the normal group of low BMI (t=4.286, p=0.029).BMI was higher than that in the low BMI group (X~2=8.296, p=0.004), which was lower than the high BMI group (X~2=37.277, p=0.000), and the incidence of giant infants in the high BMI group was higher than that of the low BMI group. =0.754), the incidence of low weight infants in high BMI group was lower than that in low BMI group (X~2=9.140, p=0.003), and the rate of NICU in BMI normal group was lower than that of low BMI group (X~2=4.193, p=0.041) and high BMI group (X~2=5.697,). There was no significant difference in the incidence of blood pressure disease (X~2=0.442, p=0.506). The incidence of hypertension in the increasing group of pregnancy was higher than that in the normal growth group (X~2=71.543, p=0.000) and the group (X~2=4.090, p=0.027). The incidence of gestational diabetes was lower than that of the normal group (X~2=8.802, p=0.003) and the increasing group (X~2=28.535, p=0.000). The incidence of multiple groups of gestational diabetes was higher than that in the normal group (X~2=102.065, p=0.000); there was no significant difference between the incidence of pregnancy cholestasis in the low growth group and the normal growth group (X~2=0.006, p=0.940) and the increasing group (X~2=0.048, p=0.826). There was no significant difference in the incidence of cholestasis of pregnancy with the normal group (X~2=0.514, p=). 0.473): the rate of premature rupture of membranes in the normal growth group was lower than that of the insufficient group (X~2=18.711, p=0.000) and the increasing group (X~2=13.997, p=0.000). There was no significant difference in the incidence of premature rupture of fetal membranes (X~2=2.465, p=0.116), and the incidence of placental abruption in the normal group was lower than that of the insufficient group (X~2=11.501, p=0.001) and growth in the normal group. There was no significant difference in the incidence of placental abruption in too many groups (X~2=6.909, p=0.009) (X~2=1.533, p=0.216), and the incidence of postpartum hemorrhage in the normal growth group was lower than that in the inadequate growth group (X~2=20.750, p=0.000), and the incidence of postpartum hemorrhage in the overgrowth group was higher than that in the inadequate growth group (X~2=6.710, p=0.010) and the normal growth group (X~2=11.8). 00, p=0.001); the incidence of puerperal infection in the normal growth group was lower than that in the low growth group (X~2=21.964, p=0.001) and the increasing group (X~2=21.964, p=0.001). There was no significant difference in the incidence of puerperal infection in the growth group and the overgrowth group (X~2=0.890, p=0.346). The rate of fetal distress in the growth normal group was lower than that of the inadequate growth group (X~2=124.859, p=0.000). There was no significant difference in the rate of fetal distress (X~2=1.835, p=0.176) in the overgrowth group (X~2=17.907, p=0.000), and the incidence of premature birth in the normal group was lower than that in the less growth group (X~2=10.994, p=0.001) and the increasing group (X~2=6.057, P =0.014), and there was no significant difference in the incidence of premature birth (X, P =0.014) (X, X). ~2=1.520, p=0.218); there was no significant difference between the normal growth group and the group (X~2=0.132, p=0.176) and the excessive growth group (X~2=0.073, p=0.787). There was no significant difference in the rate of caesarean section (X~2=0.021, p=0.555) in the normal growth group (X~2=0.021, p=0.555), and the higher rate of caesarean section in the growth group was higher than that of the inadequate growth group (X~2=6.710, p=0.010) and normal growth. Group (X~2=37.874, p=0.000); the neonatal Apgar score in the normal growth group was higher than that in the inadequate growth group (t=5.296, p=0.017) and the increasing group (t=6.545, p=0.010). There was no significant difference in the Apgarp score between the growth insufficiency group and the overgrowth group (t=0.217, p=0.658). The growth of the normal group was higher than that of the insufficient growth group (t=8.076, p=0.008), lower than the increase of excessive growth. Group (t=9.142, p=0.002); the growth of the normal group was higher than that of the undergrowth group (t=3.179, p=0.012), lower than the growth group (t=4.576, p=0.008); the growth rate in the normal group was higher than that in the undergrowth group (X~2=5.604, p=0.018), lower than the growth group (X~2=42.494, p=0.000), and the rate of growth in the normal group was too much in the increase group. There was no significant difference (X~2=0.024, p=0.877); lower than the lack of growth group (X~2=109.119, p=0.000). The rate of NICU in the normal growth group was lower than that of the inadequate growth group (X~2=23.925, p=0.000) and increased group (X~2=36.794, p=0.000). Conclusion: abnormal pregnant BMI and abnormal weight gain during pregnancy increase the risk of middle and late pregnancy complications in pregnant women, and affect the health of the fetus. The development of Kang is also one of the causes of bad pregnancy outcome, and affects the health of the newborns. It is necessary to control weight reasonably before pregnancy, scientific nutrition during pregnancy, carry out weight management during pregnancy, reduce the risk of pregnancy and improve the quality of pregnancy.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.7

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