孕前体质指数及孕期体重增长对妊娠过程及结局的影响

发布时间：2018-07-17 00:55

【摘要】：目的:探讨孕前体质指数(BMI)及孕期体重增长(GWG)与妊娠合并疾病及不良结局的关系。方法:回顾分析于复旦大学附属妇产科医院产科门诊定期产前检查并住院分娩的3541例足月单胎初产妇的临床资料。将产妇按孕前体质指数(BMI)和不同孕期体重增长(GWG)分组,采用logistic多因素回归分析孕前体质指数及孕期体重增长与妊娠合并疾病及结局的关系。结果:孕妇孕期体重平均增加(16.0±4.9)kg,新生儿平均出生体重(3341.6±425.9)g,低出生体重儿和巨大儿分别占2.1%及5.1%。根据IOM推荐孕期GWG分组,GWG过低、过高组孕妇与正常孕妇的巨大儿、剖宫产数、早产发生率比较,差异有统计学意义(P0.05)。孕前超重、肥胖能增加妊娠期糖尿病(OR=2.7,2.3)、妊娠期高血压疾病(OR=5.4,OR=7.7)、巨大儿(OR=1.6,OR=8.9)、剖宫产(OR=1.4,OR=1.7)的发生风险,而GWG过高增加剖宫产的发生风险(OR=1.5)。结论:孕前BMI不仅影响妊娠合并疾病的发生,也与妊娠结局密切相关。临床上应特别重视孕前宣教及体检,建议育龄期妇女达到合适的体质指数后怀孕。孕期过度体重增长增大了不良妊娠结局(巨大儿、剖宫产)的发生率,临床上可参照IOM推荐体重增长范围进行孕妇体重控制,加强孕期的健康教育和体重随访。同时建议利用大数据多方调研,得出适合中国各地区的孕期体重参考标准。
[Abstract]:Objective: to investigate the relationship between prepregnancy body mass index (BMI) and gestational weight gain (GWG). Methods: the clinical data of 3541 term singleton primipara were retrospectively analyzed in the obstetrical outpatient clinic of Fudan University affiliated Obstetrics and Gynecology Hospital. The pregnant women were divided into two groups according to their body mass index (BMI) and body weight gain (GWG) during pregnancy. The relationship between body mass index (BMI) and weight gain during pregnancy and the outcome of pregnancy were analyzed by logistic multivariate regression analysis. Results: the average weight of pregnant women increased (16.0 卤4.9) kg during pregnancy, and the average birth weight of newborns was (3341.6 卤425.9) g. Low birth weight infants and macrosomia infants accounted for 2.1% and 5.1%, respectively. According to IOM recommendation pregnancy GWG group GWG is too low, too high group of pregnant women and normal pregnant women's macrosomia, cesarean section number, preterm birth rate, the difference was statistically significant (P0.05). Overweight before pregnancy and obesity increased the risk of gestational diabetes mellitus (OR2. 7N), hypertensive disorder complicating pregnancy (OR5. 4), macrosomia (OR1. 6 + OR8. 9) and cesarean section (OR1. 4), while GWG increased the risk of cesarean section (OR1. 5). Conclusion: BMI before pregnancy not only affects the occurrence of pregnancy complicated diseases, but also is closely related to pregnancy outcome. In clinic, we should pay special attention to prepregnancy education and physical examination, and suggest that women of childbearing age should get pregnant after reaching a proper BMI. Excessive weight gain during pregnancy increases the incidence of adverse pregnancy outcomes (macrosomia, cesarean section). In clinical practice, maternal weight control can be carried out according to IOM's recommended range of weight growth, and health education and follow-up during pregnancy should be strengthened. At the same time, it is suggested that big data should be used to find out the reference standard of pregnancy weight for different regions of China.
【作者单位】：复旦大学附属妇产科医院;
【分类号】：R714

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