农村妇女孕期肥胖对妊娠结局的影响

发布时间：2019-05-22 13:03

【摘要】：目的:调查禹城市人民医院产一科住院分娩的农村妇女孕期肥胖情况,分析其对母婴结局的影响,探讨孕期管理体重的方法以降低不良妊娠结局,保障母儿安全。方法:本研究采用回顾性队列研究,于孕妇住院期间,通过查阅孕期保健手册和住院病历以及与孕妇会谈的方式获得相关信息,如孕妇年龄、身高、孕前体重、分娩前体重及母婴结局等,由经过培训的调查员填写本研究专用的《农村孕妇妊娠、分娩情况调查表》,收集资料完整的单胎妊娠农村初产妇896例。根据孕前BMI将孕妇分为孕前消瘦组(BMI18.5kg/m2;n=62)、孕前体重正常组(18.5 kg/m2≤BMI24 kg/m2;n=601)、孕前超重组(24 kg/m2≤BMI28 kg/m2;n=176)、孕前肥胖组(BMI≥28kg/mm2;n=57)。按孕期总增重15kg,孕期BMI增幅≥6为孕期体重增加过度为切点将孕妇分为孕期体重增加适宜组及孕期体重增长过度组。比较分析各组孕妇孕期肥胖情况对母婴结局的影响。所有数据均利用SPSS19.0统计学软件进行分析和处理。结果:1.对母体的影响:孕前超重+肥胖组与孕前体重正常组相比,孕期体重增长过度组与孕期体重增加适宜组相比,其妊娠期高血压疾病、妊娠期糖尿病、剖宫产、产后出血的发生率均明显增加。在妊娠期高血压疾病的发生率上,孕前超重+肥胖组是孕前正常体重组的5.956倍(0R,5.956;95%%CI,3.474-10.213),孕期体重增长过度组是孕期体重增加适宜组的2.777倍(OR,2.777;95%CI,1.558-4.950);在妊娠期糖尿病的发生率上,孕前超重+肥胖组是孕前正常体重组的4.212倍(0R,4.212;95%CI,2.547-6.964),孕期体重增长过度组是孕期体重增加适宜组的3.084倍(0R,3.084;95%CI,1.741-5.466);在剖宫产的发生率上,孕前超重+肥胖组是孕前正常体重组的2.871倍(0R,2.871;95%CI,2.103-3.919),孕期体重增长过度组是孕期体重增加适宜组的3.317倍(OR,3.317;95%CI,2.470-4.456);在产后出血的发生率上,孕前超重+肥胖组是孕前正常体重组的5.234倍(0R,5.234;95%CI,2.919-9.385),孕期体重增长过度组是孕期体重增加适宜组的2.914倍(0R,2.914;95%CI,1.580-5.374)。经卡方检验,差异显著,均有统计学意义(P0.01)。2.对胎儿的影响:孕前超重+肥胖组与孕前体重正常组相比,孕期体重增长过度组与孕期体重增加适宜组相比,其巨大儿发生率明显增加,孕前超重+肥胖组是孕前正常体重组的9.454倍(0R,9.454;95%CI,6.342-14.093),孕期体重增长过度组是孕期体重增加适宜组的5.108倍(0R,5.108;95%CI,3.248-8.034),经卡方检验,差异显著,有统计学意义(P0.01);孕前肥胖者新生儿窒息的发生率是孕前体重正常的0.790倍(0R,0.790;95%CI,0.255-2.448),经卡方检验无统计学意义(X2=0.168,P0.05),孕期体重增加过度者新生儿窒息的发生率是孕期体重增加适宜的1.755倍(0R,1.755;95%CI,0.750-4.110),经卡方检验无统计学意义(X2=1.721,P0,05)。3.孕前超重及肥胖组中,孕期体重增长过度发生妊娠期高血压、妊娠期糖尿病、剖宫产、产后出血、巨大儿的风险分别是孕期体重增长适宜的1.24倍(95%CI,1.113-1.388)、1.14倍(95%CI,1.023-1.280)、1.37倍(95%CI,1.029-1.833)、1.13倍(95%CI,1.019-1.243)、2.05倍(95%CI,1.653-2.545),经检验有统计学意义。4.孕前超重+肥胖组与孕前体重正常组相比,孕期体重增长过度组与孕期体重增长适宜组相比,因巨大儿行剖宫产的风险均增加,经卡方检验,有统计学意义(P0.01;P0.05);因难产行剖宫产的风险均降低,经卡方检验,差异显著,有统计学意义(P0.01);而因妊娠期高血压疾病、胎儿窘迫、胎位不正行剖宫产的风险两组差异均无统计学意义(P0.05)。结论:孕前肥胖与孕期体重增长过度增加了妊娠期高血压疾病、妊娠期糖尿病、剖宫产、产后出血、巨大儿的发生率,是导致农村孕妇不良妊娠结局的危险因素。为了母婴健康,应加强农村肥胖孕妇的体重管理,包括孕前及孕期体重增长,将体重控制在适宜标准范围内,以降低妊娠不良结局的发生。
[Abstract]:Objective: To investigate the situation of the obesity of rural women who have been hospitalized in the hospital of Yucheng People's Hospital and to analyze their influence on the outcome of mother-to-child and to explore the methods of the management of body weight during pregnancy to reduce the outcome of the poor pregnancy and to guarantee the safety of the mother and child. Methods: The retrospective cohort study was used in this study to obtain relevant information, such as the age, height, weight of the pregnant woman, the weight before delivery and the outcome of the mother and child, during the period of the pregnant woman's stay in the hospital. The survey of pregnant and delivery of pregnant women in rural pregnant women, which was dedicated to the study, was completed by trained investigators, and 896 cases of single-pregnancy rural women with complete information were collected. The pregnant women were divided into the pregestational age group (BMI18.5 kg/ m2; n = 62) according to the pre-pregnancy BMI; the normal weight of the pregestational weight (18.5 kg/ m2; BMI24 kg/ m2; n = 601); the pre-pregnancy super-recombinant (24 kg/ m2; BMI28 kg/ m2; n = 176); and the pregestational obesity group (BMI = 28 kg/ mm2; n = 57). According to the total weight gain of 15 kg during pregnancy and the increase of BMI in pregnant period, the pregnant women were divided into the appropriate group of weight gain during pregnancy and the weight gain of the pregnant women during pregnancy. The effect of the weight of the pregnant women on the mother-to-child outcome was compared and analyzed. All data were analyzed and processed using the SPSS19.0 statistical software. Results:1. The influence of the maternal body: the pre-pregnancy overweight + obese group and the pre-pregnant body weight normal group, the weight gain of the pregnant women increased over the pre-pregnancy weight gain group, the pregnancy-induced hypertension disease, the gestational diabetes, the cesarean section and the post-partum hemorrhage increased significantly compared with the suitable group in the pre-pregnancy weight gain group. The pre-pregnancy overweight + obesity group was 5.956 times (0R, 5.956;95% CI, 3.474-10.213) of the pre-pregnancy normal body, and the weight gain during pregnancy was 2.777-fold (OR, 2.777;95% CI, 1.558-4.950) in the appropriate group during pregnancy, and the rate of gestational diabetes, The pre-pregnancy overweight + obesity group was 4.212-fold (0R, 4.212;95% CI, 2.547-6.964) of the normal body of pre-pregnancy, and the weight-increasing group during pregnancy was 3.084-fold (0R, 3.084;95% CI, 1.741-5.466) in the appropriate group during pregnancy; at the rate of cesarean section, The pre-pregnancy overweight + obesity group was 2.871-fold (0R, 2.871;95% CI, 2.103-3.919) of the normal body of pre-pregnancy, and the weight-increasing group during pregnancy was 3.317-fold (OR, 3.317;95% CI, 2.470-4.456) in the appropriate group during pregnancy, and in the incidence of postpartum hemorrhage, The pre-pregnancy overweight + obesity group was 5.234-fold (0R, 5.234;95% CI, 2.919-9.385) of the pre-pregnancy normal body, and the weight gain during pregnancy was 2.914-fold (0R, 2.914;95% CI, 1.580-5.374) in the appropriate group during pregnancy. The difference was significant in Chi-square test (P0.01). The effect on the fetus: compared with the normal group in the pre-pregnant and overweight + obese group, the high incidence of the large infant in the pre-pregnant and overweight + obese group was 9.454-fold (0R, 9.454;95% CI, 6.342-14.093) of the pre-pregnancy normal body. The weight gain during pregnancy was 5.108-fold (0R, 5.108;95% CI, 3.248-8.034) in the appropriate group during pregnancy, and the difference was significant in the chi-square test (P0.01); the incidence of neonatal asphyxia in the pregestational obesity was 0.790-fold (0R, 0.790;95% CI, 0.255-2.448) of the pre-pregnancy weight. No statistical significance was found in the chi-square test (X2 = 0.168, P0.05). The incidence of neonatal asphyxia was 1.755 times (0R, 1.755;95% CI, 0.750-4.110) of weight gain during pregnancy, and no statistical significance was found in the chi-square test (X2 = 1.721, P0.05). The risk of over-pregnancy, gestational diabetes, cesarean section, and post-partum hemorrhage during pregnancy was 1.24-fold (95% CI, 1.113-1.388), 1.14-fold (95% CI, 1.023-1.280), 1.37-fold (95% CI, 1.029-1.833), 1.13-fold (95% CI, 1.019-1.243), 2.05 times (95% CI, 1.653-2.545), with statistical significance. In the pre-pregnant and overweight + obese group, compared with the normal group in the pre-pregnant weight group, the weight gain in the pregnant period increased with the appropriate group in the pre-pregnancy weight-increasing group, and the risk of the caesarean section in the large-child line increased, and the result of the chi-square test is statistically significant (P0.01; P0.05); and the risk of the cesarean section is reduced due to the difficult production line, The difference between the two groups was significant (P0.01), and there was no significant difference between the two groups (P0.05). Conclusion: The pre-pregnancy obesity and the increase of the weight of the pregnant women have increased the pregnancy-induced hypertension, the gestational diabetes, the cesarean section, the post-partum hemorrhage, the incidence of the great child, which is the risk factor leading to the poor pregnancy outcome of the pregnant women in the rural areas. In order to mother and child health, the weight management of pregnant women in rural areas should be strengthened, including pre-pregnancy and body weight increase, and the body weight should be controlled within a suitable standard to reduce the occurrence of poor pregnancy outcomes.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714

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