孕中期能量失衡流行病学特征及对妊娠特有疾病的影响研究

发布时间：2018-04-19 15:12

  本文选题：能量平衡 + 能量摄入　； 参考：《华中科技大学》2014年博士论文

【摘要】：目的 本研究旨在调查了解兰州地区妊娠中期孕妇能量摄入、消耗及储存的流行特征,探究孕中期能量失衡及相关因素对妊娠期高血压综合征(PIH)、妊娠期糖尿病(GDM)、妊娠期胆汁淤积症(ICP)(统称妊娠特有疾病)发病的影响,为预防妊娠中期能量失衡和降低妊娠特有疾病发生提供科学参考依据,促进母婴健康协调发展。 方法 于2009年7月一2012年6月选取甘肃省妇幼保健院围产门诊接受产前检查的1668名妊娠中期(孕13-27周)孕妇为研究对象,运用动态观察队列研究方法开展流行病学调查,以孕妇一般情况调查问卷、半定量食物频率问卷、体力活动调查问卷为调查工具,通过孕期营养软件估算能量日均理论需要量(ER)、能量日均实际摄入量(EI),使用体力活动权重系数法估算能量日均实际消耗量(EE),运用生物电阻抗法测定受试者体成分以了解能量储存状况,综合评估孕妇妊娠中期能量平衡流行特征；追访妊娠结局,运用巢式病例对照研究方法(以年龄、妊娠能量测评时孕周作为匹配条件,1：2匹配),分别探讨妊娠中期能量摄入、消耗、储存及相关因素对PIH、GDM、ICP的影响,寻找独立危险因素。使用SPSS20.0进行统计分析,以P0.05判定为差异有统计学意义。 结果 1.观察队列妊娠中期能量平衡流行特征 兰州地区孕妇影响能量摄入的主要问题有：妊娠中期豆制品和水产品食用频率偏低；与中国居民膳食营养素参考摄入量相比,饮食日均摄入的叶酸和碘水平明显偏低,磷水平偏高,蛋白质供能比略高,碳水化合物供能比略低；影响能量消耗的主要问题有：孕中期活动水平普遍表现不足,25-29岁组日均EE最低(P0.05)。孕妇能量摄入、消耗及储存量均随妊娠进展不断增长,妊娠中期EIEREE (P0.05);高龄、基础体重过低或肥胖孕妇以及孕23-27周阶段更易发生能量失衡(P0.001)。 2.妊娠中期能量失衡等相关因素对PIH发病的影响 单因素分析结果显示,与对照组相比,PIH病例组家庭人均月收入高、孕妇妊娠早期被动吸烟率高、孕前BMI和妊娠中期BMI均高；妊娠中期维生素A水平、铁日均摄入水平相对较低而钠摄入水平相对较高；体脂百分比(PBF)、体脂重(FM)、去脂体重指数(FFMI)及EE均高,差异均有统计学意义(P0.05)。多因素条件Logistic回归分析结果表明,孕妇孕前BMI升高(OR=2.28,95%CI:1.31-3.95)孕早期被动吸烟率增加(OR=5.46,95%CI:1.06-28.17)及孕中期FM增高(OR=2.41,95%CI.1.36—4.28)是PIH发病的危险因素。 3.妊娠中期能量失衡等相关因素对GDM发病的影响 单因素分析结果显示,与对照组相比,GDM病例组孕妇孕前BMI和妊娠中期BMI较高,家庭人均月收入和孕妇文化程度较高,经产妇比例高而既往人工流产次数略低,妊娠中期出现睡眠问题者较多,中等强度体力活动水平较低,而蛋白质摄入量、蛋白质供能比、FM和EI均高,差异均有统计学意义(P0.05)。多因素条件Logistic回归分析结果表明,孕妇孕前BMI (OR=2.71,95%CI:1.71-4.02)、家庭人均月收入(OR=1.73,95%CI:1.36-2.74)、产次增加(OR=1.63,95%CI:1.26-2.44)以及孕期蛋白质能量摄入过多(OR=1.65,95%CI:1.01-2.72)、蛋白质供能比增加(OR=2.48,95%CI:1.70-6.34)、妊娠中期FM增高(OR=4.07,95%CI:2.86-10.88)是GDM发病的危险因素。 4.妊娠中期能量失衡等相关因素对ICP发病的影响 单因素分析结果显示,与对照组相比,ICP病例组经产妇比例高、既往多次自然流产和人工流产次数高；妊娠中期PBF和FM较高,脂肪供能百分比、碳水化合物供能百分比较高,而日均膳食纤维摄入和锌摄入水平较低,差异均有统计学意义(P0.05)。多因素条件Logistic回归分析结果表明,孕妇既往自然流产次数多(OR=3.56,95%CI：1.75—8.45)和妊娠中期FM增高(OR=3.09,95%CI:1.22-7.78)是ICP发病的危险因素。 5.妊娠中期能量失衡对PIH、GDM、ICP发病的影响 妊娠中期短期的能量失衡对PIH, GDM. ICP发病无影响(P0.05),长期过度的能量正平衡状态会导致体内脂肪蓄积过度,当体脂重指数(FMI)≥7.1kg/m2(Median)时,PIH发病危险度增加2.65倍,GDM发病危险度增加5.16倍。当FMI≥8.6kg/m2时(P75值),PIH发病危险度增加4.38倍,GDM发病危险度增加15.38倍,ICP发病危险度增加1.84倍。 结论 1兰州地区孕妇豆制品和海产品食用频率低,孕中期应额外适度补充叶酸、碘、钙和锌等营养补充剂；重点加强高龄和孕23-27周孕妇的能量摄入及消耗指导,提倡孕期适度加强体力活动以维持良好的能量平衡状态。 2维持适宜的孕前BMI水平、妊娠早期降低被动吸烟环境暴露及防止妊娠中期脂肪堆积过快可降低PIH的发病风险。维持适宜的孕前BMI水平、减少生育次数、适度控制蛋白质摄入及防止妊娠中期脂肪堆积过快可降低GDM的发病风险。减少既往自然流产次数和防止妊娠中期脂肪堆积过快可降低ICP的发病风险。 3FMI升高是PIH、GDM及ICP发病的独立危险因素,体内脂肪组织增多对GDM发病的影响最大,控制体内脂肪过度增长是降低妊娠特有疾病发病率的关键。
[Abstract]:Purpose

The purpose of this study was to investigate the prevalence of energy intake , consumption and storage of pregnant women in the mid - trimester of pregnancy , to explore the effects of energy imbalance and related factors on the pathogenesis of pregnancy induced hypertension syndrome ( PIH ) , gestational diabetes mellitus ( dm ) , pregnancy - induced stasis ( ICP ) ( collectively referred to as pregnancy - specific diseases ) , to provide scientific reference for the prevention of mid - term energy imbalance in pregnancy and to reduce the occurrence of pregnancy - specific diseases , and to promote the healthy and coordinated development of mother - to - child health .

method

In July , 2012 , 1668 pregnant women ( 13 - 27 weeks ) who received prenatal examination were selected from the perinatal clinics of maternal and child health care centers in Gansu Province . The epidemiological investigation was carried out by using the dynamic observation cohort study . The energy daily average theoretical requirement ( ER ) , energy daily average intake ( EI ) were estimated by means of the maternal nutrition software , the energy daily average consumption ( EE ) was estimated by using the physical activity weight coefficient method , and the body composition of the subject was determined by using the bioresistance method to understand the energy storage condition , and the epidemic characteristics of the mid - term energy balance of the pregnant women were comprehensively evaluated ;
The effects of energy intake , consumption , storage and related factors on PIH , gdm and ICP in the medium term of pregnancy were investigated by using the nested case control method ( matched condition , 1 : 2 matching condition at the time of pregnancy and energy measurement ) , and the effects of energy intake , consumption , storage and related factors on PIH , gdm and ICP were studied respectively . The statistical analysis was made by SPSS 20.0 , and the difference was statistically significant .

Results

1 . Observation of the Epidemic Characteristics of Mid - term Energy Balance in Cohort Pregnancy

The main problems affecting energy intake in pregnant women in Lanzhou area are : low consumption of soybean products and aquatic products during pregnancy ;
Compared with the reference intake of dietary nutrients of Chinese residents , the dietary intake of folic acid and iodine was significantly lower , the phosphorus level was higher , the protein supply ratio was slightly higher , and the carbohydrate supply ratio was slightly lower ;
The main problems affecting energy consumption were : the level of middle - term activity of pregnant women was not enough , the average EE was lowest in 25 - 29 years ( P0.05 ) . The energy intake , consumption and storage of pregnant women all increased with the progress of pregnancy , EIEREE in the middle of pregnancy ( P0.05 ) , advanced age , low basal body weight or obese pregnant women and 23 - 27 weeks of pregnancy were more vulnerable to energy imbalance ( P0.001 ) .

2 . Effects of related factors on the pathogenesis of PIH during the mid - term energy imbalance of pregnancy

The results of single factor analysis showed that the average monthly income per person in PIH group was higher than that of the control group , the passive smoking rate was higher in the early stage of pregnancy , the BMI at the early stage of pregnancy and the mid - term BMI were higher in PIH group .
The levels of vitamin A and iron daily average intake were relatively low and the level of sodium intake was relatively high in the middle period of pregnancy .
( OR = 2.28 , 95 % CI : 1.31 - 3.95 ) , the passive smoking rate increased ( OR = 5.46 , 95 % CI : 1.06 - 28.17 ) and the mid - trimester FM ( OR = 2.41 , 95 % CI . 1.36 - 4.28 ) were the risk factors of PIH .

3 . Effects of related factors , such as the mid - term energy imbalance of pregnancy , on the onset of gdm

The results of single - factor analysis showed that the BMI and mid - term BMI of pregnant women were higher than those in the control group . The average monthly income of the family and the culture of the pregnant women were higher , the average monthly income of the family ( OR = 1 . 73 , 95 % CI : 1.36 - 2.74 ) , the increase of the protein supply ratio ( OR = 1 . 63 , 95 % CI : 1 . 70 - 6.34 ) , the increase of the mid - term FM ( OR = 4.07 , 95 % CI : 2.86 - 10.88 ) was a risk factor for the onset of gdm .

4 . Influence of factors related to the mid - term energy imbalance of pregnancy on the pathogenesis of ICP

The results of single factor analysis showed that compared with the control group , the proportion of women in ICP group was higher than that of control group , and the number of recurrent spontaneous abortion and induced abortion was high ;
There were significant differences in dietary fiber intake and zinc intake in pregnant women ( OR = 3.56 , 95 % CI : 1.75 - 8.45 ) and mid - pregnancy FM ( OR = 3.09 , 95 % CI : 1.22 - 7.78 ) , which were the risk factors of ICP .

5 . Effect of Mid - term energy imbalance on the pathogenesis of PIH , gdm and ICP

Short - term and short - term energy imbalance in pregnancy is associated with PIH and gdm . When FMI was 鈮，

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