孕妇肥胖和血脂水平对新生儿出生结局的影响

发布时间：2019-03-02 10:34

【摘要】：目的探讨不同孕前体质指数(body mass index, BMI)和孕期增重对母亲血脂水平的影响，以及不同血脂水平对胎儿发育的影响，为合理控制孕期饮食、降低异常出生体重儿的发生率提供依据。方法流行病学队列研究方法：选择在2011年1月~2012年7月在合肥市某妇幼保健院住院分娩的孕妇及其新生儿作为研究对象。利用回顾性调查的方式获取整个孕期详尽的保健记录，前瞻性追踪新生儿出生结局资料。资料信息用Epidata3.0软件录入，，数据分析采用SPSS16.0进行。连续性资料描述用(x±s)表示，分类资料用相对数表示。两组间均数比较采用t检验，多组间均数比较采用单因素方差分析或协方差分析，频数分布比较采用χ2检验；多元线性回归分析血脂水平与新生儿发育指标的关系，并调整孕妇年龄、孕前BMI、孕期增重、孕周等混杂因素，二分类logistic回归分析血脂水平与巨大儿发生率的关联，并调整孕妇年龄、孕前BMI、孕期增重、孕周等一系列混杂因素。结果孕妇肥胖、孕期血脂水平及其他母体因素均不同程度地对新生儿出生结局产生影响：(1)孕前超重肥胖组的孕妇分娩的新生儿出生体重、身长、头围、胸围高于孕前正常体重组和消瘦组(P0.05)。(2)孕期增重过多组的孕妇分娩的新生儿出生体重、身长、头围、胸围各项指标高于孕期增重正常组和增重不足组，差异均具有统计学意义（均P0.01）。(3)与孕前体重正常且孕期增重正常组的孕妇相比，孕前体重正常且孕期增重过多组的孕妇和孕前超重肥胖且孕期增重过多组的孕妇分娩的新生儿出生体重、身长、头围、胸围均较大(P0.05)，孕前消瘦且孕期增重过少组的孕妇分娩的新生儿出生体重较轻(P0.05)，身长较短(P0.01)。调整孕周、孕妇年龄和产次等混杂因素后，结果不变。(4)与孕前体重正常且孕期增重正常的孕妇相比，孕前消瘦且孕期增重过少的孕妇剖腹产发生率较低，孕前超重肥胖且孕期增重正常或过多的孕妇剖腹产发生率较高(P0.05)。(5)孕前消瘦组、正常体重组和超重肥胖组的孕妇相比，总胆固醇(total cholesterol,TC)，高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)，低密度脂蛋白胆固醇(low-density liprotern cholesterol,LDL-C)差异有统计学意义(P0.01)。孕前超重肥胖组的TC、HDL-C、LDL-C均低于孕前消瘦组和正常体重组(P0.05)。(6)孕期增重过多、正常和不足的三组孕妇甘油三酯(triglyceride, TG)、HDL-C水平差异有统计学意义。增重过多组TG水平高于增重不足组(P0.05)，HDL-C水平比孕期增重正常组低(P0.05)。(7)与正常待产组孕妇相比，妊娠期糖尿病组的TG水平明显升高，妊娠高血压综合征组的孕妇TG水平升高，HDL-C水平降低(P0.05)。(8)孕晚期TG与新生儿出生体重正相关(P0.05)，HDL-C与新生儿出生体重、身长、头围、胸围负相关(P0.05)。(9)单因素logistic回归分析TG与巨大儿发生率呈正相关，HDL-C与巨大儿发生率呈负相关。多因素logistic回归分析调整孕妇年龄、孕前BMI等一系列混杂因素后，孕妇的HDL-C仍然是巨大儿发生的保护因素。结论孕前BMI、孕期增重、产前BMI、孕晚期空腹血脂水平及其他社会学特征均对新生儿的发育指标、巨大儿发生率、分娩方式等产生影响。孕前高BMI、孕期增重过多、产前高BMI、孕晚期高水平空腹血脂会提高新生儿出生体重、身长、头围、胸围值，增大巨大儿发生率和剖腹产率；不同孕前体重、孕期增重以及是否患有妊娠期糖尿病、妊娠期高血压综合征的孕妇其血脂水平的分布不同。孕晚期TG、HDL-C与新生儿发育有关，TG增加巨大儿发生风险，HDL-C降低巨大儿发生风险。
[Abstract]:Objective To study the effect of body mass index (BMI) and weight gain on the blood lipid level of the mother and the effect of different blood lipid levels on the development of the fetus, and to provide the basis for the rational control of the pregnant diet and reducing the incidence of abnormal birth weight. Methods: The method of epidemiological cohort study was to select pregnant women and their newborns who were hospitalized in a maternity and child care hospital in Hefei from January 2011 to July 2012 as the research group. For example, a retrospective survey was used to obtain a thorough health-care record throughout pregnancy, looking forward to follow-up of neonatal birth outcomes Material: The data information is entered by the Epidata3.0 software, and the data analysis adopts SPSS16.0. lines. Continuity data description (x {s)} means the phase-to-number table for categorical data The results showed that the average number of the two groups was t-test, and the average number of the two groups was compared with the one-factor analysis of variance or the covariance analysis. The frequency distribution was compared with the two-factor analysis. The relationship between the blood lipid level and the development index of the newborn was analyzed by the multiple linear regression, and the age of the pregnant women, the pre-pregnancy BMI and the pregnancy increase were adjusted. The association between the level of blood lipid and the incidence of macrosomia was analyzed by the two-classification logistic regression, and a series of confounders such as the age of the pregnant women, the pre-pregnancy BMI, the weight gain of the pregnant women and the gestational weeks were adjusted. Results: (1) The birth weight, length, head circumference and chest circumference of the pregnant women in the pre-pregnancy and overweight obese group were higher than that of the normal body and the wasting group (P0. (2) The weight of birth weight, body length, head circumference and chest circumference of the pregnant women who had weight gain during pregnancy were higher than those in the normal group and the weight gain group, and the difference was of statistical significance (mean P0. 01). (3) Compared with the pregnant women with normal body weight and normal weight gain during pregnancy, the weight of the pregnant women with normal body weight and the weight gain of the pregnant women in the first trimester of pregnancy and the weight gain of the pregnant women who are overweight and obese during pregnancy and the weight gain of the pregnant women in the first trimester of pregnancy are larger than that of the pregnant women who have been given birth, and the body length, the head circumference and the chest circumference are larger (P0. (05) The weight of birth weight of pregnant women who were emaciated before and during pregnancy (P0.05), and the length of body was shorter (P 0.05). 01). After adjustment of the confounding factors such as gestational weeks, pregnant women's age and birth, the knot (4) The incidence of caesarean section of pregnant women with less weight and weight gain before and during pregnancy is lower than that of pregnant women with normal weight and normal weight gain before and during pregnancy, and the incidence of caesarean section in pregnant women who is overweight and obese before pregnancy is higher than that of pregnant women with normal weight gain during pregnancy (P0. (5) The difference of total cholesterol (total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) was statistically significant (P 01) The TC, HDL-C and LDL-C of the overweight and obese group were lower than that of the pre-pregnant and normal body (P0. (6) There was a statistically significant difference in the levels of triglyceride (TG) and HDL-C in three groups of pregnant women with excessive weight gain, normal and insufficient weight gain during pregnancy. The weight gain of the group was higher than that in the underweight group (P0.05), and the level of HDL-C was lower than that of the normal weight gain group (P 0.05). (7) The level of TG in the gestational diabetes group was significantly higher than that of the pregnant women in the normal group, and the level of TG of the pregnant women in the pregnancy-induced hypertension group was increased, and the level of HDL-C decreased (P0. (8) The TG in the late pregnancy was positively correlated with the birth weight of the newborn (P0.05), and the HDL-C was negatively correlated with the birth weight of the newborn, the length of the body, the head circumference and the chest circumference (P0. (9) The single-factor logistic regression analysis showed that the incidence of TG was positively correlated with the incidence of macrosomia, and the incidence of HDL-C and macrosomia was in the same way. There was a negative correlation. After a series of confounding factors such as the age of the pregnant woman and the pre-pregnancy BMI were adjusted by the multi-factor logistic regression analysis, the HDL-C of the pregnant women was still the protection of the large infant. Nursing factors. Conclusion The pre-pregnancy BMI, the weight gain of pregnancy, the pre-natal BMI, the level of fasting blood lipid in the late pregnancy and other social characteristics all affect the development index of the newborn, the incidence of the great child and the mode of delivery. The pregestational high BMI, the excessive weight gain, the pre-natal high BMI, the high-level fasting blood fat in the late pregnancy can increase the birth weight of the newborn, the length of the body, the head circumference, the chest circumference value, the increase of the incidence of the large infant and the rate of the caesarean section, the weight of the pre-pregnancy weight, the weight gain during the pregnancy, and whether or not it has the weight of the fetus. The level of blood lipid in pregnant women with stage 2 diabetes and pregnancy-induced hypertension The distribution of TG and HDL-C in the late pregnancy is related to the development of the newborn.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R153.1

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