妊娠合并症及不良妊娠结局与孕前体重及孕期体重增长的关系

  目的  探讨孕前体重及孕期体重增长对妊娠合并症及不良妊娠结局的影响及关系，为孕期保健及降低孕期并发症、改善母婴结局提供依据。  方法  收集2020年1月至2022年1月期间在西双版纳傣族自治州人民医院住院分娩的合并妊娠期糖尿病（gestational diabetes mellitus，GDM）、高血压等疾病及分娩巨大儿的单胎活产产妇603例，根据孕前体重指数（body mass index，BMI）及孕期体重增加（gestational weight gain，GWG）标准分别分为低体重组31例、正常体重组365例、超重组146例、肥胖组61例及体重增加不足组163例、体重增加正常组230例和体重增加过多组210例，对各组孕期并发症及不良妊娠结局，如剖宫产率、肩难产、巨大儿出生率、低出生体重儿、入住NICU率等进行对比分析。  结果  孕前肥胖是子痫前期影响因素；不同孕前BMI孕妇的子痫前期、剖宫产、早产、低出生体重儿及转NICU的发生率随着孕前BMI的递增依次升高，差异有统计学意义（P < 0.05）；孕期体重增长各组的巨大儿、肩难产、子痫前期及剖宫产的发生率随着GWG的升高依次增加，差异有统计学意义（P < 0.05）。  结论  孕前BMI过高及孕期体重增加过度均会增加妊娠期并发症的发生，并导致不良妊娠结局发生率的升高。医院及社会应进一步加强孕妇孕期体重管理和教育，对孕期体重进行全程干预，以减少妊娠合并症及不良妊娠结局的发生。

The Relationship between Pregnancy Complications and Adverse Pregnancy Outcomes and Pre-pregnancy Weight and Weight Gain during Pregnancy

  Objective  To explore the influence and relationship of prepregnancy weight and pregnancy weight gain on pregnancy complications and adverse pregnancy outcomes, and to provide the evidence for the pregnancy health care, reducing pregnancy complications and improving maternal and infant outcomes.   Methods  According to the retrospective study method, 603 singleton live pregnancies who were hospitalized and delivered in People’s Hospital of Xishuangbanna Dai Autonomous Prefecture with gestational diabetes mellitus （GDM）, hypertension and other diseases and fetal macrosomia during January 2020 to January 2022 were collected. According to the prepregnancy body mass index （BMI） and gestational weight gain （GWG） criteria, they were divided into the low weight group （n = 31）, normal weight group （n = 365）, super weight group （n = 146）, obesity group （n = 61）, underweight gain group （n = 163）, normal weight gain group （n = 230） and excessive weight gain group （n = 210）: The pregnancy complications and adverse pregnancy outcomes, such as cesarean section rate, shoulder dystocia, birth rate of macrosomia, low birth weight infants, and admission rate to NICU were compared and analyzed.  Results  Prepregnancy maternal obesity was the influencing factor of preeclampsia. The incidence of preeclampsia, cesarean section, preterm delivery, low birth weight and NICU transfer increased with the increase of BMI before the pregnancy, and the difference was statistically significant （P < 0.05）. The incidence of macrosomia, shoulder dystocia, preeclampsia and cesarean section increased with the increase of GWG, and the difference was statistically significant （P < 0.05）.   Conclusion  High BMI before the pregnancy and excessive weight gain during the pregnancy can increase the incidence of pregnancy complications and lead to the increase in the incidence of adverse pregnancy outcomes. We should further strengthen the management and education of pregnant women’s weight during the pregnancy, and carry out whole-process intervention on weight during the pregnancy.