孕期增重与早产关联的流行病学分析

目的 探讨武汉市孕妇孕期体重变化对早产的影响。方法 选择2012-2014年就诊于武汉市定点妇女儿童保健医院的孕产妇为研究对象，采用回顾性流行病学分析，通过问卷调查、孕妇保健手册以及病历记录收集资料，采用logistic回归和限制性立方样条法分析孕期增重与早产之间的关系。结果 共调查11 323名孕妇，有效问卷11 020人（97.32%）。限制性立方样条模型显示，控制混杂因素后，孕期增重与早产的关联强度呈“U”形非线性剂量反应关系（非线性检验P<0.001）。logistic回归分析显示，与孕期增重适宜（孕期增重P₁₀～P₉₀）相比，孕期增重不足（孕期增重<P₁₀）、增重过多（孕期增重>P₉₀）均是早产的独立危险因素，其OR值（95%CI）分别为1.59（1.25～2.01）和1.46（1.13～1.88）。结论 孕期增重不足或增重过多增加早产发生的危险性，应重视孕期体重监测，降低早产的发生风险。

Association between gestational weight gain and preterm birth: a retrospective epidemiological analysis in Wuhan

Objective To understand the influence of gestational weight gain (GWG) on preterm birth in Wuhan. Methods The retrospective epidemiological study was conducted in Wuhan Medical and Health Center for Women and Children between 2012 and 2014. Women who went to this hospital for antenatal care or giving birth were selected. Information was collected by using questionnaires, health care manual and clinical records. We used restricted cubic spline and multivariate logistic regression analysis to study the relationship between GWG and preterm birth. Results A total of 11 323 pregnant women participated in the investigation with 11 020 (97.32%) of them eligible for our study. The results from the restricted cubic spline indicated that after adjusting for confounding factors, a U-curve was observed for GWG and preterm births (non-linearity test P<0.001). Multivariate logistic regression analysis also indicated that both inadequate GWG (weight gain<P₁₀) and excessive GWG (weight gain>P₉₀) were independent risk factors for preterm birth compared with normal GWG (weight gain P₁₀-P₉₀) with odds ratios of 1.59 (1.25-2.01) and 1.46 (1.13-1.88), respectively. Conclusions Inappropriate GWG was the risk factor for preterm birth. Weight monitoring should be strengthened for pregnant women to reduce risk of preterm birth.