孕前体质量指数及孕期增重对妊娠结局的影响

目的探讨孕妇孕前体质量指数(BMI)、孕期增重对孕妇妊娠结局的影响。方法选取本院1427例孕妇的临床资料进行回顾性分析。根据孕前BMI情况,将孕妇分为消瘦组(BMI<18.5 kg/m 2)、正常组(BMI 18.5 kg/m 2~<25.0 kg/m 2)、超重、肥胖组(BMI≥25.0 kg/m 2)。根据2009年美国医学研究院推荐的孕期增重标准将孕妇分为增重不足组、增重正常组、增重过多组。比较不同组别的妊娠结局,并观察调整孕期增重范围后对不良妊娠结局的影响。结果超重、肥胖组妊娠期高血压疾病、妊娠期糖尿病、产后出血、巨大儿、低出生体质量儿、早产及剖宫产不良妊娠结局的发生率较高,其中3组妊娠期高血压疾病、妊娠期糖尿病、产后出血及剖宫产不良妊娠结局的发生率比较,差异有统计学意义(P<0.05);增重过多组妊娠期高血压疾病、产后出血、巨大儿及剖宫产不良妊娠结局发生率较高,其中3组妊娠期高血压疾病、产后出血及巨大儿不良妊娠结局发生率比较,差异有统计学意义(P<0.05)。孕前超重、肥胖预测早产的受试者工作曲线(ROC)下面积为0.712,预测效果尚可,差异有统计学意义(P<0.05);孕期增重过度预测巨大儿的ROC曲线下面积为0.684,预测效果尚可,差异有统计学意义(P<0.05)。BMI正常范围孕期增重值调整为10.5~15.0 kg时,增重正常组妊娠期糖尿病、贫血、产后出血和巨大儿不良妊娠结局发生率明显下降。结论孕前BMI超重和孕期体质量增长异常均会增高不良妊娠结局风险,孕前BMI及孕期增重可预测孕妇不良妊娠结局。

Impact of body mass index before pregnancy and weight gain during pregnancy on pregnancy outcomes

Objective To explore the effects of pre-pregnancy body mass index(BMI)and excessive gestational weight gain on pregnancy outcomes of pregnant women.Methods The clinical data of 1427 pregnant women was retrospectively analyzed.According to the BMI before pregnancy,these pregnant women were divided into thin group(BMI<18.5 kg/m 2),normal group(BMI 18.5 kg/m 2~<25.0 kg/m 2),overweight group and obese group(BMI≥25.0 kg/m 2).According to the weight gain criteria recommended by the Institute of Medicine in 2009,the pregnant women were divided into insufficient weight gain group,normal weight gain group,and excessive weight gain group.Pregnancy outcomes of different groups were compared,and the effect of adjusted pregnancy weight gain on adverse pregnancy outcomes was observed.Results The incidence rates of adverse pregnancy outcomes such as hypertensive disorder complicating pregnancy,gestational diabetes,postpartum hemorrhage,fetal macrosomia,low birth weight,premature delivery and cesarean section in the overweight and obese group were higher.Among them,the incidence of adverse pregnancy outcomes such as hypertensive disorder complicating pregnancy,gestational diabetes,postpartum hemorrhage and cesarean section showed statistically significant differences(P<0.05).In the excessive gestational weight gain group,incidence rates of hypertensive disorder complicating pregnancy,postpartum hemorrhage,fetal macrosomia and cesarean section were higher.Among them,adverse pregnancy outcomes including hypertensive disorder complicating pregnancy,postpartum hemorrhage and fetal macrosomia showed significant differences(P<0.05).Area under receiver operating curve(ROC)by pre-pregnancy overweight and obesity predicting premature birth was 0.712,and was 0.684 by excessive gestational weight gain predicting fetal macrosomia,and the prediction effects were both acceptable(P<0.05).The incidence of gestational diabetes mellitus,anemia,postpartum hemorrhage and adverse pregnancy outcomes in macrosomia were significantly decreased in the normal weight gain group when the weight gain value was adjusted to 10.5~15.0 kg.Conclusion Overweight BMI before pregnancy and abnormal body mass gain during pregnancy both increase the risk of adverse pregnancy outcomes,and BMI before pregnancy and weight gain during pregnancy can predict adverse pregnancy outcomes.