妊娠20周前体重增长与妊娠期高血压关系的研究

目的：探讨妊娠20周前的体重增长与妊娠期高血压发生风险的关系。方法对自2013年1月至2013年4月在北京妇产医院进行常规产前检查并在本院分娩的1263例孕妇进行前瞻性巢式病例对照研究，病例组为发生妊娠期高血压的孕妇，对照组为血压正常的孕妇。收集年龄、身高、孕前体重、分娩前体重、妊娠期体重记录、高血压家族史、孕次、产次等资料，统计学方法采用t检验、χ2检验及多因素logistic回归分析。结果病例组的孕期总增重（17．94．5kg）高于对照组（16．44．4kg），t＝2．54，P＝0．01；病例组的妊娠20周前体重增长（6．12．8 kg）也高于对照组（5．03．1kg），t＝2．72， P＝0．01。按孕前体质量指数（BMI）分组后，对于BMI＜24 kg／m2的孕妇，病例组的孕期总增重和妊娠20周前的体重增长仍明显高于对照组（P＜0．05）；对于BMI≥24 kg／m2的孕妇，病例组的孕期总增重明显高于对照组（P＜0．05），而妊娠20周前的体重增长与对照组相比虽然有增高趋势，但差异无统计学意义（P＞0．05）。控制年龄、孕前BMI、孕次、产次、高血压家族史、测量体重时的孕周等混杂因素后，妊娠20周前的体重增长每增加1kg，发生妊娠期高血压的风险增加12．5％（95％可信区间为1．038～1．220，P＝0．004）。结论妊娠20周前的体重增长是妊娠期高血压的危险因素，控制妊娠20周前的体重增长对于预防妊娠期高血压可能具有重要意义，尤其是对于孕前BMI＜24 kg／m2的孕妇。

Association of gestational weight gain up to 20 weeks with gestational hypertension

Objective To evaluate the association of gestational weight gain up to 20 weeks with the risk of gestational hypertension. Methods A prospectively nested case-control study was conducted on 1 263 pregnant women taking routine prenatal examination during January to April in 2013 and delivering in Beijing Obstetrics and Gynecology Hospital.Pregnant women with gestational hypertension were enrolled in case group, and those with normal blood pressure were included in control group.Data including age, height, pre-pregnancy weight, weight before delivery, weight during pregnancy, family history of hypertension, gravidity and parity were recorded.Statistical analysis was conducted with t test, Chi-square test and multivariate Logistic regression analysis.Results Women in the case group had greater total gestational weight gain and weight gain up to 20 weeks compared to those in the control group (17.9 ±4.5kg vs 16.4 ±4.4kg, 6.1 ±2.8 kg vs 5.0 ±3.1kg) (t value was 2.54 and 2.72, respectively, both P=0.01).For women with BMI<24 kg/m2, both total weight gain and weight gain up to 20 weeks were still significantly more in the case group than in the control group (P<0.05).For women with BMI≥24 kg/m2, the total weight gain in the case group was significantly more than in the control group (P<0.05), but there was no significant difference in weight gain up to 20 weeks between two groups (P>0.05).After adjustment for all confounding factors (age, BMI before pregnancy, gravidity, parity, history of hypertension, gestational week when weight measuring ) , risk of gestational hypertension increased by 12.5%when weight gain up to 20 weeks increased 1kg (95%CI:1.038-1.220, P=0.004).Conclusion Gestational weight gain up to 20 weeks is the risk factor of gestational hypertension.Controlling weight gain up to 20 weeks is of great importance for preventing gestational hypertension, especially for women with BMI <24 kg/m2 .