孕前超重及肥胖对孕期体质量控制及妊娠结局的影响

目的:评估孕前超重及肥胖对孕期体质量控制及妊娠结局的影响。方法:回顾性收集2015年1月-2017年12月于我院分娩足月单胎孕妇的孕前体质量指数(BMI)、孕期体质量变化及妊娠结局等资料,比较孕前超重、肥胖孕妇与孕前体质量正常孕妇的孕期体质量控制情况及妊娠结局,多因素分析孕前超重及肥胖对孕期体质量控制及妊娠结局的影响。结果:纳入超重孕妇496例(超重组),肥胖孕妇44例(肥胖组)以及体质量正常孕妇(对照组)540例,超重、肥胖及对照组的孕前BMI分别为26.3(2.0)kg/m^2、31.3(2.9)kg/m^2及20.7(2.5)kg/m^2。超重、肥胖组的孕期体质量超标比例高于对照组(分别为63.9%、72.7%及41.3%),超重及肥胖组孕妇的子痫前期、妊娠期糖尿病及剖宫产风险均高于体质量正常孕妇。超重及肥胖组的新生儿平均出生体质量高于正常组分别为(3 528.0±397.4)kg、(3 562.6±417.6)kg及(3 387.8±384.5)kg,巨大儿比例也呈升高趋势(分别为12.3%、15.9%及5.0%)。多因素分析结果显示孕前超重(OR=3.071,95%CI:2.345~4.022)及肥胖(OR=5.113,95%CI:2.507~10.431)是孕期体质量超标的影响因素,同时对子痫前期(P<0.001)、妊娠期糖尿病(P<0.001)、剖宫产(P<0.05)及巨大儿(P<0.05)风险均有显著影响。结论:孕前超重及肥胖不仅显著影响孕期体质量控制结局(尤其是孕期体质量超标风险),同时对包括子痫前期、妊娠期糖尿病、剖宫产、巨大儿风险在内的妊娠结局也影响显著;孕前体质量控制对于超重及肥胖的育龄妇女具有重要意义。

Influence of Preconception Over-Weight and Obesity on Gestational Weight Gain and Pregnancy Related Prognosis

Objective：To assess the influence of preconception over-weight and obesity on gestational weight gain and other pregnancy prognosis. Methods：We collected data of singleton pregnancies delivered in our hospital from Jan 2015 to Dec 2017. All cases were divided into three groups(over-weight, obese and normal-weight) according to preconception body mass. Comparison was conducted among the three groups on the weight gain during pregnancy and pregnancy related prognosis. By multivariate analysis, the effect of preconception over-weight and obese on weight gain during pregnancy and other pregnancy outcome were clarified. Results：1 080 cases with complete data were included: 496 overweight cases, 44 obese cases and 540 control cases. The preconception BMI of over-weight, obese and normal-weight group were 26.3(2.0) kg/m2, 31.3(2.9) kg/m2 and 20.7(2.5) kg/m2 respectively. The over-weight and obese groups developed more above-gainers than the normal weight group(63.9%,72.7% vs. 41.3%). The risks of pre-eclampsia, GDM, cesarean section were higher than the normal weight group. The over-weight and obese group demonstrated higher average birth weight (3 528.0±397.4) kg, (3 562.6±417.6) kg vs. (3 387.8±384.5 kg)] and high risk of macrosomia (12.3%, 15.9% vs. 5.0%). By multivariate analysis, preconceptional over-weight (OR=3.071, 95%CI: 2.345-4.022) and obese (OR=5.113, 95%CI: 2.507-10.431) exerted significant effect on the risk of exceeding the Institute of Medicine(IOM) recommended weight gain range and also the risk of pre-eclampsia, GDM, cesarean section and macrosomia. Conclusions：Preconception over-weight and obesity has significant influence on the result of gestational weight gain(especially the risk of over-gainer) and perinatal outcomes including pre-eclampsia, GDM, cesarean section and macrosomia. Therefore it is crucial to initiated body weight control before pregnancy especially for overweight and obese women.