妊娠期糖尿病孕前体质量指数及孕期增重对新生儿出生体质量的影响

目的:探讨妊娠期糖尿病（GDM）孕妇孕前体质量指数（BMI）及孕期增重对新生儿出生体质量的影响。方法:采用队列研究方法对2015年4-12月产检并被诊断为GDM的单胎妊娠孕妇进行随访。分析孕前BMI及孕期增重与新生儿出生体质量的关系。结果:共590例GDM孕妇纳入本研究。根据BMI分类,10.6%（63/590）孕妇体质量偏轻,65.9%（389/590）体质量正常,17.6%（104/590）超重,5.9%（34/590）肥胖。新生儿出生体质量为（3348.6±465.4）g,巨大儿发生率为7.6%（45/590）,低出生体质量儿发生率为2.4%（14/590）。随着孕前BMI增加,孕期增重过量的比例显著增加（P<0.01）,低出生体质量儿发生率,巨大儿发生率和剖宫产率显著增加（P<0.01）;随着孕期增重增加,巨大儿发生率显著增加（P<0.01）。logistic 回归分析结果显示,分娩孕周、新生儿性别及孕期增重与巨大儿发生有关,与孕期增重正常者相比,孕期增重过量显著增加巨大儿的发生风险（OR=2.57,P<0.01）。结论:GDM孕前超重及肥胖孕妇更易分娩巨大儿,应注意将计划妊娠妇女孕前体质量控制在合理范围,特别注意加强对孕前超重和肥胖GDM孕妇孕期体质量的控制。     

妊娠期糖尿病患者体质量增长与内脂素及新生儿体成分的相关性研究

目的:探讨妊娠期糖尿病（GDM）患者妊娠不同时期体质量增长与母体内脂素水平及新生儿体成分的相关性。方法:2013年7月-2015年7月分娩的妊娠足月孕妇,以年龄匹配原则,选取GDM孕妇及糖耐量正常（NGT）孕妇各130例,分为4组:NGT孕妇分娩适于胎龄儿（AGA）组 (NGT+AGA组,n =97 )、NGT孕妇分娩大于胎龄儿（LGA）组(NGT+LGA组,n =33)、GDM+AGA（n =69)和GDM+LGA（n =61)。收集临床资料,回顾性分析孕26周前、26～32周、32周至分娩3个阶段孕妇体质量增长情况;双抗体夹心酶标免疫(ELISA)分析法检测孕妇血清内脂素水平;新生儿出生后24～48 h内进行人体成分测量。分析不同组别孕妇妊娠不同时期体质量增长情况;比较组间内脂素水平及新生儿出生体质量（BW）、体脂百分含量（F %）的差异。结果:GDM患者孕前体质指数（BMI）明显高于NGT孕妇 (F = 13．247, P <0．001）;4组孕期增重存在显著性差异（F =5.501,P <0.001）, GDM+LGA组明显高于NGT+AGA组（P <0.001）。 GDM组孕妇妊娠孕26周之前体质量增速明显高于NGT组;GDM+LGA组孕妇妊娠32周至分娩前的体质量增速也显著增加。4组内脂素水平分别为(90．69±18．94)、(116.28±46．96)、(112.88±44.66)和(208.15±81.89)μg/L（F =72.602,P <0.001）,GDM+LGA组显著高于其余3组（均P <0.001）。4组新生儿F %存在显著性差异,任意2组间的差异均有统计学意义（均P <0.05）。孕妇内脂素水平与新生儿出生体质量及体脂含量均呈显著正相关（r =0.539,0.629,均P <0.001）,孕前BMI、孕26周前体质量增速、32周至分娩前的体质量增速是其重要相关因素。结论:孕前BMI以及孕26周前体质量增速是GDM的相关危险因素;32周至分娩前体质量增速则与新生儿出生体质量及体脂含量增加密切相关。孕妇内脂素水平可能是联系孕期体质量增长与新生儿体成分的中介因子。     

妊娠期糖尿病患者血糖、血脂水平与新生儿体质量的关系

目的：对妊娠期糖尿病（GDM）孕妇孕期血糖、血脂水平进行分析,探讨GDM孕妇血糖、血脂水平对新生儿出生体质量的影响。方法：空腹12h后,清晨采GDM孕妇肘静脉血测量血糖、血脂,另选择同期正常足月产妇95例作为对照组,对比观察两组血糖、血脂水平和孕期体质量增长值。结果：GDM组空腹血糖、血清总胆固醇（TC）、甘油三脂（TG）、孕期体质量增长值显著高于对照组（P〈0.05）,GDM组巨大儿比例高于对照组（P〈0.05）,而低密度脂蛋白（LDL）、高密度脂蛋白（HDL）水平差异无统计学意义（P〉0.05）。结论：GDM组孕妇血糖、血脂水平与孕期体质量增长值、新生儿体质量呈正相关性,应对GDM孕妇进行饮食指导和血糖、血脂监测,有效控制血糖、血脂水平,降低巨大儿发生率。     

孕妇年龄、孕前体质量指数对新生儿体质量的影响

目的：探讨孕妇年龄、孕前体质量指数（BMI）对新生儿出生体质量的影响。方法：选取单胎初产妇537人作为研究对象,按孕妇年龄分为低龄组144人,适龄组289人,大龄组80人,高龄组24人;按孕妇孕前BMl分为肥胖组9人,过重组44人、标准组416人,过轻组68人。分别比较各组新生儿出生体质量情况、巨大儿发生率等情况。结果：低龄组孕妇分娩的新生儿出生体质量与高龄组差异无统计学意义（P〉0．05）,适龄组、大龄组孕妇分娩的新生儿出生体质量均明显高于低龄组（P〈0．01）。孕前过重组和肥胖组孕妇分娩的新生儿体质量均明显高于标准组（P〈0．01）,孕前过轻组孕妇分娩的新生儿体质量亦明显低于孕前标准组（P〈0．01）。结论：孕妇年龄、孕前BMI均与新生儿出生体质量有关。     

妊娠糖尿病患者膳食调查及分娩巨大儿的影响因素

目的 探讨妊娠糖尿病（GDM）患者膳食情况及分娩巨大儿的危险因素。方法 选择2013年1-12月在首都医科大学附属北京友谊医院营养门诊就诊的GDM患者157例,根据其分娩新生儿的出生体质量,将其分为巨大儿组（新生儿体质量≥4000g,n=17）与正常体质量儿组（新生儿体质量为2500g～＜4000g,n=140）。记录患者身高、孕前体质量及分娩体质量等资料。采用24h膳食回顾调查法调查两组患者饮食摄入量。采用多因素Logistic回归分析GDM患者分娩巨大儿的影响因素。结果 两组年龄、妊娠早中期增重、孕期增重、糖尿病家族史、妊娠早中期增重超标比例比较,差异均无统计学意义（P＞0.05）;两组身高、孕前体质量、孕前体质指数（BMI）、分娩体质量、孕晚期增重、孕前超重、孕期增重过多、上班情况比较,差异均有统计学意义（P＜0.05）。两组患者水果、蔬菜、食用油摄入量比较,差异有统计学意义（P＜0.05）。多因素Logistic回归分析显示,孕前超重、孕期增重过多是GDM患者分娩巨大儿的影响因素（P＜0.05）。结论 GDM患者存在膳食摄入不合理情况,其分娩巨大儿的危险因素是孕前超重和孕期增重过多,应对孕前超重孕妇尽早进行膳食干预和运动干预控制孕期增重,从而减少巨大儿的出生。     

营养干预对妊娠期糖尿病孕妇母婴体质量的影响

目的:探讨妊娠期糖尿病(GDM)孕妇营养干预的方法及对母婴体质量的影响。方法:71例产检确诊GDM的孕妇作为观察组,给予营养干预措施;分娩时才确诊的GDM孕妇58例作为对照组。记录观察组孕妇干预前、后空腹血糖(FBG)水平及两组孕妇的体重,符合正常标准及巨大儿出生例数。结果:干预后,观察组GDM孕妇FBG水平低于干预前(P<0.05);观察组孕妇的孕期体重增长符合率高于对照组,巨大儿发生率也低于对照组,(P<0.05)。结论:GDM孕妇经过个性化营养干预后,可以有效控制血糖水平、孕期母婴体质量的正常增长及减少巨大儿的发生。     

妊娠期糖尿病患者血糖及血脂水平与新生儿体质量关系

目的:分析妊娠期糖尿病(GDM)孕妇孕期血糖、血脂水平,探讨GDM孕妇血糖及血脂代谢对新生儿出生体质量的影响,为妊娠糖尿病孕妇的临床管理提供参考.方法:妊娠期糖尿病(GDM)孕妇101例,对照组孕妇112例,记录两组孕妇血糖、血脂水平及孕期体质量增长.结果:与对照组比较,GDM组孕妇在年龄、孕周及孕次方面无显著性差异(...     

孕妇分娩巨大儿与体质量指数相关性的研究

目的研究北京昌平地区分娩巨大儿的孕妇的并发症与孕妇体质量指数的相关性。方法对300例分娩巨大儿的孕妇孕前、分娩前体质量的测量,分别计算孕前及分娩前体重指数（BMI）,及孕期BMI增加值,并分析分娩巨大儿的孕妇并发症与孕妇体质量指数的相关性。结果孕前理想体重组的剖宫产率以及并发症（妊娠期高血压、子痫前期、GDM）的发生率明显低于低体重组、超重组及肥胖组（BMI≥28kg／m^2）,其中肥胖组的剖宫产率以及并发症的发生率最高;而产后出血率低体重组明显低于其他3组,其中超重组最高。结论孕前BMI在评价剖宫产率、产后出血率以及并发症方面明显优于BMI的增加值。4组BMI的增加值无显著差异。     

孕前及不同孕期体质量指数增加与妊娠结局关系的临床研究

目的 探讨孕前和不同孕期体质量指数(BMI)增加对新生儿体质量及分娩方式的影响.方法 选取341名单胎、头位且无妊娠并发症的初产妇为研究对象,按照产前BMI不同,孕12周BMI增加不同,孕28周BMI增加不同及孕期BMI增加不同各分为3组,以分娩方式、新生儿出生体质量为观察指标,对各组进行随访分别比较不同孕期各组和新生儿体质量及分娩方式的关系.结果 孕前BMI分组不同与新生儿体质量差异有统计学意义(P＜0.05),与分娩方式差异无统计学意义(P＞0.05).孕12周△BMI与新生儿体质量差异无统计学意义(P＞0.05),与分娩方式差异有统计学意义(P＜0.05).孕28周△BMI及孕期△BMI与新生儿体质量及分娩方式差异均有统计学意义(P＜0.05).结论 孕前BMI及不同孕周△BMI和新生儿出生体质量及分娩方式有关,合理进行孕期体质量管理,控制△BMI有助于控制新生儿体质量并降低剖宫产率.     

妊娠期糖尿病孕妇分娩巨大儿的影响因素分析

目的:分析妊娠期糖尿病(GDM)孕妇分娩巨大儿的可能影响因素。方法:选取定期产检并分娩、孕周>37周的单活胎GDM孕妇371例临床资料,包括年龄、身高、体质量、孕前体质量指数(BMI)、孕期体质量增长、糖尿病家族史、不良孕产史、巨大儿产史、新生儿性别、血糖治疗方案、血糖控制情况、是否分娩巨大儿等。采用非条件多因素二分类logistic回归方程分析影响GDM孕妇分娩巨大儿的可能影响因素。结果:巨大儿组孕妇身高、体质量和新生儿男性人数均高于非巨大儿组(P<0.05～P<0.01),而巨大儿组孕妇血糖控制良好率明显低于非巨大儿组(P<0.01)。孕妇孕前后体质量指数差和血糖控制情况均是分娩巨大儿的独立影响因素(P<0.05)。结论:有效控制GDM孕妇孕期体质量的过度增长,维持良好的血糖水平,对于预防GDM孕妇分娩巨大儿具有潜在的意义。     

The relationship of placental weight with birth weight

To assess the relationship between placental weight and birth weight, two hundred forty six pregnant mothers, who were otherwise healthy, were prospectively followed in a city hospital during antenatal period until delivery and immediate post-partum period. Height of mothers was measured initially and weight measured at each visit during the antenatal check-up. Placental weight and birth weight of babies were measured by one of the authors immediately after delivery by a weighing scale. Eighty one percent of the mothers were between the age group of 20-29 years. The BMI of 92% mothers was 18.5 and above. Most of the mothers came both with primigravida (42%) or second gravida (33%) and in 25% cases 3rd or onwards. In 49% cases the placental weight was between 401-500 gm, in 30% cases >500 gm and in 21% cases 400 gm or less. There was delivery of appropriate-birth-weight babies in 85% cases and low-birth-weight babies in 15% cases. It was observed that a very strong correlation existed between placental weight and birth weight (r = 0.391, p<0.001). Even this correlation was stronger in small for gestational age babies. However, there was no correlation between placental weight and APGAR score at one minute. It is concluded that increment of birth weight occurs with increase of placental weight. If placental weight can be measured by ultrasonography in second or early third trimester of pregnancy birth weight is possible to be assessed and appropriate measure can be taken to increase the birth weight.     

孕前体重、孕期增重与新生儿出生体重的关系

目的探讨孕前体重和孕期增重对新生儿出生体重及身长等的影响,为降低巨大儿发生率、减少妊娠并发症提供临床资料。方法用自编问卷调查929例足月单胎产妇的孕前体重和孕期增重,随访至分娩。记录新生儿出生体重、身长、头围、胸径等体检数据,运用SPSS软件分析孕前体重、孕期增重与新生儿出生体重等的关系。结果①孕前低体重组新生儿出生体重、身长、头围、胸径、巨大儿发生率均明显低于理想体重组和超重组(P<0.05)。②孕期增重过多组巨大儿发生率、头围、胸径均明显大于增重不足和增重正常组(P<0.01),而3组间新生儿出生体重,身长两两比较差异均有统计学意义(P<0.01,P<0.05),即孕期增重越多新生儿出生体重越大,身长越长。③孕前低体重和正常体重的孕妇随着孕期增重过多,其新生儿出生体重、身长、头围、胸径明显增大。结论孕前体重,孕期增重均与新生儿出生体重及身长等发育指标有关。孕妇应根据自身条件注意调整孕期的增重范围,以便获得良好的妊娠结局。     

Relationships between pre-pregnant weight,weight gain during pregnancy and birth weight

目的 探讨孕前体重和孕期增重对新生儿出生体重及身长等的影响,为降低巨大儿发生率、减少妊娠并发症提供临床资料.方法 用自编问卷调查929例足月单胎产妇的孕前体重和孕期增重,随访至分娩.记录新生儿出生体重、身长、头围、胸径等体检数据,运用SPSS软件分析孕前体重、孕期增重与新生儿出生体重等的关系.结果 ①孕前低体重组新生儿出生体重、身长、头围、胸径、巨大儿发生率均明显低于理想体重组和超重组(P<0.05).② 孕期增重过多组巨大儿发生率、头围、胸径均明显大于增重不足和增重正常组(P<0.01),而3组间新生儿出生体重,身长两两比较差异均有统计学意义(P<0.01,P<0.05),即孕期增重越多新生儿出生体重越大,身长越长.③ 孕前低体重和正常体重的孕妇随着孕期增重过多,其新生儿出生体重、身长、头围、胸径明显增大.结论 孕前体重,孕期增重均与新生儿出生体重及身长等发育指标有关.孕妇应根据自身条件注意调整孕期的增重范围,以便获得良好的妊娠结局.     

孕前体重、孕期增重与妊高征及新生儿出生体重的关系

目的 探讨孕妇孕前体重(体质量)指数及孕期体重增加情况对妊高征及新生儿出生体重的影响。方法 测量769例足月单胎初产妇孕前的身高、体重和孕期体重增加情况,计算孕前体重指数,并随访妊高征、巨大儿和低体重儿的发生情况。结果(1)孕前肥胖孕妇妊高征和巨大儿的发生率明显高于孕前消瘦和理想体重的孕妇(P<0.01和P<0.05),而后两组间无差别(P>0.05);孕前消瘦孕妇低体重儿的发生率明显高于孕前理想体重和肥胖的孕妇(P<0.01),而后两组间无差别(P>0.05)。(2)无论孕前体重指数如何,当孕期体重增加≥18kg时妊高征和巨大儿的发生率明显增高(P<0.01),而当孕期体重增加<9kg时低体重儿的发生率明显增高(P<0.01)。(3)对孕前消瘦和理想体重的孕妇,孕期体重增加≥18kg时,妊高征的发病率明显增高,而对孕前肥胖的孕妇,孕期体重增加≥9kg时,妊高征的发病率明显增高(P<0.05);孕前理想体重孕妇孕期体重增加≥18kg时巨大儿的发病率明显增高(P<0.01),孕前消瘦和肥胖的孕妇随孕期体重的增加巨大儿的发病率也增加,但无统计学意义;对孕前消瘦和理想体重的孕妇孕期体重增加<9kg时,低体重儿的发病率明显增高(P<0.01)。结论 孕前体重指数和孕期增重是妊高征及新生儿出生体重的重要影响因素。     

Maternal pre-pregnancy weight and placental weight determine birth weight in normal Jamaican infants

Birth weight is related to neonatal health and long-term risk of chronic disease. Since animal studies have shown that birth outcome is related to placental function, the present project was designed to explore the relationship between birth weight and placental growth and composition with maternal factors during pregnancy among normal term pregnancies in 51 primiparous and 40 multiparous women delivering at the University Hospital of the West Indies. Both groups were followed from 15 weeks of gestation to term. The primiparous group was generally younger than the multiparous (mean age 22 +/- 4 versus 31 +/- 5 yr). They were significantly lighter (55 +/- 8 versus 61 +/- 9 kg) with a lower body mass index (21 +/- 3 versus 23 +/- 4 kg/m2) during early pregnancy, but gained more weight during pregnancy, 11 kg compared with 8 kg, respectively. The duration of pregnancy was similar for both groups. Although the size of the placenta was not significantly different between the two groups, the mean weight of the multiparous placentae was more than that of the primiparous placentae. Also, for all mothers both placental weight and initial maternal weight related directly to birth weight. Placental non collagen protein (NCP), sodium and potassium contents were significantly higher for multiparous women and were related to birth weight. The primiparous group had babies who were significantly lighter, 3.03 kg compared with 3.36 kg, for the multiparous and this could be attributed to differences in placental function and maternal weight. When account was taken of the difference in maternal weight at the start of pregnancy and the difference in placental weight, parity no longer explained any of the differences in birth weight. It is concluded that maternal body weight at the time of becoming pregnant and the early development of the placenta determine the efficiency with which nutrients might be delivered to the foetus and hence foetal growth. The difference in birth weight between primiparous and multiparous women can be explained by the differences in maternal weight at the time of becoming pregnant.     

孕前体重、孕期增重与妊高征及新生儿出生体重的关系

OBJECTIVE: To determine the influence of pre-pregnant body mass index (BMI) and weight gain during pregnancy on the occurrence of pregnancy-induced hypertension (PIH) and birth weight. METHODS: Pre-pregnant BMI and pregnancy weight gain of 769 mothers giving full-term birth to a single baby for the first time were measured and the pregnancy outcomes were followed up. RESULTS: (1) The incidence of PIH and fetal macrosomia was significantly higher in the overweight group than in the normal weight and underweight groups (P<0.01 and P<0.05, respectively), but differed little between the latter two groups (P>0.05). Underweight mothers were more likely to give birth to babies with low birth weight than the normal and overweight mothers (P<0.01), but the likelihood was similar between the latter two groups (P>0.05). (2) Irrespective of the pre-pregnant BMI, PIH and fetal macrosomia occurred at higher rates with the mothers with pregnancy weight gain no less than 18 kg (P<0.01), whereas low birth weight was significantly more likely with mothers with pregnancy weight gain less than 9 kg (P<0.01). (3) A weight gain during pregnancy over 18 kg gave rise to higher risk of PIH in normal and underweight mothers, but in overweight group, PIH occurred at a significantly higher rates when a weight gain more than 9 kg was recorded (P<0.05). The incidence of fetal macrosomia was significantly higher when the maternal weight gain exceeded 18 kg in the normal weight group (P<0.01), and low birth weight occurred more frequently in relation to a maternal weight gain less than 9 kg in the normal and underweight groups (P<0.01). CONCLUSION: Pre-pregnant BMI and weight gain during pregnancy can be important factors influencing the occurrence of PIH and the neonates' birth weight.     

孕妇孕期增加体重与新生儿出生体重的相关性研究

目的 探讨孕妇孕期增加体重与新生儿出生体重的关系.方法 回顾分析669例产妇资料,均为初产、单胎妊娠,年龄25~34岁,孕前体重指数(BMI)为(18.5~23.9)kg/m2.将孕期增加体重分为三组:A组(体重增加≤9 kg,n=60)、B组[体重增加(9~18)kg,n=305]和C组(体重增加≥18 kg,n=45).记录每例新生儿的出生体重,并进行相关性分析.结果 A组、B组和C组新生儿出生体重分别是(2993.43 ± 348.70)g、(3161.68 ± 464.56)g和(3330.82 ± 415.81)g,差异有统计学意义.结论孕妇孕期增加体重与新生儿出生体重呈正相关.     

妊娠中晚期增重速度与孕期总增重和新生儿出生体重的关系

目的 探讨妊娠中晚期体重增长速度与孕期总增重和新生儿出生体重的关系.方法 回顾性分析2011年8月至2012年2月在北京妇产医院进行常规产前检查和分娩的孕妇临床资料,记录年龄、分娩孕周、身高、孕前体重、分娩前体重、孕期体重监测数据、新生儿出生体重、性别等资料.对资料进行t检验、单因素方差分析、Spearman相关性分析和多元线性回归分析.结果 孕妇妊娠中期增重速度[(0.68±0.26) kg/周]大于妊娠晚期增重速度[(0.52±0.25)kg/周],差异有统计学意义(P＜0.01).妊娠中期增重速度与孕期总增重(r=0.446,P＜0.01)、新生儿出生体重(r=0.123,P＜ 0.01)皆呈正相关;而妊娠晚期增重速度只与孕期总增重呈正相关(r=0.560,P＜ 0.01),与新生儿出生体重则无显著相关性(r=-0.025,P＞0.05);巨大儿组和正常体重儿组孕妇的孕前BMI[(22.3±2.9) kg/m2 vs.(20.8±2.8) kg/m2]、孕期总增重[(18.5±4.3)kg vs.(16.6±4.6)kg]和妊娠中期增重速度[(0.74±0.26)kg/周vs.(0.67±0.26)kg/周]相比,巨大儿组皆高于正常体重儿组,P值均＜0.01;而2组的妊娠晚期增重则无明显差异(P＞0.05).结论 不同孕期体重增长速度对新生儿出生体重的影响可能不同,妊娠中期增重速度对新生儿出生体重的影响大于妊娠晚期增重速度.     

Prevalence of attempting weight loss and strategies for controlling weight.

CONTEXT: Overweight and obesity are increasing in the United States. Changes in diet and physical activity are important for weight control. OBJECTIVES: To examine the prevalence of attempting to lose or to maintain weight and to describe weight control strategies among US adults. DESIGN: The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in 1996 by state health departments. Setting The 49 states (and the District of Columbia) that participated in the survey. PARTICIPANTS: Adults aged 18 years and older (N = 107 804). MAIN OUTCOME MEASURES: Reported current weights and goal weights, prevalence of weight loss or maintenance attempts, and strategies used to control weight (eating fewer calories, eating less fat, or using physical activity) by population subgroup. RESULTS: The prevalence of attempting to lose and maintain weight was 28.8% and 35.1 % among men and 43.6% and 34.4% among women, respectively. Among those attempting to lose weight, a common strategy was to consume less fat but not fewer calories (34.9% of men and 40.0% of women); only 21.5% of men and 19.4% of women reported using the recommended combination of eating fewer calories and engaging in at least 150 minutes of leisure-time physical activity per week. Among men trying to lose weight, the median weight was 90.4 kg with a goal weight of 81.4 kg. Among women, the median weight was 70.3 kg with a goal weight of 59.0 kg. CONCLUSIONS: Weight loss and weight maintenance are common concerns for US men and women. Most persons trying to lose weight are not using the recommended combination of reducing calorie intake and engaging in leisure-time physical activity 150 minutes or more per week.