Detecting intimate partner violence during pregnancy: awareness-raising indicators for use by primary healthcare professionals

BACKGROUND: Given the deleterious consequences of intimate partner violence (IPV) for gestation, it is important to promote a more effective and amicable approach that engenders greater receptiveness, stimulates more open communication and, ultimately, facilitates addressing the problem. In this regard, active primary care professionals need to be educated about the different profiles of violence found in domestic environments. The aim of this study is to make the identification of those subgroups of pregnant women most likely to be living in IPV situations both practical and simple. Its ultimate goal is to give healthcare professionals who work directly with the public the tools to anticipate such events. To this end, this study presents a profile of IPV during pregnancy according to different characteristics observed among primary health service users. METHODS: Five hundred and twenty-seven women who carried children to term in Rio de Janeiro were interviewed. A Portuguese version of the Revised Conflict Tactics Scale (CTS2) was used to detect IPV. Several sociodemographic factors, life habits and reproductive health characteristics of pregnant women and their partners were scrutinized. Prevalence projections by subgroup were obtained using a multinomial logit model. RESULTS: The projected prevalences for negotiation, psychological violence, minor physical violence and severe physical violence were, respectively, 0.1% [95% confidence interval (CI) 0.0-0.6], 2.6% (95%CI 0.7-6.9), 7.0% (95%CI 1.7-18.5) and 90.3% (95%CI 77.2-96.8) for the extreme scenario, i.e. women <20 years of age, non-White, living in house with inadequate garbage disposal, previous history of abortion, reporting fear of someone, reporting lack of affective social support, and reporting drug use by woman or spouse. In the absence of these characteristics, the projected prevalences were 51.3% (95%CI 38.5-64.6), 40.0% (95%CI 28.5-51.9), 7.6% (95%CI 4.2-12.7) and 1.1% (95%CI 0.3-2.4), respectively. CONCLUSION: This study found that knowledge of certain characteristics of pregnant women who attend health services can alert professionals to the high probability of IPV, facilitating early identification of the problem and subsequent implementation of proactive measures.     

孕前 BMI、孕期体重增加与新生儿出生体重关系探讨

目的：探讨孕前不同体重指数（BMI）妇女孕期体重增加与新生儿出生体重的关系。方法回顾性分析2013年7—12月在北京市海淀区妇幼保健院建档、产前检查并分娩的单胎足月孕产妇资料,包括年龄、身高和孕前体重,分娩前体重,分娩孕周及新生儿出生体重等指标。结果4927例孕妇孕期平均体重增加（16.5±4.3）kg,胎儿出生体重平均为（3402.3±381.8）g,剖宫产率为34.7％。孕妇体重增加过多组、适中组和不足组的比例分别为32.9％、53.3％和13.8％,孕前不同 BMI 各组体重增长差异有统计学意义,随着孕前 BMI 增加,孕期增重数值呈下降趋势,组间差异有统计学意义。孕期体重增加与胎儿出生体重呈正相关（r ＝0.26）。分娩适宜胎龄儿3933例,孕前低体重组、孕前正常体重组、孕前超重组和肥胖组孕期增重适宜范围分别为14.0～19.0 kg、14.0～19.0 kg、11.5～17.0 kg 和8.0～16.5 kg,超过美国 IOM推荐范围,孕期体重增加的中位数（P50）分别为17.0 kg、16.0 kg、14.0和12.0 kg,孕期体重平均增加15.0kg（P50）。结论孕前 BMI、孕期孕妇体重增加与新生儿出生体重相关,孕期体重增加超过 IOM推荐范围,做好孕期体重管理势在必行。     

Emotional intimate partner violence experienced by men in same-sex relationships

Intimate partner violence research has focused almost exclusively on physical and sexual intimate partner violence in opposite-sex relationships, paying little attention to the intimate partner violence experienced by men in same-sex relationships. Emerging research focusing on intimate partner violence among male-male couples has focused largely on physical and sexual violence, with little consideration of the unique forms of emotional violence experienced by gay men. Ten focus-group discussions with gay and bisexual men were conducted to examine perceived typologies, antecedents and experiences of emotional violence that occur between male partners. Participants described emotional violence as the most threatening form of intimate partner violence, driven largely by factors including power differentials, gender roles and internalised homophobia. Results indicate that gay and bisexual men perceive emotional intimate partner violence to be commonplace. A better understanding of emotional violence within male-male relationships is vital to inform intimate partner violence prevention efforts and the more accurate measurement of intimate partner violence for gay men.     

孕期总增重与不良妊娠结局关系的前瞻性研究

目的 探讨孕期总增重与不良妊娠结局之间的关系。方法 选取成都市妇幼医疗机构产前门诊1 220名6~12孕周、单胎健康的妇女为研究对象进行前瞻性研究。通过问卷调查收集孕妇年龄、孕前体重等基本信息,于分娩前测量孕妇体重,计算孕期总增重,参照2009年美国医学研究所发布的孕期增重推荐标准将研究对象分为增重适宜、增重不足和增重过多组。于分娩后通过医院信息系统收集妊娠结局相关信息。采用多因素非条件logistic回归分析探讨孕期总增重与不良妊娠结局关系。结果 共纳入1 045名单胎活产孕妇进行分析。与孕期增重适宜组相比,孕期增重过多组脐带缠绕和大于胎龄儿发生风险升高（分别为OR=1.641,95% CI：1.197~2.252和OR=1.678,95% CI：1.132~2.488）;孕期增重过少组早产发生风险升高（OR=3.189,95% CI：1.604~6.341）。结论 孕期总增重过多和过少均可能导致不良妊娠结局。应重视孕期体重监测,降低不良妊娠结局发生风险。     

沈阳地区孕期体重增长与妊娠结局关系研究

目的:调查沈阳地区孕妇体重增长情况,探讨孕期体重增长与妊娠结局的关系。方法:单纯随机抽样方法抽取沈阳市10个区、县(市)2010年9～10月在妇幼保健机构建立《孕妇保健手册》的孕妇3 203例,自制调查问卷对孕妇整个孕期分4～7次不等进行体重等指标测量,同时追踪其妊娠结局,采用单因素分析方法进行统计分析。结果:孕前身体质量指数(BMI)越大,其新生儿体重越大;孕期体重增长与新生儿体重呈正的直线相关。结论:孕前低BMI孕妇若在孕期体重赶上增长,就能分娩出正常体重的新生儿;而孕前高BMI孕妇则必须减少孕期体重增长,才能分娩出正常体重的新生儿。     

孕前体质指数及孕期增重对新生儿出生体重影响的前瞻性队列研究

目的  分析孕妇孕前体质指数(body mass index, BMI)及孕期增重(gestational weight gain, GWG)与新生儿出生体重的关联性, 并探究孕妇孕前及孕中体重动态变化对新生儿低出生体重(low birth weight, LBW)及巨大儿的影响。 方法  收集中国孕产妇队列·协和纳入的孕早期孕妇孕前体重, 并随访至分娩后, 收集分娩前体重及新生儿出生结局。将孕妇孕前BMI分为低体重组、正常体重组及超重/肥胖组, 将GWG分为适宜、不足及过多组。采用多因素多分类(多项)Logistic回归分析模型探讨孕前BMI及GWG与新生儿出生体重的关系。 结果  孕前BMI及GWG与子代出生体重相关(均有P < 0.05)。孕前超重/肥胖(OR=2.339, 95%CI:1.674~2.282, P < 0.001)、GWG过多(OR=1.398, 95%CI:1.188~1.978, P=0.048)显示为巨大儿的危险因素, GWG不足(OR=1.479, 95%CI:1.461~1.679, P=0.035)显示为LBW的危险因素, GWG过多会降低LBW的发生风险(OR=0.428, 95%CI:0.225~0.817, P=0.010)。低BMI-GWG不足(OR=1.335, 95%CI:1.048~2.319, P=0.048)是LBW的危险因素; 正常BMI-GWG过多(OR=1.088, 95%CI:1.016~1.675, P=0.038)和超重/肥胖-GWG过多(OR=1.498, 95%CI:1.244~2.017, P=0.046)是巨大儿的危险因素。 结论  孕前BMI及GWG是影响新生儿出生体重的重要因素, 提示女性应合理控制孕前及孕中体重变化。     

A family planning clinic partner violence intervention to reduce risk associated with reproductive coercion

Background

This study examined the efficacy of a family-planning-clinic-based intervention to address intimate partner violence (IPV) and reproductive coercion.

Study Design

Four free-standing urban family planning clinics in Northern California were randomized to intervention (trained family planning counselors) or standard of care. English-speaking and Spanish-speaking females ages 16–29 years (N=906) completed audio computer-assisted surveys prior to a clinic visit and 12–24 weeks later (75% retention rate). Analyses included assessment of intervention effects on recent IPV, awareness of IPV services and reproductive coercion.

Results

Among women reporting past-3-months IPV at baseline, there was a 71% reduction in the odds of pregnancy coercion among participants in intervention clinics compared to participants in the control clinics that provided standard of care. Women in the intervention arm were more likely to report ending a relationship because the relationship was unhealthy or because they felt unsafe regardless of IPV status (adjusted odds ratio=1.63; 95% confidence interval=1.01–2.63).

Conclusions

Results of this pilot study suggest that this intervention may reduce the risk for reproductive coercion from abusive male partners among family planning clients and support such women to leave unsafe relationships.     

Maternal outcomes of intimate partner violence during pregnancy: study in Iran

Objectives

To investigate the prevalence of intimate partner violence (IPV) against pregnant women and its relationship with adverse maternal outcomes, including preterm labour, abortion, caesarean section, antenatal hospitalization and vaginal bleeding, in the West Azerbaijan, Iran.

Study design

Cross-sectional design.

Methods

In total, 1300 pregnant women, aged 18–39 years, who were referred to hospitals in the Iranian cities of Miandoab and Mahabad in the province of West Azerbaijan in 2009–2010 were recruited for this study by a convenience sampling method. Participants were asked to share their experiences of IPV during pregnancy and adverse maternal outcomes.

Results

Of these pregnant women, 945 (72.8%) reported that they had experienced IPV during their last pregnancy. A significant association was found between IPV and preterm labour [adjusted odds ratio (adjOR) 1.54, 95% confidence interval (CI) 1.16–2.03], caesarean section (adjOR 11.84, 95% CI 6.37–22.02), antenatal hospitalization (adjOR 6.34, 95% CI 3.82–10.52) and vaginal bleeding (adjOR 1.51, 95% CI 0.9–2.3).

Discussion

This study demonstrated a high prevalence of IPV during pregnancy, and found that IPV was associated with adverse maternal outcomes including preterm labour, caesarean section, antenatal hospitalization and vaginal bleeding. This adds to the existing literature and can be used to inform healthcare practices in developing countries. Medical, health and surgical services for pregnant women should consider screening for IPV, and providers should be aware that IPV victims are at increased risk for adverse outcomes. Services should also develop links with the Battered Women's Movement; such programmes now exist in many countries.     

西南3省妇女孕前体质指数和孕期增重对新生儿出生体重影响的前瞻性队列研究

目的 探讨孕妇孕前BMI、孕期增重对新生儿出生体重的影响。方法 以来自西南3省的5 395名孕妇为研究对象,根据WHO推荐的BMI分类标准将孕妇分为孕前低体重组、正常体重组、超重组以及肥胖组。按照美国医学研究院推荐的孕期增重标准定义各组孕妇孕期增重是否适宜。采用无序多分类logistic回归模型分析孕前BMI和孕期增重与新生儿出生体重的关系。结果 调整相关混杂因素后,孕前BMI较低（OR=1.91,95% CI：1.47~2.50）是分娩小于胎龄儿（SGA）的危险因素,但可降低分娩大于胎龄儿（LGA）的风险（OR=0.55,95% CI：0.47~0.66）。孕期增重不足会使SGA的发生风险增加（OR=1.57,95% CI：1.21~2.03）,分娩LGA的风险降低（OR=0.48,95% CI：0.41~0.57）。孕前超重肥胖（OR=1.85,95% CI：1.58~2.17）以及孕期增重过多（OR=1.87,95% CI：1.67~2.11）与LGA的发生风险呈正相关。分层分析显示孕期增重不足仅会使孕前BMI较低和正常的孕妇分娩SGA的风险升高,对孕前超重肥胖的孕妇分娩SGA的风险没有影响。结论 孕前BMI和孕期增重是新生儿出生体重的重要影响因素,应加强孕妇健康教育、合理控制孕期增重。     

母亲孕前体质指数及孕期增重与学龄前儿童超重肥胖的关系研究

目的 探讨母亲孕前BMI及孕期增重与学龄前儿童超重肥胖的关系。方法 2016年6-11月,以广州市4 303名3~5岁学龄前儿童为研究对象,根据WHO标准和中国成人肥胖标准分别判断儿童和母亲孕前体重状态,参照美国医学研究所孕期增重推荐值判断母亲孕期增重情况。应用多因素二分类非条件logistic回归模型和协方差分析母亲孕前BMI和孕期增重与学龄前儿童超重肥胖的关系。结果 矫正混杂因素后,logistic回归分析显示,母亲孕前超重肥胖的儿童发生超重肥胖的风险是母亲孕前体重正常儿童的1.820倍（OR=1.820,95% CI：1.368~2.422）;与母亲孕期增重适宜的儿童相比,母亲孕期增重过度的儿童超重肥胖发生风险增加（OR=1.296,95% CI：1.007~1.667）。协方差分析结果也显示,母亲孕前体重超重肥胖和母亲孕期增重过度均增加儿童BMI Z值。根据母亲孕前BMI分为3组进行分层分析,结果显示,不同孕期增重组间儿童超重肥胖发生风险差异无统计学意义（P>0.05）。但与母亲孕前BMI适宜且孕期增重适宜组相比,母亲孕前超重肥胖且孕期增重过度组的儿童发生超重肥胖的风险增加（OR=1.574,95% CI：1.029~2.409）。结论 母亲孕前超重和孕期增重过度均增加学龄前儿童超重肥胖的风险,且母亲孕前超重较孕期增重过度对学龄前儿童超重肥胖发生的影响更大。     

孕前体重指数、孕期增重对泌乳时间影响的纵向研究

目的 探讨孕前BMI和孕期增重对泌乳时间的影响。方法 采用纵向研究方法, 于2013年3-9月选取成都市妇幼医疗机构产前门诊751名单胎健康孕妇作为基线调查对象, 在其分娩前后各随访一次, 最终以473名孕妇作为研究对象, 通过问卷调查和病历记录获得其孕前体重、分娩方式、新生儿出生体重、泌乳时间及基本信息, 测量身高和分娩前体重, 计算孕期增重;控制分娩方式、母亲年龄等混杂因素后, 采用多因素有序logistic回归模型分析孕前BMI和孕期增重与泌乳时间的关系。 结果 调查对象泌乳时间<1、1~、24~、48~和≥72 h的构成比分别占16.3%、37.0%、17.5%、18.6%和10.6%。与孕前体重正常组相比, 孕前消瘦和孕前超重或肥胖均是泌乳时间延长的危险因素, OR值(95%CI)分别为2.85(1.91~4.27)和 3.42(1.69~6.90)。与孕前体重正常且孕期增重适宜组相比, 孕前消瘦且孕期增重适宜和过多均是泌乳时间延长的危险因素, OR值(95%CI)分别为2.34(1.31~4.18)和3.42(1.67~7.00);孕前超重或肥胖且孕期增重过多是泌乳时间延长的危险因素, OR值(95%CI)为3.10(1.15~8.37)。结论 孕前BMI是泌乳时间的独立影响因素, 孕期增重需联合孕前BMI对泌乳时间产生影响。     

我国北方地区单胎足月初产妇孕期体重增长适宜范围

目的:探讨我国北方地区足月妊娠妇女孕期体重增长的适宜范围。方法:收集我国北方地区5 072例单胎足月初产妇孕前、孕期及产后42天资料,按照中国成人体重指数(BM I)分类要求将5 072例孕妇分组,了解各组的孕期体重增长情况,分析各组不同孕期体重增长对母儿不良妊娠结局发生率的影响,从而为各组推荐孕期体重增长的适宜范围。结果:5 072例孕妇中,孕前BM I<18.5 kg/m2,18.5～23.9 kg/m2及≥24 kg/m2的孕妇分别占16.8%,66.8%及16.4%,不良妊娠结局发生率最低的孕期体重增长范围分别为12～18 kg,10.0～16.0 kg及8.0～14.0 kg,(P<0.05),推荐的孕期体重增长范围分别为12～18 kg,10.0～16.0 kg及8.0～14.0 kg。结论:我国北方地区孕前低、正常、超重及肥胖组孕妇的平均孕期体重增长均较高,建议其孕期体重增长范围分别控制在12～18 kg,10.0～16.0 kg及8.0～14.0 kg。     

The effects of intimate partner violence on health in young adulthood in the United States

This paper uses data on a national sample of adolescents from the United States followed through the transition into young adulthood to examine the association between intimate partner violence (IPV) and health outcomes, including depressive symptoms, self reported health status, and health care utilization. Researchers have shown an important IPV-health link in a number of settings but have often been limited by using cross-sectional data, convenience samples, and the inability to control for important risk factors and confounders. The findings from this study suggests that these limitations likely inflate the estimated link between IPV and health by as much as 60% but also show that IPV has important health impacts on a number of outcomes. The results also show no differential impact of IPV by gender or previous exposure to child abuse. The health effects of IPV are also typically larger for current exposure than previous exposure, but each exposure type is shown to reduce health.     

不同体重指数孕期体重增长指导的重要性

目的:总结目前该院正常产前检查(产检)的不同体重指数孕妇妊娠期体重增长的情况,并对其妊娠结局进行分析,指出根据不同体重指数进行正确体重增长指导的重要性。方法:对2009年1月～2010年1月在该院检查及分娩的2 557例孕妇进行分析,按孕妇孕前体重指数(BMI)进行分组,计算出不同组别的孕期体重增长值,并与2009年Institute of Medicine(IOM)体重增长指南进行比较,得出超出指南建议体重的比率,并随访妊娠结局。结果:四组孕妇体重超出指南建议的比率分别为38.36%、40.77%、65.36%、63.64%。这些孕妇与正常孕妇相比,剖宫产率、妊娠期糖尿病(GDM)、妊娠期高血压疾病(HDCP)、产后出血的发生率均升高,差异存在统计学意义(P<0.05)。结论:妊娠期提供正确的体重增长指导有着重要的意义,可以减少不良的妊娠结局,并可以减少妇女及后代肥胖症的发生。     

孕前体重指数与孕期体重增长对妊娠结局的影响

目的:探讨孕前体重指数与孕期体重增长对妊娠结局的影响。方法:选取2004年1月～2008年3月在连云港市妇幼保健院建卡并住院分娩的体重指数>24的孕妇100例,随机抽取同期分娩体重指数正常的孕妇300例,随访他们的妊娠结局。结果:①高于标准体重组的妊娠期糖尿病(GDM)、妊娠期高血压疾病(PIH)、巨大儿的发病率(分别为12.00%、14.00%、10.00%)明显高于标准体重组(分别为4.00%、4.33%、5.66%),差异有显著性意义(P<0.01);②高于标准体重组中,发生GDM组孕期体重增长明显低于未发生GDM组孕期体重增长,差异有显著性意义;③孕期体重增长≥15 kg者,其妊娠期高血压疾病、巨大儿的发病率及剖宫产率较体重增长<15 kg者高,差异具有统计学意义(P<0.01)。结论:妊娠前体重标准和孕期体重增长<15 kg者及妊娠期糖尿病体重控制正常的孕妇妊娠结局好。     

A single gestational weight gain recommendation is possible for all classes of pregnant women with obesity

ObjectivesObesity is a known risk factor for adverse pregnancy outcomes; however, appropriate gestational weight gain (GWG) may mitigate these risks. We investigated whether the singular 2009 Institute of Medicine (IOM) GWG guidelines were appropriate for all women with obesity, or whether separate recommendations were needed by class.MethodsThis cross-sectional study of pregnant women with obesity used 2014 U.S. birth certificate data (N=646,642) and included only term pregnancies. Adjusted log-binomial regression models examined the relative risk of adverse maternal, obstetric, and neonatal outcomes for pregnant women with class I–III obesity who: lost weight during pregnancy, gained below IOM guidelines, or gained above IOM guidelines, compared to women who gained within IOM guidelines.ResultsMost women (55.1; 95% CI: 55.0-55.3) gained above IOM guidelines. As BMI severity increased, significantly fewer women had excessive GWG (Class I: 61.6%, 95% CI: 61.4-61.7; II: 50.7%, 95% CI: 50.4-50.9; III: 41.1%, 95% CI: 40.8-41.4). All classes of women with obesity who lost weight during pregnancy or gained below had a significantly decreased risk for caesarean delivery (RR (95% CI) class I: 0.92 (0.90-0.94); II: 0.91 (0.89-0.93); III: 0.92 (0.90-0.93)) and large-for-gestational age (LGA) births (class I: 0.80 (0.77-0.83); II: 0.76 (0.73-0.78); III: 0.73 (0.70-0.75)), but significantly increased risk of small-for-gestational age (SGA) births (class I: 1.34 (1.26-1.43); II: 1.38 (1.28-1.49); III: 1.35 (1.24-1.46)).ConclusionThe observed pattern of association was the same for all obese classes, hence evidence supports a possible singular GWG recommendation for all women with obesity, regardless of class.     

孕前体质指数及妊娠期体重增长与妊娠期糖尿病及高血压的关系

目的 研究孕前体质指数(pBMI)及妊娠期体重增长(GWG)与产妇患妊娠期糖尿病及高血压的关系.方法 回顾性分析2011年2月至2012年2月行常规产前检查并住院分娩的产妇1240例,记录pBMI、GWG、第24～ 28孕周的空腹血糖及血压水平.采用相关性分析及Logistic回归分析的方法研究pBMI及GWG与妊娠期糖尿病及高血压的关系.结果 根据pBMI分组,轻体重组260例,正常体重组917例,超重组36例,肥胖组27例.根据GWG分组,低度增长组104例,正常增长组758例,中度增长组249例,高度增长组129例.pBMI与GWG呈负相关(r=-0.646,P＜0.01).以正常体重组为参照,超重组妊娠期糖尿病发病率为11.11％(4/36),OR值为4.120,P＜0.05;肥胖组妊娠期糖尿病发病率为18.52％(5/27),OR值为7.492,P＜0.05;肥胖组妊娠期高血压发病率为11.11％(3/27),OR值为6.243,P＜0.05.以正常增长组为参照,低度增长组妊娠期糖尿病发病率为15.38％(16/104),OR值为9.006,P＜0.05;低度增长组妊娠期高血压发病率为4.81％(5/104),OR值为3.140,P＜0.05;高度增长组妊娠期高血压发病率为4.65％(6/129),OR值为3.033,P＜0.05.各组空腹血糖及血压水平比较差异无统计学意义(P＞0.05).结论 pBMI与GWG呈负相关,pBMI偏高及GWG偏低均是患妊娠期糖尿病及高血压的危险因素.     

天津地区双胎孕妇妊娠期增重趋势探讨

目的 初探天津地区不同孕前BMI双胎孕妇妊娠期增重趋势和各妊娠期推荐增重范围。方法 回顾性分析2010年1月至2018年11月在天津市分娩且有完整产检的1 346例健康双胎孕妇数据,按照孕前BMI分为体重不足组（BMI<18.5,n=117）、标准体重组（18.5≤BMI≤23.9,n=783）、超重组（24.0≤BMI≤27.9,n=320）、肥胖组（BMI≥28.0,n=126）。绘制各组孕妇的妊娠期体重增长曲线,按P²5～P75计算不同组别双胎孕妇妊娠早、中、晚期适宜增重范围,分析孕前BMI与新生儿体重的关系。结果 孕前BMI与年龄呈正相关（r=0.06,P<0.05）,与分娩孕周呈负相关（r=-0.12,P<0.001）,双胎之间出生体重呈正相关（r=0.69,P<0.001）。四组孕妇妊娠期适宜增重范围分别是:体重不足组20.27（17.00～24.24）kg,标准体重组20.95（16.64～25.66）kg,超重组16.94（13.39～20.62）kg,肥胖组16.44（11.29～21.79）kg,差异有统计学意义（P<0.01）。孕前BMI与双胎新生儿出生体重之间差异无统计学意义（P>0.05）。结论 本研究初步得出我国北方城市天津不同孕前BMI双胎孕妇在妊娠早、中、晚期的适宜增重范围及增重速度,为现有指南中缺少的孕前体重不足组双胎孕妇的妊娠期增重范围提供参考。     

孕前体重指数和孕期体重增长与早产的关系

目的:探讨孕前体重指数和孕期体重增长与早产的关系。方法:回顾性分析2003年1月2005年1月我院592例单胎早产孕妇孕前体重指数和孕期体重增长情况。结果:排除混杂因素影响,孕前体重过低或孕前体重正常而孕期体重增长不足的孕妇发生早产的AOR值和95%可信区间分别是5.96(1.26,46.5)和3.96(1.82,9.62)。结论:孕前体重过低或孕前体重正常的孕妇若孕期体重增长不足会增加早产的危险。     

孕前体质指数和孕期增重与子痫前期及其临床亚型的关系

目的 探讨孕前BMI和孕期增重与子痫前期（PE）及其临床亚型的发生风险的关系。方法 选取2012年3月至2016年9月在山西医科大学第一医院妇产科分娩的孕妇,根据纳入排除标准,共纳入9 274例孕妇,901例PE孕妇作为病例组,8 373例非PE孕妇作为对照组。收集一般人口学特征、孕前身高和体重、孕期生活方式、生育史和疾病史等资料,计算孕前BMI及孕期增重。采用非条件logistic回归分析孕前BMI和孕期增重与PE及其临床亚型的关系。结果 PE中早发型PE （EOPE）401例、晚发型PE （LOPE）500例,轻度PE （MPE）178例、重度PE （SPE）723例。PE孕妇和非PE孕妇在年龄、居住地、产次、妊娠期糖尿病及高血压家族史等方面差异有统计学意义（P<0.05）。调整以上因素后,logistic回归分析结果显示,孕前BMI<18.5 kg/m²和孕期增重不足是PE的保护因素（OR=0.74,95%CI：0.56~0.98;OR=0.78,95%CI：0.62~0.99）,孕前BMI ≥ 24.0 kg/m²和孕期增重过多是PE的危险因素（OR=1.82,95%CI：1.54~2.14;OR=1.82,95%CI：1.54~2.15）。对PE临床亚型分析后结果显示,孕前BMI<18.5 kg/m²是EOPE和MPE的保护因素（OR=0.52,95%CI：0.32~0.83;OR=0.47,95%CI：0.23~0.97）,孕前BMI ≥ 24.0 kg/m²和孕期增重过多是PE临床亚型的危险因素。按孕前BMI分层后,孕前18.5 kg/m² ≤ BMI<24.0 kg/m²和孕前BMI ≥ 24.0 kg/m²的孕妇中孕期增重过多（OR=1.86,95%CI：1.51~2.30;OR=1.90,95%CI：1.39~2.60）均是PE的危险因素;孕前BMI ≥ 24.0 kg/m²的孕妇中孕期增重不足（OR=0.55,95%CI：0.34~0.89）是PE的保护因素。孕前BMI<18.5 kg/m²的孕妇中孕期增重过多（OR=4.05,95%CI：1.20~13.69）是EOPE的危险因素;孕前18.5 kg/m² ≤ BMI<24.0 kg/m²的孕妇中孕期增重过多是PE各临床亚型的危险因素;孕前BMI ≥ 24.0 kg/m²的孕妇中孕期增重不足是EOPE和MPE的保护因素（OR=0.39,95%CI：0.19~0.80;OR=0.29,95%CI：0.11~0.77）,孕期增重过多是EOPE、LOPE和SPE的危险因素（OR=1.60,95%CI：1.06~2.42;OR=2.20,95%CI：1.44~3.37;OR=2.28,95%CI：1.58~3.29）。结论 孕前BMI和孕期增重影响PE及其临床亚型的发生风险,且不同孕前BMI人群孕期增重对PE的影响有差异,提倡同时关注孕前BMI和孕期体重变化,从而减少PE发生。