孕前超重/肥胖与婴儿不良出生结局关系前瞻性队列研究

  目的  探讨妇女连续两次妊娠间孕前体重变化与早产、低出生体重、巨大儿、小于胎龄儿及大于胎龄儿的关系。  方法  基于广东省妇幼卫生信息系统，收集2015 — 2020年具有两次分娩记录的6 589名孕妇及其分娩婴儿的资料，将生育间体质指数（BMI）变化分为4组（< – 1、 – 1～、1～、 ≥ 3），使用logistic回归模型分析两次妊娠间孕前BMI变化与不良出生结局的关联。  结果   本研究纳入的6 589名孕产妇及其子女早产、低出生体重儿、巨大儿、小于胎龄儿、大于胎龄儿的发生率分别为5.6 %、4.7 %、2.4 %、11.4 %和5.4 %。logistic回归结果显示，相对于BMI变化 − 1～的参照组，BMI变化1～组发生巨大儿风险增加66 %（OR = 1.66，95 % CI = 1.13～2.24），BMI变化 ≥ 3组发生巨大儿、大于胎龄儿的风险分别增加131 %（OR = 2.31，95 % CI = 1.42～3.70）、87 %（OR = 1.87，95 % CI = 1.33～2.60）。BMI每增加1，小于胎龄儿风险降低7 %（OR = 0.93，95 % CI = 0.89～0.97）。各组发生早产、低出生体重的风险与对照组相比差异均无统计学意义（P > 0.05）。  结论  两次妊娠间体重的增长与巨大儿及大于胎龄儿的风险增加相关。应加强对妇女妊娠期及分娩后的体重管理，以降低二胎巨大儿、大于胎龄儿的发生风险。

Fetal origins of adult disease: strength of effects and biological basis

  Objective  To investigate associations of interpregnancy weight change with preterm birth, low birth weight, macrosomia, small for gestational age (SGA), and large for gestational age (LGA).   Methods  The data on 6 589 pregnant women having two or more singleton live births during 2015 – 2020 and their newborns were extracted from the Maternal and Child Health Information System of Guangdong province. The pregnant women were assigned into four groups according to the changes in their interpregnancy body mass index (BMI) of ＜−1, −1 – ＜1 , 1 – ＜3, and ≥ 3 kg/m². Logistic regression model was used to assess the associations of interpregnancy BMI change with adverse birth outcomes.   Results  In all the newborns, the proportion was 5.5% for preterm birth, 4.7% for low birth weight, 2.4% for macrosomia, 11.4% for SGA, and 5.4% for LGA, respectively. The results of logistic regression analysis showed that compared to those with the interpregnancy BMI change of −1 – < 1, the pregnant women having the change of 1 – < 3 have an increased risk of giving a birth to a macrosomia (odds ratio [OR] = 1.66, 95% confidence interval [95% CI]: 1.13 – 2.24); the women with the interpregnancy BMI change of 3 and more have an increased risk of giving a birth to a macrosomia (OR = 2.31, 95% CI: 1.42 – 3.70) and to a LGA infant (OR = 1.87, 95% CI: 1.33 – 2.60); while, each increase of 1 kg/m² in interpregnancy BMI is associated with a 7% decreased risk of SGA (OR = 0.93, 95% CI: 0.89 – 0.97). No significant association of interpregnancy BMI change with preterm birth or low birth weight was observed (P > 0.05).   Conclusion  Pregnant women′s interpregnancy weight gain is associated with increased risks of macrosomia and LGA of their newborns. The results suggest that body weight control during pregnancy and after delivery need to be promoted among pregnant women.