基于广义估计方程探讨长沙市开福区产妇产后体重滞留现状及其影响因素

目的：了解长沙市开福区产妇产后体重滞留(postpartum weight retention，PPWR)的现状，基于广义估计方程探讨PPWR的影响因素。方法：采用整群抽样法，选取2015年1至12月在湖南省长沙市开福区3个街道社区卫生服务中心分娩的产妇作为研究对象。根据纳入和排除标准，最终纳入研究的样本为783例。采用前瞻性队列研究方法，应用自制调查问卷收集产妇产后1，3，6及8个月的PPWR资料；并进一步采用广义估计方程分析PPWR的影响因素。 结果：产妇PPWR随产后时间的推移而逐渐降低，有34.6%的妇女在产后8个月恢复到孕前体重。由广义估计方程结果可知，产后体重滞留的影响因素有孕期增重、孕前体重指数、分娩方式及喂养方式(P<0.05)，尚未发现年龄、文化程度、家庭人均收入、产次和产后抑郁与PPWR有关(P>0.05)。结论：孕期增重是影响PPWR的重要因素。减少PPWR的关键在于监控孕期增重。重视对孕产妇身心健康的宣传教育和科学指导，加强对妇女产后1年内的体重管理，尤其是剖宫产和母乳喂养的产妇，有利于减小因PPWR带来的超重或肥胖的风险。

Factors associated with postpartum weight retention based on the generalized estimation equation in Kaifu District in Changsha

Objective: To investigate the current status of the postpartum weight retention (PPWR) in Kaifu District of Changsha, and explore the influential factors with PPWR based on the generalized estimating equation model. Methods: A cluster sampling method was applied to select women who gave birth at the health service centers of 3 street communities in Kaifu District of Changsha during 2015. According to the inclusion and exclusion criteria, 783 cases were finally included in the study. Data on PPWR were collected prospectively by using the self-made questionnaire at 1, 3, 6 and 8 months after childbirth. Analysis were performed to investigate the associations between PPWR and its potential factors with generalized estimation equation model. Results: The mean PPWR of women was gradually decreased with the increase of postpartum time, and 34.6% of them have returned to the pre-pregnancy weight in the 8 months postpartum. Our findings revealed that gestation weight gain (GWG), pre-pregnancy body mass index, feeding patterns, and delivery mode were significantly associated with maternal PPWR (P<0.05). In contrast, maternal age, educational level, per capita income of family, parity and postpartum depression were not contributed to PPWR (P>0.05). Conclusion: GWG is one of the most important predictors for PPWR. The key to reducing PPWR is to control GWG systematically. Early targeted interventions and health education should be taken to prevent women from excessive PPWR at the first-year postpartum, in particular to the women who underwent cesarean deliveries and breastfed their infants. It is conducive to reduce the risks of overweight or obesity caused by PPWR.