孕前体质指数及孕期体重增长对妊娠过程及结局的影响

目的:探讨孕前体质指数(BMI)及孕期体重增长(GWG)与妊娠合并疾病及不良结局的关系。方法:回顾分析于复旦大学附属妇产科医院产科门诊定期产前检查并住院分娩的3541例足月单胎初产妇的临床资料。将产妇按孕前体质指数(BMI)和不同孕期体重增长(GWG)分组,采用logistic多因素回归分析孕前体质指数及孕期体重增长与妊娠合并疾病及结局的关系。结果:孕妇孕期体重平均增加(16.0±4.9)kg,新生儿平均出生体重(3341.6±425.9)g,低出生体重儿和巨大儿分别占2.1%及5.1%。根据IOM推荐孕期GWG分组,GWG过低、过高组孕妇与正常孕妇的巨大儿、剖宫产数、早产发生率比较,差异有统计学意义(P0.05)。孕前超重、肥胖能增加妊娠期糖尿病(OR=2.7,2.3)、妊娠期高血压疾病(OR=5.4,OR=7.7)、巨大儿(OR=1.6,OR=8.9)、剖宫产(OR=1.4,OR=1.7)的发生风险,而GWG过高增加剖宫产的发生风险(OR=1.5)。结论:孕前BMI不仅影响妊娠合并疾病的发生,也与妊娠结局密切相关。临床上应特别重视孕前宣教及体检,建议育龄期妇女达到合适的体质指数后怀孕。孕期过度体重增长增大了不良妊娠结局(巨大儿、剖宫产)的发生率,临床上可参照IOM推荐体重增长范围进行孕妇体重控制,加强孕期的健康教育和体重随访。同时建议利用大数据多方调研,得出适合中国各地区的孕期体重参考标准。

The effect of pre-pregnancy body mass index,gestational weight gain in pregnancy process and outcome

Objective:To investigate the relationship between pre-pregnancy body mass index(BMI) and gestational weight gain(GWG) to pregnancy complications and adverse out-comes. Method:A total of 3541 singleton pregnant women received routine antenatal care in the Obstetrics and Gynecology Hospital of Fudan University from Feb. to Nov. according to BMI and different GWG. Multivariate Logistic regression was used to estimate the odds ratio and 95%confidence intervals ( CI ) . Result:The average weight of 3541 pregnant women increased by (16. 0±4. 9)kg,the average birth weight of newborns was (3341. 6±425. 9)g,the low and ex-cess birth weight accounted for 2. 1% and 5. 1% respectively. According to IOM recommended weight gain during pregnancy grouping, GWG is too low, too many groups of pregnant women and normal pregnant women is relatively large,cesarean section,premature birth rate difference was statistically significant(P<0. 05). Pregnancy overweight and obesity raised the risk of ges-tational diabetes mellitus (OR=2. 7,2. 3),gestational hypertension(OR=5. 4,7. 7),increased the number of giant newborns (OR=1. 6,8. 9 ),and the occurance of cesarean section(OR=1. 4,1. 7). GWG at too high will aslo contribute to the incidence of cesarean section(OR=1. 4, 1 . 7 ) . Conclusion:Overweight and obese women not only increase the risk of pregnancy com-plications,while increasing the risk of adverse outcomes. In obstetric care management,special attention should be paid to prenatal education and physical examination,it is recommended that women meet the appropriate body mass index after pregnancy. Pregnancy weight managementcan refer to IOM recommended weight gain for pregnant women weight control,the possible risk factors for appropriate intervention,in order to reduce the incidence of pregnancy complications, improve maternal and child outcomes. It is suggested to study large data and formulate guideline for Chinese women.