孕前人体质量指数与妊娠高血压综合征的关系

目的 了解孕前人体质量指数(body mass index,BMI)与妊娠高血压综合征(pregnancy-induced hypertension,PIH)发生危险性之间的关系.方法 数据来自"中美预防出生缺陷和残疾合作项目"中嘉兴地区的围产保健监测数据库.研究对象为1995-2000年在嘉兴地区参加婚前或孕前体检且分娩了单胎活产儿的孕满20周的83 159名孕产妇.运用X2检验或X<,趋势>2检验比较不同BMI组或其他特征人群PIH发病率的差别,利用多元logistic回归分析孕前BMI与PIH发生危险性之间的关系.结果 PIH发病率为11.01%(9153/83 159;95%CI:10.79%～11.22%).PIH的发病率自BMI<18.5 kg/m2组的9.08%(1405/15 472;95%CI:8.63%～9.54%),18.5～22.9 kg/m2组的10.82%(6389/59 054;95%CI:10.57%～11.07%),23.0～24.9 kg/m2组的14.63%(943/6444;95%CI:13.78%～15.52%)升至BMI≥25/0 kg/m2组的19.00%(416/2189;95%CI:17.38%～20.71%),差异有统计学意义(X<,趋势>2=261.028,P=0.000).以BMI为18.5～22.9 kg/m2者为参照组,BMI<18.5 kg/m2、23.0～24.9 kg/m2和≥25.0 kg/m2组发生PIH的RR值分别为0.82(95%CI:0.77～0.87)、1.41(95%CI:1.31～1.52)和1.93(95%CI:1.73～2.16).调整地区、年龄、文化程度、职业、产次、产前检查次数和既往高血压病史或家族史后,上述RR值分别为0.85(95%CI:0.80～0.90)、1.37(95%CI:1.27～1.47)和1.88(95%CI:1.68～2.10).结论 PIH的发生危险随孕前BMI的升高而升高.

The relationship between prepregnancy body mass index and the occurrence of pregnancy induced hypertension

Objective To examine the relationship between prepregnancy body mass index (BMI) and the risk of pregnancy-induced hypertension (PIH) in Chinese population. Methods Data were collected in 6 counties/cities covered by Perinatal Health Care Surveillance System which was part of the Sino-American cooperative project on neural tube defects prevention established in 1992. The study population consisted of 83 159 women who attended premarital or preconception medical physical examination and delivered single live births with at least 20 gestational weeks from 1995 to 2000 in Jiaxing area. The Chi-square test was employed to test the difference in the rates of PIH among groups with different BMI. Multivariate logistic regression was conducted to examine the association between prepregnancy BMI and the risk of PIH. Results The rate of PIH was 11.01% (9153/83159;95% CI: 10.79%-11.22%). The rate of PIH among women with BMI <18.5 kg/m2>, 18.5-22.9 kg/m2,23.0-24.9 kg/m2, and ≥25.0 kg/m2(6389/59 054;95% CI: 10. 57%-11.07% ), 14.63% (943/6444; 95% CI: 13.78% - 15.52% ), and 19. 00% (416/2189; 95% CI: 17. 38% - 20. 71% ), respectively, the difference was significant (X<,trend>2 =261.028, P=0.000). Taking those with BMI 18.5-22.9 kg/m2 as reference,the unadjusted RR for PIH was 0. 82 (95% CI: 0.77-0.87) among women with BMI < 18.5 kg/m2, 1.41 (95% CI: 1.31-1.52) among women with BMI 23.0-24.9 kg/m2, and 1.93 (95% CI: 1.73 - 2. 16 ) among women with BMI ≥ 25.0 kg/m2. After controlling for area, maternal age at delivery, educational level, occupation, parity, times of prenatal visit as well as the individual or family history of chronic hypertension, the estimated RR were 0. 85 (95 % CI:0. 80 -0.90),1.37(95% CI:1.27 -1.47) and 1.88(95% CI:1.68-2.10),respectively. Conclusion High prepregnancy BMI could increase the risk of PIH.