基于美国医学研究院推荐的孕期增重与围产结局的回顾性研究

A retrospective study on gestational weight gain and perinatal outcomes based on IOM recommendations

目的研究分析福州地区孕期增重与围产结局的关系。方法选择2017年1-6月份在福建省妇幼保健院围产保健门诊建档并定期产前检查、分娩的单胎孕妇3086例,回顾病历资料,依据中国成人超重和肥胖预防控制指南,将研究对象按孕前体质指数(BMI)分为低体重组、正常体重组、超重及肥胖组,参照美国医学研究院(Institute of Medicine,IOM)发布的妊娠期增重推荐标准,将孕期增重分为增重不足、增重达标、增重超标3组。分析3组早产、巨大儿、妊娠并发症发生情况。结果孕前低体重730例(23.66%)、正常体重2059例(66.72%)、超重与肥胖297例(9.62%)。孕期增重不足467例(15.13%)、增重达标1318例(42.71%)、增重超标1301例(42.16%)。调整孕妇年龄、文化程度、孕次、产次及孕前BMI。多因素Logistic回归显示:与孕期增重达标孕妇相比,低体重组和正常体重组,孕期增重不足增加早产的发生风险,OR值分别为2.67(95%CI:1.19~6.0)、2.19(95%CI:1.38~3.93),孕期增重超标增加巨大儿的发生风险,OR值分别为2.72(95%CI:1.13~6.52)、2.22(95%CI:1.42~3.46);正常体重组和超重肥胖组,孕期增重超标增加妊娠期高血压疾病风险,OR值分别为1.80(95%CI:1.04~3.13)、9.03(95%CI:1.18~68.86)。结论孕前低体重、正常体重的孕妇孕期增重不足增加早产的风险,增重超标增加巨大儿风险,正常体重和超重肥胖孕妇,孕期增重超标增加妊娠期高血压疾病风险。

Objective Objective To study the relationship between pregnancy weight gain and perinatal outcomes in Fuzhou area.Methods A total of 3086 singleton pregnant women with regular antenatal examination and delivery were selected from the perinatal health clinic of Fujian Maternal and Child Health Care Hospital from January to June 2017.According to the Chinese Adult Overweight and Obesity Prevention and Control guidelines,the subjects were divided into underweight,normal weight,overweight and obese according to pre-pregnancy BMI.According to the Institute of Medicine(IOM)criteria,weight gain during pregnancy was classified as inadequate,adequate,and excessive.The incidence of premature delivery,macrosomia and pregnancy complications of the three groups were analyzed.Results The prevalence of underweight,normal weight,overweight and obesity was 730 cases(23.66%),2059 cases(66.72%),and 297 cases(9.62%),respectively.The subjects during pregnancy with inadequate weight gain,adequate and excessive were 467 cases(15.13%),1318(42.71%),and 1301(42.16%),respectively.Adjusting the maternal age,education,gravidity,parity and BMI,multiple factors logistic regression showed that compared with adequate weight gain,underweight and normal weight group,inadequate weight gain during pregnancy increased the risk of preterm birth,with OR of 2.67(95%CI:1.19-6.0),2.19(95%CI:1.38-3.93),respectively.Excessive weight gain increased the risk of the occurrence of macrosomia,with OR of 2.72(95%CI:1.13-6.52),and 2.22(95%CI:1.42-3.46),respectively.In the normal weight,overweight and obesity group,excessive weight gain during pregnancy increased the risk of hypertension during pregnancy,with OR of 1.80(95%CI:1.04-3.13)and 9.03(95%CI:1.18-68.86),respectively.Conclusion The risk of premature delivery is increased in underweight and normal weight pregnant women who gain inadequate weight during pregnancy.The risk of macrosomia is increased in underweight and normal weight women who gain excessive weight.The excessive weight gain in women with normal,overweight or obesity is related with high risk of hypertension during pregnancy.