孕前体重指数对初次妊娠妇女妊娠结局的影响

THE EFFECT OF BEFORE PREGNANCY BODY MASS INDEX ON PREGNANCY OUTCOME IN NULLIPAROUS WOMEN

目的:探讨初次妊娠妇女待孕前体重指数对妊娠结局的影响。方法:采用回顾性群组研究方法,对2000～2006年间,在牡丹江中医院产前门诊就诊并在其院部分娩单胎的839名初次妊娠的育龄妇女进行了研究。这些妇女按体重指数分成五组:偏轻组(BMI<18.5kg/m2)、正常组(BMI=18.5～23.9kg/m2)、超重组(BMI=24～27.9kg/m2)、肥胖组(BMI=28～31.9kg/m2)、和病态肥胖组(BMI≥32kg/m2)。使用单变量和多变量分析对比各组对妊娠结局的影响。结果:和正常组妇女相比,病态肥胖组妇女患妊娠高血压疾病{OR4.37(95%CI1.32,14.41)}和妊娠期糖尿病{OR6.01(95%CI1.95,18.52)}的风险极高,而体重偏轻组妇女的患病风险最低。病态肥胖组妇女引产几率最高{OR2.94(95%CI1.02,8.48)},体重偏轻组妇女引产几率最低。病态肥胖组妇女剖腹产几率最高{OR3.22(95%CI1.13,9.22)},体重偏轻组妇女剖腹产几率最低。病态肥胖组妇女更容易患产后出血症{OR4.05(95%CI1.08,15.20)}和早产{OR5.55(95%CI1.14,27.15)}。病态肥胖组妇女分娩巨大儿的风险最高{OR5.55(95%CI1.14,27.15)},而体重偏轻组妇女风险最低。体重偏轻组妇女分娩低体重儿的风险最高{OR5.14(95%CI1.26,20.92)}。结论:孕妇体重指数的增加相应带来妊娠期高血压疾病、妊娠期糖尿病、巨大儿、引产、剖腹产发生率的增加。与拥有正常体重指数的妇女相比,体重偏轻的妇女有比较好的妊娠结局。

Objective： To explore the effect of body mass index before pregnancy on pregnancy outcomeeffect in nulliparous women. Methods ：This was a retrospective cohort study, based on all nulliparous 839 women visited in Mudanjiang traditional Chinese Medical Hospital antepartum clinic and delivering singlet on babies in Mudanjiang Traditional Chinese Medical Hospital between 2000 and 2006. Women were categorized into five groups - underweight（ BMI 〈 18. 5 Kg/m） ,normal（BMI = 18.5 - 23.9 Kg/m） ,over- weight（BMI = 24 - 27. 9 Kg/m） ,obese（BMI = 28 - 31.9 Kg/m） and morbidly obese（BMI ≥ 32 Kg/m）. Obstetric and pefinatal outcomes were compared by univariate and multivariate analyses. Results： In comparison with normal women, morbidly obese women faced the highest risk of gestational hypertension { OR 4. 37 （95 % CI 1.32,14.41 ） } and gestational diabetes mellitus { OR 6. 01 （95 % CI 1.95,18. 52） }, underweight women face the lower risk. Induced labour was highest in the morbidly obese { OR 2. 94 （95% CI 1.02, 8.48） } and lowest in underweight women. Caesarean delivery was highest in the morbidly obese { OR 3.22（95% CI 1.13,9.22） } and lowest in underweight women. Obese women were more likely to have postpartum haemorrhage { OR 4. 05 （95 % CI 1.08,15.20） } and prcterm delivery { OR 5.55 （95 % CI 1.14,27. 15 ） }. The highest risk of birth weights 〉 4,000 g was in the morbidly obese{ OR 5.55 （95% CI 1.14,27. 15 ）} and the lowest in underweight women. Birthweights less than 2,500 g were more common in underweight women { OR 5.14（95% CI 1.26,20. 92） }. Conclusion：Increasing BMI is associated with increased incidence of gestational hypertension, gestational diabetes mellitus, macrosomia, induction of labour and caesarean delivery ; while underweight women had better pregnan- cy outcomes than women with normal BMI.