孕期营养状况及膳食摄入营养素水平与妊娠结局关系的调查

Survey on prenatal intake of various nutrients and pregnancy outcomes

目的调查孕妇孕期营养状况，了解孕期营养状况对妊娠结局的影响，为采取针对性的干预措施提供依据。方法于2006年1月至2008年4月间对厦门市妇幼保健院的800例正常孕妇进行营养知识、态度及行为的调查，共734例按要求合格完成调查，记录了其中571例孕妇人组时（〈孕20周）、孕26～27周、孕35～36周的多个营养素指标、妊娠结局，分析彼此间关系。结果（1）孕妇文化程度越高，营养知识、态度及行为的科学性越高（P〈0．05）。734例孕妇中，39．2％（288例）的孕妇营养知识不足，44．4％（326例）营养知识匮乏，营养行为不良者占48．8％（358例）。对1927份孕期膳食结构问卷分析发现孕期每天均有奶类、鱼贝类或豆类摄入者分别占52．2％、34．3％、29．5％。（2）入组时只有血清甘油三酯水平在不同体重指数（BMI）孕妇中存在差异，BMI越高甘油三酯越高（P〈0．01）。此外，随孕周增加，血清铁蛋白和叶酸呈显著下降趋势（P〈0．05），甘油三酯、胆固醇呈显著上升趋势（P〈0．01）。（3）新生儿出生体重与孕20周前BMI呈正相关（r=0．23，P〈0．05），入组时BMI过高是新生儿出生体重异常的危险因素（OR=4．051，95％CI：1．085～15．117，P〈0．05），且剖宫产率显著高于BMI低下或正常者（60．3％与29．4％和34．7％，P〈0．05）。孕期孕妇血清铁蛋白水平越低，产后出血量越多（P〈0．05）。结论孕前及孕期合理控制体重，孕期加强营养知识指导，增加奶类、鱼贝类及豆类食品的比例，控制高脂高糖饮食，注重红色动物性食物摄入，全程补充叶酸、铁和钙，避免血脂过高，可能降低异常体重儿、产后出血及剖宫产率，改善妊娠结局。

Objective To investigate the maternal nutritional status and its influences on pregnancy outcomes in order to provide evidence for possible prenatal interventions. Methods A survey was conducted in 800 pregnant women, who presented at Xiamen Maternal and Child Healthcare Hospital between January 2006 to April 2008. The information of knowledge, attitude and behavior towards maternal nutrition were collected in 734 women and 571 women were followed up before 20 weeks of gestation, at 26-27 weeks, and 35-36 weeks to analyze the relationship between different nutrients and the pregnant outcomes. Results The questionnaire survey showed that women who had received higher education presented with better knowledge, attitude and behavior on maternal nutrition （P〈0.05）. Among the 734 women, 39.2% （288） had poor knowledge, 44.5% （326） were lack of knowledge, and 44.8% （358） with poor behavior. Prenatal diet analysis found that the percentage of these women with milk, fish and beans intake daily was 52.2%, 34. 3%, and 29.5%, respectively, Before 20 weeks of gestation, significant difference was identified only in the level of triglyceride among different BMI groups, and the higher the BMI, the higher the level of triglyceride （P〈0.01）. With the progress of pregnancy, the level of serum ferritin and folic acid was decreasing （P〈0.05）, while the level of triglyceride and cholesterol was increasing （P〈0.01）. The newborn＇s birth weight was positively correlated to maternal BMI before 20 weeks （r= 0. 23, P〈 0.05）, and higher BMI was a risk factor for abnormal birth weight （OR=4. 051, 95% CI： 1. 085- 15. 117, P〈0.05） and also complicated with higher cesarean section rate than those women with lower or normal BMI （60.3% vs 29.4% and 34.7% ,P〈0.05）. The rate of postpartum hemorrhage was increased with the reduced ferritin level （P〈0.05）. Conclusions The pregnancy outcomes can be improved through the following measures： appropriate control of the maternal weight before and during the pregnancy, increased intake of milk, fish, beans and so on, reduced intake of food containing abundant fat and sugar, more intake of red animal foodstuff, supplementation of folic acid, iron and calcium throughout the pregnancy, and prevention against high level of triglyceride and cholesterol.