孕妇体质量指数及孕期增重对妊娠结局的影响

Influences of increment in BMI and weight gain during pregnancy on pregnancy outcome

目的 研究孕妇孕妇体质量指数及其孕期增重对妊娠结局的影响.方法 选取2005～2008年在本院分娩符合标准的孕妇1 897例,根据不同的孕妇体质量指数分为3组,根据孕期体重增大的不同幅度分为3组,比较各组的剖宫产率、新生儿窒息率、巨大儿发生率、产后出血率、早产率、低体重儿发生率.结果 超重组的剖宫产率（36.04% vs 28.03%）、巨大儿发生率（10.41% vs 6.83%）、新生儿窒息率（8.63% vs 2.89%）、早产（5.33% vs 2.09%）、低出生体重（4.82% vs 2.49%）均高于正常体重组（均P＆lt;0.05）,消瘦组早产、低出生体重发生率高于正常体重组（6.59% vs 2.09%,5.43% vs 2.49%,均P＆lt;0.05）.孕期体重增长过多或者增重不足组妊娠结局明显差于增重合适组（P＆lt;0.05）.增重过多组剖宫产、新生儿窒息、早产、低出生体重发生率约为增重合适组的2倍[OR分别为1.82（95%CI 1.47～2.26）,2.34（95%CI 1.43～3.84）,2.20（95%CI 1.25～3.86）1.92（95%CI 1.06～3.47）,均P＆lt;0.05].结论 孕妇体重指数、孕期体重增长的增幅对分娩结局有影响,孕前保持正常体重、孕期合理营养控制适宜的体重增长有利于取得理想的分娩结局.

Objective To investigate influences of increment in maternal BMI and weight gain during pregnancy on pregnancy outcome. Methods 1897 pregnant women who delivered in our hospital in a period from Jan. ,2005 to Dec. ,2008 were investigated. According to maternal BMI and weight gain during pregnancy, the pregnant women were divided into 3 BMI groups and 3 weight gain groups. The incidence rates of cesarean section, neonatal asphyxia, macrosomia, postpartum hemorrhage, preterm birth and low birth weight infants were compared among different groups. Results The cesarean section rate and incidence rates of macrosomia, neonatal asphyxia, preterm labor, low birth weight infants in over weight gain group were higher than those in normal weight gain group （36.04% vs 28.03% ; 10.41% vs 6.83% ; 8.63% vs 2.89% ; 5.33% vs 2.09% ; 4. 82% vs 2.49%, all P 〈 0.05）. The rates of preterm labor and low birth weight infants in under weight gain group were higher than those in normal weight gain group（6.59% vs 2.09% ; 5.43% vs 2.49% ,both P 〈 0.05 ） o The pregnancy outcoms of pregnant women in normal weight gain group were better than that in both over and under weight gain groups （both P 〈 0.05）. The cesarean section rate, incidence rates of neonatal asphyxia, preterm labor, low birth weight infants in over weight gain group were twice of those in the normal weight gain group （ OR = 1.82, 95% CI： 1.47-2.26; OR =2.34, 95% CI： 1.43-3.84; OR =2.20, 95% CI： 1.25-3.86; OR = 1.92, 95% CI： 1.06-3.47, all P 〈0.05）. Conclusion Increment in maternal BMI and weight gain during pregnancy impact on pregnancy outcomes. Maintaining normal body weight before pregnancy, reasonable nutrition and appropriately controlling weight gain during pregnancy could help to achieve better pregnancy outcomes.