孕妇体重增幅与母婴不良结局关系的Meta分析

Meta-analysis of the Relationship between Maternal Body Weight Gain and Poor Pregnancy Outcomes

目的综合评价孕妇妊娠期体重增幅与母婴不良结局之间的关系,为制定干预措施提供依据。方法利用meta分析的方法,综合国内孕妇妊娠期体重增幅与母婴不良结局之间关系的队列研究25篇,采用ReviewManager4.2软件进行分析评价。结果孕妇妊娠期体重增幅≥15kg会使以下不良结局的发生风险增加:妊娠期高血压疾病(RR=1.18,1.42～2.48)、剖宫产(RR=2.12,1.65～2.72)、妊娠期糖尿病(RR=3.34,2.20～5.09)、阴道助产(RR=1.63,1.12～2.37)、产后出血(RR=3.96,2.56～6.13)、产程异常(RR=3.05,2.19～4.24)、巨大儿(RR=2.73,1.97～3.78)、新生儿窒息(RR=1.70,1.10～2.60);会使低出生体重的发生风险降低(RR=0.38,0.18～0.81);会使产程平均时间增加5.29(4.81～5.77)个小时,使新生儿平均体重增加378.65(297.80～459.51)克。孕妇妊娠期体重增幅过小(≤9kg或10kg)会使妊娠期高血压疾病(RR=0.27,0.16～0.48)和巨大儿(RR=0.38,0.36～0.41)的发生风险降低,但是会使低出生体重的风险增加(RR=2.50,2.32～2.69)。结论孕妇妊娠期体重增幅过大或过小都会给母婴带来不良的影响,应严格控制孕妇孕期的体重增幅,最适宜的体重增幅应是10～15kg。

Objective To evaluate the relationship between maternal body weight gain and poor pregnancy outcomes and provide evidence for intervention.Methods The results of 25 domestic cohort studies were analyzed by meta-analysis method in this study.This analysis was performed on Review Manager 4.2 software.Results The maternal body weight gain≥15kg could increase the risk of outcomes as follows：pregnancy induced hypertension（RR=1.18,1.42～2.48）,cesarean section（RR=2.12,1.65～2.72）,gestational diabetes（RR=3.34,2.20～5.09）,operative vaginal delivery（RR=1.63,1.12～2.37）,postpartum hemorrhage（RR=3.96,2.56～6.13）,abnormal labor（RR=3.05,2.19～4.24）,macrosomia（RR=2.73,1.97～3.78）,neonatal asphyxia（RR=1.70,1.10～2.60）.The maternal body weight gain≥15kg could decrease the risk of low birth weight（RR=0.38,0.18～0.81）.Besides,the maternal body weight gain≥15kg could increase the mean labor duration by 5.29（4.81～5.77）hours,and the mean neonatal weight by 378.65（297.80～459.51）g.The maternal inadequate body weight gain could decrease the risk of pregnancy induced hypertension（RR=0.27,0.16～0.48） and macrosomia（RR=0.38,0.36～0.41）,but could increase the risk of low birth weight（RR=2.50,2.32～2.69）.Conclusion Either maternal excessive body weight gain or maternal inadequate body weight gain will do harm to mother and newborn,so we should control maternal body weight gain strictly,the most appropriate weight gain would be 10～15kg.