孕期热能个体化供给与分娩方式的关系探讨

Relation between individualization energy supply during pregnancy and mode of labor

目的探讨在我国不同孕前BMI孕期理想的热能供给降低医学指征的剖宫产率的可行性。方法随机选取2003年7月—2006年7月济南市妇幼保健院进行常规产前检查并住院分娩的既往无心、肝、肾疾病,无慢性高血压、糖尿病等合并症及遗传性疾病的单胎初产妇1003例作为研究组,同时选取同期1258例作为对照组,根据孕前或孕12周前体重指数(BMI)分组,分别为正常体重组(BMI 18.5～22.9)、超重组(BMI23.0～24.9)、肥胖组(BMI≥25.0),研究组、对照组孕妇的年龄及BMI均无显著差异。根据孕前或孕12周前BMI的不同,制定不同的热能供给方案,对照组热能供给不限制。指导孕妇进行轻体力劳动,以上各组孕期进行系统的产前检查,定期B超检查,分别观察胎儿增长规律、孕期体重、孕期体重指数增加幅度、孕期并发症、分娩方式及新生儿出生体重。结果研究组的医学指征剖宫产率低于对照组,结果有显著性差异(P<0.05)。分娩方式经单因素筛选后进行多因素Logistic回归分析,表明:孕前体重、孕前体重指数、孕期体重增长幅度、孕期体重指数增长幅度与有正相关性。结论对孕前不同BMI孕妇,给予不同的热能供给方案,对降低医学指征的剖宫产率等取得了良好的临床效果。孕期个体化的热能供给切实可行。

Objective To investigate the feasibility of decrease the rate of euterine-incision delivery based on the medicine indicated by supply different energy according to the different pregestational BMI. Methods Totally 1003 women were selected as the research group who have their prenatal examination and delivered at Jinan women and children hospital from 2003 7 to 2008 7,another 1258 women were selected as the control group,both of them were primipara and single birth,without complications and genetic disease.According to the pregestational BMI,we divided them into different groups,they were normal weight（BMI 18.5～22.90）,overweight（BMI 23～24.90） and obesities（BMI≥25.0）.The age and BMI were no significant deviation between research and control group.The study institute different energy supply projects according to different BMI,but the control group without restriction.The two groups were directed to do light physical work,The two groups have systemic prenatal examination,type-B ultrasonic regularly.We observed the fetal growth rule,the weight of pregnancy,the extent of the BMI increased,complications of pregnancy,the mode of delivery,the weight of the newborn. Results The rate of euterine-incision delivery based on the medicine indicated in research group was significantly lower than that of control group（P0.05）.We carry out the Logistic regression analysis on the mode of labor after it was filtrated by single factor,it indicated that the progestational weight,progestational BMI,the extent of the weight gain during pregnancy,the extent of BMI increased have the positive correlation with the mode of labor. Conclusions Provide different energy supply project according to the different pregestational BMI,Gained satisfactory clinic effect on decrease the rate of euterine-incision delivery based on the medicine indicated.It is feasible to give the individualization energy supply during pregnancy.