孕前体质指数及孕期体重的增加对妊娠结局的影响

Pre-pregnancy weight and weight gain during pregnancy have an influence on pregnancy outcome

目的探讨孕前不同的体质指数(BMI)和孕期体重的增加对妊娠结局的影响。方法选取该院2008～2011年758例有完整的产检和妊娠结局记录的正常单胎孕妇资料进行回顾性分析。结果 (1)按孕前BMI的不同,将758例孕妇分为不同的组,A组(孕前消瘦组)共157例,B组(孕前正常体重组)共541例,C组(孕前超重肥胖组)共60例,A、B、C组妊娠期糖尿病(GDM)的发生率分别为2.5%(4/157)、6.7%(36/541)、15%(9/60),其差异有统计学意义(P<0.05),C组最高;子痫前期的发生率分别为0.6%(1/157),3.0%(16/541),8.3%(5/60),其差异有统计学意义(P<0.05),C组最高;巨大儿的发生率分别为1.3%(2/157)、7.4%(40/541)、20%(12/60),其差异有统计学意义(P<0.05),C组最高;剖宫产率分别为31.8%(50/157)、31.2%(169/541)、51.7%(31/60),其差异有统计学意义(P<0.05),C组最高,而早产的发生率未见统计学差异。(2)按孕期体重增加的不同,将758例孕妇分为不同的组,D组(孕期增加过少)共61例,E组(孕期体重增加正常)共209例,F组(孕期体重增加过多)488例,D、E、F组GDM的发生率分别为14.8%(9/61)、5.7%(12/209)、5.7%(28/488),其差异有统计学意义(P<0.05),D组最高;巨大儿的发生率分别为3.3%(2/61)、2.9%(6/209)、9.4%(46/488),其差异有统计学意义(P<0.05),F组最高;剖宫产率分别为18.0%(11/61)、24.4%(51/209)、38.5%(188/488),其差异有统计学意义(P<0.05),F组最高,而子痫前期和早产的发生率未见统计学差异。结论孕前超重肥胖及孕期体重增加过多、过少均会导致不良的妊娠结局。

Objective To investigate the relationships between pre-pregnancy weight, weight gain durling pregnancy and pregnancy out- come. Methods Retrospective analysis was made of 758 singleton pregnancy women data. Results Altogether 758 pregnancy women were divided into different groups according to pre-pregnancy BMI. Group A（ low weight pre-pregnancy） the number of which was 157, Group B（ normal weight pre-pregnancy）the number of which was 541, Group C （overweight and obesity pre-pregnancy）the number of which was 60 ,The incidence rates of GDM in Group A,B,C was 2.5% （4/157） ,6.7% （36/541） ,and 15% （9/60）. There was differ- ence in the three groups（ P 〈 0.05 ） ,The incidence rate of GDM in Group C was the highest. The incidence rates of eclampsism in Group A, B, C were 0.6 % （ 1/157 ） ,3.0% （ 16/541 ）, 8.3 % （ 5/60 ）. There was difference in the three groups （ P 〈 0.05 ）. The incidence rate of eclampsism in Group C was the highest. The incidence rates of large for date infant in Group A, B, C were 1.3 % （2/157） ,7.4% （40/ 541 ） ,20% （12/60）. There was difference in the three groups（ P 〈 0.05 ）. The incidence rate of large for date infant in Group C was the highest. The incidence rates of uterine-incision delivery in Group A, B, C were 31.8% （50/157） ,31.2% （ 169/541 ） ,51.7% （31/60）. There was difference in the three groups （ P 〈 0.05 ）. The incidence rate of uterine-incision delivery in Group C was the highest, while there was no difference in the three groups about the incidence rate of premature delivery. Patients were divided into different groups ac- cording to weight gain during pregnancy. Group D （ low weight gain during pregnancy） the number of which was 61, Group E （ normal weight gain during pregnancy） the number of which was 209, Group F （ much weight gain during pregnancy） the number of which was 488. The incidence rates of GDM in Group D, E, F were 14.8% （9/61） ,5.7% （ 12/209 ） ,5.7% （28/488）. There was difference in the three groups （ P 〈 0.05 ）. The incidence rates of GDM in Group D was the highest. The incidence rates of large for date infant in Group D, E, F were 1.3 % （2/157） ,7.4% （40/541） ,20% （12/60）. There was difference in the three groups （P 〈 0.05 ）. The incidence rate of large for date infant in Group F was the highest;The incidence rate of uterine-incision delivery in Group D, E, F were 18.0% （11/61 ） ,24.4% （51/209） ,38.5% （ 188/488 ）. There was difference in the three groups（ P 〈 0.05 ）. The incidence rate of uterine-incision delivery in Group F was the highest, while there were no difference in the three groups about the incidence rate of eclampsism and premature deliver- y. Conclusion Pre-pregnancy overweight or obesity and much or little weight gain during pregnancy have a harmful influence on preg- nancy outcome.