成都市孕前体质指数正常孕妇孕期增重速率对妊娠结局的影响

Effect of gestational weight gain rate on pregnancy outcomes among Chengdu City pregnant women with normal pre-pregnancy body mass index

目的研究孕前体质指数(BMI)正常孕妇各孕期增重速率对妊娠结局的影响。方法采用前瞻性队列研究,于2013年选取成都市妇幼医疗机构产前门诊389名孕前BMI正常的孕(12±1)周单胎健康孕妇为研究对象,通过自制问卷调查收集孕妇年龄、孕前体重等基线资料,并测量身高、体重。分别于孕(28±1)周及分娩前测量体重,计算各孕期增重速率,并参照美国IOM(2009)孕期增重推荐标准进行分类。分娩后收集分娩孕周、妊娠期糖尿病(GDM)、分娩方式等信息。采用多因素非条件Logistic回归分析分别探讨孕早、中、晚期增重速率对不良妊娠结局的影响。结果孕早期增重过缓率和过快率分别为50.7%及31.8%,孕中、晚期增重过快率分别高达68.5%及57.8%。控制孕妇年龄、孕次及文化程度等混杂因素后,多因素非条件Logistic回归分析显示:与孕晚期增重适宜组相比,孕晚期增重过缓(OR=2.48,95%CI 1.18~5.23)和过快组(OR=1.76,95%CI 1.02~3.03)剖宫产发生风险均明显增加;与孕早期增重适宜组相比,孕早期增重过快组发生GDM风险明显增加(OR=2.55,95%CI 1.03~6.28);未观察到各孕期增重速率对妊娠期高血压疾病、产后出血及早产的影响(P>0.05)。结论孕期增重速率异常会增加剖宫产、GDM的发生风险。

Objective To explore the association between gestational weight gain rate (GWGR)and pregnancy outcomes among pregnant women with normal pre-pregnancy body mass index (BMI).Methods In this prospective study,389 healthy pregnant women at the (12±1)th with normal pre-pregnancy BMI from Chengdu City who delivered a singleton were included in 2013.The basic information such as age,pre-pregnant weight was obtained by questionnaire,height and weight was measured.Then the weight was measured at the (28±1)th and last week before delivery,respectively,the different trimester GWGR was calculated and classified by IOM criteria.Gestational age, gestational diabetes mellitus (GDM)and other pregnancy outcomes were collected by questionnaire.Multiple non-conditional Logistic regression models were used to test the association between GWGR and pregnancy outcomes.Results The proportion of insufficient GWGR and excessive GWGR in first trimester was 50.7% and 31.8%, respectively,the proportion of excessive GWGR in the second and third trimester was 68.5% and 57.8%,respectively.After adjusting the age,education,gravidity and family disease history and other confounding factors,multiple non-conditional logistic regression showed:compared with adequate GWGR in the third trimester,insufficient and excessive GWGR were associated with increased risk of cesarean delivery (OR =2.48, 95%CI 1.18-5.23 and OR =1.76,95%CI 1.02-3.03,respectively).Compared with adequate GWGR in the first trimester,excessive GWGR were associated with increased risk of GDM (OR =2.55,95%CI 1.03-6.28).Conclusion The abnormal of GWGR would increase the risk of cesarean delivery and GDM.