育龄妇女适宜孕期体重增长值及其与妊娠结局关系的研究

Optimal Gestational Weight Gain for Fertile Women and Its Association with Adverse Outcomes

目的：探讨育龄期妇女合理的孕期体重增长值（GWG）范围,并研究GWG与不良妊娠及结局的关系.方法：整群抽取2010年2月至2011年12月在甘肃省妇幼保健院分娩的孕妇（6640例）,选择有良好出生结局的单胎足月无合并症孕妇（4462例）,分析其孕期体重增加情况,取增重分布的四分位数为推荐的适宜GWG范围;通过x2检验和多元Logistic回归,分析GWG在推荐范围外与母婴不良妊娠及结局（5464例）之间的关系,并以此验证本推荐范围是否合理.结果：孕前体重过低（BMI＜18.5 kg/m2）、正常（18.5 kg/m2≤BMI ＜24.0 kg/m2）、超重（24.0 kg/m 2≤BMI＜ 28.0 kg/m 2）、肥胖（BMI≥28.0 kg/m2）孕妇适宜的GWG范围分别为：14.5～21.0kg、14.0 ～20.0 kg、12.0 ～ 19.0 kg、10.0～16.0 kg.在GWG过高组,妊娠期高血压疾病、产后出血、产程异常、剖宫产、巨大儿、新生儿窒息发生的危险性高于GWG正常组,采用母亲年龄、孕前BMI、孕周、产次、吸烟史及饮酒史调整后差异均有统计学意义（P＜0.05）;在GWG过低组,孕妇新生儿窒息、出生缺陷、低出生体重的危险性高于GWG正常的孕妇,调整前差异均有统计学意义（P＜0.05）.结论：孕前体重过低、正常、超重、肥胖孕妇适宜的GWG范围分别为：14.5 ～21.0kg、14.0～ 20.0 kg、12.0～19.0 kg、10.0～16.0 kg,GWG在此推荐的适宜范围内,可以获得较好的出生结局,此推荐范围可作为孕期妇女的体重增重的参考标准.

Objective：To investigate the optimal gestational weight gain （GWG）and assess the impact of GWG on pregnancy outcomes among reproductive-aged women. Methods：All women（6640 cases）who de- livered singleton term births in gansu provincial maternity and child care hospital between February 2010 and December 2011 were included into the study. Optimal GWG was calculated based on the study subjects who delivered a normal term baby and without any maternal complications outcomes. Then we evaluated the as- sociation between abnormal GWG and the risk of adverse birth outcomes as well as maternal complications. Results：The optimal GWG was 14.5 -21.0 kg for women with BMI 〈18. 5 kg/m2 ,14. 0 -20. 0 kg for BMI between 18. 5 and 24. 0 kg/m2 ,12.0 -19, 0 kg for BMI between 24.0 and 28.0 kg/m2 ,and 10.0 -16.0 kg for BMI ≥28. 0 kg/m2, respectively. Gestational hypertension, postpartum hemorrhage, abnormal stage of la- bor,cesarean delivery,macrosomia were associated with an increased risk of excessive GWG after adjust- ment for potential confounding factors including maternal age, pre-pregnant BMI, gestational weeks, parity, smoking history and drinking histories. Increased risks of neonatal asphyxia, birth defects ,and low birth weight were significantly associated with insufficient GWG. Conclusion：The optimal GWG was 14.5 -21.0 kg for women with BMI 〈 18.5 kg/m2, 14.0-20. 0 kg for BMI between 18.5 and 24. 0 kg/m2, 12. 0-19. 0 kg for BMI between 24.0 and 28.0 kg/m2 ,and 10.0 -16.0 kg for BMI≥28. 0 kg/m2 ,respectively. Optimal GWG is important in prevention of certain adverse birth outcomes and pregnancy complications, and it canbe the reference standard of gestational weight gain.