IOM孕期体质量控制标准对上海地区孕妇的适用情况初探

Study on the Adaption of IOM Weight Gain Recommendation for Native Women in Singleton Pregnancies

目的:评估美国科学院医学院(IOM)孕期体质量控制标准是否适用于上海地区孕妇。方法:回顾性收集2014年1月至2015年3月于同济大学附属第一妇婴保健院分娩产妇的孕期体质量变化及妊娠结局资料,按WHO体质量分类标准将孕前体质量分为体质量过低组、正常组、超重组、肥胖组,按孕期体质量控制是否符合IOM标准进行分组(未达标、达标、超标),比较不同组别包括出生体质量在内的各种妊娠结局,分析IOM体质量控制标准在上海地区人群中的适用情况。结果:纳入研究资料齐全孕妇6915例,体质量过低、正常、超重、肥胖的孕妇分别占15.7%(1086例)、76.4%(5281例)、7.3%(502例)及0.7%(46例),仅43.3%(2991/6915)孕妇孕期体质量控制达到IOM体质量控制标准。未达标、达标及超标组间,除低体质量组的巨大儿发生率,正常组的子痫前期、妊娠期糖尿病、剖宫产率、巨大儿发生率、低出生体质量及巨大儿总发生率,超重组的妊娠期糖尿病、巨大儿发生率外,其余差异均无统计学意义(P>0.05)。孕期体质量变化与低出生体质量儿及巨大儿联合风险曲线图显示,当孕期体质量控制低于IOM时,风险最低。结论:IOM推荐孕期体质量控制范围不适用于上海地区孕妇,上海地区孕妇可能需要更严格的孕期体质量控制以改善包括新生儿出生体质量在内的妊娠结局。

Objective： To make it clear whether IOM recommendations on gestational weight gain applicable to Shanghai population.Methods： We collected data about singleton pregnancies delivered in our hospital from Jan2014 to Mar 2015. All cases were divided into four groups（ including underweight,normal,overweight,obese groups） according to whether meeting the IOM criterion.By comparing the delivery and fetal prognosis including neonatal birth weight,we evaluated the adaption of IOM recommendation on native pregnant women.Results： 6915 cases with complete data were included,15. 7% underweight（ 1086 cases）,76. 4% normal（ 5281 cases）,7. 3%overweight（ 502 cases） and 0. 7% obese（ 46 cases）,among whom only 43. 3% meeting the IOM recommendation.NO significant differences were observed between the groups who met the criterion and those who did not（ P0. 05）.The curve plot about the relationship of weight gain and combined risk of FGR neonates and macrosomia demonstrated that weight gain less than IOM recommendation led to the lowest risk.Conclusions： IOM recommendations on gestational weight gain are probably not applicable to Shanghai population. We need to control weight gain more strictly to gain more favorable prognosis in Shanghai region.