孕早期体重指数对孕产妇和新生儿的影响

Influences of body mass index of early pregnancy on pregnant women and newborns

目的 探讨孕早期体重指数（BMI）对妊娠期糖尿病和巨大儿发生率的影响。方法 回顾性分析2012年1月～2015年12月南京医科大学附属南京妇幼保健院收治的孕妇595例的临床资料。根据孕早期BMI将孕妇分为肥胖组（BMI≥25 kg/m^2）和对照组（BMI〈25 kg/m^2）。观察两组妊娠期糖尿病、巨大儿、剖宫产、产后出血和头盆不称的发生率;观察两组胎位异常、宫缩乏力、妊娠期高血压、胎膜早破、新生儿窒息的发生率及新生儿体重。结果 与对照组比较,肥胖组妊娠期糖尿病发生率显著增高（16.59%比2.86%,P=0.000）,巨大儿发生率显著增高（12.80%比2.34%,P=0.000）,剖宫产率显著增加（36.97%比17.45%,P=0.000）;产后出血发生率显著增加（2.37%比0.00%,P=0.010）,头盆不称发生率显著增高（2.84%比0.26%,P=0.016）,胎位异常发生率明显增高（2.84%比0.26%,P=0.000）,宫缩乏力发生率增高（7.11%比1.04%,P=0.000）,妊娠期高血压发生率增高（2.37%比0.26%,P=0.042）,胎膜早破发生率增高（3.79%比0.52%,P=0.008）,新生儿窒息发生率增高（2.84%比0.52%,P=0.048）,新生儿出生时体重增加[（3372.15±475.45）比（3220.93±461.36）g,P=0.000],差异均有统计学意义。结论 孕早期BMI大于等于25kg/m^2可导致孕妇和新生儿预后不良。

Objective To investigate the influences （BMI） of body mass index of early pregnancy on the incidence of gestational diabetes mellitus and macrosomia. Methods Clinical data of 595 pregnant women from January 2012 to De- cember 2015 in Nanjing Maternal and Child Health Hospital, Nanjing Medical University were retrospectively analyzed. According to the BMI of early pregnancy, all pregnant women were Signed into fat group （BMI ≥25 kg/m^2） or control group （BMI 〈25 kg/m^2）. The incidences of gestational diabetes mellitus, macrosomia, placenta accrete, postpartum hemorrhage and cephalopelvic of two groups were observed; the rates of abnormal fetal position, uterine inertia, pregnancy induced hypertension, premature rupture of membranes, neonatal asphyxia and neonatal weight of two groups were observed. Results When compared with the control group, fat group got a significantly higher rate of gestational diabetes mellitus （16.59% vs 2.86%, P = 0.000）, macrosomia （12.80% vs 2.34%, P = 0.000）, placenta accreta （36.97% vs 17.45%, P = 0.000）, postpartum hemorrhage （2.37% vs 0.00%, P = 0.010）, cephalopelvic （2.84% vs 0.26%, P = 0.016）, abnormal fetal position （9.95% vs 1.30%, P = 0.000）, uterine inertia （7.11% vs 1.04%, P = 0.000）, pregnancy induced hypertension （2.37% vs 0.26%, P = 0.042）, premature rupture of membranes （3.79% vs 0.52%, P = 0.008）, and neonatal asphyxia （2.84% vs 0.52%, P = 0.048）, a higher level of neonatal weight [（3372.15±475.45） vs （3220.93±461.36） g, P = 0.000）], the differences were statistically significant. Conclusion BMI more than 25 kg/m^2 is a risk factor for worse clinical outcomes for pregnant women and newborns.