生物电阻抗法分析分娩巨大儿妇女妊娠期体成分

Body composition in the second and last trimester of pregnant women delivered macrosomic fetus measured by bioelectrical impedance technique

目的探讨分娩巨大儿的妇女孕中期及晚期的母体体成分特点。方法采用巢式病例对照研究方法,对象全部来自2012年5月20日-2013年12月31日参与研究的多中心队列人群,选取孕38～41周分娩且新生儿出生体质量≥4 000 g的62例产妇作为巨大儿组,并于同期队列孕38～41周分娩且新生儿出生体质量2 500～4 000 g的产妇中,根据怀孕年龄、孕前体质量和身高进行配对选取62例为对照组。分析两组在孕中期（孕第22～24周）和孕晚期（孕第36～38周）的人体成分,比较两组间的体质量（body mass,BM）、体质量指数（body mass index,BMI）、去脂体质量（free fat mass,FFM）、肌肉质量（muscular mass,MM）、体脂（fat mass,FM）、体脂百分比（fat mass percentage,FMP）、细胞外液（extracellular water,ECW）、细胞内液（intracellular water,ICW）和总体水分（total body water,TBW）的差异。结果巨大儿组孕妇在孕中期BM和ECW均显著高于对照组[（64.80±9.52）kg vs（62.68±8.43）kg,（14.26±1.64）kg vs（13.64±1.83）kg;P〈0.05],孕晚期BM、BMI、FFM、MM、ECW、ICW和TBW均显著高于对照组[（74.86±9.38）kg vs（70.86±8.39）kg,（27.82±3.13）kg vs（26.71±2.80）kg,（50.07±5.91）kg vs（47.27±4.50）kg,（44.59±6.21）kg vs（42.36±4.64）kg,（16.05±2.18）kg vs（15.29±1.63）kg,（18.62±2.86）kg vs（17.72±2.39）kg,（34.68±4.94）kg vs（33.09±3.61）kg;P〈0.05],而两组孕中期和孕晚期的FM及FMP差异均无统计学意义（P〉0.05）。结论分娩巨大儿孕妇在孕晚期的去脂体质量显著高于分娩正常出生体质量新生儿的孕妇,而体脂储备与正常孕妇无差异。

Objective To investigate characteristics of the maternal body composition in the second and last trimester of pregnant women delivered macrosomic fetus. Methods Nested case-control study design was adopted, and samples of pregnant women were from our multicenter cohort from May 20, 2012 to December 31, 2013. There were 62 cases who had macrosomic infants（≥4 000 g） delivery in the 38-41 gestational weeks in macrosomia group and another 62 age-, pre-pregnant body weight-and height-matched pregnant women who had a neonatal birth weighing 2 500 to 4 000 g served as control group. The maternal body composition in subjects at 14-16 gestational weeks and 36-38 gestational weeks were tested by multi-frequency bioelectrical impedance analysis. The body mass（BM）, body mass index（BMI）, free fat mass（FFM）, muscular mass（MM）, fat mass（FM）, fat mass percentage（FMP）, extracellular water（ECW）, intracellular water（ICW） and total body water（TBW） were analyzed and compared between the two groups. Results The BM, ECW in the second trimester and BM, BMI, FFM, MM, ECW, ICW, TBW in the last trimester in macrosomia group were significantly higher than control group [（64.80±9.52） kg vs（62.68±8.43） kg,（14.26±1.64） kg vs（13.64±1.83） kg;（74.86±9.38） kg vs（70.86±8.39） kg,（27.82±3.13） kg vs（26.71±2.80） kg,（50.07±5.91） kg vs（47.27±4.50） kg,（44.59±6.21） kg vs（42.36±4.64） kg,（16.05±2.18） kg vs（15.29±1.63） kg,（18.62±2.86） kg vs（17.72±2.39） kg,（34.68±4.94） kg vs（33.09±3.61） kg; P〈0.05）, but there were no significant differences in FM and FMP between two groups（P〈0.05）. Conclusion The FFM in the last trimester in women delivered macrosomic fetus is significantly higher than women delivered normal birth weight infant, but the fat reserves are similar in the two groups.