2013年中国足月单胎产妇孕期增重情况及适宜范围探讨

Gestational weight gain and optimal ranges in Chinese mothers giving singleton and full-term births in 2013

目的 分析中国足月单胎产妇孕期增重情况,探讨孕期增重适宜范围.方法 于2013年采用多阶段分层与人口成比例的整群随机抽样方法,调查对象为中国内地除西藏自治区以外的30个省份的55个县（市/区）产后0~24个月的足月单胎母婴,共计8323对.问卷调查乳母怀孕前体重、分娩前体重、孕期疾病、有无产后大出血,以及儿童出生体重和身长等妊娠结局信息;测量乳母身高和体重,以及儿童身长和体重.根据中国《成人体重判定》,将乳母划分为孕前低体重（BMI〈18.5 kg/m2）、正常体重（BMI 18.5~23.9 kg/m2）、超重（BMI 24.0~27.9 kg/m2）和肥胖（BMI≥28.0 kg/m2）;根据美国医学研究所（IOM）2009年孕期体重增加推荐值评价孕期增重适宜情况;根据不同水平孕期增重与不良妊娠结局及不良母婴体格状况的关系,以及具有良好妊娠结局和良好母婴体格状况的乳母孕期增重的P25~P75推算我国足月单胎产妇的孕期增重适宜范围;同时根据计算的孕期增重适宜范围对孕期增重进行再评价.结果8323名乳母孕期增重的P50（P25~P75）为15.0（10.0~19.0）kg,依据IOM推荐值,孕期增重不足、适宜和过多的检出率分别为27.2%（2263名）、36.2%（3016名）和36.6%（3044名）.孕前低体重、正常体重、超重和肥胖孕妇孕期增重适宜范围分别为11.5~18.0、10.0~15.0、8.0~14.0和5.0~11.5 kg.以本研究获得的孕期增重适宜范围为标准,则样本人群中孕期增重不足、适宜和过多的检出率分别为15.7%（1303名）、45.0%（3744名）和39.3%（3276名）,与根据IOM标准计算的检出率差异有统计学意义（χ2=345.36,P〈0.001）.结论 中国乳母的孕期增重P50为15.0 kg,处于较高水平.本研究初步为中国足月单胎女性建立了孕期增重适宜范围,此适宜范围低于IOM的推荐值.

Objective To analyze the status of gestational weight gain （GWG） among Chinese mothers who gave singleton and full-term births,and to look at optimal GWG ranges. Methods In 2013, using the multi-stage stratified and population proportional cluster sampling method,we investigated 8 323 mother-child pairs at their 0-24 months postpartum from 55 counties （cities/districts） of 30 provinces （except Tibet）in China's Mainland.Questionnaire was used to collect data on body weight before pregnancy and delivery,diseases during gestation,hemorrhage or not at postpartum,child birth weight and length,and other information about pregnant outcomes.We measured mother＇s body weight and height,and child＇s body weight and length. Based on＇Chinese Adult Body Weight Standard＇, we divided mothers into four groups according to their body weight before pregnancy： low weight （BMI〈18.5 kg/m2）, normal weight （BMI 18.5-23.9 kg/m2）, overweight （BMI 24.0-27.9 kg/m2） and obesity （BMI≥28.0 kg/m2）. The status of GWG was assessed by IOM optimal GWG guidelines. Chinese optimal GWG ranges were calculated according to the association of GWG with pregnant outcomes and anthropometry of mothers and children, and according to P25-P75 of GWG among mothers who had good pregnant outcomes and good anthropometry, and whose children had good anthropometry.The status of GWG was assessed by the new optimal ranges.Results P50 （P25-P75） of GWG among the 8 323 mothers was 15.0 （10.0-19.0） kg. According to the proposed optimal GWG ranges of IOM,the proportions of inadequate,optimal and excessive GWG accounted for 27.2%（2 263 mothers）, 36.2% （3 016 mothers） and 36.6% （3 044 mothers）. The optimal GWG ranges for low weight, normal weight, overweight and obesity were 11.5-18.0, 10.0-15.0, 8.0-14.0 and 5.0-11.5 kg. Based on these optimal GWG ranges established in this study, the rates of inadequate, optimal and excessive GWG were 15.7% （1 303 mothers）, 45.0% （3 744 mothers） and 39.3% （3 276 mothers）, and these rates were significantly different from that defined by the IOM standards （χ2=345.36, P〈0.001）. Conclusion The median of GWG among Chinese mothers is 15.0 kg,which is at a relatively higher level.This study suggests the optimal GWG ranges for Chinese women who give singleton and full-term babies, which appears lower than IOM＇s.