孕期营养不均衡的危险因素及其对妊娠结局的影响

Risk factors of nutritional imbalance during pregnancy and its effect on pregnancy outcome

目的探讨孕期营养不均衡的危险因素及其对妊娠结局的影响。方法选取2016年7月至2017年8月于我院产科建立档案的630名单胎初产妇为研究对象,依据《中国居民膳食营养素参考摄入量2013版》中孕妇的营养素推荐摄入量(RNIs)为标准综合评价营养状况,分为营养均衡组(营养素摄入量为RNIs的90%～110%)、营养不均衡组(营养素摄入量低于RNIs的90%或超过RNIs的110%),调查其一般资料,并利用营养分析软件,了解其对各营养素摄入量,分析孕期营养不均衡的危险因素及对妊娠结局的影响。结果 630名单胎初产妇中,营养不足150例,营养正常320例,营养过剩160例,营养不均衡率为49. 21%;单因素及多因素logistic回归分析结果显示,家庭月收入、每日摄入维生素、每日摄入膳食纤维及孕13～28周体重增加是孕期营养不均衡的危险因素(OR=2. 257,2. 081,2. 248,1. 573,P <0. 05),而了解《中国居民膳食指南》、选择营养价值高食物是其保护因素(OR=0. 759,0. 526,P <0. 05);营养均衡组产妇剖宫产率、妊娠期糖尿病、妊娠期高血压疾病、产后出血量及新生儿胎儿窘迫、巨大儿、胆红素血症发生率低于营养不均衡组(P <0. 05),而新生儿Apgar评分高于营养不均衡组(P <0. 05)。结论家庭月收入、每日摄入维生素、每日摄入膳食纤维及孕13～28周体重增加是孕期营养不均衡的危险因素,可导致不良母婴结局,应提高孕妇对营养均衡的认识,避免营养摄入不足或过剩。

Objective To explore the risk factors of nutritional imbalance during pregnancy and its effect on pregnancy outcome. Methods To select 630 cases of monotocous primiparas who established pregnancy check-up profiles in our hospital from July 2016 to August 2017 as research subjects. By comprehensive evaluation of nutrition conditions of them according to the recommended intakes of nutrients （RNIs） for pregnant women in the ＂2013 dietary references for Chinese residents＂, they were divided into the nutritional balanced group （nutrient intake is from 90% to 110% of RNIs） and the nutritional unbalanced group （nutrient intake is less than 90% of RNIs or above 110% of RNIs）. The general information was investigated and their intakes of nutrients were gained by nutrition analysis software. Then the risk factors of nutritional imbalance during pregnancy and the impact on pregnancy outcomes were analyzed. Results Among the 630 cases of monotocous primiparas, there were 150 cases of unbalance nutrition, 320 cases of normal nutrition, and 160 cases of over-nutrition. The nutritional imbalance rate was 49.21%. The results of single factor and multivariate logistic regression analysis showed that the family monthly income, daily vitamins intake, daily intake of dietary fiber and weight gain during 13 to 28 weeks of pregnancy were risk factors for nutritional imbalance during pregnancy（OR=2.257,2.081,2.248,1.573, P 〈0.05）. Understanding the ＂Chinese dietary guidelines＂ and selecting high-nutrition foods are protective factors（OR=0.759,0.526, P 〈0.05）. The rates of cesarean, gestational diabetes, hypertensive disorder complicating pregnancy, postpartum hemorrhage and neonatal fetal distress, macrosomia, and bilirubinemia were lower than that of the nutritional unbalanced group（ P 〈0.05）. However, the neonatal Apgar score was higher than that of the nutritional unbalanced group（ P 〈0.05）. Conclusion Family monthly income, daily intake of vitamins, daily intake of dietary fiber and weight gain during 13 to 28 weeks of pregnancy are risk factors for nutritional imbalance during pregnancy, which may lead to poor maternal and child outcomes. Consequently, we should improve pregnant women understanding of nutritional balance to avoid insufficient or excess nutrient intake during pregnancy.