孕前超重/肥胖对母儿结局及产程的影响研究

Effects of pre-pregnancy overweight/obesity on obstetric outcomes and labor duration

目的:探讨孕前超重/肥胖对母儿结局及产程的影响。方法:回顾分析2017年6月至2018年5月于南方医科大学珠江医院定期产检的单胎足月、头先露、选择阴道试产且临床资料齐全的初产妇649例,按孕前体重指数(BMI)分为3组:低体重组(BMI<18.5kg/m^2,174例)、正常体重组(BMI为18.5～23.9kg/m^2,396例)、超重肥胖组(BMI≥24kg/m^2,79例)。结果:超重肥胖组的妊娠期糖尿病(31.6%)、妊娠期高血压疾病(19.0%)发生率均高于正常体重组(18.4%,3.5%),差异有统计学意义(P<0.05)。低体重组的妊娠期糖尿病发生率(10.3%)低于正常体重组,差异有统计学意义(P<0.05)。超重肥胖组的剖宫产(31.6%)、球囊引产(35.4%)、缩宫素静滴发生率(49.4%)均高于正常体重组(16.4%、22.5%、34.3%),差异均有统计学意义(P<0.05)。低体重组的球囊引产(10.3%)及缩宫素静滴(21.3%)发生率均低于正常体重组,差异均有统计学意义(P<0.05)。3组的第一产程、第二产程、第三产程及总产程比较,差异均无统计学意义。结论:孕前BMI超重及肥胖会对母儿带来不良影响,增加不良妊娠结局、产时干预及剖宫产风险。对育龄期女性应加重孕前管理,使孕前BMI控制在正常范围。

Objective:To investigate the effect of pre-pregnancy overweight/obesity on obstetric outcomes and labor duration.Methods:Retrospectively analyze clinical data of 649 cases of primipara in Zhujiang hospital in Jun.2017 to May 2018.The full-term,single cephalic presentation and select vaginal trial was included in the study.The patients were divided into three groups:low weight group(BMI<18.5 kg/m^2,174 cases)、normal weight group(BMI of 18.5~ 23.9 kg/m^2,396 cases)、overweight obesity group(BMI 24 kg/m^2,79 cases).Results:The rate of gestational diabetes mellitus(31.6%)、hypertensive disorders of pregnancy(19.0%) in overweight obesity group were higher and statistically different from normal weight group(18.4%,3.5%)(P<0.05).Gestational diabetes mellitus(31.6%) in low weight group was lower and statistically different from normal weight group(P<0.05).Cesarean delivery(31.6%)、balloon labor induction(35.4%)、oxytocin intravenous drip(49.4%) in overweight obesity group were higher in normal weight group(16.4%、22.5%、34.3%)(P<0.05).Labor induction(10.3%) and oxytocin intravenous drip(21.3%) in the low weight group were lower than that in the normal weight group(P<0.05).There was no significant difference in the first stage,second stage,third stage and total stage between the three groups(P>0.05).Conclusion:Overweight and obesity bring adverse effects on the mother and child,increase the risk of intervention and cesarean delivery.strengthen the pre-pregnancy management for women of childbearing age,the pregnancy BMI can be controlled in the normal range.