孕前体质量指数与孕期体质量增加对妊娠结局及新生儿的影响

Effects of pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes and neonates

目的研究不同孕前体质量指数(BMI)与孕期体质量增加(GWG)对妊娠结局及新生儿的影响。方法选取2016年1~12月在合肥市第二人民医院产检并住院分娩的349例产妇为研究对象,根据孕前BMI分为低体质量组(BMI<18.5kg/m^2,50例)、正常体质量组(18.5kg/m^2≤BMI<25.0kg/m^2,260例)与超重肥胖组(BMI≥25.0kg/m^2,39例);根据孕期GWG不同,分为GWG过少组(41例)、GWG适宜组(133例)、GWG过多组(175例)。比较各组产妇分娩方式、妊娠并发症和新生儿结局等情况。结果孕前超重肥胖组产妇剖宫产率、GDM、产后出血、胎膜早破、巨大儿的发生率均高于其他两组,差异有统计学意义(P<0.05),孕前低体质量组产妇贫血、新生儿早产、低出生体质量儿、胎儿窘迫发生率均高于其他两组,差异有统计学意义(P<0.05)。与孕期GWG过少、GWG适宜组产妇相比,GWG过多组产妇剖宫产、产后出血、胎膜早破、巨大儿的发生率较高,差异有统计学意义(P<0.05)。与孕期GWG过多、GWG适宜组产妇相比,GWG过少组产妇GDM、早产、胎儿窘迫的发生率较高,差异有统计学意义(P<0.05)。结论产科医师和产妇都要重视孕前BMI与孕期GWG异常对母婴的影响,临床应严格调控孕前BMI及孕期GWG在适宜范围之内。

Objective To study the effects of different pre-pregnancy body mass index (BMI) and gestational weight gain(GWG) on pregnancy outcomes and neonates. Methods A total of 349 pregnant women who underwent maternity examination and in-patient delivery in the Second People’s Hospital of Hefei from January 2016 to December 2016 were selected as the research object, and divided into low body mass group (BMI<18.5 kg/m^ 2, 50 cases), normal body mass group (18.5 kg/m^ 2≤BMI<25.0 kg/m ^2, 260 cases), overweight and obesity group (BMI≥25.0 kg/m^ 2, 39 cases) according to BMI. Then according to the differences of GWG, they were divided into low GWG group (41 cases), appropriate GWG group (133 cases) and excessive GWG group (175 cases). The delivery mode, pregnancy complications and neonatal outcomes of pregnant women in each group were compared. Results The incidences of cesarean section, gestational diabetes mellitus, postpartum hemorrhage, premature rupture of membranes and macrosomia were higher in overweight and obesity group than those in the other two groups, and the difference was statistically significant ( P <0.05). The incidences of maternal anemia,neonatal preterm birth, low birth body mass and fetal distress were higher in low body mass group than those in the other two groups, and the difference was statistically significant ( P <0.05). The incidences of cesarean section, postpartum hemorrhage, premature rupture of membranes and macrosomia in group with excessive total weight gain during pregnancy were higher than those in the other two groups, and the difference was statistically significant( P <0.05). The incidences of gestational diabetes mellitus, preterm delivery and fetal distress in group with too little total weight gain were higher than those in group with too much GWG and appropriate GWG during pregnancy, and the difference was statistically significant ( P <0.05). Conclusions Clinicians and pregnant women should fully recognize the effects of abnormal pregnant weight and abnormal weight gain during pregnancy on mothers and babies, and strictly control the body mass index before pregnancy and the total weight gain during pregnancy in the appropriate range.