孕早期体重指数及孕期增加体重对母儿不良妊娠结局的影响

Influence of early pregnancy body mass index(BMI)and gestation weight gain(GWG)on adverse pregnancy outcomes

目的探讨孕早期体重指数(BMI)及孕期增加体重(GWG)对母儿不良妊娠结局的影响。方法对2018年3月至8月在新疆医科大学第一附属医院规律产检并分娩的适龄初产妇890例临床资料进行回顾性分析。将病例根据2009年美国医学研究院(IOM)修订的孕早期BMI及GWG指南作为标准,按孕早期BMI及GWG分组。分为低标准体重组(BMI<18.5)、标准体重组(18.5≤BMI<25)、超重组(25≤BMI<30)、肥胖组(BMI≥30);GWG过低组,GWG正常组,GWG过高组(无论孕早期BMI分组情况,GWG低于IOM推荐范围则纳入GWG过低组;处于推荐范围,纳入GWG正常组;高于推荐范围纳入GWG过高组),分析孕早期BMI、GWG与剖宫产率、妊娠期合并症及新生儿不良结局的影响。结果低标准体重组(15.1%)、标准体重组(73.0%)、超重组(9.9%)、肥胖组(2.0%)分别有134例、650例、88例、18例。孕早期BMI超重、肥胖是剖宫产(OR 2.46、5.20)、妊娠期糖尿病(OR 1.86、1.33)、妊娠期高血压疾病(OR4.07、4.53)、巨大儿(OR 5.72、2.87)、早产(OR 2.15、9.19)的危险因素。不论孕早期BMI情况,GWG超过IOM推荐增重范围,是剖宫产(OR=2.93)、妊娠期糖尿病(OR=1.10)、妊娠期高血压疾病(OR=1.50)、巨大儿(OR=1.15)的危险因素,高龄(>35~40岁)亦是剖宫产(OR=6.42)、妊娠期糖尿病(OR=4.89)、妊娠期高血压疾病(OR=3.98)、胎膜早破(OR=2.48)的危险因素。结论孕早期体重指数超重或肥胖,GWG过高以及高龄均增加剖宫产率,导致母儿不良结局。故孕早期备孕控制体重以及孕期合理增重尤为重要。

Objective To explore the impact of early pregnancy body mass index(BMI)and weight gain during pregnancy(GWG)on adverse pregnancy outcome in mothers and children.Methods The clinical data of 890 primiparas of childbearing age who underwent regular antenatal examination and delivered in the First Affiliated Hospital of Xinjiang Medical University from March to August 2018 were analyzed retrospectively. The cases were divided into low body bass group(BMI<18.5),normal body mass group(18.5≤BMI<25),overweight group(25≤BMI<30),and obesity group(BMI≥30);low GWG group,normal GWG group,excessive GWG group(regardless of early pregnancy BMI grouping,those with GWG below the IOM recommended range were included in the low GWG group,within the recommended range in the normal GWG group,and higher than the recommended range in the excessive GWG group)according to early pregnancy BMI and GWG guideline revised by American Institute of Medicine(IOM)in 2009 based on early pregnancy BMI and GWG;analyze the impacts of early pregnancy BMI and GWG on cesarean section rate,gestational complications and adverse neonatal outcomes.Results Low body mass group accounted for 15.1%(134 cases),normal body mass group represented 73.0%(650 cases),overweight group occupied 9.9%(88 cases),and obesity group accounted for 2.0%(18 cases).Early pregnancy BMI overweight and obesity increased the risk of cesarean section(OR 2.46,5.20),gestational diabetes(OR 1.86,1.33),gestational hypertensive diseases(OR 4.07,4.53),fetal macrosomia(OR 5.72,2.87)and premature delivery(OR 2.15,9.19). Regardless of early pregnancy BMI,GWG exceeding the IOM recommended weight gain range increased the risk of cesarean section(OR=2.93),gestational diabetes(OR=1.10),gestational hypertensive diseases(OR=1.50)and fetal macrosomia(OR=1.15). Advanced age(>35-40 years old)also increased the risk of cesarean section(OR=6.42),gestational diabetes(OR=4.89),gestational hypertensive diseases(OR=3.98),and premature rupture of fetal membranes(OR=2.48).Conclusion Early pregnancy overweight or obesity,excessive GWG and advanced age will increase cesarean section rate,leading to adverse outcomes in mothers and children. Therefore,it is of great importance to control the weight in the preparation of pregnancy and to increase the weight reasonably during pregnancy.