妊娠压力对上海孕妇孕晚期饮食倾向的影响

Gestational stress on dietary preferences in late pregnancy

目的研究上海孕妇受孕前后3个月、孕中晚期妊娠压力对于孕晚期饮食倾向的作用。方法 2016年4月-2018年4月在上海市两家接产医院首次建卡的孕妇中,经知情同意纳入上海亲子队列研究,利用孕妇生活事件量表分别评估其在受孕前后3个月、孕32~36周的妊娠压力,采用食物频率问卷和因子分析法评估孕晚期饮食倾向,同时问卷获取重要混杂因素。采用二分类Logistic回归模型分析妊娠压力与饮食倾向的关系。结果纳入分析的2634名孕妇中,因子分析得到6类孕晚期饮食倾向,分别为"均衡"类、"荤食和豆"类、"高糖或高油"类、"腌制品和内脏"类、"营养补充"类和"咖啡因"类。控制潜在混杂因素(包括孕妇年龄、文化程度、职业、家庭年收入、孕前体质指数、产次、孕中晚期焦虑情况、孕中晚期抑郁情况)后,受孕前后3个月较高的总体和主观妊娠压力可使孕妇在孕晚期更不倾向于"均衡"类饮食(OR=0.76,95%CI 0.61~0.95);孕中晚期较高妊娠压力可使孕妇更倾向于"均衡"类饮食(OR=1.66,95%CI 1.22~2.25),但同时也促进其对"腌制品和内脏"类饮食的倾向(OR=1.32,95%CI 0.98~1.78),并可抑制对"荤食和豆"类饮食的倾向(OR=0.72,95%CI 0.53~0.96)。结论孕期较低的妊娠压力有利于孕晚期膳食的均衡;相较于孕中晚期,受孕前后3个月的妊娠压力更可能对孕晚期饮食倾向造成负面影响。

OBJECTIVE To prospectively analyze the effects of gestational stress around 3 months of conception and stress in the second and third trimesters of pregnancy on the dietary preferences in late pregnancy of women in Shanghai City. METHODS From April 2016 to April 2018,pregnant women who registered in 2 delivery hospitals in Shanghai were recruited as participants of Shanghai Maternal-Child Pair Cohort with informed consent. Life Events Scale for Pregnant Women was used to evaluate the gestational stress around 3 months of conception and stress during 32-36 weeks of pregnancy, respectively. Food Frequency Questionnaire and factor analysis were used to evaluate the dietary tendency in late pregnancy. Binary Logistic regression model was used to analyze the relationship between gestational stress and dietary tendency. RESULTS Among the 2634 pregnant women included in this study, factor analysis revealed six dietary preferences in the third trimester of pregnancy, which were ’balanced’, ’meat and beans’,’richer in sugar or oil’,’pickled products and giblets’,’nutritional supplement’ and ’caffeine’, respectively. After controlling for potential confounding factors of age, education, occupation, annual family income, body mass index before pregnancy, parity, anxiety and depression in the second and third trimesters of pregnancy, higher total and subjective gestational stress around conception would make pregnant women less likely to have a "balanced" diet in late pregnancy(OR=0.76,95%CI 0.61-0.95). The higher level of gestational stress in the second and third trimesters of pregnancy was associated with a greater preference for a "balanced" diet(OR=1.66,95%CI 1.22-2.25), but it also increased the preference for a "pickled products and giblets" diet(OR=1.32,95%CI 0.98-1.78)and inhibited a preference for a "meat and beans" diet(OR=0.72,95%CI 0.53-0.96). CONCLUSION Lower level of gestational pressure during pregnancy is beneficial to the balance of diet in late pregnancy. Compared with that in the second and third trimesters of pregnancy, gestational stress around conception is more likely to negatively affect dietary preferences in late pregnancy.