育龄期女性孕前体重及孕期体重增加与新生儿出生体重关系的回顾性队列研究

A retrospective cohort study on the relationship between pre-pregnancy weight,weight gain during pregnancy and birth weight in women of childbearing age

目的探讨育龄期女性孕前体重及孕期体重增加与新生儿出生体重的关系。方法选取2016年1月至2019年1月于北部战区总医院和平分院单胎分娩的产妇14543例为研究对象,依据孕前体质量指数(body mass index,BMI)、孕期增重指南推荐体重增重值和新生儿出生体重情况进行分组。采用Logistic回归模型分析孕前BMI及孕期体重增加对新生儿出生体重的影响。结果①孕前不同BMI和孕期体重增加异常对新生儿出生体重结局有相关性,孕期体重增加不足和过多是早产儿[OR 1.30(95%CI:1.09-1.56)、2.45(95%CI:1.99-3.01)]和小于胎龄儿[OR 1.76(95%CI:1.13-2.48)、OR 2.14(95%CI:1.32-3.47)]出生风险高危人群。②孕期体重增加不足低体重孕妇,早产儿出生风险是正常体重孕妇2.77倍。而孕期体重增加过多的超重孕妇,早产儿出生风险是正常体重孕妇4.03倍。孕期体重增加适宜的超重孕妇,小于胎龄儿出生风险是正常体重孕妇2.62倍。③孕前低体重孕妇更容易发生孕期体重增加不足(OR 2.94,95%CI:2.30-3.75),孕前肥胖更容易导致孕期体重增加过多(OR 1.05,95%CI:0.94-1.61)。结论为合理控制孕前体重及孕期体重增长,减少新生儿不良结局发生,应将控制孕前体重及孕期体重增加作为孕前保健及围产期保健的重要内容,并根据孕前BMI制定个性化的营养计划。

Objective To explore the relationship between pre-pregnancy weight and weight gain during pregnancy and the birth weight of newborns.Methods A total of 14543 women who delivered singletons at the Heping Branch of the Northern Theater General Hospital from January 2016 to January 2019 were selected.According to pre-pregnancy body mass index(BMI),weight gain recommended by pregnancy guidelines and newborn birth weight were grouped.Logistic regression model was used to analyze the effects of pre-pregnancy BMI and weight gain during pregnancy on newborn birth weight.Results①Different BMI before pregnancy and abnormal weight gain during pregnancy have statistical significance for birth weight outcomes in newborns.Not enough and too much weight gain during pregnancy was the high risk group of premature infants[OR 1.30(95%CI:1.09-1.56),2.45(95%CI:1.99-3.01)]and small gestational age infants[OR 1.76(95%CI:1.13-2.48),OR 2.14(95%CI:1.32-3.47)].②If the weight gain during pregnancy was not enough,the birth risk of premature infants was 2.77 times that of pregnant women with normal weight.For overweight pregnant women with too much weight gain during pregnancy,the birth risk of premature infants was 4.03 times that of pregnant women with normal weight.For overweight pregnant women with appropriate weight gain during pregnancy,the risk of birth of small gestational age infants was 2.62 times that of normal weight pregnant women.③Pre-pregnancy low-weight pregnant women were more likely to suffer from insufficient weight gain during pregnancy(OR 2.94,95%CI:2.30-3.75),and obese pregnant women before pregnancy were more likely to cause excessive weight gain during pregnancy(OR 1.05,95%CI:0.94-1.61).Conclusion In order to rationally control the weight before pregnancy and weight gain during pregnancy,and reduce the incidence of adverse neonatal outcomes,controlling weight before pregnancy and weight gain during pregnancy should be an important part of pre-pregnancy care and perinatal care,and develop a personalized nutrition plan based on pre-pregnancy BMI.