足月臀位产妇的孕前体质量指数与新生儿入院风险的相关性分析

Correlation analysis of prepregnancy body mass index of the full-term breech position pregnancies and neonatal admission risk

目的探讨足月臀位产妇的孕前体质量指数(body mass index,BMI)与新生儿入院风险之间的相关性。方法采用横断面研究方法,选择2004年1月至2016年12月在德国法兰克福歌德大学医院足月臀位(>37周)的1013例产妇为研究对象。将娩出新生儿分为入院组(n=73)与非入院组(n=940),先探讨BMI作为连续变量与新生儿入院风险的关系,再将BMI分为4组:BMI<20 kg/m^(2)组(n=167),20 kg/m^(2)≤BMI<24 kg/m^(2)组(n=534),24 kg/m^(2)≤BMI<28 kg/m^(2)组(n=220),BMI≥28 kg/m^(2)组(n=92),探讨BMI与新生儿入院风险的关系。统计学方法采用χ2检验、t检验、秩和检验和Logistic回归分析。结果1013例足月臀位产妇的平均BMI为(23.1±3.9)kg/m^(2),所分娩新生儿入院率为7.2%(73/1013)。Logistic回归分析显示,随着产妇孕前BMI的增加,新生儿入院风险呈增加趋势,BMI每增加1 kg/m^(2),新生儿入院风险上升6.3%(95%CI:1.010~1.119,P=0.019);在调整了孕期、产次、出生体质量、分娩方式、阴道撕裂程度、会阴切开、助娩胎肩、助娩胎头后,新生儿入院风险上升5.7%(95%CI:1.000~1.118,P=0.050)。以20 kg/m^(2)≤BMI<24 kg/m^(2)为参照组,BMI<20 kg/m^(2)、24 kg/m^(2)≤BMI<28 kg/m^(2)、BMI≥28 kg/m^(2)3组新生儿入院的风险较参照组分别上升3.7%、7.6%、142.0%。在模型全部调整后,新生儿入院的风险较参照组分别上升28.2%(95%CI:0.616~2.670,P=0.507)、7.9%(95%CI:0.563~2.066,P=0.819)、125.8%(95%CI:1.097~4.646,P=0.027)。结论随着足月臀位产妇孕前BMI的增加,新生儿入院风险呈增加趋势,且在BMI≥28 kg/m^(2)时这种风险更为显著。

Objective To explore the correlation between prepregnancy body mass index(BMI)of the full-term breech position pregnancies and neonatal admission risk.Method Used a cross-sectional study method,a total of 1013 pregnant women with full-term breech position(>37 weeks)were selected,they were from the Goethe University Hospital Frankfurt,Germany from January 2004 to December 2016.Neonates were delivered into admission(n=73)and non-admission(n=940).First,the association between BMI as a continuous variable and the risk of neonatal admission was explored,then the BMI was divided into four groups:BMI<20 kg/m^(2)group(n=167),20 kg/m^(2)≤BMI<24 kg/m^(2)group(n=534),24 kg/m^(2)≤BMI<28 kg/m^(2)group(n=220)and BMI≥28 kg/m^(2)group(n=92).The association between BMI and neonatal admission risk was analyzed.Statistical methods performed byχ2 test,t test,rank sum test and Logistic regression analysis.Result The mean BMI of 1013 full-term breech position pregnancies was(23.10±3.92)kg/m^(2).And the admission rate of all neonates was 7.2%(73/1013).Logistic regression analysis showed that neonatal admission risk increased with increasing maternal prepregnancy BMI.The risk increased by 6.3%for each 1 kg/m^(2)increase in BMI(95%CI:1.010-1.119,P=0.019).After adjusting for gestation,the number of births,birth weight,mode of delivery,degree of vaginal tearing,perineal incision,assisted delivery of the fetal shoulder,and assisted delivery of the fetal head,the risk of neonatal admission increased by 5.7%(95%CI:1.000-1.118,P=0.050).When taking 20 kg/m^(2)≤BMI<24 kg/m^(2)as the reference group,the risk of neonatal admission to hospital in the BMI<20 kg/m^(2),24 kg/m^(2)≤BMI<28 kg/m^(2),and BMI≥28 kg/m^(2)three group increased by 3.7%,7.6%and 142.0%respectively.After all adjustments,the risk of neonatal admission increased by 28.2%(95%CI:0.616-2.670,P=0.507),7.9%(95%CI:0.563-2.066,P=0.819),125.8%(95%CI:1.097-4.646,P=0.027)compared with the reference group,respectively.Conclusion The risk of neonatal admission increases with the increase of prepregnancy BMI of full-term breech position pregnancies.The risk is more significant when BMI≥28 kg/m^(2).