不同程度肥胖孕妇1044例不良妊娠结局的回顾性分析

Retrospective analysis of adverse pregnancy outcomes in 1044 pregnant women with different levels of obesity

目的探讨肥胖患者妊娠前体质指数(body mass index,BMI)与妊娠结局及妊娠期合并症、并发症的关系。方法回顾性纳入2016年1月至2020年12月于首都医科大学附属北京妇产医院住院分娩的肥胖孕产妇共1044例。按妊娠前BMI分为轻度肥胖组(28 kg/m^(2)≤BMI<30 kg/m^(2))345例、中度肥胖组(30 kg/m^(2)≤BMI<35 kg/m^(2))584例和重度肥胖组(BMI≥35 kg/m^(2))115例。分析不同妊娠前BMI肥胖患者的妊娠结局及妊娠期合并症和并发症的发生情况。结果①肥胖孕妇妊娠前BMI越大,其合并高血压病及糖尿病的发生风险越高(OR=2.534、2.483),患病率与BMI呈正相关(P<0.01)。重度肥胖组脂肪肝患病率高于中度肥胖组(P<0.05)。②妊娠期体重增长越多,妊娠期高血压疾病发生风险越高(OR=1.624),且患病率与体重增加呈正相关(P<0.05)。肥胖是妊娠期糖尿病的危险因素,BMI越大,发生风险越高(OR=1.376),且患病率与其呈正相关(P<0.05)。③不同程度肥胖组经阴道分娩各组总产程、第一、二、三产程、新生儿出生体重及新生儿Apgar评分比较,差异均无统计学意义(P>0.05)。三组肥胖孕妇早产、剖宫产、产后出血、阴道助产、巨大儿及新生儿窒息发生率比较,差异均无统计学意义(P>0.05)。④三组肥胖孕妇75 g糖耐量试验的血糖水平比较,差异无统计学意义(P>0.05),而血脂及纤维蛋白原水平比较,差异均有统计学意义(P<0.05),且随着肥胖程度的增加呈上升趋势(P<0.05)。结论肥胖孕妇妊娠前BMI越大,妊娠合并症及并发症的患病率越高,且妊娠期体重增加越多,患妊娠期高血压疾病的风险越高,血脂水平也随着肥胖程度的增加呈上升趋势。因此,应重视对妊娠前、妊娠期的营养与体重管理。

Objective To investigate the relationship between pre-pregnancy body mass index(BMI)and pregnancy outcome and complications in obese patients.Methods A total of 1044 obese pregnant women who were hospitalized and delivered in Beijing Maternity Hospital Affiliated to Capital Medical University from January 2016 to December 2020 were retrospectively included.According to pre-pregnancy BMI,345 cases were included as mild obesity group(28kg/m^(2)≤BMI<30 kg/m^(2)),584 cases were included as moderate obesity group(30 kg/m^(2)≤BMI<35 kg/m^(2))and 115 cases were included as severe obesity group(BMI≥35 kg/m^(2)).Analyze the pregnancy outcomes,complications of obese patients with different pre-pregnancy BMI.Results①The higher the BMI of obese pregnant women before pregnancy,the higher the risk of chronic hypertension and diabetes(OR=2.534,2.483),and the prevalence was positively correlated with BMI(P<0.01).The prevalence of fatty liver in severe obesity group was higher than that in moderate obesity group(P<0.05).②The more the body weight increased during pregnancy,the higher the risk of hypertensive disorder during pregnancy(OR=1.624),and the prevalence rate was positively correlated with weight gain(P<0.05).Obesity is a risk factor for gestational diabetes.The higher the BMI,the higher the risk(OR=1.376),and the prevalence is positively correlated with it(P<0.05).③There was no significant difference in the total labor process,the first,second,third labor process,newborn birth weight and newborn Apgar score of different obese vaginal delivery groups(P>0.05).There was no significant difference in premature delivery rate,cesarean section rate,postpartum hemorrhage,vaginal delivery rate,macrosomia and neonatal asphyxia rate among obese pregnant women in the three groups(P>0.05).④There was no significant difference in 75g sugar tolerance test blood glucose levels among the three groups of obese pregnant women(P>0.05),but had significant difference by comparing with the level of blood lipid and fibrinogen(P<0.05).Conclusions The greater the BMI of obese pregnant women before pregnancy,the higher the prevalence of pregnancy complications and the more the body mass increases during pregnancy,the higher the risk of pregnancy induced hypertension,and the blood lipid level also increases with the increase of obesity.Therefore,we should pay attention to the management of nutrition and body mass before and during pregnancy.