基于结构方程模型分析孕期生活饮食习惯对足月新生儿出生体质量的影响

The effect of lifestyle and dietary habit during pregnancy on birth weight of full-term neonates:based on the structural equation model

目的探讨孕期生活饮食模式与足月新生低出生体质量儿及巨大儿发生风险的关系。方法收集2018年4月—2019年2月在江西省某市人民医院分娩且符合纳入排除标准的2013对孕妇及其足月单胎新生儿作为研究对象,采用因子分析和结构方程模型相结合的方法研究母亲孕期生活饮食模式与新生低出生体质量儿、巨大儿的关系。结果足月新生低出生体质量儿和巨大儿的发生率分别为3.7%和5.7%。因子分析和回归分析显示,孕期运动模式可降低新生儿低出生体质量发生风险(OR=0.89,95%CI:0.80~0.98);而孕期高盐高脂饮食模式则可增加巨大儿的发生风险(OR=1.07,95%CI:1.01~1.14)。结构方程模型分析发现,孕期高盐高脂饮食对新生巨大儿的发生风险的总效应为0.069,其中直接效应为0.064,通过孕期增重过度的中介效应(0.061)而产生的间接效应为0.005;而孕期运动可降低新生儿低出生体质量的发生风险(直接效应为-0.058),但未发现孕期增重的中介效应。结论孕期运动和高盐高脂饮食与足月新生儿出生体质量密切相关,孕期适量运动锻炼、控制高盐高脂及垃圾食品的摄入,对降低足月新生儿低出生体质量、巨大儿的发生风险具有重要意义。

Objective To study the association between lifestyle and dietary pattern and risk of low birth weight(LBW)and macrosomia of full-term neonates.Methods A total of 2013 pregnant women and single full-term neonates who met the inclusion and exclusion criteria were selected from April 2018 to February 2019 as subjects in this study.The relationship between lifestyle-dietary pattern and risk of LBW and macrosomia was analyzed by using factor analysis and structural equation model.Results The incidences of neonatal LBW and macrosomia were 3.7%and 5.7%,respectively.Factor analysis and regression model showed that the exercise pattern can reduce the neonatal LBW(OR=0.89,95%CI:0.80-0.98),the high salt and fat dietary pattern can increase the risk of macrosomia(OR=1.07,95%CI:1.01-1.14).Structural equation model analysis showed that the total effect of high salt and fat dietary pattern during pregnancy on the risk of neonatal macrosomia was 0.069,of which the direct effect was 0.064,and the indirect effect was 0.005 through the mediating effect(0.061)of excessive gestational weight gain(GWG)during pregnancy.Exercise pattern can reduce the neonatal LBW(the direct effect was-0.058)and wasn′t related to the GWG.Conclusion The exercise pattern and the high salt and fat dietary pattern were closely related to birth weight of full-term neonates.Appropriate exercise,limiting the intake of high salt,high fat and junk food are of great significance to reduce the risk of LBW and macrosomia in full-term newborns.