孕前体重指数和妊娠期体重增加与巨大儿发生的关联性

Association of pre-pregnancy body mass index and gestational weight gain with macrosomia

目的分析孕前体重指数和妊娠期体重增加与巨大儿发生的关联性。方法本研究为回顾性队列研究,连续收集北京协和医院产科中心2020年7月至2021年6月全部产妇及新生儿数据,包括产妇基础信息、妊娠期合并症、新生儿情况等,共2422例单胎足月活产妊娠产妇及其新生儿纳入分析,根据新生儿出生体重计算巨大儿(≥4000 g)发生率,采用logistic回归和发病率热图分析孕前体重指数和妊娠期体重增加与巨大儿发生的关联性。结果单胎足月活产新生儿中巨大儿发生率为4.00%(97/2422)。巨大儿组孕前体重、孕前体重指数、孕前超重肥胖比例、分娩前体重、妊娠期总增重、全妊娠期平均每周增重、妊娠期增重过多比例、妊娠时间、初产及文化程度大专及以下比例均显著高于非巨大儿组[(63.87±8.27)比(58.14±7.86)kg、(23.33±2.97)比(21.60±2.72)kg/m^(2)、35.1%比17.3%、(77.48±9.11)比(70.02±8.79)kg、(13.61±4.56)比(11.88±4.40)kg、(0.34±0.11)比(0.30±0.11)kg、58.8%比31.1%、(280.47±7.79)比(276.14±7.83)d、34.1%比23.7%、18.6%比7.5%](均P<0.05)。孕前体重指数(OR=1.227,95%CI:1.145~1.314)、全妊娠期平均每周增重(OR=33.453,95%CI:5.172~217.947)、妊娠时间(OR=1.083,95%CI:1.055~1.112)、初产(OR=1.969,95%CI:1.232~3.101)、文化程度大专及以下(OR=2.525,95%CI:1.325~4.668)均与巨大儿发生呈正相关(均P<0.05),且巨大儿发生率随孕前体重指数和全妊娠期平均每周增重的增加而升高。结论孕前体重指数和全妊娠期平均每周增重过高与巨大儿发生风险增加有关,合理的妊娠期体重管理或有助于减少不良妊娠结局发生。

Objective To analyze the association of pre-pregnancy body mass index(BMI)and gestational weight gain with macrosomia.Methods In this retrospective cohort study,data of all puerperae and newborns in the Obstetrics Center of Peking Union Medical College Hospital from July 2020 to June 2021 were collected,including basic maternal information,pregnancy complications and neonatal conditions.A total of 2422 pregnant women with full-term singleton live birth and their newborns were included in the analysis.The incidence of macrosomia(≥4000 g)was calculated according to the birth weight of the newborns.Logistic regression and heat map were used to analyze the associations of pre-pregnancy BMI and gestational weight gain with macrosomia.Results The incidence of macrosomia was 4.00%(97/2422)in full-term singleton live birth newborns.Pre-pregnancy body weight,pre-pregnancy BMI,pre-pregnancy overweight/obesity rate,pre-delivery body weight,total weight gain during pregnancy,mean weekly weight gain during pregnancy,the proportion of excessive weight gain during pregnancy,duration of pregnancy,and the proportion of primiparity and education level of junior college or below were all significantly higher in the puerperae of the macrosomia group than those in the non-macrosomia group[(63.87±8.27)vs(58.14±7.86)kg,(23.33±2.97)vs(21.60±2.72)kg/m^(2),35.1%vs 17.3%,(77.48±9.11)vs(70.02±8.79)kg,(13.61±4.56)vs(11.88±4.40)kg,(0.34±0.11)vs(0.30±0.11)kg,58.8%vs 31.1%,(280.47±7.79)vs(276.14±7.83)d,34.1%vs 23.7%,18.6%vs 7.5%](all P<0.05).Pre-pregnancy BMI(OR=1.227,95%CI:1.145-1.314),mean weekly weight gain during the whole pregnancy(OR=33.453,95%CI:5.172-217.947),duration of pregnancy(OR=1.083,95%CI:1.055-1.112),primiparity(OR=1.969,95%CI:1.232-3.101)and education level of junior college or below(OR=2.525,95%CI:1.325-4.668)were all positively associated with occurrence of macrosomia(all P<0.05).The incidence of macrosomia increased with the pre-pregnancy body mass index and mean weekly weight gain during the whole pregnancy.Conclusions High pre-pregnancy BMI and mean weekly weight gain during the whole pregnancy are associated with the increased risk of macrosomia.Appropriate weight management during pregnancy may help to reduce the incidence of adverse pregnancy outcomes.