中国城市地区高龄孕妇孕期增重情况

Gestational weight gain among women with advanced maternal age in urban areas of China

目的了解中国城市地区高龄孕妇孕期增重情况,探讨高龄孕妇孕期增重特点,为临床科学开展高龄孕妇体重管理提供参考。方法依托国家重点研发计划高龄孕产妇队列研究,纳入2017年7月至2021年6月在国内7个大城市8家三甲医院进行孕期体检和分娩的13567名孕妇,其中高龄孕妇(分娩年龄≥35岁)10972名,非高龄孕妇2595名。收集孕妇人口学信息和孕期随访资料,计算孕期总增重和孕期别增重,并按国内《妊娠期妇女体重增长推荐值标准》分为增重不足、增重合适和增重过度三组。采用混合效应线性模型估计高龄与非高龄孕妇孕期增重均值差值(MD),采用混合效应多分类Logistic模型估计高龄与非高龄孕妇增重不足和增重过度比值比(OR),采用分段线性混合效应模型拟合绘制高龄和非高龄孕妇的孕期增重轨迹。结果高龄孕妇平均孕期总增重为(12.7±4.9)kg,增重不足和增重过度者分别占比12.1%和45.8%。高龄与非高龄孕妇孕期总增重差异不具有统计学意义(调整MD=-0.2 kg,95%CI:-0.5~0.1 kg),孕期总增重不足和过度的风险差异也未见统计学意义(增重不足:调整OR=0.99,95%CI:0.81~1.20;增重过度:调整OR=0.92,95%CI:0.81~1.04)。分孕期看,与非高龄孕妇相比,高龄孕妇孕早期增重更多(调整MD=0.3 kg,95%CI:0.1~0.4 kg),孕中晚期增重更少(调整MD=-0.4 kg,95%CI:-0.7~-0.2 kg);孕早期增重不足和增重过度的风险均增加(增重不足:调整OR=1.28,95%CI:1.02~1.60;增重过度:调整OR=1.32,95%CI:1.16~1.51);孕中晚期增重不足的风险增加(调整OR=1.21,95%CI:1.02~1.43)。孕期增重轨迹也显示,高龄孕妇孕早期增重多于非高龄孕妇,而孕中晚期增重少于非高龄孕妇。结论中国城市地区高龄孕妇孕期总增重为(12.7±4.9)kg,增重不足和增重过度的比例分别为12.1%和45.8%,即有超过一半的高龄孕妇存在孕期增重不适宜的问题,值得关注。与非高龄孕妇相比,高龄孕妇孕早期增重不足和增重过度的风险均升高,孕中晚期增重不足的风险升高,提示临床宜针对高龄孕妇孕期增重特点开展精细化、规范化的孕期体重管理。

Objective To describe the gestational weight gain(GWG)of women with advanced maternal age(AMA)in urban areas of China and to explore the characteristics of GWG of AMA women,so as to provide reference for the clinical weight management for AMA women.Methods Based on the University Hospital Advanced Age Pregnant Cohort,a total of 13567 pregnant women were enrolled from July 2017 to June 2021 in 8 tertiary hospitals in 7 cities.Among them,10972 were AMA women(maternal age at delivery≥35 years),and 2595 were non-AMA women.The general demographic characteristics and follow-up data during pregnancy were collected.Total GWG and GWG in different trimesters were calculated and divided into three groups:insufficient GWG,appropriate GWG,and excessive GWG,according to the GWG recommendations.The mean difference(MD)between AMA and non-AMA women was estimated by mixed effects linear model,and the odds ratio(OR)between AMA and non-AMA women was estimated by mixed effects multinomial logistic model.Piecewise mixed effects linear model was used to fit the GWG trajectories.Results The average total GWG was(12.7±4.9)kg,and the proportion of insufficient total GWG and excessive total GWG were 12.1%and 45.8%,respectively,for AMA women.There was no statistically significant difference in total GWG between AMA and non-AMA women(adjusted MD[aMD]=-0.2 kg,95%CI:-0.5 to 0.1 kg),nor was there any statistically significant difference in risk of insufficient total GWG and excessive total GWG(insufficient GWG:adjusted OR[a OR]=0.99,95%CI:0.81 to 1.20;excessive GWG:a OR=0.92,95%CI:0.81 to 1.04).AMA women had higher GWG(aMD=0.3 kg,95%CI:0.1 to 0.4 kg)in the first trimester and lower GWG(aMD=-0.4 kg,95%CI:-0.7 to-0.2 kg)in the second and third trimester.AMA women had higher risk of insufficient GWG and excessive GWG(insufficient GWG:a OR=1.28,95%CI:1.02-1.60;excessive GWG:a OR=1.32,95%CI:1.16-1.51)in the first trimester and higher risk of insufficient GWG(a OR=1.21,95%CI:1.02-1.43)in the second and third trimester.The GWG trajectory also showed that AMA women gained more weight in the first trimester and less weight in the second and third trimesters than non-AMA women.Conclusion The average GWG of AMA women in urban areas was(12.7±4.9)kg,and the proportions of insufficient and excessive GWG were 12.1%and 45.8%,respectively,indicating that more than half of AMA women have inappropriate GWG.Compared with non-AMA women,AMA women had a higher risk of insufficient and excessive GWG in the first trimester,and a higher risk of insufficient GWG in the second and third trimester.There is a need to refine and standardize weight management according to the characteristics of GWG of AMA women.