Gestational Weight Gain in Obese Patients and Adverse Pregnancy Events

Objectives: To examine pre-pregnancy obesity and gestational weight gain as predictors for adverse pregnancy outcomes in a predominantly non-white obstetric resident clinic population. Methods: Prenatal charts for patients with pre-pregnancy obesity cared for at our resident clinic from January 1, 2008 through December 31, 2010 were reviewed. Adverse maternal outcomes were grouped into a “Composite Morbidity Index” (CMI-M) and included gestational diabetes, gestational hypertension, preeclampsia, superimposed preeclampsia, dystocia, operative delivery, Cesarean section for arrest disorders, wound infection and disruption, and thromboembolic events. Fetal events, similarly categorized into a composite adverse fetal index (CMI-F), included macrosomia, Apgar at 5 minutes (≤3), NICU admission, congenital anomalies and intrauterine fetal demise. Results: 627 women with a singleton pregnancy and a pre-pregnancy body mass index (BMI) of 30 and greater were included in the analysis. As measured by the composite morbidity index, women with Class III obesity at their first prenatal visit were more likely to have at least one or more maternal and fetal complications compared to women with Class II or Class I obesity. For adverse maternal outcomes (CMI-M), 40.2%, 33.8%, and 27.4% of women within each respective obesity class experienced an adverse event (p = 0.027). Applying the CMI-F, fetal complications were observed in 28.2%, 18%, and 13.9% of Class III, II, and I obesity (p = 0.003). Total gestational weight gain per week was significantly greater for patients with one or more maternal complications (p = 0.045). Conclusion: Among an obese, resident clinic population comprised primarily of women of ethnic minorities, pre-pregnancy body mass index was the strongest indicator for adverse maternal and fetal outcomes.

Analysis on Family History of Diabetes, Weight Gain during Pregnancy and Pre-pregnancy Body Mass Index on 82 Pregnant Women with Gestational Diabetes Mellitus

Objective:To investigate the effects of family history of diabetes mellitus,Gestational Weight Gain(GWG)and Body Mass Index(BMI)before pregnancy on Gestational Diabetes Mellitus(GDM).Method:82 pregnant women with GDM who were hospitalized and delivered in the obstetrics department of our hospital from September 2017 to September 2019 were selected as the observation group,and 60 pregnant women with normal glucose tolerance test in the same period were selected as the control group;The relationship between family history of diabetes,weight gain during pregnancy and pre-pregnancy Body Mass Index and GDM were analyzed.Results:The age,pre-pregnancy weight and weight gain during pregnancy were significantly higher in the observation group than in the control group(P<0.05),and the family history of diabetes and pre-pregnancy Body Mass Index were higher in the observation group than in the control group(P<0.05),and the differences were statistically significant.Conclusion:It is suggested that family history of diabetes is related to gestational diabetes mellitus.Excessive GWG growth during pregnancy and high Body Mass Index before pregnancy may increase the risk of gestational diabetes mellitus in pregnant women.

Effects of gestational weight gain on the outcome of labor at the Yaounde central hospital maternity, Cameroon

Obesity rates are increasing in Cameroon. Obstetric literature has recently focused on the rising incidence of complications with increases in weight gain in pregnancy. Some of these complications include gestational diabetes, hypertensive disorders, operative deliveries, genital tract lacerations and fetal birth trauma. Examining the effects of excess weight gain during the course of pregnancy could help identify weight gain limits. The Institute of Medicine (IOM) was recommended by the World Health Organization (WHO) to develop guidelines for weight gain during pregnancy and we designed this study in order to determine delivery outcomes when weight is gained above these guidelines. We also sought to know if these guidelines are applicable in our environment. In this cross-sectional analytic design, pre-pregnancy and intra-partum BMIs were calculated for all the parturients who consented. They were classified into normal weight gain and excessive weight gain based on IOM recommendations. Those in the normal weight gain group were women with BMIs that ranged between 18.5 kg/m2 and 30 kg/m2 and who gained 9 - 16 kgs. Those who gained weight above these range were considered as having gained excessive weight during pregnancy. They were all follow-up in labor using the partogram. We compared prepartum, intra-partum and post-partum outcomes in the two groups by calculating odds ratios (ORs), 95% confidence intervals and p values. One hundred and ten (110) overweight women were matched against the same number of women who had normal weight gain. There was no significant difference between social status, marital status as well as level of educational and weight gain in the two groups. Underweight (BMI p = 0.048). Women who gained weight above the recommended range suffered from preeclampsia 18.2% vs. 6.4% (OR 3.2, 95% CI 1.3 - 8.0, p = 0.014), higher cesarean section rates 27.3% vs. 10% (OR 3.3, 95% CI 1.5 - 7.1, p = 0.002), higher rates of induced labor 19.1% vs. 9.0% (OR 2.4, 95% CI 1.0 - 5.2, p = 0.05), prolonged labor 43.6% vs. 16.4% (OR 4.0, 95% CI 2.1 - 7.4, p = 0.000), postpartum hemorrhage 10% vs. 1.8% (OR 6.2, 95% CI 1.3 - 9.2, p = 0.002). There were also higher rates of fetal mal-presentation, 11.8% vs. 3.6% (OR 4.0, 95% CI 1.31 - 11.9, p = 0.004), macrosomia 30.9% vs. 6.4% (OR 7.0, 95% CI 2.7 - 15.6, p p = 0.0045) and birth trauma 10% vs. 1.8%. (OR 6.2, 95% CI 1.3 - 9.2, p = 0.023). Women who gained weight during pregnancy above the recommended range had increased risk of adverse obstetric and neonatal outcomes.

Impact of inflammatory bowel disease activity and thiopurine therapy on birth weight: A meta-analysis

AIM To investigate the effect of disease activity or thiopurine use on low birth weight and small for gestational age in women with inflammatory bowel disease(IBD).METHODS Selection criteria included all relevant articles on the effect of disease activity or thiopurine use on the risk of low birth weight(LBW) or small for gestational age(SGA) among pregnant women with IBD. Sixtynine abstracts were identified,35 papers were full text reviewed and,only 14 of them met inclusion criteria. Raw data were extracted to generate the relative risk of LBW or SGA. Quality was assessed using the Newcastle Ottawa Scale.RESULTS This meta-analysis is reported according to PRISMA guidelines. Fourteen studies met inclusion criteria,and nine reported raw data suitable for meta-analysis. We found an increased risk ratio of both SGA and LBW in women with active IBD,when compared with women in remission: 1.3 for SGA(4 studies,95%CI: 1.0-1.6,P = 0.04) and 2.0 for LBW(4 studies,95%CI: 1.5-2.7,P < 0.0001). Women on thiopurines during pregnancy had a higher risk of LBW(RR 1.4,95%CI: 1.1-1.9,P = 0.007) compared with non-treated women,but when adjusted for disease activity there was no significant effect on LBW(RR 1.2,95%CI: 0.6-2.2,P = 0.6). No differences were observed regarding SGA(2 studies; RR 0.9,95%CI: 0.7-1.2,P = 0.5). CONCLUSION Women with active IBD during pregnancy have a higher risk of LBW and SGA in their neonates. This should be considered in treatment decisions during pregnancy.

Maternal weight and its association with risk of overweight in offspring:a trajectory analysis from a birth cohort in China

Background Most studies on the association of maternal pregnancy weight with offspring weight trajectory have a short follow-up time.This study aimed to explore the associations of maternal prepregnancy body mass index(BMI)and gestational weight gain(GWG)with childhood weight trajectories in a 7-year birth cohort.Methods A total of 946 mother–child pairs(467 boys and 479 girls)from a longitudinal birth cohort in Tianjin City,China,were included in this study,ranging from pregnancy to offspring at 7 years.The outcome variable was defined as overweight or not overweight in offspring at the last round.A group-based trajectory model was applied to identify childhood BMI trajectory groups.Results Five discrete BMI trajectory groups were identified and characterized as constant underweight(25.2%),constant normal weight(42.8%),and high or increasing trajectory[at risk of overweight(16.9%),progressive overweight(11.0%)and progressive obesity(4.1%)].Maternal prepregnancy overweight was associated with 1.72(95%CI 1.14–2.60,P=0.01)to 4.02(95%CI 1.94–8.36,P<0.001)times the risk of all high or increasing trajectory groups,and excessive GWG was related to groups at risk of overweight[relative risk ratio(RRR)2.09,95%CI 1.27–3.46,P=0.004]and progressive obesity(RRR 3.33,95%CI 1.13–9.79,P=0.029).Children in all high or increasing trajectory groups were associated with greater overweight risk at the last round[risk ratios(RRs)ranged from 3.54(95%CI 2.53–4.95,P<0.001)to 6.18(95%CI 4.05–9.42,P<0.001)].Conclusion Maternal prepregnancy overweight and excessive gestational weight gain were associated with increasing or high-level childhood body mass index trajectories as well as a greater risk of overweight at 7 years.

Association of gestational anemia with pregnancy conditions and outcomes: A nested case-control study

BACKGROUND Gestational anemia is a serious public health problem that affects pregnant women worldwide.Pregnancy conditions and outcomes might be associated with the presence of gestational anemia.This study investigated the association of pregnancy characteristics with anemia,exploring the potential etiology of the disease.AIM To assess the association of pregnancy parameters with gestational anemia.METHODS A nested case-control study was conducted based on the Chinese Pregnant Women Cohort Study-Peking Union Medical College Project(CPWCS-PUMC).A total of 3172 women were included.Patient characteristics and gestational anemia occurrence were extracted,and univariable and multivariable logistic regression models were used to analyze the association of pregnancy parameters with gestational anemia.RESULTS Among the 3172 women,14.0% were anemic,46.4% were 25-30 years of age,21.9%resided in eastern,15.7%in middle,12.4%in western 18.0% in southern and 32.0%in northern regions of China.Most women(65.0%)had a normal prepregnancy body mass index.Multivariable analysis found that the occurrence of gestational anemia was lower in the middle and western regions than that in the eastern region[odds ratio(OR)=0.406,95%confidence interval(CI):0.309-0.533,P<0.001],higher in the northern than in the southern region(OR=7.169,95% CI:5.139-10.003,P<0.001),lower in full-term than in premature births(OR=0.491,95% CI:0.316-0.763,P=0.002),and higher in cases with premature membrane rupture(OR=1.404,95% CI:1.051-1.876,P=0.02).CONCLUSION Gestational anemia continues to be a health problem in China,and geographical factors may contribute to the situation.Premature birth and premature membrane rupture may be associated with gestational anemia.Therefore,we should vigorously promote local policy reformation to adapt to the demographic characteristics of at-risk pregnant women,which would potentially reduce the occurrence of gestational anemia.

Effects of pre-pregnancy body mass index and gestational weight gain on neonatal birth weight

To evaluate the effects of maternal pre-pregnancy body mass index （pre-BMI） and gestational weight gain （GWG） on neonatal birth weight （NBW） in the population of Chinese healthy pregnant women, attempting to guide weight control in pregnancy. A retrospective cohort study of 3772 Chinese women was conducted. The population was stratified by maternal pre-BMI categories as underweight （〈18.5 kg/m2）, normal weight （18.5-23.9 kg/m2）, overweight （24.0-27.9 kg/m2）, and obesity （〉28.0 kg/m2）. The NBW differences were tested among the four groups, and then deeper associations among maternal pre-BMI, GWG, and NBW were investigated by multivariate analysis. NBW increased significantly with the increase of maternal pre-BMI level （P〈0.05）, except overweight to obesity （P〉0.05）. The multivariate analysis showed that both pre-BMI and GWG were positively correlated with NBW （P〈0.05）. Compared with normal pre-BMI, underweight predicted an increased odds ratio of small-for-gestational-age （SGA） and decreased odds ratio for macrosomia and large-for-gestational-age （LGA）, and the results were opposite for overweight. With the increase of GWG, the risk of SGA decreased and the risks of macrosomia and LGA increased. In addition, in different pre-BMI categories, the effects of weight gain in the first trimester on NBW were different （P〈0.05）. NBW is positively affected by both maternal pre-BMI and GWG, extreme pre-BMI and GWG are both associated with increased risks of abnormal birth weight, and maternal pre-BMI may modify the effect of weight gain in each trimester on NBW. A valid GWG guideline for Chinese women is an urgent requirement, whereas existing recommendations seem to be not very suitable for the Chinese.

Effect of individualized nutrition interventions on clinical outcomes of pregnant women with gestational diabetes mellitus

BACKGROUND Gestational diabetes mellitus(GDM)can lead to excessive pregnancy weight gain(PWG),abnormal glucolipid metabolism,and delayed lactation.Therefore,it is necessary to provide appropriate and effective interventions for pregnant women with GDM.AIM To clarify the effects of individualized nutrition interventions on PWG,glucolipid metabolism,and lactation in pregnant women with GDM.METHODS The study population consisted of 410 pregnant women with GDM who received treatment at the Northern Jiangsu People's Hospital of Jiangsu Provinceand Yangzhou Maternal and Child Health Hospital between December 2020 and December 2022,including 200 who received routine in-terventions[control(Con)group]and 210 who received individualized nutrition interventions[research(Res)group].Data on PWG,glucolipid metabolism[total cholesterol,(TC);triglycerides(TGs);fasting blood glucose(FPG);glycosylated hemoglobin(HbA1c)],lactation time,perinatal complications(cesarean section,premature rupture of membranes,postpartum hemorrhage,and pregnancy-induced hypertension),and neonatal adverse events(premature infants,fetal macrosomia,hypo-glycemia,and respiratory distress syndrome)were collected for comparative analysis.RESULTS The data revealed markedly lower PWG in the Res group vs the Con group,as well as markedly reduced TG,TC,FPG and HbA1c levels after the intervention that were lower than those in the Con group.In addition,obviously earlier lactation and statistically lower incidences of perinatal complications and neonatal adverse events were observed in the Res group.CONCLUSION Individualized nutrition interventions can reduce PWG in pregnant women with GDM,improve their glucolipid metabolism,and promote early lactation,which deserves clinical promotion.

Outcomes of Fetal Macrosomia and Associated Factors: A Case-Control Facility Based Study

Objective: To identify risk factors of perinatal complications among macrosomic babies in a third level health care facility. Method: We conducted a case-control institutional based study. Cases (macrosomic babies and mothers with perinatal complications) and controls (pairs free of perinatal complication) of singleton live births were extracted from the maternity registry from January 2017 to December 2019. Matching was done for sex and gestational age after exclusion of genetic cause of macrosomia. The main primary outcome was the risk factors for complications. Logistic regression was used to estimate the odds ratio and the magnitude of association between the primary endpoint and the different covariates of the study. Results: Out of 362 couples included, we had 186 cases and 176 controls. The main perinatal complications were the delivery by caesarean section (26.5%) and lesions of the genital canal, 20.2%. There were no maternal deaths. Among newborns, metabolic complications (19.6%) were a leading cause of harmful outcomes before respiratory complications (12.4%), dystocic presentations (6.3%) or traumatic injuries (1.7%). The neonatal case fatality rate was 2.8%. Maternal age ≥30 years (p = 0.024);non-screening for gestational diabetes (p = 0.027);history of caesarean section (p = 0.041);weight gain ≥16 kg (p 0.001);maternal HIV (p = 0.047);birth weight ≥4500 g (p = 0.015) and birth height ≥52.7 ± 1.7 cm (p = 0.026) were risk factors for perinatal adverse outcomes. Conclusion: The delivery of a macrosomic baby remains problematic in this setting, and emphasizes the need to improve routine screening of gestational diabetes within a quality of prenatal follow-up through a multidisciplinary perinatal team involving obstetricians, endocrinologists and neonatal pediatricians.

孕前不同体质量指数及孕期体重不同增加量与子痫前期产妇妊娠结局的关系

目的:探讨孕前不同体质量指数(BMI)及孕期体重不同增加量(GWG)与子痫前期(PE)产妇妊娠结局的关系。方法:选取160例收治的PE产妇作为PE组;同期60例健康体检孕妇作为对照组。PE组产妇再根据病情分为轻度组(MPE组,n=65)和重度组(SPE组,n=95);根据BMI分为超重肥胖组(n=15)、正常体重组(n=107)及低体重组(n=38);根据GWG分为增长过多组(EGWG组,n=91)、增长适宜组(AGWG组,n=47)及增长过少组(IGWG组,n=22)。比较PE组与对照组及不同病情PE组一般资料、孕前BMI、孕期GWG,分析孕前BMI、孕期GWG与PE产妇妊娠结局的关系。结果:PE组和对照组年龄、孕前BMI、孕期GWG、妊娠期糖尿病、高血压家族史有统计学差异(P<0.05);不同病情PE组患者孕前BMI、孕期GWG、妊娠期糖尿病、高血压家族史差异有统计学意义(P<0.05)。超重肥胖组和低体重组不良妊娠结局的总发生率高于正常体重组(P<0.05)。妊娠EGWG组和IGWG组不良妊娠结局的总发生率高于妊娠AGWG组(P<0.05)。相关性分析显示,孕前BMI、孕期GWG与PE妊娠结局均呈正相关关系(P<0.05)。结论:孕前BMI、孕期GWG与PE发生密切相关,且孕前超重肥胖、低体重、EGWG、IGWG均与PE患者不良妊娠结局密切相关。

妊娠期糖尿病患者体重增长情况及与母婴不良结局的相关性研究

目的根据我国妊娠期体重增长(GWG)标准,分析妊娠期糖尿病(GDM)孕妇妊娠期体重增长情况及其和母婴不良结局的相关性。方法选取北京市朝阳区2019年2月至2022年8月建档分娩的单胎妊娠GDM孕妇10539例为研究对象,采用Logistic回归分析GDM孕妇GWG与妊娠期高血压、妊娠合并贫血、子痫前期/子痫、胎膜早破、剖宫产、低出生体重、巨大儿、小于胎龄儿(SGA)、大于胎龄儿(LGA)的相关性。结果10539例GDM孕妇中,35.53%GWG过多,20.56%GWG不足,43.90%GWG适宜;42.49%的超重人群和45.61%的肥胖人群GWG过多。在调整年龄、民族、文化程度、职业、孕次、孕前体质量指数、孕龄后,多因素Logistic回归分析结果显示,GWG过多是妊娠期高血压、子痫前期/子痫、剖宫产、巨大儿和LGA的危险因素(aOR值介于1.39~2.37之间,P<0.05),是低出生体重、SGA的保护性因素(aOR值分别为0.60、0.61,P<0.01);而GWG不足是低出生体重、SGA的危险因素(aOR值分别为1.81、1.38,P<0.01),是胎膜早破、剖宫产、LGA的保护性因素(aOR值分别为0.65、0.89、0.81,P<0.05);未观察到GWG与妊娠合并贫血的相关性(P>0.05)。结论在我国妊娠期体重增长标准下,GDM孕妇中约20%增重不足,约40%的肥胖和超重人群增重过多。GDM孕妇妊娠期体重增长过多和不足均会增加母婴不良结局的风险,为GDM人群制定针对性妊娠期增重标准,指导和监测GDM孕妇妊娠期增重具有一定的意义。

Gestational diabetes: weight gain during pregnancy and its relationship to pregnancy outcomes

Background:Weight gain during pregnancy reflects the mother's nutritional status.However, it may be affected by nutritional therapy and exercise interventions used to control blood sugar in gestational diabetes mellitus (GDM).This study aimed to evaluate weight gain during gestation and pregnancy outcomes among women with GDM.Methods:A retrospective study involving 1523 women with GDM was conducted between July 2013 and July 2016.Demographic data, gestational weight gain (GWG), blood glucose, glycated-hemoglobin level, and maternal and fetal outcomes were extracted from medical records.Relationships between GWG and pregnancy outcomes were investigated using multivariate logistic regression.Results:In total, 451 (29.6%) women showed insufficient GWG and 484 (31.8%) showed excessive GWG.Excessive GWG was independently associated with macrosomia (adjusted odds ratio [aOR] 2.20, 95% confidence interval [CI] 1.50-3.52, P<0.001), large for gestational age (aOR 2.06, 95% CI 1.44-2.93, P<0.001), small for gestational age (aOR 0.49, 95% CI 0.25-0.97, P=0.040), neonatal hypoglycemia (aOR 3.80, 95% CI 1.20-12.00, P=0.023), preterm birth (aOR 0.45, 95% CI 0.21-0.96, P=0.040), and cesarean delivery (aOR 1.45, 95% CI 1.13-1.87, P=0.004).Insufficient GWG increased the incidence of preterm birth (aOR 3.53, 95% CI 1.96-6.37, P<0.001).Conclusions:Both excessive and insufficient weight gain require attention in women with GDM.Nutritional therapy and exercise interventions to control blood glucose should also be used to control reasonable weight gain during pregnancy to decrease adverse pregnancy outcomes.

双胎妊娠增重适宜范围与母婴围产期结局的关系

目的 探讨双胎妊娠孕妇孕中、晚期适宜的孕期体重增长(gestational weight gain,GWG)范围,并进一步分析GWG范围与母婴围产期妊娠结局的关系。方法 选取2012年1月—2022年12月于广东省佛山市妇幼保健院建档产检并分娩的2 222例双胎妊娠孕妇为研究对象,根据体质指数(body mass index,BMI)将孕妇分为低体重组、正常体重组、超重组及肥胖组。根据围产期结局确定低风险人群,采用四分位数法计算该人群孕中、晚期每周增重的适宜范围,并将双胎妊娠孕妇增重情况分为增重不足、增重适宜和增重过多。采用多因素logistic回归模型分别分析增重情况与6种围产期结局的关系,对新生儿结局采用广义估计方程进行分析。结果 不同BMI组别间初产妇占比、绒毛膜性、受孕方式的比较差异均有统计学意义(均P <0.05)。对于围产期结局,不同BMI组别间妊娠期糖尿病、妊娠期高血压和大于胎龄儿的比较差异均有统计学意义(均P<0.05)。根据819例低风险孕妇计算得出低体重组、正常体重组、超重组和肥胖组每周体重增长适宜范围分别为0.579~0.808 kg、0.531~0.769 kg、0.479~0.711 kg和0.430~0.679 kg。多因素logistic回归模型提示,GWG不足会增加早产(OR=1.36,95%CI:1.11~1.67)、小于胎龄儿(OR=1.74,95%CI:1.34~2.27)的发生风险,而GWG过多则会增加子痫前期(OR=1.82,95%CI:1.30~2.54)、妊娠期高血压(OR=1.72,95%CI:1.04~2.86)和大于胎龄儿(OR=2.17,95%CI:1.52~3.11)的发生风险。结论 基于低风险人群孕中、晚期GWG的适宜范围,双胎妊娠孕妇GWG增重过多或过少都会增加不良妊娠结局的风险,加强对双胎妊娠孕妇的体重管理有助于促进双胎妊娠孕妇母婴围产期健康。

Excessive gestational weight gain in early pregnancy and insufficient gestational weight gain in middle pregnancy increased risk of gestational diabetes mellitus

Background:Gestational weight gain(GWG)is associated with the risk of gestational diabetes mellitus(GDM).However,the effect of weight gain in different trimesters on the risk of GDM is unclear.This study aimed to evaluate the effect of GWG on GDM during different trimesters.Methods:A birth cohort study was conducted from 2017 to 2020 in Shenzhen,China.In total,51,205 participants were included comprising two models(early pregnancy model and middle pregnancy model).Gestational weight(kg)was measured at each prenatal clinical visit using a standardized weight scale.Logistic regression analysis was used to assess the risk of GDM.Interaction analysis and mediation effect analysis were performed in the middle pregnancy model.Results:In the early pregnancy model,the risk of GDM was 0.858 times lower(95%confidence interval[CI]:0.786,0.937)with insufficient GWG(iGWG)and 1.201 times higher(95%CI:1.097,1.316)with excessive GWG after adjustment.In the middle pregnancy model,the risk of GDM associated with iGWG increased 1.595 times(95%CI:1.418,1.794)after adjustment;for excessive GWG,no significant difference was found(P=0.223).Interaction analysis showed no interaction between GWG in early pregnancy(GWG-E)and GWG in middle pregnancy(GWG-M)(F=1.268;P=0.280).The mediation effect analysis indicated that GWG-M plays a partial mediating role,with an effect proportion of 14.9%.Conclusions:eGWG-E and iGWG-M are associated with an increased risk of GDM.Strict control of weight gain in early pregnancy is needed,and sufficient nutrition should be provided in middle pregnancy.

Gestational weight gain among minority adolescents predicts term birth weight

Background In adolescents, there is limited evidence on the independent and additive effect of prepregnancy body mass index (BMI) and gestational weight gain on infant birth weight. Data also show that this effect may vary by race. We sought to examine the impact of maternal prepregnancy BMI and gestational weight gain on birth weight and risk of large for ges-tational age (LGA) in term newborns of minority adolescent mothers. Methods This was a retrospective cohort study of 411 singleton live term infants born to mothers ≤ 18 years. Data were abstracted from electronic medical records. Results Gestational weight gain was related to infant birth weight (ρ = 0.36,P < 0.0001), but BMI was not (ρ = 0.025, P = 0.61). On regression analysis, gestational weight gain, gestational age and Hispanic ethnicity were independent predic-tors of birth weight, controlling for maternal age, BMI, parity, tobacco/drug use and preeclampsia. The probability of having an LGA infant increased with weight gain [adjusted odds ratio (aOR) 1.14, 95% confidence interval (CI) 1.07–1.21] but not with BMI. Mothers who gained weight in excess of 2009 Institute of Medicine (IOM) recommendations had a greater risk of having an LGA infant compared to those who gained within recommendations (aOR 5.7, 95% CI 1.6–19.5). Conclusions Minority adolescents with greater gestational weight gain had infants with higher birth weight and greater risk of LGA;BMI was not associated with either outcome. Further studies are needed to examine the applicability of the 2009 BMI-specific IOM gestational weight gain recommendations to adolescents in minority populations.

正常孕妇妊娠期增重和糖脂代谢与巨大儿发生风险的关系

目的:分析妊娠期体质量和糖脂水平在分娩巨大儿的无妊娠合并症/并发症、非肥胖、非高龄的正常孕妇中的变化特点,探讨其对巨大儿发生风险的影响。方法:选取2020年9—12月在上海交通大学医学院附属国际和平妇幼保健院定期产检的正常孕妇,根据是否分娩巨大儿分为巨大儿组(104例)和对照组(258例),比较2组基本情况和妊娠期糖脂水平,并采用Logistic回归分析正常孕妇分娩巨大儿的影响因素。结果:相较于正常对照组,巨大儿组妊娠期空腹血糖、妊娠早晚期三酰甘油(triglyceride,TG)水平更高,妊娠早晚期高密度脂蛋白(high density lipoprotein,HDL)水平更低,且巨大儿组妊娠期TG变化差值更大、HDL变化差值更小(均P<0.05)。与妊娠期增重适宜的正常孕妇相比,增重过多的正常孕妇分娩巨大儿的风险升高142%(OR=2.42,95%CI:1.34~4.39),增重不足的正常孕妇分娩巨大儿的风险降低73%(OR=0.27,95%CI:0.10~0.77);妊娠晚期HDL每升高1 mmol/L,分娩巨大儿风险下降79%(OR=0.21,95%CI:0.08~0.57)。结论:正常孕妇群体仍需严格控制妊娠期体质量以降低巨大儿的发生风险,并且仍需关注血脂代谢,其中妊娠晚期HDL的水平及变化情况或可辅助筛查隐匿性巨大儿。

父母孕前BMI联合儿童出生体质量及BMI对哮喘发生的预测价值

目的探讨父母孕前身体质量指数(BMI)、儿童出生体质量及BMI与儿童哮喘发生的潜在关联及预测价值。方法选取2019年9月至2023年1月在合肥市第二人民医院儿科就诊并符合纳入标准的患儿1760例,根据是否患有哮喘,分为哮喘组(n=440)和对照组(n=1320)。比较两组患儿一般临床资料,使用多因素logistic回归分析父亲BMI、母亲孕前BMI、母亲妊娠期体质量增加量、儿童出生体质量及儿童BMI与儿童哮喘发生的相关性;使用受试者工作特征(ROC)曲线分析危险因素对儿童哮喘发生的预测价值。结果两组患儿父亲BMI、母亲孕前BMI、妊娠期体质量增加量、儿童出生体质量、BMI、母亲患有哮喘的比例差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,父亲BMI(OR=1.610,95%CI:1.431~1.821)、母亲孕前BMI(OR=2.107,95%CI:1.839~2.424)、母亲妊娠期体质量增加量(OR=3.970,95%CI:3.325~4.801)、儿童出生体质量(OR=1.006,95%CI:1.006~1.007)及BMI(OR=1.427,95%CI:1.109~1.841)是儿童哮喘的危险因素(P<0.05)。ROC曲线分析显示,儿童出生体质量、母亲妊娠期体质量增加量、儿童BMI、母亲孕前BMI和父亲BMI 5项危险因素联合检测对哮喘发生预测的曲线下面积为0.960,分别大于单独检测(0.826、0.893、0.562、0.827、0.718)。联合评估的灵敏度为91.7%,特异度为91.5%,均高于单独检测(67.0%、85.7%、67.3%、78.4%、58.2%;84.5%、83.7%、44.2%、90.2%、77.1%)。结论父母孕前BMI、母亲妊娠期体质量增加量、儿童出生体质量及BMI与哮喘发生密切相关,联合诊断对哮喘发生有更高的预测价值。

妊娠期糖尿病、孕期增重和喂养方式对其子代神经发育迟缓的影响

目的 探讨妊娠期糖尿病、孕期增重和喂养方式对其子代神经发育迟缓的影响。方法 采用回顾性队列研究,对纳入队列的8 023例产妇及其子代的基本信息进行描述性分析,在调整协变量后分析妊娠期糖尿病、孕期增重和喂养方式和其子代神经发育迟缓的关联。结果 研究对象妊娠年龄为(29.46±4.57)岁,孕前体质量指数(BMI)为(21.38±3.09)kg/m2。纳入子代中,男性4 450例(55.5%),采用母乳喂养4 351例(54.2%),出生时有735例(9.2%)为低体重新生儿。在校正了协变量后的logistic模型中,人工喂养与神经行为发育迟缓呈正相关[OR=1.70,95%CI:1.24~2.33]。在校正了协变量的多元线性回归模型中,妊娠期糖尿病、孕期增重不足,人工喂养与总发育商呈负相关(β=-0.44,95%CI:-0.87~-0.008;β=-0.73,95%CI:-1.25~-0.22;β=-0.80,95%CI:-1.34~-0.26)。母体妊娠糖尿病对其子代大运动和社交能力发育迟缓有明确影响(P <0.05);产妇增重不足对其子代五大能区的神经迟缓的影响均有统计学意义(P <0.05);人工喂养对其子代五大能区的神经迟缓有明确影响(P <0.05)。结论 产妇妊娠期增重不足以及采用人工喂养的方式是子代神经发育迟缓的危险因素,母体妊娠糖尿病是其子代大运动和社交能力发育迟缓的危险因素。

孕妇血糖异常项数、孕期增重及其交互作用对妊娠不良结局的影响

目的探讨妊娠期糖尿病(GDM)患者在24~28周口服75g葡萄糖耐量试验(OGTT)的血糖异常项数、孕期增重(GWG)及其交互作用对妊娠不良结局的影响。方法选择2020年4月至2023年3月于中国人民解放军北部战区总医院定期产检并分娩的404例GDM孕妇为研究对象。按照OGTT血糖异常数量分1项、2项和3项异常,分别标记为Ⅰ组、Ⅱ组和Ⅲ组。根据美国医学研究所(IOM)的建议将GWG分为增重适宜、增重不足、增重过多组。比较不同组间孕妇临床资料的差异,采用Logistic回归及相乘相加模型,研究血糖异常项数和孕期增重对妊娠不良结局的影响是否存在交互作用。结果多因素Logistic回归分析显示,2项或3项血糖异常均是发生妊娠期高血压疾病(HDP)、妊娠期甲减、剖宫产、早产和大于胎龄儿(LGA)的危险因素(aOR值介于3.417~8.444之间,P<0.05);3项血糖异常是导致巨大儿发生的危险因素(aOR=6.199,P<0.05);孕期增重不足是引起孕妇妊娠期甲减的危险因素(aOR=10.537,P<0.05);增重过多是孕妇发生HDP、剖宫产、早产、巨大儿、LGA的危险因素(aOR值介于2.587~6.948之间,P<0.05)。亚组分析显示,Ⅰ组孕妇中孕期增重不足是引起妊娠期甲减、早产的危险因素,孕期增重过多是发生HDP、剖宫产的危险因素(aOR值介于4.609~41.366之间,P<0.05);Ⅱ组孕妇中孕期增重不足是发生剖宫产的危险因素,孕期增重过多是发生早产的危险因素(aOR值分别为8.878、12.722,P<0.05);Ⅲ组孕妇中孕期增重过多是孕妇发生剖宫产的危险因素(aOR=38.666,P<0.05);相乘、相加交互模型的结果提示,血糖异常项数≥2项和孕期不合理增重对妊娠不良结局无交互作用。结论孕妇OGTT血糖异常项数的增多及孕期不合理增重均会增加不良妊娠结局的发生风险,且随着OGTT异常项数的增多,孕期不合理增重对不良妊娠结局的影响作用逐渐减弱。血糖异常项数2项及以上、孕期不合理增重对妊娠不良结局的发生无相乘相加交互作用。

一般自我效能感在孕妇体重控制中的作用分析

目的探索影响孕妇孕前体重及孕期体重增加(GWG)的相关因素,了解孕妇自身一般自我效能对于其体重控制的直接影响与中介效应。方法于2019年1月至2020年7月对在某社区卫生服务中心建档的900名孕妇进行问卷调查。结果AMOS中介效应检验结果显示,孕妇的孕前个人社会基础、孕前社会心理支持、孕前一般效能感、医生孕期体重管理认可度对孕妇体重控制有直接正向中介效应,而一般自我效能还在社会心理支持水平与GWG和孕前BMI之间起部分中介效应;另外,孕前BMI、孕妇对医生孕期体重管理认可度则在一般自我效能与GWG结果之间起部分中介效应。结论应对低一般自我效能感和低社会心理支持水平孕妇的体重控制情况予以重点关注,制定个性化的干预措施并开展综合干预。