孕前体重指数和孕期增重对妊娠结局的影响
잉전체중지수화잉기증중대임신결국적영향
Impact of gestational weight gain and pre-pregnant body mass index on pregnant outcomes
  • 万方数据
    中华围产医学杂志 중화위산의학잡지
    CHINESE JOURNAL OF PERINATAL MEDICINE
    2013年 9期 561-565 ,共5页

    童锦%顾宁%李洁%许晨晨%杨岚%朱振华%王志群

    동금%고저%리길%허신신%양람%주진화%왕지군

    人体质量指数%妊娠%体重增长%妊娠结局 人體質量指數%妊娠%體重增長%妊娠結跼
    인체질량지수%임신%체중증장%임신결국
    Body mass index%Pregnancy%Weight gain%Pregnancy outcome
    目的 探讨孕前体重指数(body mass index,BMI)和孕期增重对妊娠结局的影响,为制定孕期体重分级管理方案提供依据. 方法 研究对象为2009年1月至2010年4月在南京大学医学院附属鼓楼医院产科定期产前检查的健康单胎妊娠孕妇2409例.根据孕前BMI分为孕前体重过低(BMI＜ 18.5)、体重正常(BMI 18.5～)、超重和肥胖(BMI≥24.0)3组.孕期增重计算方法为分娩前最高体重减去孕前体重.将孕前体重过低和体重正常的孕产妇,分别按孕期增重＜10 kg、10 kg～、≥15 kg分为3个亚组；孕前超重和肥胖的孕产妇,按孕期增重＜5 kg、5 kg～、10 kg～、≥15 kg分为4个亚组.记录分娩孕周、分娩方式、新生儿出生体重和Apgar评分,以及妊娠期高血压疾病、妊娠期糖尿病、巨大儿、胎儿生长受限及早产的发生率.统计学分析采用t检验、方差分析、Student-Newman-Keuls检验、x2检验或Fisher精确概率法. 结果 (1)2409例孕妇中,孕前体重过低、体重正常、超重和肥胖组的构成比分别为18.5％(445例)、69.9％(1685例)和11.6％(279例).孕前超重和肥胖组HDP、GDM和巨大儿发生率、剖宫产率分别为12.9％(36例)、17.9％(50例)、13.6％(38例)和52.3％(146例),均高于孕前体重过低组[3.4％(15例)、4.3％(19例)、3.8％(17例)和25.8％(115例),x2分别为23.8、37.1、23.5和50.2,P＜0.05]和体重正常组[5.5％(92例)、7.8％(132例)、7.8％(132例)和31.6％(532例),x2分别为21.8、29.0、10.1和3.4,P＜0.05].(2)孕前体重正常者,孕期增重＜10 kg亚组FGR发生率和早产率分别为3.5％(4/115)和8.7％(10/115),高于增重10 kg～亚组[0.7％(4/548)和3.3％(18/548),x2分别为6.0和6.9,P＜0.05]和≥15 kg亚组[0.8％(8/1022)和3.6％(37/1022),x2分别为7.2和6.7,P＜0.05].增重≥15 kg亚组巨大儿发生率和剖宫产率分别为10.7％(109/1022)和34.5％(353/1022),高于增重＜10 kg亚组[3.5％(4/115)和32.2％(37/115),x2分别为6.0和63.0,P＜0.05]和10 kg～亚组[3.5％(19/548)和25.9％(142/548),x2分别为24.7和31.0,P＜0.05].(3)孕前超重和肥胖者,孕期增重不同的4个亚组妊娠并发症和妊娠结局比较,差异均无统计学意义(P＞0.05). 结论 孕前超重或肥胖者妊娠并发症和剖宫产的风险增加.孕前体重正常者如果孕期增重过高或过低,也可能增加妊娠并发症风险,孕期增重控制在10～15 kg较为适宜.
    목적 탐토잉전체중지수(body mass index,BMI)화잉기증중대임신결국적영향,위제정잉기체중분급관리방안제공의거. 방법 연구대상위2009년1월지2010년4월재남경대학의학원부속고루의원산과정기산전검사적건강단태임신잉부2409례.근거잉전BMI분위잉전체중과저(BMI＜ 18.5)、체중정상(BMI 18.5～)、초중화비반(BMI≥24.0)3조.잉기증중계산방법위분면전최고체중감거잉전체중.장잉전체중과저화체중정상적잉산부,분별안잉기증중＜10 kg、10 kg～、≥15 kg분위3개아조；잉전초중화비반적잉산부,안잉기증중＜5 kg、5 kg～、10 kg～、≥15 kg분위4개아조.기록분면잉주、분면방식、신생인출생체중화Apgar평분,이급임신기고혈압질병、임신기당뇨병、거대인、태인생장수한급조산적발생솔.통계학분석채용t검험、방차분석、Student-Newman-Keuls검험、x2검험혹Fisher정학개솔법. 결과 (1)2409례잉부중,잉전체중과저、체중정상、초중화비반조적구성비분별위18.5％(445례)、69.9％(1685례)화11.6％(279례).잉전초중화비반조HDP、GDM화거대인발생솔、부궁산솔분별위12.9％(36례)、17.9％(50례)、13.6％(38례)화52.3％(146례),균고우잉전체중과저조[3.4％(15례)、4.3％(19례)、3.8％(17례)화25.8％(115례),x2분별위23.8、37.1、23.5화50.2,P＜0.05]화체중정상조[5.5％(92례)、7.8％(132례)、7.8％(132례)화31.6％(532례),x2분별위21.8、29.0、10.1화3.4,P＜0.05].(2)잉전체중정상자,잉기증중＜10 kg아조FGR발생솔화조산솔분별위3.5％(4/115)화8.7％(10/115),고우증중10 kg～아조[0.7％(4/548)화3.3％(18/548),x2분별위6.0화6.9,P＜0.05]화≥15 kg아조[0.8％(8/1022)화3.6％(37/1022),x2분별위7.2화6.7,P＜0.05].증중≥15 kg아조거대인발생솔화부궁산솔분별위10.7％(109/1022)화34.5％(353/1022),고우증중＜10 kg아조[3.5％(4/115)화32.2％(37/115),x2분별위6.0화63.0,P＜0.05]화10 kg～아조[3.5％(19/548)화25.9％(142/548),x2분별위24.7화31.0,P＜0.05].(3)잉전초중화비반자,잉기증중불동적4개아조임신병발증화임신결국비교,차이균무통계학의의(P＞0.05). 결론 잉전초중혹비반자임신병발증화부궁산적풍험증가.잉전체중정상자여과잉기증중과고혹과저,야가능증가임신병발증풍험,잉기증중공제재10～15 kg교위괄의.
    Objective To evaluate the effects of gestational weight gain(GWG) in different prepregnant body mass index (BMI) women on perinatal outcomes and to provide evidences for gestational weight management protocol.Methods Totally,2409 healthy singleton pregnant women accepted regular prenatal examinations in Nanjing Drum Tower Hospital from January 2009 to April 2010 were recruited in this study.They were divided into three groups according to pre-pregnant BMI,which were low BMI group (BMI＜18.5),normal BMI group (BMI 18.5-) and high BMI group (BMI≥24.0).According to GWG,the difference between pre-delivery maximal weight and prepregnant weight,the low and normal BMI women were divided into ＜10 kg,10 kg-and ≥15 kg GWG subgroups,and the high BMI women were divided into ＜5 kg,5 kg-,10 kg and ≥15 kg GWG subgroups.Data including gestational age,delivery modc,newborns' birth weight,Apgar score and incidences of gestational complications,such as hypertensive disorders complicating pregnancy (HDP),gestational diabetes mellitus (GDM),macrosomia,fetal growth restriction (FGR) and preterm birth,were recorded.Analysis of variance,Student-Newman Keuls,Chi-square test and Fisher exact test were applied for statistics.Results (1) Among the 2409 women,the percentages of low,normal and high BMI groups were 18.5％ (n=445),69.9％ (n=1685) and 11.6％ (n=279),respectively.The incidences of HDP,GDM,macrosomia and caesarean delivery in high BMI group were 12.9％ (n=36),17.9％ (n=50),13.6％ (n=38) and 52.3％ (n=146),respectively,higher than those in low BMI group [3.4％ (n=15),4.3 ％ (n=19),3.8％ (n=17) and 25.8％(n=115),x2 =23.8,37.1,23.5 and 50.2,P＜0.05] and those in normal BMI group [5.5％ (n=92),7.8％ (n=132),7.8％ (n=132)and 31.6％ (n=532),x2=21.8,29.0,10.1 and 3.4,P＜0.05].(2) In normal BMI group,the rates of FGR and preterm birth in GWG ＜10 kg subgroup were 3.5％ (4/115) and 8.7％ (10/115),higher than those in GWG 10 kg-subgroup [0.7％(4/548) and 3.3％(18/548),x2=6.0 and 6.9,P＜0.05] and GWG ≥15 kg subgroup [(0.8 ％ (8/1022) and 3.6％ (37/1022),x2=7.2 and 6.7,P＜0.05].The rates of macrosomia and cesarean delivery in GWG ≥15 kg subgroup were 10.7％ (109/1022) and 34.5％ (353/1022),higher than those in GWG＜10 kgsubgroup [3.5％ (4/115) and 32.2％ (37/115),x2=6.0 and 63.0,P＜0.05] and GWG 10 kg subgroup [3.5％ (19/548) and 25.9％ (142/548),x2=24.7 and 31.0,P＜0.05].(3) In high BMI group,the incidences of all pregnancy complications and perinatal outcomes did not show statistical significance among the four GWG subgroups (P＞0.05).Conclusions High prepregnant BMI is a high risk factor of pregnancy complications.It is suggested that normal BMI women should control GWG at 10-15 kg to lower the incidences of pregnancy complications.
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