目的 探讨甘肃地区妇女妊娠前超重与肥胖的发生情况,分析其相关因素,并研究妊娠前体重指数(body mass index,BMI)与妊娠期增重和母婴并发症的关系. 方法 整群抽取2010年2月至2011年12月期间在甘肃省妇幼保健院分娩的孕妇进行回顾性问卷调查.采用世界卫生组织推荐的亚洲人群BMI分类标准分析研究对象超重及肥胖的发生情况.分析超重及肥胖的相关因素,以及妊娠前BMI与妊娠期体重增长和发生母婴并发症的关系.采用方差分析、x2检验、等级相关分析、单因素和多元Logistics回归分析进行统计学处理. 结果 共6 400例产妇纳入本研究.6 400例孕妇BMI为13.3～38.1,平均为20.6±2.7.根据世界卫生组织推荐的亚洲人群BMI分类标准,6 400例孕妇中,超重636例(9.9％),肥胖416例(6.5％).BMI与年龄呈正相关,体重过低组、体重正常组、超重组和肥胖组孕妇平均年龄逐渐增大[分别为(27.8±3.8)、(29.1±4.3)、(30.3±4.7)和(30.6±4.6)岁],差异有统计学意义(F=77.490,P＜ 0.01).随年龄增加,BMI逐渐增高(r=0.18,P＜0.01);非初产妇BMI高于初产妇(分别为21.2±2.6和20.4±2.6),差异有统计学意义(t=-9.630,P＜ 0.01);BMI与教育程度及经济收入水平呈负相关(r=-0.06,P＜0.01;r=-0.04,P=0.036).随BMI增加,4组妊娠13周内增重、妊娠期总增重逐渐减少(F值分别为8.892和21.700,P值均＜0.01).超重组新生儿出生体重最大,依次高于肥胖组、体重正常组和体重过低组,4组差异有统计学意义(F=11.261,P＜0.01).随着BMI升高,4组中单胎孕妇妊娠期高血压疾病、妊娠期糖尿病、产后出血、新生儿肺透明膜病和新生儿低血糖发生率逐渐升高(x2值分别为85.758、58.913、13.501、6.563和9.579,P值均＜0.05),剖宫产率和巨大儿、出生缺陷发生率逐渐升高(x2值分别为125.442、62.963和9.087,P值均＜0.05).超重组脐带异常发生率依次高于体重正常组、体重过低组和肥胖组,差异有统计学意义(x2=15.828,P=0.001).肥胖组新生儿电解质紊乱发生率依次高于体重过低组、体重正常组和超重组,差异有统计学意义(x2=12.092,P=0.007).超重组早产发生率依次高于肥胖组、体重正常组和体重过低组,差异有统计学意义(x2=7.865,P=0.049).相对于体重正常组,超重组剖宫产、妊娠期高血压疾病、妊娠期糖尿病和脐带异常的发生风险增加[OR值(95％CI)分别为1.700(1.325～2.181)、2.436(1.578～3.761)、3.182(1.049～9.653)和2.252 (1.267～4.004)],肥胖组妊娠期高血压疾病、巨大儿和新生儿电解质紊乱的发生风险增加[OR值(95％CI)分别为2.585(1.020～6.914)、2.484(1.017～6.070)和4.430(1.290～15.217)].结论 本地区妇女妊娠前BMI随年龄、产次增加而增加,随教育程度提高以及经济收入增加而降低.妊娠早期(妊娠13周内)和妊娠期总增重随BMI增大而降低.妊娠前超重和肥胖可增加剖宫产、妊娠高血压疾病、妊娠期糖尿病、巨大儿及新生儿电解质紊乱的风险.
目的 探討甘肅地區婦女妊娠前超重與肥胖的髮生情況,分析其相關因素,併研究妊娠前體重指數(body mass index,BMI)與妊娠期增重和母嬰併髮癥的關繫. 方法 整群抽取2010年2月至2011年12月期間在甘肅省婦幼保健院分娩的孕婦進行迴顧性問捲調查.採用世界衛生組織推薦的亞洲人群BMI分類標準分析研究對象超重及肥胖的髮生情況.分析超重及肥胖的相關因素,以及妊娠前BMI與妊娠期體重增長和髮生母嬰併髮癥的關繫.採用方差分析、x2檢驗、等級相關分析、單因素和多元Logistics迴歸分析進行統計學處理. 結果 共6 400例產婦納入本研究.6 400例孕婦BMI為13.3～38.1,平均為20.6±2.7.根據世界衛生組織推薦的亞洲人群BMI分類標準,6 400例孕婦中,超重636例(9.9％),肥胖416例(6.5％).BMI與年齡呈正相關,體重過低組、體重正常組、超重組和肥胖組孕婦平均年齡逐漸增大[分彆為(27.8±3.8)、(29.1±4.3)、(30.3±4.7)和(30.6±4.6)歲],差異有統計學意義(F=77.490,P＜ 0.01).隨年齡增加,BMI逐漸增高(r=0.18,P＜0.01);非初產婦BMI高于初產婦(分彆為21.2±2.6和20.4±2.6),差異有統計學意義(t=-9.630,P＜ 0.01);BMI與教育程度及經濟收入水平呈負相關(r=-0.06,P＜0.01;r=-0.04,P=0.036).隨BMI增加,4組妊娠13週內增重、妊娠期總增重逐漸減少(F值分彆為8.892和21.700,P值均＜0.01).超重組新生兒齣生體重最大,依次高于肥胖組、體重正常組和體重過低組,4組差異有統計學意義(F=11.261,P＜0.01).隨著BMI升高,4組中單胎孕婦妊娠期高血壓疾病、妊娠期糖尿病、產後齣血、新生兒肺透明膜病和新生兒低血糖髮生率逐漸升高(x2值分彆為85.758、58.913、13.501、6.563和9.579,P值均＜0.05),剖宮產率和巨大兒、齣生缺陷髮生率逐漸升高(x2值分彆為125.442、62.963和9.087,P值均＜0.05).超重組臍帶異常髮生率依次高于體重正常組、體重過低組和肥胖組,差異有統計學意義(x2=15.828,P=0.001).肥胖組新生兒電解質紊亂髮生率依次高于體重過低組、體重正常組和超重組,差異有統計學意義(x2=12.092,P=0.007).超重組早產髮生率依次高于肥胖組、體重正常組和體重過低組,差異有統計學意義(x2=7.865,P=0.049).相對于體重正常組,超重組剖宮產、妊娠期高血壓疾病、妊娠期糖尿病和臍帶異常的髮生風險增加[OR值(95％CI)分彆為1.700(1.325～2.181)、2.436(1.578～3.761)、3.182(1.049～9.653)和2.252 (1.267～4.004)],肥胖組妊娠期高血壓疾病、巨大兒和新生兒電解質紊亂的髮生風險增加[OR值(95％CI)分彆為2.585(1.020～6.914)、2.484(1.017～6.070)和4.430(1.290～15.217)].結論 本地區婦女妊娠前BMI隨年齡、產次增加而增加,隨教育程度提高以及經濟收入增加而降低.妊娠早期(妊娠13週內)和妊娠期總增重隨BMI增大而降低.妊娠前超重和肥胖可增加剖宮產、妊娠高血壓疾病、妊娠期糖尿病、巨大兒及新生兒電解質紊亂的風險.
목적 탐토감숙지구부녀임신전초중여비반적발생정황,분석기상관인소,병연구임신전체중지수(body mass index,BMI)여임신기증중화모영병발증적관계. 방법 정군추취2010년2월지2011년12월기간재감숙성부유보건원분면적잉부진행회고성문권조사.채용세계위생조직추천적아주인군BMI분류표준분석연구대상초중급비반적발생정황.분석초중급비반적상관인소,이급임신전BMI여임신기체중증장화발생모영병발증적관계.채용방차분석、x2검험、등급상관분석、단인소화다원Logistics회귀분석진행통계학처리. 결과 공6 400례산부납입본연구.6 400례잉부BMI위13.3～38.1,평균위20.6±2.7.근거세계위생조직추천적아주인군BMI분류표준,6 400례잉부중,초중636례(9.9％),비반416례(6.5％).BMI여년령정정상관,체중과저조、체중정상조、초중조화비반조잉부평균년령축점증대[분별위(27.8±3.8)、(29.1±4.3)、(30.3±4.7)화(30.6±4.6)세],차이유통계학의의(F=77.490,P＜ 0.01).수년령증가,BMI축점증고(r=0.18,P＜0.01);비초산부BMI고우초산부(분별위21.2±2.6화20.4±2.6),차이유통계학의의(t=-9.630,P＜ 0.01);BMI여교육정도급경제수입수평정부상관(r=-0.06,P＜0.01;r=-0.04,P=0.036).수BMI증가,4조임신13주내증중、임신기총증중축점감소(F치분별위8.892화21.700,P치균＜0.01).초중조신생인출생체중최대,의차고우비반조、체중정상조화체중과저조,4조차이유통계학의의(F=11.261,P＜0.01).수착BMI승고,4조중단태잉부임신기고혈압질병、임신기당뇨병、산후출혈、신생인폐투명막병화신생인저혈당발생솔축점승고(x2치분별위85.758、58.913、13.501、6.563화9.579,P치균＜0.05),부궁산솔화거대인、출생결함발생솔축점승고(x2치분별위125.442、62.963화9.087,P치균＜0.05).초중조제대이상발생솔의차고우체중정상조、체중과저조화비반조,차이유통계학의의(x2=15.828,P=0.001).비반조신생인전해질문란발생솔의차고우체중과저조、체중정상조화초중조,차이유통계학의의(x2=12.092,P=0.007).초중조조산발생솔의차고우비반조、체중정상조화체중과저조,차이유통계학의의(x2=7.865,P=0.049).상대우체중정상조,초중조부궁산、임신기고혈압질병、임신기당뇨병화제대이상적발생풍험증가[OR치(95％CI)분별위1.700(1.325～2.181)、2.436(1.578～3.761)、3.182(1.049～9.653)화2.252 (1.267～4.004)],비반조임신기고혈압질병、거대인화신생인전해질문란적발생풍험증가[OR치(95％CI)분별위2.585(1.020～6.914)、2.484(1.017～6.070)화4.430(1.290～15.217)].결론 본지구부녀임신전BMI수년령、산차증가이증가,수교육정도제고이급경제수입증가이강저.임신조기(임신13주내)화임신기총증중수BMI증대이강저.임신전초중화비반가증가부궁산、임신고혈압질병、임신기당뇨병、거대인급신생인전해질문란적풍험.
Objective To explore the prevalence and the relative factors of the overweight and the obese in a population of Gansu Province pre-pregnancy women.and the effects of pre-pregnancy maternal body mass index (BMI) on gestational weight gain and pregnant outcome.Methods We conducted a populationbased birth cohort study in Gansu Province Maternity and Child Health Care Hospital from February,2010 to December,2011.Single live term birth women who have complete anthropometry were enrolled this study.They were categorized into four BMI groups according to World Health Organization's BMI recommendations for Asian populations.We explored the prevalence and the relative factors of the overweight and the obese,and the effects of pre-pregnancy maternal body mass index on gestational weight gain and birth outcomes by Chi-square test,analysis of variance.Results A total of 6 400 cases included in this study.The BMI range is from 13.3 to 38.1,the average BMI is (20.6 ±2.7).Among 6 400 cases,636 cases(9.9％) and 416 cases (6.5％) were overweight and obese.The average age (unit:years) is increase gradually in low weight group (27.8±3.8),normal group (29.1 ±4.3),overweight group (30.3 ±4.7) and obese group (30.6±4.6),the difference was statistically significant (F=77.490,P＜0.01).The result prompt that the median BMI increased with the increasing of maternal age (r=0.18,P＜0.01).The BMI of multiparous women (21.22 ±2.63) is higher than nulliparous women (20.43 ± 2.64),the difference was statistically significant (t=-9.630,P＜0.01).The BMI has negatively correlated with education level and economic income level (r=-0.06,P＜0.01; r=-0.04,P=0.036).With the increase of BMI,the weight gain of early (13 weeks) pregnancy (F=8.892,P＜ 0.01) and the total weight gain during whole pregnancy (F=21.700,P＜ 0.01) gradually reduced in four groups.The neonatal birth weight in overweight group is largest,in turn higher than obesity group,normal group and low weight group,the difference was statistically significant (F=11.261,P＜0.01).With increasing BMI,the incidence of pre eclampsia (x2=85.758,P＜0.05),gestational diabetes mellitus (x2=58.913,P＜0.05),postpartum hemorrhage (x2=13.501,P＜0.05),neonatal hypoglycemia (x2=6.563,P＜0.05) and neonatal pulmonary hyaline membrane (x2=9.579,P＜0.05) was increased.The incidence of caesarean section (x2=125.442,P＜0.05),macrosomia (x2=62.963,P＜0.05) and birth defects (x2=9.087,P＜0.05) also increased.The incidence of abnormal umbilical cord in overweight group is highest,in turn higher than normal group,low weight group,and the obesity group (x2=15.82g,P=0.001).The incidence of neonatal electrolyte disorder in obesity group was higher than low weight group,normal group,and the overweight group (x2=12.092,P=0.007).The incidence of preterm birth in overweight group is highest,in turn higher than obesity group,normal group and the low weight group (x2=7.865,P=0.049).Compared with the normal group,the risk of caesarean section (OR=l.700,95％ CI:1.325-2.181),pre-eclampsia (OR=2.436,95％ CI:1.578-3.761),gestational diabetes (OR=3.182,95％ CI:1.049-9.653) and abnormal umbilical cord (OR=2.252,95％ CI:1.267-4.004) in overweight group was increased.the risk of pre eclampsia (OR=2.585,95％ CI:1.020-6.914),macrosomia (OR=2.484,95％ CI:1.017 6.070),neonatal electrolyte disorder (OR=4.430,95％ CI:1.290-t5.217) in obesity group was increased.Conclusions The median BMI before pregnancy increased with increasing maternal age,parity,but decreased with education level and income level.The weight gain of early (13 weeks) pregnancy and the total weight gain during whole pregnancy decreased with increasing BMI.Overweight and obesity before pregnancy increased the risk the caesarean section,preeclampsia,gestational diabetes,macrosomia and neonatal electrolyte disorder.
