CAJ | 학술논문

目的探讨孕前BMI、孕期增重与小于胎龄儿(small for gestational age,SGA)的关系,为预防小于胎龄儿的发生提供理论依据.方法以2012年3月至2014年7月在山西医科大学第一医院产科分娩的4 754例单胎孕妇为研究对象,收集其一般人口学特征及健康状况、分娩情况等资料,测量其孕前身高、体重和分娩前体重,计算孕前BMI及孕期增重并分组,收集新生儿出生结局,了解孕前BMI和孕期增重对SGA的影响.结果 SGA发生率为9.26％(440/4 754).孕前体重较低组、正常组及超重/肥胖组SGA发生率为9.85％、8.54％和9.45％,调整孕妇年龄、孕产史等因素后,孕前BMI过高和超重/肥胖者SGA发生率低于孕前BMI正常范围的孕妇(OR=0.714,95％CI:0.535 ～ 0.953);不同孕期增重组SGA发生率分别为孕期增重低于美国医学研究所(IOM)建议范围下限组12.20％、增重在建议范围组9.23％、增重超过建议范围上限组8.45％;调整孕妇年龄、孕产史等因素后,孕期增重低于IOM建议范围下限增加SGA的发生风险(OR=1.999,95％CI:1.487～ 2.685),无论是孕前BMI较低、适宜还是超重/肥胖,分别以增重适宜作为参照,孕期增重低于IOM建议范围下限均增加SGA的发生风险,OR值分别为2.558(95％CI:1.313～ 4.981)、1.804(95％CI:1.258～2.587)、3.108(95％CI:1.237 ～ 7.811).孕前高BMI和孕期增重不足间未发现相加和相乘交互作用.结论孕前BMI超重/肥胖者SGA发生率低于孕前BMI正常范围的孕妇,孕期增重不足增加SGA的发生风险,无论孕前BMI较低、正常还是超重/肥胖的孕妇增重均应避免低于IOM推荐的增重范围下限,以减少SGA的发生.
목적 탐토잉전BMI、잉기증중여소우태령인(small for gestational age,SGA)적관계,위예방소우태령인적발생제공이론의거.방법 이2012년3월지2014년7월재산서의과대학제일의원산과분면적4 754례단태잉부위연구대상,수집기일반인구학특정급건강상황、분면정황등자료,측량기잉전신고、체중화분면전체중,계산잉전BMI급잉기증중병분조,수집신생인출생결국,료해잉전BMI화잉기증중대SGA적영향.결과 SGA발생솔위9.26％(440/4 754).잉전체중교저조、정상조급초중/비반조SGA발생솔위9.85％、8.54％화9.45％,조정잉부년령、잉산사등인소후,잉전BMI과고화초중/비반자SGA발생솔저우잉전BMI정상범위적잉부(OR=0.714,95％CI:0.535 ～ 0.953);불동잉기증중조SGA발생솔분별위잉기증중저우미국의학연구소(IOM)건의범위하한조12.20％、증중재건의범위조9.23％、증중초과건의범위상한조8.45％;조정잉부년령、잉산사등인소후,잉기증중저우IOM건의범위하한증가SGA적발생풍험(OR=1.999,95％CI:1.487～ 2.685),무론시잉전BMI교저、괄의환시초중/비반,분별이증중괄의작위삼조,잉기증중저우IOM건의범위하한균증가SGA적발생풍험,OR치분별위2.558(95％CI:1.313～ 4.981)、1.804(95％CI:1.258～2.587)、3.108(95％CI:1.237 ～ 7.811).잉전고BMI화잉기증중불족간미발현상가화상승교호작용.결론 잉전BMI초중/비반자SGA발생솔저우잉전BMI정상범위적잉부,잉기증중불족증가SGA적발생풍험,무론잉전BMI교저、정상환시초중/비반적잉부증중균응피면저우IOM추천적증중범위하한,이감소SGA적발생.
Objective To investigate the relationship between maternal pre-pregnancy body mass index,weight gain during pregnancy and small for gestational age (SGA) birth so as to provide evidence for the development of comprehensive prevention programs on SGA birth.Methods Between March,2012 and July,2014,4 754 pregnant women were asked to fill in the questionnaires which were collected from the First Affiliated Hospital of Shanxi Medical University.Data related to general demographic characteristics,pregnancy and health status of those pregnant women was collected and maternal pre-pregnancy body mass index and maternal weight gain were calculated.Subjects were divided into different groups before the effect of maternal pre-pregnancy body mass index and weight gain during pregnancy on SGA birth were estimated.Results The overall incidence of SGA birth was 9.26％ (440/4 754).Proportions of SGA birth from pre-pregnant,underweight group,normal weight group,overweight and obese groups were 9.85％,8.54％ and 9.45％,respectively.Results from multi-factor logistic regression analyses showed that after adjusting the confounding factors as age,history on pregnancies etc.,women with high pre-pregnancy BMI showed a lower incidence of SGA than those under normal pre-pregnancy BMI (OR=0.714,95％ CI:0.535-0.953).Different weight gains during pregnancy were statistically significant (x 2=8.811,P=0.012).Incidence of SGA birth that was below the recommended range in the 2009 Institute of Medicine Guidelines (12.20％) was higher than those within (9.23％) or beyond (8.45％) the recommended range.Results from the multi-factor logistic regression analyses showed that,after adjusting the confounding factors as age,pregnancy history etc.,factor as weight gain below the recommended level could increase the risk of SGA (OR=1.999,95％ CI:1.487-2.685).In the underweight,normal weight,overweight or obese groups,with weight gain during pregnancy below the range,the incidence of SGA showed an increase (OR=2.558,95％ CI:1.313-4.981,OR=1.804,95％ CI:1.258-2.587,OR =3.108,95％ CI:1.237-7.811).There was no interaction of addictive or multiplicative models between these two factors under ‘interaction analysis’.Conclusion Women with high pre-pregnancy BMI presented a lower incidence of SGA than those within the normal range.Insufficient weight gain during pregnancy could increase the risk of SGA delivery.These findings called for attention to be paid to the gestational weight gain,in order to decrease the risk of SGA.