妊娠前体质指数及妊娠期体重增加对妊娠并发症和妊娠结局影响的前瞻性队列研究
- Author:
- No author available
- Journal Title:
- Chinese Journal of Obstetrics and Gynecology
- Issue:
- 3
- DOI:
- 10.3760/cma.j.issn.0529-567x.2019.03.008
- Key Word:
- No keyword available
Abstract： 目的 探讨妊娠前体质指数(BMI)、妊娠期体重增加对妊娠并发症及妊娠结局的影响.方法 2016年1月至2017年6月,在重庆市6家医院招募自愿参加队列研究的计划妊娠妇女2 394例,收集其人口社会学指标、身高、妊娠前体重及妊娠早、中、晚期的体重,妊娠并发症和妊娠结局的情况.孕妇以妊娠前BMI分为4组,BMI<18.5 kg/m2为消瘦组,18.5～<25.0 kg/m2为正常组,25.0～<30.0 kg/m2为超重组,≥30.0 kg/m2为肥胖组.妊娠期体重增加的标准为消瘦孕妇推荐增加12.5～18.0 kg、正常孕妇为11.5～16.0 kg、超重孕妇为7.0～11.5 kg、肥胖孕妇为5.0～9.0 kg,将孕妇分为增重不足、增重正常、增重过度3组.比较不同组间孕妇发生妊娠并发症和不良妊娠结局的趋势关系,并采用多因素非条件logistic回归模型进行分析.结果 不同妊娠前BMI组孕妇的妊娠期高血压疾病、胎膜早破、低出生体重儿、巨大儿、剖宫产的发生率,分别比较,差异均有统计学意义(P均<0.01);且随着妊娠前BMI的增加,发生率有上升的趋势(P均<0.01).不同妊娠期体重增加组孕妇的妊娠期高血压疾病、妊娠期糖尿病、胎膜早破、低出生体重儿、巨大儿的发生率,分别比较,差异均有统计学意义(P均<0.05).妊娠前肥胖(RR=3.49,95%CI为2.41～5.06)、妊娠期过度增重(RR=5.53,95%CI为3.59～8.51)是发生妊娠期高血压疾病和(或)妊娠期糖尿病的危险因素.结论 妊娠早期BMI不可替代妊娠前BMI.妊娠前肥胖、妊娠期体重增加过多可协同导致妊娠期高血压疾病和(或)妊娠期糖尿病.加强妊娠前营养评价和体重管理,合理控制妊娠前BMI及妊娠期体重的增加,能有效降低妊娠期高血压疾病和(或)妊娠期糖尿病的发生风险.
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