妊娠剧吐与胎儿生长受限的关联研究  

Association between hyperemesis gravidarum and fetal growth restriction

作　　者：黄文[1] 朱鹏[1] 高荣[1] 鲁影[1] 梁贞贞[1] 陶芳标[1] 

机构地区：[1]安徽医科大学公共卫生学院儿少卫生与妇幼保健学系,合肥230032

出　　处：《卫生研究》2012年第4期602-608,共7页Journal of Hygiene Research

基　　金：国家"十一五"规划科技支撑计划重大项目(No.2006BAI05A03);国家自然科学基金项目(No.30901203;30901202;81072310);安徽医科大学博士科研资助项目(No.XJ201019)

摘　　要：目的探讨妊娠剧吐(HG)与胎儿生长受限(FGR)间的关联及其作用途径。方法问卷调查收集2 522名住院待产孕妇的人口统计学信息、孕期HG发生情况(HG组、轻度呕吐组、无呕吐组)、孕期饮食行为和心理状况,在分娩后记录新生儿出生结局。结果 HG组孕妇孕早期妊娠相关焦虑得分、孕晚期焦虑和抑郁得分均显著高于无呕吐组,孕期增重显著低于无呕吐组。多因素Logistic回归模型显示,早产(RR=1.94,95%CI 1.05～3.56)、女婴(RR=2.50,95%CI 1.67～3.76)、奶及奶制品摄入减少(RR=1.87,95%CI 1.10～3.18)、孕早期妊娠相关焦虑得分<P25(RR=2.05,95%CI 1.27～3.31)、孕晚期抑郁得分>P75(RR=1.85,95%CI 1.05～3.25)、孕期增重<P25(RR=1.75,95%CI 1.04～2.95)会显著增加FGR的风险。结构方程模型显示,HG可通过显著减少奶及奶制品摄入和增加孕妇心理应激水平两种途径,减少孕期增重,最终间接增加FGR发生的风险。结论 HG作为独立的危险因素,并不会显著增加FGR的发生风险,但HG与FGR的多种危险因素间存在显著关联,可通过影响这些危险因素间接增加FGR的发生风险。孕期心理应激是HG与FGR关联中除营养摄入外的另一重要中介因素。Objective To estimate the association （HG） and the risk of fetal growth restriction （FGR） which HG contributing to the risk of FGR. Methods between hyperemesis gravidarum and the possible mechanisms by The maternal socio-demographic characteristics, hyperemesis gravidarum, food intake changes and psychological stress during pregnancy of 2 522 women were assessed through questionnaires. The neonatal outcome data were obtained from medical records. Results Women with HG were combined with higher psychological stress, including pregnancy related anxiety during first trimester, anxiety and depression in the third trimester, and with lower gestational weight gain compared with women without HG. In the multiple logistic regression model, FGR was significantly associated with premature delivery （RR = 1.94, 95% CI 1.05-3.56） , female infants （RR = 2.50, 95% CI 1.67-3.76） , less milk products intake during pregnancy （RR =- 1.87, 95% CI 1. 10-3.18 ）, lower scores of anxiety during first trimester （ RR = 2.05, 95 % CI 1.27-3.31 ） , higher scores of depression in the third trimester （RR = 1.85, 95% CI 1.05-3.25 ） , and lower gestational weight gain （RR = 1.75, 95% CI 1.04-2.95）. Path model showed that women with HG are predisposed to experience less milk products intake and more psychological stress during pregnancy, which could reduced maternal weight gain, and finally result in increasing the risk of FGR. Conclusion Hyperemesis gravidarum could not independently increase the risk of FGR. However, HG is significantly associated with multiple risk factors, through which HG indirectly increased the risk of FGR. Psychological stress and food intake during pregnancy mediated the negative effects of HG on FGR.

关 键 词：妊娠剧吐 胎儿生长受限 心理应激 饮食摄入 

分 类 号：R17[医药卫生—妇幼卫生保健] R715.3[医药卫生—公共卫生与预防医学]