孕前体质量指数与妊娠结局关系的评价  

Effects of pre-pregnancy body mass index on pregnancy outcomes

作　　者：李春明[1] 张为远[1] 

机构地区：[1]首都医科大学附属北京妇产医院,100026

出　　处：《中华医学杂志》2014年第1期36-38,共3页National Medical Journal of China

基　　金：北京市卫生系统高层次卫生技术人才培养计划（2009-2-11）;卫生行业科研专项项目（201002013）

摘　　要：目的评价孕前体质量指数与母婴妊娠结局的关系。方法收集2011年在全国39家二级以上专科及综合医院分娩的48867名单胎足月妊娠初产妇临床资料。按照孕前体质量指数（BMI）分为4组：低体质量组（BMI〈18．5kg／m^2），正常体质量组（18．5kg／m^2≤BMI〈23．9kg／m^2）、超重组（24kg／m^3≤BMI〈27．9kg／m^2）和肥胖组（BMII〉28kg/m^2）。Logistic回归评价母亲不良妊娠结局：妊娠期高血压疾病、妊娠期糖尿病、产后出血、胎膜早破、过期妊娠的发生率及危险度；胎儿的不良结局：巨大儿、低出生体重儿、新生儿死亡的发生率及危险度；以及分娩方式：剖宫产、阴道产及阴道助产的发生率及危险度。结果（1）与正常体质量组相比，孕前低体质量组、超重组和肥胖组孕妇患妊娠期高血压疾病的危险度（RR）分别为0．68、2．29和6．02；妊娠期糖尿病的RR分别为0．71、2．27和4．99；（2）与正常体质量组相比，孕前低体质量组、超重组和肥胖组新生儿不良妊娠结局巨大儿的RR值分别为0．59、1．99和3．15；孕前低体质量是低出生体重儿的危险因素，RR值为1．62；（3）与正常体质量组相比，孕前低体质量组、超重组和肥胖组剖宫产分娩的RR值分别为0．59、1．99和3．15；阴道自娩的RR值分别为1．45、0．69和0．46。结论孕前肥胖是许多母亲及胎儿不良妊娠结局的独立危险因素，而孕前低体质量则会增加低出生体重儿的风险，加强孕前体质量控制宣教力度，避免体质量过轻及过重，可减少母婴并发症。Objective To explore the effects of pre-pregnancy body mass index （BMI） upon adverse pregnancy outcomes. Methods We selected a population-based cohort of 48 867 nulliparous women in China's Mainland with singleton and full-term deliveries in 2011. The cohort was categorized in accordance with pre-pregnancy BMI as follows ： underweight 〈 18.5 ; normal weight = 18.5 - 23.9 ; overweight = 24 - 27.9; obesity I〉 28. Logistic regression was used to estimate the association between BMI and adverse maternal, peripartum and perinatal outcomes with normal weight as a reference range. Results （1） Overweight and obese women were more likely to have hypertensive disorders with odds ratios of 2. 29 and 6. 02, gestational diabetes mellitus 2. 27, 4. 99 ; （2） the odds ratios for fetal macrosomia increased among women with higher BMI as follows： 0. 59, 1.99 and 3. 15, whereas only lean women had significantly increased risk of delivering babies with low birth weight （LBW） 1.62 ; （ 3 ） increased BMI was associated with reduced rates of assisted vaginal delivery and increased rates of caesarean section. Conclusion As an independent risk factor for adverse maternal and fetal outcomes, pre-pregnancy obesity should be managed properly.

关 键 词：体质量指数 妊娠结局 肥胖症 胎儿疾病 

分 类 号：R714.7[医药卫生—妇产科学]