糖耐量正常孕妇晚孕期增重速率对新生儿体重及母儿健康结局的影响  

Gestational weight gain rate in third trimester relates to maternal and neonatal outcomes in pregnancies with normal glucose tolerance

作　　者：王清[1] 田志红[1] 张莉[1] 李光辉[1] Wang Qing Tian Zhihong Zhang Li Li Guanghui(Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China)

机构地区：[1]首都医科大学附属北京妇产医院产科,100026

出　　处：《中华围产医学杂志》2016年第11期842-849,共8页Chinese Journal of Perinatal Medicine

基　　金：北京市卫生系统高层次卫生技术人才培养计划基金（2014-3-074）

摘　　要：目的 探讨糖耐量正常孕妇晚孕期增重速率对新生儿体重及母儿健康结局的影响。方法 回顾性分析2013年1月至12月在首都医科大学附属北京妇产医院定期行产前检查，24~28孕周行口服葡萄糖耐量试验（oral glucose tolerance test，OGTT）结果正常的单胎足月妊娠孕妇，共1967例的临床资料。计算晚孕期增重速率。根据2009年美国国立医学研究院（Institute of Medicine，IOM）推荐的晚孕期增重速率适宜范围，将这些孕妇分为增重过慢、增重正常和增重过快组。根据孕前体重指数（body mass index，BMI）所处水平，将3组再分别分为低BMI（〈18.5）、正常BMI（≥18.5~〈25.0）和高BMI（≥25.0）亚组。分析各组妊娠结局。分别采用单因素方差分析、χ^2检验或Fisher精确概率法、Logistic回归及相关分析等方法对数据进行统计学分析。结果 （1）1 967例糖耐量正常孕妇中，晚孕期增重速率正常者575例（29.2%），增重过快者982例（49.9%），增重过慢者410例（20.8%）。3组孕妇的平均年龄、产次、平均教育程度，以及糖尿病和慢性高血压家族史等差异均无统计学意义（P值均〉0.05）。（2）1 967例孕妇晚孕期平均增重速率为（0.56±0.23）kg/周，新生儿平均出生体重为（3 442±396）g，二者呈直线相关关系（r=0.621，P〈0.01），其直线回归方程为Y=103.839X＋3383.752。增重过快组新生儿出生体重明显高于增重正常组[分别为（3 463.1±417.3）和（3 427.4±376.1）g，F=4.901，P=0.014]，而增重过慢组的新生儿出生体重为（3 375.1±370.1）g，低于增重正常组（F=4.408，P=0.021）。与增重正常组相比，增重过快组分娩巨大儿和低出生体重儿的风险均明显增大（OR=1.59，95%CI：1.10~2.30；OR=2.25，95%CI：1.03~4.94），分娩正常出生体重儿的可能性减小（OR=0.81，95%CI：0.77~0.95）。与增重正常组相比，增重过慢组分娩低出生体重儿Objective To investigate the association between third-trimester gestational weight gain rate （GWGR） and both maternal and neonatal health outcomes in a normal glucose tolerance obstetric population.Methods This was a retrospective cohort study of full-term singleton live births （n=1 967） in women with a normal oral glucose tolerance test （OGTT） tested at 24-28 gestational weeks, who gave birth at Beijing Obstetrics and Gynecology Hospital, Capital Medical University, between January and December in 2013. The subjects were divided into three groups based on third-trimester GWGR category of the 2009 Institute of Medicine （IOM） guidelines. Each group was divided into three subgroups by pre-pregnancy body mass index （BMI）： low （〈18.5）, normal （≥18.5-〈25.0）, and high （≥25.0）. One-way analysis of variance, Chi-square or Fisher＇s exact test, Logistic regression and corrected analysis were performed for statistical analysis.Results （1） Of the 1 967 women analyzed, third-trimester weight gain distribution was normal in 575（29.2%）, excessive in 982（49.9%）, and insufficient in 410（20.8%）. No significant differences were found in terms of age, parity, education level, family history of diabetes or hypertension among the GWGR groups （all P〉0.05）. （2） The mean third-trimester weight gain in the 1 967 normal OGTT women was （0.56±0.23） kg/week and the mean neonatal birth weight was （3 442±396） g. The above two parameters were linearly correlated （Y=103.839X＋3383.752, r=0.621, P〈0.01）. The excessive GWGR group had higher birth weight infants than the normal GWGR group [（3 463.1±417.3） vs （3 427.4±376.1） g, F=4.901, P=0.014]. Women in the insufficient GWGR group had lower birth weight infants （3 375.1±370.1） g than those in the normal GWGR group （F=4.408, P=0.021）. Compared to the normal GWGR group, the excessive GWGR group was associated with an increased risk of fetal macrosomia （OR=1.59, 95%CI： 1.10-2.30） and low bi

关 键 词：妊娠 体重增长 妊娠末期 人体质量指数 出生体重 婴儿 新生 妊娠结局 

分 类 号：R714[医药卫生—妇产科学]