妊娠不同时期增重对新生儿出生体质量的影响研究  

Effect of Timing of Gestational Weight Gain on Birth Weight

作　　者：郑薇 张莉[1] 田志红[1] 李光辉[1] 张为远[1] ZHENG Wei;ZHANG Li;TIAN Zhihong;LI Guanghui;ZHANG Weiyuan(Division of Endocrinology and Metabolism,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围产内分泌代谢科,北京市100026

出　　处：《中国全科医学》2018年第35期4316-4321,共6页Chinese General Practice

基　　金：国家重点研发项目(2016YFC1000304);国家自然科学基金资助项目(81671477);北京市自然科学基金三元联合资助项目(S160001)

摘　　要：背景妊娠期增重过多或不足均可增加不良妊娠结局发生风险,但妊娠不同时期增重对围生结局的影响是否不同目前尚无定论。目的本研究拟分析比较妊娠不同时期增重对大于胎龄儿(LGA)和小于胎龄儿(SGA)发生风险的影响。方法选取妊娠早期在首都医科大学附属北京妇产医院建档并接受规律产检,于2014-06-01至2015-05-31在本院分娩的单胎孕妇,共纳入15 334例。采用队列研究的方法,收集孕妇基线信息、妊娠期增重情况及分娩结局,分析妊娠不同时期增重对新生儿出生体质量的影响。按照世界卫生组织(WHO)标准将孕妇按照妊娠前体质指数(BMI)分为4组:低体质量组(<18.5 kg/m^2,n=2 438),正常体质量组(18.5~24.9 kg/m^2,n=11 052),超重组(25.0~29.9 kg/m^2,n=1 600)及肥胖组(≥30.0 kg/m^2,n=244)。由于本院产检建档时间为妊娠16周,因此按照0~16周(妊娠早期)、17~28周(妊娠中期)及29周至分娩(妊娠晚期)计算各期增重。根据美国医学研究所(IOM)推荐的妊娠早期及妊娠中期平均每周增重标准,按照具体孕周对不同BMI组妊娠期增重划分为增重不足、增重适宜及增重过多。结果15 334例孕妇中LGA发生率为15.66%(2 401/15 334),而SGA发生率为2.93%(449/15 334)。低体质量组、正常体质量组、超重组和肥胖组妊娠期总增重分别为(16.2±4.7)kg、(15.8±4.9)kg、(13.6±5.5)kg和(10.8±5.8)kg,分别有27.62%(1 456/5 272)、73.41%(3 870/5 272)及49.89%(2 630/5 272)的孕妇在妊娠早期、妊娠中期和妊娠晚期增重过多,而50.89%(2 683/5 272)、13.54%(714/5 272)及31.83%(1 678/5 272)的孕妇在此3个阶段增重不足。多因素Logistic回归分析结果显示,妊娠早期、妊娠中期增重过多增加LGA发生风险(P<0.001),增重不足增加SGA发生风险(P<0.001);妊娠晚期增重情况对SGA、LGA的发生无影响(P>0.05)。其中,妊娠中期增重过多对LGA发生的人群归因危险度百分比(PAR%)最高。低体质量组、正常体质�BackgroundExcessive or insufficient gestational weight gain （GWG） during pregnancy can increase the risk of adverse pregnancy outcomes,but whether the effects of GWG in different periods of pregnancy on perinatal outcomes are different are still inconclusive.ObjectiveThis study aimed to analyze the effects of GWG in different pregnancy periods on risk of large for gestational age （LGA） and small for gestational age （SGA）.MethodsWe conducted a cohort study using the baseline characteristics,GWG in different pregnancy periods and pregnancy outcomes collected from pregnant women.We enrolled a total of 15 334 participants who established a medical record for receiving healthcare at the first trimester of pregnancy and underwent regular antenatal care and delivered a singleton infant between June 1,2014 and May 31,2015 from Beijing Obstetrics and Gynecology Hospital,Capital Medical University.The effects of GWG on neonatal birth weight and corresponding population attributable risk （PAR%） were analyzed.Participants were classified to be underweight（〈18.5 kg/m2, n=2 438）,normal weight（18.5-24.9 kg/m2,n=11 052）,overweight （25.0-29.9 kg/m2,n=1 600）and obese（≥ 30.0 kg/m2,n=244） according to WHO classification of prepregnancy BMI.GWG during 0-16 weeks of pregnancy was defined as the GWG in early pregnancy,because the formal medical record during pregnancy should be established within 16 weeks＇ gestation in our hospital.And the GWG during 17-28 weeks of pregnancy and 29 weeks of pregnancy to delivery was determined as the GWG in mid pregnancy,late pregnancy,respectively.Insufficient,normal and excess GWG during early and mid-pregnancy were defined by Institute of Medicine （IOM） average weight gain per week criteria.ResultsPrevalences of LGA and SGA were 15.66%（2 401/15 334） and 2.93%（449/15 334）,respectively.The total GWG for underweight,normal weight,overweight and obese groups was （16.2±4.7）kg,（15.8±4.9）kg,（13.6±5.5）kg and （10.8±5.8）kg,respectively.Appr

关 键 词：妊娠 体重变化 出生体重 婴儿 小于胎龄 大于胎龄儿 影响因素分析 

分 类 号：R339.2[医药卫生—人体生理学]