孕前超重肥胖者妊娠期增重过度对妊娠结局和新生儿情况的影响  

Impact of excessive pregnancy weight gain on pregnancy outcomes and neonatal conditions in prepregnancy overweight and obese women

作　　者：陈霞 袁云兰 张焱[2] 马梓汶 张建敏 CHEN Xia;YUAN Yunlan;ZHANG Yan;MA Ziwen;ZHANG Jianmin(Department of Gynecology,Waitan Street Community Health Service Center of Huangpu District,Shanghai 200010,China;Department of Gynecology and Obstetrics,Pudong New Area Health Care Hospital for Women and Child Gynecological Clinic,Shanghai 200120,China)

机构地区：[1]上海市黄浦区外滩街道社区卫生服务中心妇科,上海200010 [2]上海市浦东新区妇幼保健院妇产科,上海200120

出　　处：《上海预防医学》2024年第3期255-261,共7页Shanghai Journal of Preventive Medicine

摘　　要：【目的】探讨孕前超重肥胖者孕期增重过度对妊娠结局及新生儿状况的影响,为育龄妇女孕前体重和孕期增重制定体重管理策略,预防不良母婴妊娠结局的发生。【方法】选择上海市黄浦区某社区2017—2021年收集的2172例产妇作为研究对象。按孕前体重指数(BMI)分为孕前超重肥胖组(530例)、孕前体重正常组(937例)和孕前体重过低组(705例)。按孕期增重是否合理分为适宜增重(MGWG)组和不合理孕期增重(EGWG)组。记录妊娠结局(产后出血、产褥感染、胎盘早剥、胎膜早破、分娩方式)及新生儿情况[早产、死胎、胎儿窘迫、入住重症监护室(ICU)、巨大儿、Apgar评分],比较组间妊娠结局和新生儿情况的差异,并分析孕前BMI及妊娠期增重对妊娠结局和新生儿情况的影响。【结果】孕前超重肥胖组胎盘早剥、胎膜早破、剖宫产、早产、胎儿窘迫、巨大儿比例均高于孕前体重正常组与孕前体重过低组,Apgar评分低于孕前体重正常组与孕前体重过低组(均P<0.05)。EGWG组产后出血、胎盘早剥、胎膜早破、早产、胎儿窘迫、死胎、入住ICU、巨大儿比例均高于MGWG组(均P<0.05)。孕前超重肥胖者EGWG组胎盘早剥、胎膜早破、剖宫产、早产、胎儿窘迫、入住ICU、巨大儿比例均高于MGWG组,Apgar评分低于MGWG组(均P<0.05),孕前体重正常者EGWG组胎盘早剥、胎膜早破、早产、胎儿窘迫、入住ICU、巨大儿比例均高于孕前体重正常者MGWG组(均P<0.05),孕前超重肥胖者EGWG组胎膜早破、剖宫产、早产、胎儿窘迫、巨大儿比例均高于孕前体重正常者EGWG组(P<0.05)。多因素logistic回归分析显示,孕前超重肥胖者EGWG为胎盘早剥(OR=2.971,95%CI:1.098~8.042)、胎膜早破(OR=4.662,95%CI:2.798~7.770)、剖宫产(OR=1.375,95%CI:1.260~2.541)、早产(OR=4.249,95%CI:2.384~7.573)、胎儿窘迫(OR=3.238,95%CI:1.589~6.598)、入住ICU(OR=3.010,95%CI:1.265~7.164)、巨大儿(OR=5.43[Objective]To explore the influence of excessive weight gain during pregnancy in pre-pregnancy overweight and obese women on pregnancy outcomes and neonatal conditions,and to provide scientific evidence for formulating weight management strategies before and during pregnancy and prevent adverse pregnancy outcomes.[Methods]Clinical data of 2172 parturients collected from a community in Huangpu District from 2017 to 2021 were retrospectively analyzed,and they were divided into pre-pregnancy overweight and obesity group(n=530),normal pre-pregnancy weight group(n=937),and underweight pre-pregnancy group(n=705)according to maternal precursor body mass index(BMI).Based on their weight gain during pregnancy,the parturient were divided into moderate gestational weight gain(MGWG)group and excessive gestational weight gain(EGWG)group.Meanwhile,the pregnancy and neonatal outcomes such as postpartum hemorrhage,puerperal infection,placental abruption,premature rupture of membranes,mode of delivery,premature birth,stillbirth,fetal distress,admission to the intensive care unit(ICU),macrosomia,and Apgar score,were recorded.Then the differences in pregnancy and neonatal outcomes between groups were compared.The effects of pre-pregnancy BMI and gestational weight gain on pregnancy outcomes and neonatal conditions was retrospectively analyzed.[Results]The pre-pregnancy overweight and obese group had higher proportions of placental abruption,premature rupture of membranes,cesarean section,premature birth,fetal distress,and macrosomia compared to the normal pre-pregnancy weight group and the underweight pre-pregnancy group,with Apgar scores lower than the normal pre-pregnancy weight group and the underweight prepregnancy group(all P<0.05).The EGWG group had higher proportions of postpartum hemorrhage,placental abruption,premature rupture of membranes,cesarean section,premature birth,fetal distress,admission to the ICU,and macrosomia than the MGWG group(all P<0.05).In the pre-pregnancy overweight and obese group,the EGWG group had hig

关 键 词：超重肥胖 孕期体重增加 妊娠结局 新生儿 影响 

分 类 号：R173[医药卫生—妇幼卫生保健]