孕前正常BMI人群的营养状况新亚群的识别及与早产风险的关系  

Identification of the nutritional subgroups of women with normal pre-pregnancy body mass index and the correlation between the body mass index of the women and their preterm birth risk

作　　者：何振 贺媛 马旭 花琳琳 张庆 蒋丽芳 施学忠[1] HE Zhen;HE Yuan;MA Xu;HUA Linlin;ZHANG Qing;JIANG Lifang;SHI Xuezhong(College of Public Health,Zhengzhou University,Zhengzhou,Henan Province,450052;National Research Institute for Family Planning,Beijing;The Second Affiliated Hospital of Zhengzhou University)

机构地区：[1]郑州大学公共卫生学院,450052 [2]国家卫生健康委科学技术研究所 [3]郑州大学第二附属医院

出　　处：《中国计划生育学杂志》2024年第5期1107-1112,共6页Chinese Journal of Family Planning

基　　金：国家重点研发计划(2016YFC1000102);河南省重点研发与推广专项(J BKY2021007)。

摘　　要：目的:既往研究大多验证异常孕前体质指数(BMI)与不良妊娠结局的关联,尚无研究对孕前正常BMI人群进行分型及其对早产的影响。方法:孕前BMI为18.5~23.9kg/m2的女性人群(418397人)按3:1的比例随机划分训练集(313799人)和验证集(104598人),对孕前血糖、肝酶和促甲状腺素进行K-Means聚类。使用logistic回归分析和敏感性分析判断不同亚组与早产的关系。结果:训练集中存在着有4个特征分组并与验证集存在一致性:肝酶偏高组(ELE),血糖供给良好组(OBGS),促甲状腺素偏高组(ETSH)和代谢状况偏低组(LMS)。与LMS组相比,仅OBGS组与早产发生风险降低相关[aOR(95%CI)训_(练集)=0.88(0.84~0.92);aOR(95%CI)_(验证集)=0.87(0.80~0.95)]。结论:孕前正常BMI人群中存在4个可以复现的新亚群,正常BMI人群中孕前血糖供给良好时早产发生率较低。Objective:Previous studies had primarily confirmed the correlation between the abnormal pre-pregnancy body mass index(BMI)of pregnant women and their adverse pregnancy outcomes,but rare studies had focused on the stratification of the women with pre-pregnancy normal BMI and its impact on the preterm birth of the women.Methods:418,397women with pre-pregnancy BMIs of 18.5-23.9kg/m2 were randomly divided into the training cohort(313,799women)and the validation cohort(104,598women)at a 3:1ratio.The levels of the pre-pregnancy blood glucose,liver enzymes and thyroid-stimulating hormones of the women were clustered using K-Means.Logistic regression analysis and sensitivity analysis were used to identify the correlation between the BMI of the women in different subgroups and their preterm birth.Results:Four distinct feature groups were identified in the training cohort,and which showed the consistent presence in the validation cohort,including the elevated liver enzyme group(ELE),the optimal blood glucose supply group(OBGS)and the elevated thyroid-stimulating hormone group(ETSH),and the low metabolic status group(LMS).Compared to that of the LMS group,only the OBGS group was associated with a reduced risk of the premature birth[aOR(95%CI)of the training cohort=0.88(0.84-0.92);aOR(95%CI)of the validation cohort=0.87(0.80-0.95)].Conclusion:Four replicable new subgroups exist in the women with the normal pre-pregnancy BMI.There is a lower rate of the premature births among the women with normal pre-pregnancy BMI when their pre-pregnancy blood glucose supply is optimal.

关 键 词：孕前期体质指数 早产 K-均值聚类 

分 类 号：R714.21[医药卫生—妇产科学]