妊娠期代谢异常孕妇分娩早产儿风险研究  

Risk of premature birth in pregnant women with metabolic abnormalities during pregnancy

作　　者：赵永鲜[1] 王蕾[1] 贾朝霞[1] 黄丽丽[1] 王朝[1] 张娣[1] 王军华[1] 武明辉[1] ZHAO Yong Xian;WANG Lei;JIA Zhao Xia;HUANG Li Li;WANG Zhao;ZHANG Di;WANG Jun Hua;WU Ming Hui(Beijing Obstetrics and Gynecology Hospital,Capital Medical University(Beijing Maternal and Child Health Care Hospital),Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院(北京妇幼保健院),北京100026

出　　处：《中国妇幼卫生杂志》2024年第6期45-50,共6页Chinese Journal of Women and Children Health

基　　金：中国疾病预防控制中心妇幼保健中心2022年度“母婴营养与健康研究项目”(2022FYH016)。

摘　　要：目的 评估妊娠期各类代谢异常孕妇分娩不同早产类型的风险,为制定不同类型代谢异常孕妇的孕期保健管理措施提供依据。方法 本研究为回顾性队列研究。利用医院电子病历系统以及自制问卷回顾性收集北京妇产医院2021年5月1日-12月31日分娩孕妇的健康信息,并观察其新生儿结局。按照新的高危儿分类框架,将早产儿分为两类:早产适于胎龄儿(preterm and appropriate for gestational age,早产AGA)、早产小于胎龄儿(pretermand and small for gestationage,早产SGA)。运用卡方检验比较各类妊娠期代谢异常孕妇分娩不同类型早产儿的差异,运用logistic回归模型计算各类代谢异常孕妇分娩早产儿的风险值。结果 研究共计纳入7 233名孕妇,妊娠期高血糖、妊娠期高血压疾病、孕期甘油三脂> 3.68 mmol/L以及孕前肥胖率的发生率分别为20.8%、9.9%、23.8%以及5.3%;早产AGA以及早产SGA的发生率分别为5.5%和1.0%。控制其他因素后,孕妇妊娠期高血糖与分娩早产AGA之间存在中等强度关联(OR=1.92,95%CI:1.49~2.45),与分娩早产SGA之间未观察到明显关联(OR=1.28,95%CI:0.70~2.24)。未观察到孕妇肥胖与分娩早产AGA(OR=1.20,95%CI:0.77~1.81)以及早产SGA(OR=0.281,95%CI:0.70~2.24)之间存在关联。孕妇患妊娠期高血压疾病与分娩早产AGA(OR=1.43,95%CI:1.01~1.99)之间存在弱关联,与分娩早产SGA(OR=7.40,95%CI:4.26~12.77)存在强关联。高甘油三酯水平的孕妇其分娩早产AGA的风险增高(OR=1.35,95%CI:1.05~1.71),但未发现其分娩早产SGA的风险增加(OR=1.14,95%CI:0.65~1.95)。结论 妊娠期不同的代谢异常孕妇分娩早产SGA和AGA的风险值不同,对其进行孕期保健管理时应有所侧重。Objective To evaluate the risk of different types of preterm delivery in pregnant women with different types of metabolic abnormalities during pregnancy.Methods This study was a retrospective cohort study.Health information of women delivered between May 1,2021 and December 31,2021,in Beijing Obstetrics and Gynecology Hospital was collected retrospectively using the Hospital Information System and self-made questionnaire,and their neonatal outcomes were observed.According to the new high-risk infant classification framework,preterm infants are divided into two categories:preterm infants suitable for gestational age(AGA)and preterm infants small for gestational age(SGA).Chi-square test was used to compare the differences in types of preterm delivery among pregnant women with different types of metabolic abnormalities,and logistic regression model was used to calculate the risk value of preterm delivery in pregnant women with various metabolic abnormalities.Results A total of 7233 pregnant women were included in the study.The incidence of hyperglycemia,hypertension disorders,triglyceride>3.68 mmol/L and pre-pregnancy obesity were 20.8%,9.9%,23.8%,and 5.3%.respectively.The incidence of AGA and SGA were 5.5%and 1.0%respectively.There was a moderate association between hyperglycemia and preterm AGA delivery(OR=1.92,95%CI:1.49-2.45),but no significant association was observed between hyperglycemia and preterm SGA delivery(OR=1.28,95%CI:0.70-2.24).No association was observed between maternal obesity and preterm AGA(OR=1.20,95%CI:0.77-1.81)or preterm SGA delivery(OR=0.281,95%CI:0.70-2.24).Gestational hypertensive disorders has a weak association with preterm AGA delivery(OR=1.43,95%CI:1.01-1.99),but a strong association with preterm SGA delivery(OR=7.40,95%CI:4.26-12.77).Pregnant women with high triglyceride levels had an increased risk of preterm AGA delivery(OR=1.35,95%CI:1.05 to 1.71),but no increased risk of preterm SGA delivery was observed(OR=1.14,95%CI:0.65 to 1.95).Conclusion Pregnant women with different metabol

关 键 词：妊娠期高血糖 妊娠期高血压疾病 肥胖 妊娠期高甘油三酯 早产 

分 类 号：R714.256[医药卫生—妇产科学]