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目的研究孕前体质指数(BMI)正常孕妇各孕期增重速率对妊娠结局的影响。方法采用前瞻性队列研究,于2013年选取成都市妇幼医疗机构产前门诊389名孕前BMI正常的孕(12±1)周单胎健康孕妇为研究对象,通过自制问卷调查收集孕妇年龄、孕前体重等基线资料,并测量身高、体重。分别于孕(28±1)周及分娩前测量体重,计算各孕期增重速率,并参照美国IOM(2009)孕期增重推荐标准进行分类。分娩后收集分娩孕周、妊娠期糖尿病(GDM)、分娩方式等信息。采用多因素非条件Logistic回归分析分别探讨孕早、中、晚期增重速率对不良妊娠结局的影响。结果孕早期增重过缓率和过快率分别为50.7%及31.8%,孕中、晚期增重过快率分别高达68.5%及57.8%。控制孕妇年龄、孕次及文化程度等混杂因素后,多因素非条件Logistic回归分析显示:与孕晚期增重适宜组相比,孕晚期增重过缓(OR=2.48,95%CI 1.185.23)和过快组(OR=1.76,95%CI 1.023.03)剖宫产发生风险均明显增加;与孕早期增重适宜组相比,孕早期增重过快组发生GDM风险明显增加(OR=2.55,95%CI 1.036.28);未观察到各孕期增重速率对妊娠期高血压疾病、产后出血及早产的影响(P>0.05)。结论孕期增重速率异常会增加剖宫产、GDM的发生风险。
Abstract：Objective To explore the association between gestational weight gain rate( GWGR) and pregnancy outcomes among pregnant women with normal pre-pregnancy body mass index( BMI). Methods In this prospective study,389 healthy pregnant women at the( 12 ± 1) th with normal pre-pregnancy BMI from Chengdu City who delivered a singleton were included in 2013. The basic information such as age,pre-pregnant weight was obtained by questionnaire,height and weight was measured. Then the weight was measured at the( 28 ± 1) th and last week before delivery,respectively,the different trimester GWGR was calculated and classified by IOM criteria. Gestational age,gestational diabetes mellitus( GDM) and other pregnancy outcomes were collected by questionnaire. Multiple non-conditional Logistic regression models were used to test the association between GWGR and pregnancy outcomes. Results The proportion of insufficient GWGR and excessive GWGR in first trimester was 50. 7% and 31. 8%,respectively,the proportion of excessive GWGR in the second and third trimester was68. 5% and 57. 8%,respectively. After adjusting the age,education,gravidity and family disease history and other confounding factors,multiple non-conditional logistic regression showed: compared with adequate GWGR in the third trimester,insufficient and excessive GWGR were associated with increased risk of cesarean delivery( OR = 2. 48,95% CI 1. 18-5. 23 and OR = 1. 76,95% CI 1. 02-3. 03,respectively). Compared with adequate GWGR in the first trimester,excessive GWGR were associated with increased risk of GDM( OR = 2. 55,95% CI 1. 03-6. 28). Conclusion The abnormal of GWGR would increase the risk of cesarean delivery and GDM.
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基本信息:
DOI：10.19813/j.cnki.weishengyanjiu.2018.06.004
中图分类号:R153;R714
引用信息:
[1]周凤鸣,鲍妍宏,吴成,等.成都市孕前体质指数正常孕妇孕期增重速率对妊娠结局的影响[J].卫生研究,2018,47(06):890-894.DOI:10.19813/j.cnki.weishengyanjiu.2018.06.004.
基金信息:
中国营养学会营养科研基金(No.CNS-2012-002)
2018-11-30
2018-11-30