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目的探讨农村孕妇孕前体质指数(BMI)及孕期增重对妊娠结局的影响,为有针对性地制定孕期体质量管理提供理论依据。方法采用回顾性研究的方法,对658例足月单胎初产妇身高、体重及孕期体重增长情况进行整理,计算BMI;根据妊娠前BMI值分为BMI<25.0 kg/m2及BMI≥25.0 kg/m22组;按照妊娠期体质量增加情况,分为妊娠期体质量增加≥15 kg及妊娠期体质量增加<15 kg 2组。比较各组妊娠期糖尿病、妊娠高血压疾病、产褥感染、产后出血、会阴裂伤、产程异常、剖宫产、新生儿体重(≥4 000 g)间差异。采用PASW Statistics 18.0进行统计学分析。结果孕前BMI≥25.0 kg/m2能显著增加妊娠期糖尿病(RR=3.80,95%CI 2.36~6.12),妊娠高血压疾病(RR=3.50,95%CI 2.15~5.72),产褥感染(RR=7.48,95%CI 2.49~22.44),产程异常(RR=4.79,95%CI 3.77~6.09),剖宫产(RR=1.81,95%CI 1.65~1.97)以及新生儿体重≥4 000 g(RR=5.14,95%CI=2.90~9.10)的发生率,P均<0.01。孕期体质量增加≥15.0 kg能显著增加妊娠期糖尿病(RR=3.56,95%CI 1.96~6.47),妊娠高血压疾病(RR=1.79,95%CI 1.06~3.01),产褥感染(RR=4.41,95%CI 1.31~14.88),产程异常(RR=2.52,95%CI 1.93~3.30),以及新生儿体重≥4 000 g(RR=2.80,95%CI 1.52~5.17)的发生率,P均<0.05。结论孕前BMI≥25.0 kg/m2以及孕期体重增加≥15.0 kg会增加孕期并发症的发生率以及增加不良妊娠结局的发生。应该在加强对肥胖孕产妇的围生期监护及产后随访的同时,积极控制孕期体质量的增加。
Objective To investigate the effect of pre-pregnancy body mass index (BMI) and pregnancy weight gain on pregnant outcome in pregnant women in rural areas and provide a theoretical basis for the targeted management of body weight during pregnancy. Methods A retrospective study was conducted to determine the height and weight of 658 full-term singleton primiparous women and the weight gain during pregnancy. BMI was calculated according to the pre-pregnancy BMI. The BMI was 25.0 kg / m2 and the BMI was 25.0 kg / m22 group. According to the increase of body weight during gestation, the body weight of gestation period was increased by 15 kg and the weight gain during gestation was less than 15 kg. The differences of gestational diabetes mellitus, pregnancy-induced hypertension, puerperal infection, postpartum hemorrhage, perineal laceration, birth disorders, cesarean section and newborn weight (≥4 000 g) were compared between groups. PASW Statistics 18.0 for statistical analysis. Results Pre-pregnancy BMI≥25.0 kg / m2 significantly increased gestational diabetes mellitus (RR = 3.80, 95% CI 2.36-6.12), pregnancy-induced hypertension (RR 3.50, 95% CI 2.15-5.72), puerperal infection (RR = (RR = 4.79, 95% CI 3.77-6.09), cesarean section (RR = 1.81, 95% CI 1.65-1.97), and neonatal weight ≥ 4000 g (RR) = 5.14, 95% CI = 2.90 ~ 9.10), P <0.01. Weight gain during pregnancy ≥15.0 kg could significantly increase gestational diabetes mellitus (RR = 3.56, 95% CI 1.96-6.47), pregnancy-induced hypertension (RR = 1.79, 95% CI 1.06-3.01), puerperal infection , 95% CI 1.31 ~ 14.88), the incidence of labor was abnormal (RR = 2.52, 95% CI 1.93 ~ 3.30), and the incidence of newborns weighing 4000 g (RR = 2.80,95% CI 1.52-5.17) <0.05. Conclusion Pre-pregnancy BMI≥25.0 kg / m2 and pregnancy weight gain ≥15.0 kg will increase the incidence of complications during pregnancy and increase the incidence of adverse pregnancy outcomes. Should strengthen the monitoring of obese pregnant women perinatal period and postpartum follow-up, and actively control the increase in body mass during pregnancy.