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目的:探讨孕前体质指数(BMI)及孕期体重增长(GWG)与妊娠合并疾病及不良结局的关系。方法:回顾分析于复旦大学附属妇产科医院产科门诊定期产前检查并住院分娩的3541例足月单胎初产妇的临床资料。将产妇按孕前体质指数(BMI)和不同孕期体重增长(GWG)分组,采用logistic多因素回归分析孕前体质指数及孕期体重增长与妊娠合并疾病及结局的关系。结果:孕妇孕期体重平均增加(16.0±4.9)kg,新生儿平均出生体重(3341.6±425.9)g,低出生体重儿和巨大儿分别占2.1%及5.1%。根据IOM推荐孕期GWG分组,GWG过低、过高组孕妇与正常孕妇的巨大儿、剖宫产数、早产发生率比较,差异有统计学意义(P<0.05)。孕前超重、肥胖能增加妊娠期糖尿病(OR=2.7,2.3)、妊娠期高血压疾病(OR=5.4,OR=7.7)、巨大儿(OR=1.6,OR=8.9)、剖宫产(OR=1.4,OR=1.7)的发生风险,而GWG过高增加剖宫产的发生风险(OR=1.5)。结论:孕前BMI不仅影响妊娠合并疾病的发生,也与妊娠结局密切相关。临床上应特别重视孕前宣教及体检,建议育龄期妇女达到合适的体质指数后怀孕。孕期过度体重增长增大了不良妊娠结局(巨大儿、剖宫产)的发生率,临床上可参照IOM推荐体重增长范围进行孕妇体重控制,加强孕期的健康教育和体重随访。同时建议利用大数据多方调研,得出适合中国各地区的孕期体重参考标准。
Objective: To explore the relationship between pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) and pregnancy-related diseases and adverse outcomes. Methods: The clinical data of 3541 full-term single-born primiparae who were scheduled for prenatal check-up and hospital delivery in Obstetrics and Gynecology Hospital of Fudan University were retrospectively analyzed. The mothers were grouped according to BMI and GWG. Logistic regression was used to analyze the relationship between BMI before pregnancy, body weight gain during pregnancy and pregnancy-related diseases and outcomes. Results: Pregnant women gained an average of 16.0 ± 4.9 kg of body weight during pregnancy and an average of 3341.6 ± 425.9 g of newborns, with low birth weight children and huge children accounting for 2.1% and 5.1% respectively. According to IOM recommended gestational GWG group, GWG is too low, too high group of pregnant women and normal pregnant women with giant children, cesarean section, the incidence of preterm birth, the difference was statistically significant (P <0.05). Excessive pregnancy, obesity increased gestational diabetes mellitus (OR = 2.7, 2.3), gestational hypertension (OR = 5.4, OR = 7.7), macrosomia (OR = 1.6, OR = 8.9), cesarean section (OR = 1.4, OR = 1.7). However, GWG increased the risk of cesarean section (OR = 1.5). Conclusion: Pre-pregnancy BMI not only affects the occurrence of pregnancy-related diseases, but also with the pregnancy outcome is closely related. Special attention should be paid in clinical pre-pregnancy mission and physical examination, it is recommended that women of childbearing age reach a suitable body mass index after pregnancy. Excessive weight gain during pregnancy increases the incidence of adverse pregnancy outcomes (macrosomia and cesarean section). Pregnant women may be given weight control based on the IOM recommended weight gain range, and health education and weight follow-up during pregnancy may be strengthened. At the same time, it is suggested to make use of the multi-party research on big data to come up with reference standards for pregnancy weight for all regions of China.