孕前体重指数、孕期体重增加与妊娠期并发症及妊娠结局的关系

The association of pre-pregnancy weight and weight gain during pregnancy with pregnancy complications and delivery outcome

摘要:

目的 探讨孕前和孕期体重增加与妊娠期并发症及妊娠结局的关系。方法 回顾性分析2017 年 1 月—2019年8月在余姚市人民医院妇产科住院分娩的425例初产妇的临床资料，根据孕前体重指数（BMI）分为 消瘦组（BMI<18.5 kg/m2）、正常组（BMI 18.5～25.0 kg/m2）、超重和肥胖组（BMI>25.0 kg/m2）；根据孕期体 重增加（GWG）情况分为GWG不足组、GWG正常组及GWG过度组3组。比较各组妊娠期并发症发生情况及 妊娠结局。结果 消瘦组孕前体重、分娩体重及新生儿体重均低于正常组（P <0.05），GWG高于正常组（P < 0.05）；而超重和肥胖组孕前体重、分娩体重及新生儿体重均高于正常组（P <0.05），GWG 低于正常组（P < 0.05）。GWG不足组孕前体重、分娩体重、GWG及新生儿体重均低于GWG正常组（P <0.05）；而GWG过度组 孕前体重、分娩体重、GWG均高于GWG正常组（P <0.05），新生儿体重低于GWG正常组（P <0.05）。与正常 组比较，消瘦组妊娠高血压、胎膜早破及巨大儿发生率低，新生儿窒息、低出生体重儿、剖宫产发生率高（P < 0.05）；而超重和肥胖组妊娠期高血压、妊娠糖尿病、产后出血、胎膜早破、新生儿窒息、巨大儿、剖宫产发生率 高于正常组（P <0.05），低出生体重儿发生率低于正常组（P <0.05）。与GWG正常组比较，GWG不足组胎膜早 破、新生儿窒息、低出生体重儿、剖宫产发生率高（P <0.05）；GWG过度组妊娠期高血压、妊娠糖尿病、胎膜 早破、巨大儿、剖宫产发生率高于GWG正常组（P <0.05）。结论 孕前肥胖、孕期体重增加过度均可导致妊娠 期并发症及不良妊娠结局。应加强孕妇营养评价和体重管理，合理控制孕前BMI及孕期体重增加。

Abstract:

Objective To investigate the correlation of pre-pregnancy weight and weight gain during pregnancy with pregnancy complications and delivery outcome. Methods The clinical data of 425 primiparas who gave birth in the Department of Obstetrics and Gynecology of Yuyao People's Hospital from January 2017 to August 2019 were retrospectively analyzed. According to the pre-pregnancy body mass index (BMI), they were divided into emaciated group (BMI < 18.5 kg/m2), normal group (BMI 18.5～25.0 kg/m2), and overweight and obese group (BMI > 25.0 kg/m2). Based on the weight gain (GWG) during pregnancy, the primiparas were divided into low GWG group, normal GWG group and excessive GWG group. Pregnancy complications and delivery outcomes were compared among the groups. Results Compared with the normal group, the maternal weight before pregnancy and at delivery, and neonatal weight in the emaciated group were all lower (P < 0.05), while the maternal weight gain during pregnancy was higher (P < 0.05). The maternal weight before pregnancy and at delivery, and neonatal weight in the overweight and obese group were all higher than those in the normal group (P < 0.05), while the maternal weight gain during pregnancy in the overweight and obese group was lower than that of the normal group (P < 0.05). Compared with the normal GWG group, the low GWG group had lower maternal weight before pregnancy and at delivery, maternal weight gain during pregnancy and neonatal weight (P < 0.05). The maternal weight before pregnancy and at delivery, and maternal weight gain during pregnancy in the excessive GWG group were all higher than those in the normal GWG group (P < 0.05), while the neonatal weight in the excessive GWG group was lower than that in the normal GWG group (P < 0.05). Compared with the normal group, the incidence of gestational hypertension, premature rupture of membranes and macrosomia in the emaciated group was lower, while the incidence of neonatal asphyxia, low birth weight and cesarean section was higher (P < 0.05). The incidence of gestational hypertension, gestational diabetes mellitus, postpartum hemorrhage, premature rupture of membranes, neonatal asphyxia, macrosomia, cesarean section in the overweight and obese group was higher than that in the normal group, while the incidence of low birth weight in the overweight and obese group was lower than that in the normal group (P < 0.05). Compared with the normal GWG group, the incidence of premature rupture of membranes, neonatal asphyxia, low birth weight and cesarean section was higher in the low GWG group (P < 0.05). The incidence of gestational hypertension, gestational diabetes mellitus, premature rupture of membranes, macrosomia and cesarean section in the excessive GWG group was higher than that in the normal GWG group (P < 0.05). Conclusions Obesity before pregnancy and excessive weight gain during pregnancy can lead to pregnancy complications and adverse delivery outcomes. Nutrition evaluation and weight management of pregnant women should be strengthened to properly control BMI before pregnancy and weight gain during pregnancy.