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中国循证儿科杂志

中国循证儿科杂志 ›› 2015, Vol. 10 ›› Issue (6): 414-418.

• 论著 • 上一篇    下一篇

孕前体重及孕期体重增长与巨大儿发生的关系

李浩捷1，沈敏1，沈婉蓉2，谈韬1，陆丽萍1，徐仁应1，万燕萍1     

  1. 1 上海交通大学医学院附属仁济医院临床营养科 上海，200127；2 上海市长宁区妇幼保健院营养科 上海，200051
  • 收稿日期:2015-07-13 修回日期:2015-12-24 出版日期:2015-12-05 发布日期:2015-12-04
  • 通讯作者: 万燕萍

The relationship between pre-gravid body weight, gestational weight gain and the prevalence of macrosomia

LI Hao-jie1, SHEN Min1, SHEN Wan-rong2, TAN Tao1, LU Li-ping1, XU Ren-ying1, WAN Yan-ping1   

  1. 1 Department of Clinical Nutrition, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; 2 Department of Nutrition, Maternal and Child Health Care Center, Changning District, Shanghai 200051, China
  • Received:2015-07-13 Revised:2015-12-24 Online:2015-12-05 Published:2015-12-04
  • Contact: WAN Yan-ping

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摘要：

目的 研究孕前体重状况与孕期体重增长与巨大儿发生的关系。方法 以上海2家医院健康产妇为研究对象。采集产妇指标（年龄、身高、孕前BMI、文化程度、既往疾病史、分娩前体重、血三酰甘油）和新生儿指标（性别、出生体重、出生身长、出生孕周）。采用二项Logistic回归进行多因素分析。以孕前BMI分组，将新生儿是否为巨大儿作为因变量，孕期增重作为检验变量，对孕前营养不良、正常和超重（肥胖）组分别使用ROC曲线计算界值，得出孕期合理体重增长的上限值。结果 共纳入1 286例产妇，平均年龄（28.8±3.7）岁。孕前营养不良、正常和超重(肥胖)组分别为239例（18.6%）、872例（67.8%）和175例（13.6%）。孕期平均增重（15.4±4.7） kg，其中孕期体重增长过少206例（16.0%）、正常488例（37.9%）、过多592例（46.0%）。新生儿出生体重（3 380±384）g，巨大儿发生率6.0%（77/1 286）。孕前营养不良、正常和超重（肥胖）组巨大儿发生率分别为2.9%（7/239）、5.6%（49/872）和12.0%（21/175）。巨大儿产妇孕周、孕前BMI、孕期增重、高三酰甘油血症发生率均明显高于正常出生体重儿产妇。多因素Logistic分析显示孕前超重、孕周增加、孕期体重增长过多和高三酰甘油血症是巨大儿发生的危险因素。孕前营养不良、正常和超重（肥胖）组孕期体重增重界值分别为20.8、14.8和15.3 kg。结论 孕前超重、孕周增加、孕期体重增长过多和高三酰甘油血症与巨大儿发生相关。

Abstract:

Objective To evaluate the effects of pre-gravid body weight, gestational weight gain (GWG) on the prevalence of macrosomia. Methods Healthy pregnancy women with singleton in Renji Hospital and Changning Maternal and Child Health Care Center were recruited for the study. Maternal (age, education, disease history, gestational age, GWG, and triglycerides) and neonatal (gender and birthweight) indexes were obtained according to medical records. Pre-gravid body weight was obtained after delivery by a trained nutritionist and classified by body mass index (BMI). Results A total number of 1 286 pregnancy women aged (28.8±3.7) years were enrolled in the study. The number of undernutrition, normal, and overweight women before pregnancy was 239 (18.6%), 872 (67.8%), and 175 (13.6%), respectively. The mean GWG was (15.4±4.7) kg in our study population. Among them, 16.0% (206/1 286) gained body weight less than low value of GWG recommendation, while 37.9% (488/1 286) were in normal range, and 46.0% (592) exceeded the upper value of recommendation GWG. The mean birth weight was (3 380±384) g and the prevalence of macrosomia was 6.0% (77/1 286). Gestational age, pre-gravid BMI, GWG, and triglyceride level were obvious higher in macrosomia group compared with those in normal birth weight group. Pre-gravid overweight, increase of gestational age and GWG, and hypertriglyceridemia were the risk factors for macrosomia by multivariate logistical regression. Conclusion Pre-gravid overweight, increase of gestational age and GWG, hypertriglyceridemia are closely related with macrosomia.