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近年来人民生活水平的提高使妇女出现孕前肥胖及孕期体质量过度增长问题日趋明显,我国孕妇肥胖的发生率10%~24%[1-2],孕妇肥胖是常见的妊娠并发症共同危险因素之一[3],孕期体质量控制不良不利于孕妇自身健康及胎儿的生长发育[4]。因此,女性孕前及孕期的营养状况对产科结局的影响已受到产科医护人员的广泛关注。研究[5]表明,孕前体质量指数(BMI)及妊娠期体质量变化与产科结局息息相关。本文旨在探讨孕妇妊娠体质量增加与孕前BMI对产科结局的影响,为科学管理孕前及孕期体质量、预防母婴并发症等提供可靠依据。
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共3 190例孕妇纳入研究范围,年龄20~36岁。孕前低体质量组孕妇325例(10.2%),标准组孕妇2 186例(68.5%),超重组679例(21.3%);妊娠期体质量增加低标组516例(16.2%),达标组孕妇1 092例(34.2%),超标组1 582例(49.6%)。
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超重组的剖宫产率、产钳助产率、巨大儿出生率、新生儿窒息率、第一产程及第二产程均明显高于低体质量组和标准组(P<0.05)。3组在第三产程、产后出血、低体质量儿发生率上差异无统计学意义(P>0.05)(见表 1)。
分组 n 剖宫产 产钳助产 第一产程/h 第二产程/h 第三产程/min 产后出血 新生儿窒息 巨大儿 低体质量儿 低体质量组 325 46(14.3) 28(8.7) 12.1±3.6 1.2±0.3 6.8±3.3 6(1.8) 15(4.6) 34(10.6) 24(7.5) 标准组 2 186 391(17.9) 146(6.7) 11.9±4.7 1.4±0.4 6.8± 3.1 56(2.6) 73(3.3) 199(9.1) 111(5.1) 超重组 679 231(34.0)* 125(18.4)* 13.1±4.0* 2.1±0.6* 6.8±3.2 25(5.1) 57(8.4)* 93(13.7)* 45(6.7) χ2 — 91.53 84.17 18.83△ 11.04△ 1.00△ 3.51 30.52 11.94 4.4 P — <0.01 <0.01 <0.01 <0.01 >0.05 >0.05 <0.01 <0.01 >0.05 △示F值;与标准组比较*P<0.05 表 1 不同孕前BMI孕妇的产科结局比较[n; 百分率(%)]
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超标组的剖宫产率、产钳助产率、巨大儿出生率、新生儿窒息率均明显高于低标组和达标组(P<0.05);低标组的低体质量儿发生率明显高于达标组和超标组(P<0.05);但超标组的低体质量儿发生率和达标组相比差异无统计学意义(P>0.05)。3组在第三产程、产后出血上差异无统计学意义(P>0.05)(见表 2)。
分组 n 剖宫产 产钳助产 第一产程/h 第二产程/h 第三产程/min 产后出血 新生儿窒息 巨大儿 低体质量儿 低标组 516 71(13.8) 34(6.6) 11.3±4.0 1.4±0.5 6.7±3.3 9(1.7) 20(3.9) 34(6.6) 45(8.7)* 达标组 1 092 171(15.7) 87(8.0) 11.8±3.7 1.4±0.6 6.7±3.9 30(2.7) 26(2.4) 88(8.1) 58(5.3) 超标组 1 582 426(26.9)* 178(11.3)* 12.3±3.7* 1.5±0.3* 7.0±3.6 48(3.0) 99(6.3)* 204(12.9)* 77(4.9) χ2 — 68.73 13.82 15.48△ 19.14△ 2.68△ 2.45 23.02 25.31 11.2 P — <0.01 <0.01 <0.01 <0.01 >0.05 >0.05 <0.01 <0.01 <0.01 △示F值;与达标组比较*P<0.05 表 2 不同妊娠期体质量增幅孕妇的产科结局比较[n; 百分率(%)]
妊娠体质量增加与孕前体质量指数对产科结局的影响
Effect of gestational weight gain and pre-pregnancy body mass index on obstetric outcome
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摘要:
目的探讨妊娠体质量增加与孕前体质量指数对产科结局的影响,以期指导合理的孕期增重。 方法回顾性分析3 190例足月单胎活产孕产妇的临床资料,按孕前体质量指数将孕妇分为低体质量组、标准组、超重组,再按照妊娠体质量增加情况分为低标组、达标组、超标组,对组间相关临床参数进行比较,分析不同孕前体质量指数和妊娠体质量增加量对产科结局的影响。 结果标准体质量指数的孕妇占68.5%,超重组的剖宫产率、产钳助产率、巨大儿出生率、新生儿窒息率、第一产程及第二产程均高于低体质量组和标准组;超标组的剖宫产率、产钳助产率、巨大儿出生率、新生儿窒息率均高于低标组和达标组;低标组的低体质量儿发生率明显高于达标组和超标组(P < 0.05)。 结论孕前体质量指数过大和妊娠体质量增加过多可对产科结局造成负面影响。应指导育龄妇女保持正常的孕前体质量和合理的孕期增重,从而改善不良产科结局。 Abstract:ObjectiveTo investigate the effects of gestational weight gain and pre-pregnancy body mass index(BMI) on obstetric outcome, and guide reasonable weight gain during pregnancy. MethodsThe clinical data of 3 190 term singleton live births pregnant women were retrospectively analyzed.The patients were divided into the low weight group, normal weight group and overweight group based on the pre-pregnancy BMI, and the below standard group, reach standard group and exceed standard group according to the weight increasing during pregnancy.The clinical parameters among different groups were compared to analyze the influence of the pregestational body mass index and pregnancy body gain on obstetric outcome. ResultsThe pregnant women with standard(BMI) accounted for 68.5%, and the cesarean section rate, forceps midwifery rate, macrosomia birth rate, neonatal asphyxia rate, the first and second stages of labor in overweight group were significantly higher than those in low weight group and normal weight group.The cesarean section rate, forceps midwifery rate, macrosomia birth rate and neonatal asphyxia rate in overstandard group were significantly higher than those in reach standard group and exceed standard group.The incidence rate of low body mass children in low standard group was significantly higher than that in reach standard group and exceed standard group(P < 0.05). ConclusionsExcessive BMI before pregnancy and excessive pregnancy weight gain can negatively affect on obstetric outcomes.Women of child-bearing age should be guided to maintain normal pre-pregnancy weight and reasonable pregnancy weight gain so as to improve obstetric outcomes. -
Key words:
- gestational /
- weight gain /
- pre-pregnancy body mass index /
- obstetric outcome
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表 1 不同孕前BMI孕妇的产科结局比较[n; 百分率(%)]
分组 n 剖宫产 产钳助产 第一产程/h 第二产程/h 第三产程/min 产后出血 新生儿窒息 巨大儿 低体质量儿 低体质量组 325 46(14.3) 28(8.7) 12.1±3.6 1.2±0.3 6.8±3.3 6(1.8) 15(4.6) 34(10.6) 24(7.5) 标准组 2 186 391(17.9) 146(6.7) 11.9±4.7 1.4±0.4 6.8± 3.1 56(2.6) 73(3.3) 199(9.1) 111(5.1) 超重组 679 231(34.0)* 125(18.4)* 13.1±4.0* 2.1±0.6* 6.8±3.2 25(5.1) 57(8.4)* 93(13.7)* 45(6.7) χ2 — 91.53 84.17 18.83△ 11.04△ 1.00△ 3.51 30.52 11.94 4.4 P — <0.01 <0.01 <0.01 <0.01 >0.05 >0.05 <0.01 <0.01 >0.05 △示F值;与标准组比较*P<0.05 表 2 不同妊娠期体质量增幅孕妇的产科结局比较[n; 百分率(%)]
分组 n 剖宫产 产钳助产 第一产程/h 第二产程/h 第三产程/min 产后出血 新生儿窒息 巨大儿 低体质量儿 低标组 516 71(13.8) 34(6.6) 11.3±4.0 1.4±0.5 6.7±3.3 9(1.7) 20(3.9) 34(6.6) 45(8.7)* 达标组 1 092 171(15.7) 87(8.0) 11.8±3.7 1.4±0.6 6.7±3.9 30(2.7) 26(2.4) 88(8.1) 58(5.3) 超标组 1 582 426(26.9)* 178(11.3)* 12.3±3.7* 1.5±0.3* 7.0±3.6 48(3.0) 99(6.3)* 204(12.9)* 77(4.9) χ2 — 68.73 13.82 15.48△ 19.14△ 2.68△ 2.45 23.02 25.31 11.2 P — <0.01 <0.01 <0.01 <0.01 >0.05 >0.05 <0.01 <0.01 <0.01 △示F值;与达标组比较*P<0.05 -
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