摘要
第一部分孕前体重及孕期增重与产科并发症及妊娠结局关系的分析
目的
了解孕妇不同孕前体重及孕期体重变化与产科并发症及妊娠结局的关系,以探讨孕前体重、孕期增重的适宜范围,即在排除了相关因素后妊娠和分娩并发症发生最少、对母儿影响最小的体重范围。
方法
对某三级甲等综合医院产科产前检查直至住本院分娩的孕足月、单活胎初产妇747例进行前瞻性调查,观察记录孕前1月体重、测记身高、住院分娩时的产前体重、妊娠期并发症(妊娠期高血压疾病、妊娠期糖尿病)、分娩方式、分娩期并发症(产后出血、产程阻滞)、新生儿出生体重、巨大儿、新生儿Apgar's评分及围产儿并发症(胎儿窘迫、新生儿窒息、新生儿病理性黄疸),计算孕前体重指数(BMI)、孕期增重。根据孕前体重指数的不同分为四组：消瘦组(BMI＜18.5)、正常组(18.5≤BMI＜23)、超重组(23≤BMI＜25)、肥胖组(BMI≥25)；又根据孕期体重不同幅度的增加(ΔW)分为三组：△W<15kg、kg15≤△W<20kg、△W≥20kg。比较分析各组间产科并发症及妊娠结局的关系。采用SPSS13.0软件进行统计分析。
结果
(1)孕前体重各组间产程阻滞及难产剖宫产发生率比较,有统计学差异(P＜0.05),肥胖组是难产剖宫产的危险因素(RR＞1)。
(2)孕前体重各组间妊娠期高血压疾病、妊娠期糖尿病、新生儿出生体重、巨大儿及孕期增重比较,均有统计学差异(P＜0.05),随孕前体重增加,妊娠期高血压疾病、妊娠期糖尿病、新生儿出生体重及巨大儿逐渐增加、孕期增重逐渐减少。超重组和肥胖组是妊娠期高血压疾病、妊娠期糖尿病的危险因素(RR＞1)。
(3)孕前体重各组间胎儿窘迫、新生儿窒息、新生儿病理性黄疸及产后出血的发生率差异无统计学意义(P＞0.05)。
(4)孕期增重各组间妊娠期高血压疾病、巨大儿发生率及新生儿出生体重比较,均有统计学差异(P＜0.05),随孕期体重增加,妊娠期高血压疾病、新生儿体重逐渐增加、巨大儿逐渐增多(P＜0.01),孕期增重≥15k是发生巨大儿的危险因素(RR＞1)。
(5)孕期增重各组间产程阻滞、难产剖宫产、产后出血及胎儿窘迫、新生儿窒息、新生儿病理性黄疸发生率无统计学差异(P＞0.05)。
(6)孕期增重≥15kg妊娠期糖尿病发生率较孕期增重＜15kg明显降低(P＜0.05),孕期增重≥15k妊娠期糖尿病的一保护因素(RR＜1)。
(7)孕前体重指数与孕期增重呈负相关(r=-0.132,P＜0.001)。
(8)新生儿体重与孕前体重、孕期增重及产前体重呈正相关(P＜0.001)。
结论对孕前体重及孕期增重适当控制,可显著减少妊娠期高血压疾病、妊娠期糖尿病、产程阻滞、难产剖宫产的发生,降低新生儿出生体重及巨大儿发生,改善母儿预后,对临床孕期保健有重要指导意义。本研究建议最佳体重范围：18.5≤孕前BMI＜23,孕期增重＜15kg。
第二部分产前体重与产科并发症及妊娠结局的关系
目的
了解产前体重与产科并发症及妊娠结局的关系,探讨妊娠期肥胖的体重范围,以加强孕期保健,及时发现产科并发症,降低孕妇肥胖所致产科并发症及不良妊娠结局的发生。
方法
对某三级甲等综合医院产科产前检查直至住本院分娩的孕足月、单活胎初产妇747例进行前瞻性调查,观察记录孕前1月体重、测记身高、住院分娩时的产前体重、妊娠期并发症、分娩方式、分娩期并发症、新生儿出生体重、巨大儿、新生儿Apgar's评分及围产儿并发症,计算孕前体重指数、产前体重指数及孕期增重。根据产前体重的不同,按体重指数分为：A组(BMI＜26)、B组(26≤BMI＜28)、C组(28≤BMI＜30)、D组(30≤BMI)；按产前体重的公斤数分为：a组(W＜65kg)、b组(65kg≤W＜75kg)、c组(75kg≤W＜85kg)、d组(W≥85kg),比较分析各组间产科并发症及妊娠结局的关系。采用SPSS13.0软件进行统计分析。
结果
(1)A组、B组、C组、D组间与a组、b组、c组、d组间妊娠期高血压疾病、新生儿出生体重、巨大儿、产程阻滞、难产剖宫产及孕前体重、孕期增重比较,均有统计学差异(P＜0.001),随产前体重(指数)增加而增高,C组、D组与c组、d组明显高于A组、B组与a组、b组,D组与d组又明显高于C组与c组。D组与c组、d组是发生妊娠期高血压疾病的危险因素(RR＞1)；D组与d组是产程阻滞、难产剖宫产的危险因素(RR＞1)；C组、D组与b组、c组、d组是巨大儿的危险因素(RR＞1)。
(2)产前体重(指数)与孕前体重(指数)及孕期增重呈正相关(P＜0.001),产前体重(指数)有随孕前体重指数增加而增高趋势(P＜0.001)。
(3)A组、B组、C组、D组间与a组、b组、c组、d组间妊娠期糖尿病、产后出血、胎儿窘迫、新生儿窒息及新生儿病理性黄疸发生率无统计学差异(P＞0.05)。
结论
不同孕前体重有不同孕期增重适宜范围,最终产前体重应控制在适当范围,以减少产科并发症及不良妊娠结局的发生,对孕期保健与临床实践有重要指导意义；为妊娠期肥胖标准的确定提供科学依据。本研究建议最佳产前体重指数与体重范围：BMI＜28,W＜75kg。
Part1 Relationship between obstetric complications,delivery outcome and Different pre-pregnancy weight and pregnancy weight gain
Objective:To understand the relationship between obstetric complications,delivery outcome and different pre-pregnancy weight and pregnancy weight gain, to approach the appropriate range of the pre-pregnancy weight and pregnancy weight gain, in order to provide the scientific basis of clinical pregnancy care.
Methods:747 cases of primipara were divided into four groups according to pre-pregnancy body mass index:thin group (BMI<18.7), normal weight group (normal group 18.7≤BMI<23), overweight group (23≤BMI<25), obese group (BMI≥25), were divided into three groups according to different ranges of body weight increase during pregnancy (△W):△W<15kg, kg15≤△W<20kg,20kg≤△W.To record pregnant women's pre-pregnancy weight and measured height a month before delivery,, the pre-hospital childbirth weight, pregnancy complications (pregnancy-induced hypertension, gestational diabetes), mode of delivery, birth complications (postpartum hemorrhage, birth process block), neonatal birth weight, macrosomia, neonatal Apgar's score and perinatal concurrent syndrome (fetal distress, neonatal asphyxia, neonatal jaundice), calculation of pre-pregnancy body mass index (BMI), weight gain during pregnancy.To compare the relationgship of obstetric complications and delivery outcome between different groups.
Results:
(1)The rate of birth process block and uterine-incision delivery of thin group, normal group, overweight group and obese group had statistically significant difference (P<0.05). The obese group was one of risk factors (RR>1) in uterine-incision delivery.
(2)Pregnancy-induced hypertension, gestational diabetes, neonatal body weight,fetal macrosomia and weight gain during pregnancy were compared statistically significant difference (P<0.05) between thin group, normal group, overweight and obesity, with pre-pregnancy weight gain, the incidence of hypertensive, gestational diabetes,and fetal macrosomia disorders in pregnancy gradually increased, a gradual increase in birth weight, pregnancy weight gain, reduced gradually. Overweight and obesity, the incidence of pregnancy-induced hypertension group and gestational diabete group weresignificantly higher than thin group, normal group, overweight and obesity were similar. The overweight group and obese group were risk factors in pregnancy-induced hypertension and gestational diabetes (RR>1).
(3) Fetal distress, neonatal jaundice, neonatal asphyxia and postpartum hemorrhage had no statistical significance (P> 0.05) between thin group, normal group, overweight and obesity.
(4) Pregnancy weight gain<15kg,15～20kg,≥20kg,the incidence of pregnancy induced hypertension and fetal macrosomia between the two groups were statistically significant different(P<0.05), birth weight in each group comparison werestatistically significant different (P<0.01). Pregnancy weight gain≥15kg was one of risk factors (RR>1) in fetal macrosomia.
(5) Pregnancy weight<15kg,15～20kg,≥20kg,postpartum hemorrhage, abor block, dystocia cesarean section, fetal distress,fetal pathologic jaundice and neonatal asphyxia had no significant difference (P> 0.05).
(6).Pregnancy weight≥15kg,gestational diabetes significantly lower than pregnancy weight <15kg group. Pregnancy weight gain≥15kg was protective factors(RR< 1).
(7)There was a negative correlation between pre-pregnancy weight and pregnancy weight gain(r=-0.132,P<0.001).
(8)Therewere positive correlations between pre-pregnancy weight, pregnancy weight gain and prenatal weight (P<0.001).
Conclusion:Properly controling pre-pregnancy weight and pregnancy weight gain in a certain range can significantly reduce the occurrence of pregnancy-induced hypertension, gestational diabetes,production process block, neonatal body weight,fetal macrosomia,cesarean section rate and improve the health of mother and child. This study suggests that the best weight range:18.5≤pre-pregnancy BMI<23, pregnancy weight gain<15kg.
Part 2 Relationship between obstetric complications,pregnancy outcome anddifferent prenatal weight
Objective:To understand the relationship between obstetric complications,delivery outcome and different prenatal weight,to explore the scope of pregnancy obesity.
Methods:747 cases of primipara were divided into four groups according to the different prenatal weight:group A (BMI<26), group B (26≤BMI<28), group C (28≤BMI<30), group D (30≤BMI); were divided into four groups according to the absolute value of antepartum weight:group a(W<65kg), group b (65kg≤W<75kg), group c (75kg≤W<85kg), group d (W≥85kg). To record pregnant women's pre-pregnancy weight and measured height a month before delivery, the pre-hospital childbirth weight, pregnancy complications (pregnancy-induced hypertension, gestational diabetes), mode of delivery, birth complications (postpartum hemorrhage, birth process block), neonatal birth weight, macrosomia, neonatal Apgar's score and perinatal concurrent syndrome (fetal distress, neonatal asphyxia, neonatal jaundice), calculation of pre-pregnancy body mass index (BMI), weight gain during pregnancy.To compare the relationgship of obstetric complications and delivery outcome between different groups.
Results
(1).The pregnancy-induced hypertension, birth weight,fetal macrosomia, abor block, dystocia cesarean section, pregnancy weight gain and pre-pregnancy weight had a statistically significant difference between the two groups of group A, group B, group C, group D and group a, group b, group c, group d (P<0.001). Group D and group c,group d were risk factors in pregnancy-induced hypertension (RR>1).Group D and group d were risk factors in birth process block and uterine-incision delivery (RR>1).Group C, group D and group b, group c, group d were risk factors in fetal macrosomia (RR>1).
(2)Pre-delivery body mass index would increase higher when pre-pregnancy weight become higher.
(3)Postpartum hemorrhage, gestational diabetes,fetal distress,neonatal asphyxia and neonatal jaundicehad no statistically significant difference between the two groups of group A, group B, group C, group D and group a, group b, group c, group d (P> 0.05).
Conclusion
Different pre-pregnancy weight,, there are different appropriate range of pregnancy weight gain, the final pre-delivery weight should be controlled appropriately, in order to reduce the obstetric complications and the occurrence of adverse pregnancy outcomes. This study suggests that the best range of pre-delivery 1 body mass index and weight:BMI<28, W<75kg.
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