孕前体重指数、孕期体重增加与新生儿窒息的关系

刘英惠; 刘建蒙; 刘伟宏; 马蕊; 叶荣伟; 陈华; 薛明君; 成伶春; 吴立民; 潘玉娟; 陈浩; 任爱国; 李松; 李竹

Abstract

刘英惠,刘建蒙,刘伟宏,马蕊,叶荣伟,陈华,薛明君,成伶春,吴立民,潘玉娟,陈浩,任爱国,李松,李竹.孕前体重指数、孕期体重增加与新生儿窒息的关系[J].Chinese journal of Epidemiology,2008,29(7):661-667

孕前体重指数、孕期体重增加与新生儿窒息的关系

Relations between pre-pregnancy body mass index,gestational weightgain, and the occurrence of neonatalasphyxia

Received:January 09, 2008

DOI：

KeyWord: 新生儿窒息体重指数孕期

English Key Word: Neonatal asphyxia Body mass index Pregnancy

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Author Name	Affiliation
LIU Ying-hui	nstitute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100083, China
LIU Jian-meng	nstitute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100083, China
LIU Wei-hong	nstitute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100083, China
MA Rui	nstitute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100083, China
YE Rong-wei	nstitute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100083, China
CHEN Huan	浙江省嘉兴市妇幼保健院
XUE Ming-jun	嘉兴市秀洲区妇幼保健所
CHENG Ling-chun	嘉善县妇幼保健所
WU Li-min	平湖市妇幼保健所
PAN Yu-juan	海盐县妇幼保健所
CHEN Hao	桐乡市妇幼保健廣
REN Ai-guo	nstitute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100083, China
LI Song	北京大学第三医院
LI Zhu	nstitute of Reproductive and Child Health, Peking University Health Science Center, Beijing 100083, China

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Abstract:

目的了解孕前体重指数(BMI)、孕期体重增加与新生儿窒息发生危险的关系。方法数据来自“中美预钫出生缺陷和残疾合作项目”中嘉兴地区的围产保健监测数据库。研究对象为 1995-2000年在嘉兴地区参加婚前/孕前体检且分娩单胎活产儿孕满20周的83 030名孕产妇。运用 x2检验或趋势x2检验比较不同BMI组或其他特征人群新生儿窒息发病率的差别,利用多元logistic 回归分析孕前BMI、孕期体重增加与新生儿窒息发生危险之间的关系。结果新生儿窒息发病率为 11.396(9596 CJ: 11.1%~ 11.6%)。新生儿窒息发病率从BMI< 18.S kg/m2组的 11.0%(95%CJ: 10.5%~11.5%)逐渐升至81^1>25.0 1^/1112组的12.9%(95%CL:11.6%~14.4%),自孕期体重增加 <0.3 kg/wk 的 12.4%(95%CI： 11.9%~ 13.0%)逐渐降至 >0.5 kg/wk 的 10.6%(95%CI-.10.1%~11.0%)?孕前BMI>25.0 kg/m2组的新生儿重度窒息发生率高于BMI更低组。在调整了地区、年龄、文化程度、职业、产次、产前检查次数、孕期高危因素、产时高危因素、孕周和出生体重后,以BMI<18.5 kg/m2组为参照组,BMI *18.5-22.9 kg/m2、23.0~24.9 kg/m2 和>25.0 kg/m2 组发生新生儿窒息的 OR 值分别为 1.03(95%Cl:0.97~1.09)、1.06(95%Cl: 0.96~1.16)和 1.14 (95%CI:1.00~1.31)o进一步调整孕期增重后,上述OR值分别为1.02(95%CI:0.95?1.09)、1.01(95%.a:0.90~l.13)和 1.08(95%a:0.92 — 1.28)。以孕期体重增加>0.5 kg/wk组作为参照,孕期体重增加为0.3~kg/wk和<0.3 kg/wk组发生新生儿窒息的OR值分别为1.06(95%Cl:1.01~I.12)和1.09(95%Cl:1.02?1.20)。结论孕期体重增加<0.5 kg/wk加大新生儿窒息发生的危险,提示临床上宜对妇女孕前的BMI进行监测,并据此进行孕前指导和孕期管理,以保持合理的孕期体重,降低新生儿窒息的发生危险。

English Abstract:

Objective To assess the relationship between pre-pregnancy body mass index (BMI), weightgain during pregnancy, and the risk of neonatal asphyxia. Methods Data was collected in 6 countie cities covered by Peri-natal Health Care Surveillance System which was part of a Sino-American cooperative project on neural tube defects prevention established in 1992. The study population consisted of 83 030 women who attended premarital/preconception medical physical examination program and had delivered single live birth with at least 20gestational weeks from 1995 to 2000 in Jiaxing area, Zhejiang province. Results from the Chi-square test were employed to test the differences in the rates of neonatal asphyxia betweengroups with different BMI and other characteristics，Multivariate logistic regression method was conducted to examine the association between pre-pregnancy BMI,gestational weightgain, and the risk of asphyxia. Results The average rate of neonatal asphyxia was 11.3%(95%Cl：11.1%-11.6%).The rates of neonatal asphyxia among women with BMI< 18.5 kg/m_{2.18.5-22.9 kg/m2,23.0-24.9 kg/m_{2, and>25.0 kg/m_{2 were 11,0%(95%Cl: 10.5%-ll.5%),11.3%(95%Cl:11.1 %-11.6%), 11.8%(95%C7：11.0%-12.6%), and 12.9%(95%Cl:11.6%-14.4%) respectively. The rates of neonatal asphyxia were 12.4%among women with weightgain <0.3 kg/wk, higher than women with higher weightgain. After adjusting for residencial area, maternal age，educational level, occupation, parity, times of prenatal visit, high-risk experiences during pregnancy, high-risk experiences at time of delivery,gestational week and birth weight，the estimated ORs were 1.03 (95 %Cl: 0.97-1.09), 1.06 (95%Cl:0.96-1.16) and 1.14(95%CI:1.00-1.31), respectively. These ORs became 1.02(95 %CI: 0.95-1.09), 1.01 (95 %CI :0.90-1.13) and 1.08(95 %Cl：0.92-1.28) after further adjusting the variable “gestational weightgain”. The estimated ORs for neonatal asphyxia were 1.06(95%C/： 1.01-1.12) for women with weightgain at 0.3-kg/wk and 1.09 (95%CI ： 1.02- 1.20) for women with weightgain <0.3 kg/wk when compared to those with weightgain ^0.5 kg/wk. Conclusion Lower weightgain seemed to have the effect of increasing the risk of neonatal asphyxia.}}}

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