江苏省昆山市孕产妇孕期体重变化与胎儿出生体重关系的流行病学分析

胡文斌; 赵瑶; 罗晓明; 丁晋飞; 郑艳敏; 沈月平

Abstract

胡文斌,赵瑶,罗晓明,丁晋飞,郑艳敏,沈月平.江苏省昆山市孕产妇孕期体重变化与胎儿出生体重关系的流行病学分析[J].Chinese journal of Epidemiology,2012,33(3):313-317

江苏省昆山市孕产妇孕期体重变化与胎儿出生体重关系的流行病学分析

Association between gestational weight gain and birth weight (2001-2009) :a cohort study carried outin Kunshan city, Jiangsu province, China

DOI：

KeyWord: 孕期体重变化低出生体重巨大胎儿发生率

English Key Word: Gestational weight gain Low birth weight Macrosomia Prevalence

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Author Name	Affiliation
HU Wen-bin	Department of Epidemiology and Medical Statistics, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
ZHAO Yao	Department of Epidemiology and Medical Statistics, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
LUO Xiao-ming	Maternal and Child Health Care Hospital of Kunshan
DING Jin-fei	Department of Epidemiology and Medical Statistics, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
ZHENG Yan-min	Department of Epidemiology and Medical Statistics, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
SHEN Yue-ping	Department of Epidemiology and Medical Statistics, School of Public Health, Medical College of Soochow University, Suzhou 215123, China

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Abstract:

目的探讨孕期体重变化与胎儿出生体重之间的关联.方法以2001-2009年江苏省昆山市围产保健监测系统登记的33 631名孕产妇与单胎活产新生儿为研究对象,排除母亲孕前糖尿病和及其他因素,以产检期内体重变化为研究变量,按照初次产检时BMI进行分层,以此探究孕期体重变化与胎儿出生体重之间关联.孕期周体重(kg)变化=(末次产检体重-初次产检体重)/(末次产检孕周-初次产检孕周).结果昆山市在2001-2009年的9年间低出生体重平均发生率为1.86％；而巨大胎儿发生率则相对较高(8.47％).以初次产检BMI进行分层,调整潜在的混杂因素后,无序多分类logistic回归分析表明,在体重偏低组,第三、四分位水平的孕期体重变化可减少低出生体重( ＜2500 g)胎儿发生风险；在体重正常组,第二、三、四分位水平的孕期体重变化可减少低出生体重胎儿发生风险,体重偏低及正常组其第四分位现患比值比(POR及其95％CI分别为0.51(0.32 ～0.80)和0.58(0.42 ～ 0.79);趋势检验显示,随着孕期增重变化水平增加,低出生体重胎儿发生风险在逐渐降低.对巨大胎儿(≥4000 g),产妇不论是偏瘦还是肥胖,高水平的孕期体重变化均可增加巨大胎儿发生风险.体重偏低、正常、超重及肥胖组其第四分位体重变化水平的POR值(95％CI)分别为4.69(2.82 ～ 7.81)、4.15(3.43～5.03)、3.64(2.62～ 5.06)和1.96(1.48 ～ 2.60);随着孕期体重变化水平增加,分娩巨大胎儿风险亦逐渐增加.结论在偏瘦及体重正常组的孕妇,随着孕期体重变化水平增加,分娩低出生体重胎儿风险逐渐减小；不论产妇是偏瘦还是肥胖,随着孕期体重的增加,巨大胎儿发生风险则逐渐增加.

English Abstract:

Objective To identify the association between gestational weight gain and birth weight over the past 9 years in Kunshan city,Jiangsu province,China.Methods This population-based study was conducted between 2001 to 2009.Data were retrieved from Perinatal Monitoring System of Maternal and Child Health Care Hospital of Kunshan.The study population consisted of 33 631 women and singleton live fetus.Gestational weight gain was defined as the total weight gain during the last and first prenatal care program and divided by the interval weeks.Results From 2001 to 2009,the average incidence of low birth weight was 1.86％,while the average incidence of macrosomia was a bit higher,fluctuating around 8.47％.On those underweight mothers,after adjustment for potential confounders,and stratified by the BMI levels,which were evaluated at the first prenatal care program,we found that weight gain in the 3rd and 4th intervals,could reduce the risk of low birth weight (less than 2500 g).With those mothers with normal-weight,weight gain in the 2 rid,3 rd and 4th intervals,would reduce the risk of low birth weight.Risks in the 4th quantile among underweight and normal-weight group were prevalence odds radio (POR) 95％CI:0.51 (0.32-0.80) and 0.58 (0.42-0.79),respectively.The risks showed a significant downward trend in underweight and normal- weight groups with increased gestational weight gain.As for macrosomia (≥4000 g),the risks increased (POR 95％CI) 4.69(2.82-7.81 ) in underweight,4.15 (3.43-5.03) in normal-weight,in overweight,3.64 (2.62-5.06) and 1.96 (1.48-2.60) in obese mothers with increased levels of gestational weight gain.Trend tests indicated that the risks of marcosomia increased in all levels of BMI,with the increase of gestational weight gain.Conclusion Findings from this population-based study suggested that gestational weight gain could reduce the risks of low birth weight among underweight and normal-weight groups,while increase the risks of macrosomia in all parturients,as compared with lowest levels of gestational weight gain.?

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