孕前体重指数及孕期增重与小于胎龄儿的关系

彭婷婷; 岳福娟; 王芳; 冯永亮; 邬惟为; 王素萍; 张亚玮; 杨海澜

Abstract

彭婷婷,岳福娟,王芳,冯永亮,邬惟为,王素萍,张亚玮,杨海澜.孕前体重指数及孕期增重与小于胎龄儿的关系[J].Chinese journal of Epidemiology,2015,36(6):644-648

孕前体重指数及孕期增重与小于胎龄儿的关系

Relationship between pre-pregnant body mass index,maternal weight gain and small for gestational age

Received:November 14, 2014

DOI：10.3760/cma.j.issn.0254-6450.2015.06.023

KeyWord: 小于胎龄儿体重指数孕期增重

English Key Word: Small for gestational age Body mass index Aestational weight gain

FundProject:山西省百人计划项目; 山西省自然科学基金(2013021033-2); 山西医科大学青年基金(Q02201211)

Author Name	Affiliation	E-mail
Peng Tingting	Department of Epidemiology, Shanxi Medical University, Taiyuan 030001, China
Yue Fujuan	Department of Epidemiology, Shanxi Medical University, Taiyuan 030001, China
Wang Fang	Department of Epidemiology, Shanxi Medical University, Taiyuan 030001, China
Feng Yongliang	Department of Epidemiology, Shanxi Medical University, Taiyuan 030001, China
Wu Weiwei	Department of Epidemiology, Shanxi Medical University, Taiyuan 030001, China
Wang Suping	Department of Epidemiology, Shanxi Medical University, Taiyuan 030001, China	spwang88@163.com
Zhang Yawei	Division of Environmental Health Sciences, School of Public Health, Yale University
Yang Hailan	Obstetrics and Gynecology, First Hospital of Shanxi Medical University

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Abstract:

目的探讨孕前BMI、孕期增重与小于胎龄儿(small for gestational age,SGA)的关系,为预防小于胎龄儿的发生提供理论依据.方法以2012年3月至2014年7月在山西医科大学第一医院产科分娩的4 754例单胎孕妇为研究对象,收集其一般人口学特征及健康状况、分娩情况等资料,测量其孕前身高、体重和分娩前体重,计算孕前BMI及孕期增重并分组,收集新生儿出生结局,了解孕前BMI和孕期增重对SGA的影响.结果 SGA发生率为9.26%(440/4 754).孕前体重较低组、正常组及超重/肥胖组SGA发生率为9.85%、8.54%和9.45%,调整孕妇年龄、孕产史等因素后,孕前BMI过高和超重/肥胖者SGA发生率低于孕前BMI正常范围的孕妇(OR=0.714,95%CI:0.535～0.953);不同孕期增重组SGA发生率分别为孕期增重低于美国医学研究所(IOM)建议范围下限组12.20%、增重在建议范围组9.23%、增重超过建议范围上限组8.45%;调整孕妇年龄、孕产史等因素后,孕期增重低于IOM建议范围下限增加SGA的发生风险(OR=1.999,95%CI:1.487～2.685),无论是孕前BMI较低、适宜还是超重/肥胖,分别以增重适宜作为参照,孕期增重低于IOM建议范围下限均增加SGA的发生风险,OR值分别为2.558(95%CI:1.313～4.981)、1.804(95%CI:1.258～2.587)、3.108(95%CI:1.237～7.811).孕前高BMI和孕期增重不足间未发现相加和相乘交互作用.结论孕前BMI超重/肥胖者SGA发生率低于孕前BMI正常范围的孕妇,孕期增重不足增加SGA的发生风险,无论孕前BMI较低、正常还是超重/肥胖的孕妇增重均应避免低于IOM推荐的增重范围下限,以减少SGA的发生.

English Abstract:

Objective To investigate the relationship between maternal pre-pregnancy body mass index,weight gain during pregnancy and small for gestational age(SGA) birth so as to provide evidence for the development of comprehensive prevention programs on SGA birth. Methods Between March,2012 and July,2014,4 754 pregnant women were asked to fill in the questionnaires which were collected from the First Affiliated Hospital of Shanxi Medical University. Data related to general demographic characteristics,pregnancy and health status of those pregnant women was collected and maternal pre-pregnancy body mass index and maternal weight gain were calculated. Subjects were divided into different groups before the effect of maternal pre-pregnancy body mass index and weight gain during pregnancy on SGA birth were estimated. Results The overall incidence of SGA birth was 9.26%(440/4 754). Proportions of SGA birth from pre-pregnant,underweight group,normal weight group,overweight and obese groups were 9.85%,8.54% and 9.45%,respectively. Results from multi-factor logistic regression analyses showed that after adjusting the confounding factors as age,history on pregnancies etc.,women with high pre-pregnancy BMI showed a lower incidence of SGA than those under normal pre-pregnancy BMI (OR=0.714,95%CI:0.535-0.953). Different weight gains during pregnancy were statistically significant(χ²=8.811,P=0.012). Incidence of SGA birth that was below the recommended range in the 2009 Institute of Medicine Guidelines(12.20%) was higher than those within(9.23%) or beyond (8.45%) the recommended range. Results from the multi-factor logistic regression analyses showed that,after adjusting the confounding factors as age,pregnancy history etc.,factor as weight gain below the recommended level could increase the risk of SGA (OR=1.999,95%CI:1.487-2.685). In the underweight,normal weight,overweight or obese groups,with weight gain during pregnancy below the range,the incidence of SGA showed an increase (OR=2.558,95%CI:1.313-4.981,OR=1.804,95%CI:1.258-2.587,OR=3.108,95%CI:1.237-7.811). There was no interaction of addictive or multiplicative models between these two factors under ‘interaction analysis'. Conclusion Women with high pre-pregnancy BMI presented a lower incidence of SGA than those within the normal range. Insufficient weight gain during pregnancy could increase the risk of SGA delivery. These findings called for attention to be paid to the gestational weight gain,in order to decrease the risk of SGA.

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