中国城区妇女孕期增重适宜值研究
|
摘要
目的探讨中国妇女孕期体重增长适宜值。方法选取2013年1月—2016年5月于武汉市加入同济母婴健康队列(TMCHC)的单胎足月产孕妇6998人,于孕8～16周问卷调查了解其社会人口学、既往病史等资料并测量体重及身高。分娩前测量产前体重;分娩后通过医院记录收集分娩孕周、分娩方式、妊娠合并症、新生儿性别、出生体重及身长等信息。采用限制性三次样条回归模型分别拟合孕期增重与小于胎龄儿、大于胎龄儿、低出生体重、巨大儿、剖宫产、妊娠高血压及妊娠期糖尿病发生率关系曲线,寻找各妊娠结局发生率均较低的增重范围作为同济推荐值。将孕期增重的P25～P75作为百分位数法孕期增重推荐值。采用Logistic回归模型,分别以同济和百分位数法推荐孕期增重适宜值为参照,分析孕期增重过多或不足对不良妊娠结局的影响。结果 (1)不同孕前体质指数组各种不良妊娠结局发生率较低的孕期增重范围分别为:低体重组12.0～17.0 kg、正常体重组9.0～14.0 kg、超重组7.0～11.0 kg,以此作为孕期增重的同济推荐值。百分位数法孕期增重推荐值分别为:孕前低体重组14.0～19.0 kg、正常体重组13.0～19.0 kg、超重组10.8～18.0 kg及肥胖组9.0～15.8 kg。(2)与同济增重适宜组相比,增重过多组发生不良妊娠结局的风险分别为大于胎龄儿(OR=2.94,95%CI 2.31～3.73)、巨大儿(OR=3.13,95%CI 2.38～4.13)、剖宫产(OR=1.53,95%CI 1.38～1.71)及妊娠高血压(OR=2.18,95%CI 1.50～3.17);增重不足组发生的风险为小于胎龄儿(OR=1.82,95%CI 1.32～2.53)。按百分位数法推荐值分组,相应的风险值分别为大于胎龄儿(OR=2.11,95%CI 1.76～2.54)、巨大儿(OR=2.16,95%CI 1.76～2.65)、剖宫产(OR=1.53,95%CI 1.36～1.72)、妊娠高血压(OR=1.39,95%CI 1.02～1.90)及小于胎龄儿(OR=1.60,95%CI 1.29～1.98)。结论推荐中国孕妇孕期增重分别为:孕前低体重者12.0～17.0 kg、正常体重者9.0～14.0 kg及超重者7.0～11.0 kg。
OBJECTIVE To examine optimal gestational weight gain(GWG) for Chinese pregnant women. METHODS A total of 6998 women with singleton and term pregnancy recruited to the Tongji Maternal and Child Health Cohort during January 2013 to May 2016 in Wuhan, Hubei were included. Information on sociodemographic, medical and family history of disease was obtained by questionnaire, body weight and height were measured at the first antenatal care during 8-16 weeks of gestation. Prenatal weight of mothers were measured, and gestational week, mode of delivery, pregnancy complications, gender of newborn, birth weight and length were collected from medical records after delivery. Restricted cubic spline was used to model nonlinear relationships between GWG and the occurrence of small for gestational age(SGA), large for gestational age(LGA), low birth weight(LBW), macrosomia, cesarean, gestational hypertension(GH)and gestational diabetes mellitus(GDM), respectively. The GWG of the lowest risks for adverse pregnant outcomes was regarded as optimal GWG recommended by Tongji(TJ) for pregnant women. The P25-P75 of GWG was defined as the optimal GWG recommended by percentile method. Logistic regression was used to analyze the effect of excessive or insufficient GWG on adverse pregnancy outcomes, while the recommendations of TJ and percentile method were used as references, respectively. RESULTS(1) The GWG with lower risk of adverse pregnant outcomes based on pre-gravid body mass index(BMI) are 12.0-17.0 kg for underweight, 9.0-14.0 kg for normal weight and 7.0-11.0 kg for overweight, respectively, which are defined as TJ recommendations. The recommended GWG by percentile method are 14.0-19.0 kg for underweight, 13.0-19.0 kg for normal weight, 10.8-18.0 kg for overweight and 9.0-15.8 kg for obesity, respectively.(2) Compared to women gain within the TJ recommendations, OR of LGA is 2.94(95%CI 2.31-3.73), macrosomia is 3.13(95%CI 2.38-4.13), cesarean is 1.53(95%CI 1.38-1.71) and GH is 2.18(95%CI 1.50-3.17) for those with excessive GWG, OR of SGA is 1.82(95%CI 1.32-2.53) for those who gain less. The corresponding ORs according to percentile method are 2.11(95%CI 1.76-2.54) for LGA, 2.16(95%CI 1.76-2.65) for macrosomia, 1.53(95%CI 1.36-1.72) for cesarean, 1.39(95%CI 1.02-1.90) for GH and 1.60(95%CI 1.29-1.99) for SGA, respectively. CONCLUSION The optimal GWG of Chinese pregnant women recommended by the study are 12.0-17.0 kg for pre-gravid underweight women, 9.0-14.0 kg for normal weight women and 7.0-11.0 kg for overweight, respectively.
OBJECTIVE To examine optimal gestational weight gain(GWG) for Chinese pregnant women. METHODS A total of 6998 women with singleton and term pregnancy recruited to the Tongji Maternal and Child Health Cohort during January 2013 to May 2016 in Wuhan, Hubei were included. Information on sociodemographic, medical and family history of disease was obtained by questionnaire, body weight and height were measured at the first antenatal care during 8-16 weeks of gestation. Prenatal weight of mothers were measured, and gestational week, mode of delivery, pregnancy complications, gender of newborn, birth weight and length were collected from medical records after delivery. Restricted cubic spline was used to model nonlinear relationships between GWG and the occurrence of small for gestational age(SGA), large for gestational age(LGA), low birth weight(LBW), macrosomia, cesarean, gestational hypertension(GH)and gestational diabetes mellitus(GDM), respectively. The GWG of the lowest risks for adverse pregnant outcomes was regarded as optimal GWG recommended by Tongji(TJ) for pregnant women. The P25-P75 of GWG was defined as the optimal GWG recommended by percentile method. Logistic regression was used to analyze the effect of excessive or insufficient GWG on adverse pregnancy outcomes, while the recommendations of TJ and percentile method were used as references, respectively. RESULTS(1) The GWG with lower risk of adverse pregnant outcomes based on pre-gravid body mass index(BMI) are 12.0-17.0 kg for underweight, 9.0-14.0 kg for normal weight and 7.0-11.0 kg for overweight, respectively, which are defined as TJ recommendations. The recommended GWG by percentile method are 14.0-19.0 kg for underweight, 13.0-19.0 kg for normal weight, 10.8-18.0 kg for overweight and 9.0-15.8 kg for obesity, respectively.(2) Compared to women gain within the TJ recommendations, OR of LGA is 2.94(95%CI 2.31-3.73), macrosomia is 3.13(95%CI 2.38-4.13), cesarean is 1.53(95%CI 1.38-1.71) and GH is 2.18(95%CI 1.50-3.17) for those with excessive GWG, OR of SGA is 1.82(95%CI 1.32-2.53) for those who gain less. The corresponding ORs according to percentile method are 2.11(95%CI 1.76-2.54) for LGA, 2.16(95%CI 1.76-2.65) for macrosomia, 1.53(95%CI 1.36-1.72) for cesarean, 1.39(95%CI 1.02-1.90) for GH and 1.60(95%CI 1.29-1.99) for SGA, respectively. CONCLUSION The optimal GWG of Chinese pregnant women recommended by the study are 12.0-17.0 kg for pre-gravid underweight women, 9.0-14.0 kg for normal weight women and 7.0-11.0 kg for overweight, respectively.
引文
[1] Institute of Medicine.Weight gain during pregnancy:reexamining the guidelines[M].Washington DC:National Academies Press,2009:173-195.
[2] LUDWIG D S,CURRIE J.The association between pregnancy weight gain and birthweight:a within-family comparison [J].Lancet,2010,376(9745):984-990.
[3] YANG S,PENG A,WEI S,et al.Pre-pregnancy body mass index,gestational weight gain,and birth weight:a cohort study in China [J].PLoS One,2015,10(6):e130101.
[4] LI C,LIU Y,ZHANG W.Joint and independent associations of gestational weight gain and pre-pregnancy body mass index with outcomes of pregnancy in Chinese women:a retrospective cohort study [J].PLoS One,2015,10(8):e136850.
[5] GOLDSTEIN R F,ABELL S K,RANASINHA S,et al.Association of gestational weight gain with maternal and infant outcomes a systematic review and meta-analysis [J].JAMA,2017,317(21):2207-2225.
[6] SCHIEVE L A,COGSWELL M E,SCANLON K S,et al.Prepregnancy body mass index and pregnancy weight gain:associations with preterm delivery:the NMIHS collaborative study group [J].Obstet Gynecol,2000,96(2):194-200.
[7] Institute of Medicine.Weight gain during pregnancy:reexamining the guidelines [M].Washington DC:National Academies Press,2009:2-3.
[8] 中国肥胖问题工作组数据汇总分析协作组.我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究 [J].中华流行病学杂志,2002,23(1):10-15.
[9] 胡亚美,江载芳,诸福棠.实用儿科学 [M].北京:人民卫生出版社,2008:409-410.
[10] 王卫平.儿科学 [M].8版.北京:人民卫生出版社,2013:93-94.
[11] 朱丽,张蓉,张淑莲,等.中国不同胎龄新生儿出生体重曲线研制 [J].中华儿科杂志,2015,53(2):97-103.
[12] American Diabetes Association.Standards of medical care in diabetes—2014 [J].Diabetes Care,2014,37(Suppl 1):S14-S80.
[13] 乐杰.妇产科学[M].7版.北京:人民卫生出版社,2008:92-93.
[14] 王文鹏,陈芳芳,米杰,等.孕妇孕期适宜体质量增加范围的探讨及其与新生儿出生体质量的关系 [J].中华妇产科杂志,2013,48(5):321-325.
[15] 沈艳辉,李竹,季成叶,等.孕前体重孕期增重与新生儿出生体重的关系 [J].中华围产医学杂志,2000,3(2):77-79.
[16] KINNUNEN T I,LUOTO R,GISSLER M,et al.Pregnancy weight gain from 1960s to 2000 in Finland [J].Int J Obes Relat Metab Disord,2003,27(12):1572-1577.
[17] CHU S Y,CALLAGHAN W M,KIM S Y,et al.Maternal obesity and risk of gestational diabetes mellitus [J].Diabetes Care,2007,30(8):2070-2076.
[18] BHATTACHARYA S,CAMPBELL D M,LISTON W A,et al.Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies [J].BMC Public Health,2007,7:168.
[19] AVERETT S L,FLETCHER E K.Prepregnancy obesity and birth outcomes [J].Matern Child Health J,2016,20(3):655-664.
[20] ZHONG C,LI X,CHEN R,et al.Greater early and mid-pregnancy gestational weight gain are associated with increased risk of gestational diabetes mellitus:A prospective cohort study [J].Clin Nutr ESPEN,2017,22:48-53.
[2] LUDWIG D S,CURRIE J.The association between pregnancy weight gain and birthweight:a within-family comparison [J].Lancet,2010,376(9745):984-990.
[3] YANG S,PENG A,WEI S,et al.Pre-pregnancy body mass index,gestational weight gain,and birth weight:a cohort study in China [J].PLoS One,2015,10(6):e130101.
[4] LI C,LIU Y,ZHANG W.Joint and independent associations of gestational weight gain and pre-pregnancy body mass index with outcomes of pregnancy in Chinese women:a retrospective cohort study [J].PLoS One,2015,10(8):e136850.
[5] GOLDSTEIN R F,ABELL S K,RANASINHA S,et al.Association of gestational weight gain with maternal and infant outcomes a systematic review and meta-analysis [J].JAMA,2017,317(21):2207-2225.
[6] SCHIEVE L A,COGSWELL M E,SCANLON K S,et al.Prepregnancy body mass index and pregnancy weight gain:associations with preterm delivery:the NMIHS collaborative study group [J].Obstet Gynecol,2000,96(2):194-200.
[7] Institute of Medicine.Weight gain during pregnancy:reexamining the guidelines [M].Washington DC:National Academies Press,2009:2-3.
[8] 中国肥胖问题工作组数据汇总分析协作组.我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究 [J].中华流行病学杂志,2002,23(1):10-15.
[9] 胡亚美,江载芳,诸福棠.实用儿科学 [M].北京:人民卫生出版社,2008:409-410.
[10] 王卫平.儿科学 [M].8版.北京:人民卫生出版社,2013:93-94.
[11] 朱丽,张蓉,张淑莲,等.中国不同胎龄新生儿出生体重曲线研制 [J].中华儿科杂志,2015,53(2):97-103.
[12] American Diabetes Association.Standards of medical care in diabetes—2014 [J].Diabetes Care,2014,37(Suppl 1):S14-S80.
[13] 乐杰.妇产科学[M].7版.北京:人民卫生出版社,2008:92-93.
[14] 王文鹏,陈芳芳,米杰,等.孕妇孕期适宜体质量增加范围的探讨及其与新生儿出生体质量的关系 [J].中华妇产科杂志,2013,48(5):321-325.
[15] 沈艳辉,李竹,季成叶,等.孕前体重孕期增重与新生儿出生体重的关系 [J].中华围产医学杂志,2000,3(2):77-79.
[16] KINNUNEN T I,LUOTO R,GISSLER M,et al.Pregnancy weight gain from 1960s to 2000 in Finland [J].Int J Obes Relat Metab Disord,2003,27(12):1572-1577.
[17] CHU S Y,CALLAGHAN W M,KIM S Y,et al.Maternal obesity and risk of gestational diabetes mellitus [J].Diabetes Care,2007,30(8):2070-2076.
[18] BHATTACHARYA S,CAMPBELL D M,LISTON W A,et al.Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies [J].BMC Public Health,2007,7:168.
[19] AVERETT S L,FLETCHER E K.Prepregnancy obesity and birth outcomes [J].Matern Child Health J,2016,20(3):655-664.
[20] ZHONG C,LI X,CHEN R,et al.Greater early and mid-pregnancy gestational weight gain are associated with increased risk of gestational diabetes mellitus:A prospective cohort study [J].Clin Nutr ESPEN,2017,22:48-53.