基于广义估计方程探讨长沙市开福区产妇产后体重滞留现状及其影响因素
|
摘要
目的:了解长沙市开福区产妇产后体重滞留(postpartum weight retention,PPWR)的现状,基于广义估计方程探讨PPWR的影响因素。方法:采用整群抽样法,选取2015年1至12月在湖南省长沙市开福区3个街道社区卫生服务中心分娩的产妇作为研究对象。根据纳入和排除标准,最终纳入研究的样本为783例。采用前瞻性队列研究方法,应用自制调查问卷收集产妇产后1,3,6及8个月的PPWR资料;并进一步采用广义估计方程分析PPWR的影响因素。结果:产妇PPWR随产后时间的推移而逐渐降低,有34.6%的妇女在产后8个月恢复到孕前体重。由广义估计方程结果可知,产后体重滞留的影响因素有孕期增重、孕前体重指数、分娩方式及喂养方式(P<0.05),尚未发现年龄、文化程度、家庭人均收入、产次和产后抑郁与PPWR有关(P>0.05)。结论:孕期增重是影响PPWR的重要因素。减少PPWR的关键在于监控孕期增重。重视对孕产妇身心健康的宣传教育和科学指导,加强对妇女产后1年内的体重管理,尤其是剖宫产和母乳喂养的产妇,有利于减小因PPWR带来的超重或肥胖的风险。
Objective: To investigate the current status of the postpartum weight retention(PPWR) in KaifuDistrict of Changsha, and explore the influential factors with PPWR based on the generalized estimating equation model.Methods: A cluster sampling method was applied to select women who gave birth at the health service centers of 3 street communities in Kaifu District of Changsha during 2015. According to the inclusion and exclusion criteria, 783 cases were finally included in the study. Data on PPWR were collected prospectively by using the self-made questionnaire at 1, 3, 6 and 8 months after childbirth. Analysis were performed to investigate the associations between PPWR and its potential factors with generalized estimation equation model.Results: The mean PPWR of women was gradually decreased with the increase of postpartum time, and 34.6% of them have returned to the pre-pregnancy weight in the 8 months postpartum. Our findings revealed that gestation weight gain(GWG), pre-pregnancy body mass index, feeding patterns, and delivery mode were significantly associated with maternal PPWR(P<0.05). In contrast, maternal age, educational level, per capita income of family, parity and postpartum depression were not contributed to PPWR(P>0.05).Conclusion: GWG is one of the most important predictors for PPWR. The key to reducing PPWR is to control GWG systematically. Early targeted interventions and health education should be taken to prevent women from excessive PPWR at the first-year postpartum, in particular to the women who underwent cesarean deliveries and breastfed their infants. It is conducive to reduce the risks of overweight or obesity caused by PPWR.
Objective: To investigate the current status of the postpartum weight retention(PPWR) in KaifuDistrict of Changsha, and explore the influential factors with PPWR based on the generalized estimating equation model.Methods: A cluster sampling method was applied to select women who gave birth at the health service centers of 3 street communities in Kaifu District of Changsha during 2015. According to the inclusion and exclusion criteria, 783 cases were finally included in the study. Data on PPWR were collected prospectively by using the self-made questionnaire at 1, 3, 6 and 8 months after childbirth. Analysis were performed to investigate the associations between PPWR and its potential factors with generalized estimation equation model.Results: The mean PPWR of women was gradually decreased with the increase of postpartum time, and 34.6% of them have returned to the pre-pregnancy weight in the 8 months postpartum. Our findings revealed that gestation weight gain(GWG), pre-pregnancy body mass index, feeding patterns, and delivery mode were significantly associated with maternal PPWR(P<0.05). In contrast, maternal age, educational level, per capita income of family, parity and postpartum depression were not contributed to PPWR(P>0.05).Conclusion: GWG is one of the most important predictors for PPWR. The key to reducing PPWR is to control GWG systematically. Early targeted interventions and health education should be taken to prevent women from excessive PPWR at the first-year postpartum, in particular to the women who underwent cesarean deliveries and breastfed their infants. It is conducive to reduce the risks of overweight or obesity caused by PPWR.
引文
[1]Institute of Medicine and National Research Council.Weight gain during pregnancy:Reexamining the guidelines[M].Washington,DC:The National Academies Press,2009:40-41.
[2]Endres LK,Straub H,McKinney C,et al.Postpartum weight retention risk factors and relationship to obesity at 1 year[J].Obstet Gynecol,2015,125(1):144-152.
[3]王杰,杨振宇,庞学红,等.2013年中国乳母产后体重滞留状况及其影响因素[J].中华预防医学杂志,2016,50(12):1067-1073.WANG Jie,YANG Zhenyu,PANG Xuehong,et al.The status of postpartum weight retention and its associated factors among Chinese lactating women in 2013[J].Chinese Journal of Preventive Medicine,2016,50(12):1067-1073.
[4]潘丽莉,赖建强,曾果,等.城乡产后妇女体重滞留及影响因素分析[J].卫生研究,2012,41(3):504-507.PAN Lili,LAI Jianqiang,ZENG Guo,et al.Analysis of urban and rural women postpartum weight retention and influencing factors[J].Journal of Hgiene Reserch,2012,41(3):504-507.
[5]陈亮.妇女产后一年内体重滞留及其影响因素的队列研究[D].合肥:安徽医科大学,2013.CHEN Liang.Influence factors on postpartum weight retention among women during one year after childbirth:A prospective cohort study[D].Hefei:Anhui Medical University,2013.
[6]Linne Y,Dye L,Barkeling B,et al.Long-term weight development in women:a 15-year follow-up of the effects of pregnancy[J].Obes Res,2004,12(7):1166-1178.
[7]Chescheir NC.Global obesity and the effect on women’s health[J].Obstet Gynecol,2011,117(5):1213-1222.
[8]Rong K,Yu K,Han X,et al.Pre-pregnancy BMI,gestational weight gain and postpartum weight retention:a Meta-analysis of observational studies[J].Public Health Nutrition,2015,18(12):2172-2182.
[9]Shao HH,Hwang LC,Huang JP,et al.Postpartum weight retention risk factors in a taiwanese cohort study[J].Obes Facts,2018,11(1):37-45.
[10]Zanotti J,Capp E,Wender MC.Factors associated with postpartum weight retention in a Brazilian cohort[J].Rev Bras Ginecol Obstet,2015,37(4):164-171.
[11]Kapinos KA,Yakusheva O,Weiss M.Cesarean deliveries and maternal weight retention[J].BMC Pregnancy Childbirth,2017,17(1):343.
[12]高哈尔.母乳喂养时间与产后体重滞留的研究进展[J].卫生研究,2015,44(6):1019-1022.GAO Haer.Research progress of breastfeeding time and postpartum weight retention[J].Journal of Hgiene Reserch,2015,44(6):1019-1022.
[13]Zeger SL,Liang KY,Albert PS.Models for longitudinal data:a generalized estimating equation approach[J].Biometrics,1988,44(4):1049-1060.
[14]赵振,潘晓平,张俊辉.广义估计方程在纵向资料中的应用[J].现代预防医学,2006,33(5):707-708.ZHAO Zhen,PAN Xiaoping,ZHANG Junhui.Application of generalized estimating equations in longitudinal data[J].Modern Preventive Medicine,2006,33(5):707-708.
[15]Holland E,Moore ST,Doyle CD,et al.Self-reported pre-pregnancy weight versus weight measured at first prenatal visit:effects on categorization of pre-pregnancy body mass index[J].Matern Child Health J,2013,17(10):1872-1878.
[16]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):5-10.Coorperative Meta-analysis Group of China Obesity Task Force.Predictive values of body mass index and waist circumference to risk factors of related disease in Chinese adult population[J].Chinese Journal of Epidemiology,2002,23(1):5-10.
[17]Lee DT,Yip SK,Chiu HF,et al.Detecting postnatal depression in Chinese women.Validation of the Chinese version of the Edinburgh Postnatal Depression Scale[J].Br J Psychiatry,1998,172:433-437.
[18]仇剑崟,王祖承,罗来敏,等.爱丁堡产后抑郁量表的临床应用[J].上海精神医学,2001,13(4):219-221.QIU Jianyin,WANG Zucheng,LUO Laimin,et al.The clinical use of Edinburgh Postnatal Depression Scale[J].Shanghai Archives of Psychiatry,2001,13(4):219-221.
[19]沙婷婷,颜艳,高晓,等.基于结构方程模型探讨长沙市开福区产妇产后抑郁现状及其影响因素[J].中南大学学报(医学版),2017,42(10):1191-1197.SHA Tingting,YAN Yan,GAO Xiao,et al.Influential factors for postpartum depression based on the structural equation model in Kaifu District in Changsha[J].Journal of Central South University.Medical Science,2017,42(10):1191-1197.
[20]庞学红,滕越,王杰,等.北京市妇女产后体重滞留的影响因素调查[J].卫生研究,2016,45(1):111-113.PANG Xuehong,TENG Yue,WANG Jie,et al.Analysis of urban and rural women postpartum weight retention and influencing factors[J].Journal of Hygiene Research,2016,45(1):111-113.
[21]杨建洲,陈云霞,宋雯霞,等.山西东南部地区妇女产后体重滞留现状及影响因素[J].中国公共卫生,2018,34(7):946-948.YANG Jianzhou,CHEN Yunxia,SONG Wenxia,et al.Prevalence and influencing factors of postpartum weight retention among women in southeastern Shanxi province[J].Chinese Journal of Public Health,2018,34(7):946-948.
[22]Kac G,Benicio MH,Velasquez-Melendez G,et al.Gestational weight gain and prepregnancy weight influence postpartum weight retention in a cohort of brazilian women[J].J Nutr,2004,134(3):661-666.
[23]He X,Zhu M,Hu C,et al.Breast-feeding and postpartum weight retention:a systematic review and meta-analysis[J].Public Health Nutr,2015,18(18):3308-3316.
[24]秦凤云,罗艳,胡传来,等.产妇久坐行为对产后一年体重滞留影响的研究[J].中华流行病学杂志,2015,36(7):743-746.QIN Fengyun,LUO Yan,HU Chuanlai,et al.Influence of sedentary behavior on weight retention among postpartum women within one year after childbirth[J].Chinese Journal of Epidemiology,2015,36(7):743-746.
[25]Tzeng YL,Chen SL,Chen CF,et al.Sleep trajectories of women undergoing elective cesarean section:Effects on body weight and psychological well-being[J].PLoS One,2015,10(6):e129094.
[26]Natamba BK,Sanchez SE,Gelaye B,et al.Concordance between selfreported pre-pregnancy body mass index(BMI)and BMI measured at the first prenatal study contact[J].BMC Pregnancy Childbirth,2016,16(1):187.
[27]Gunderson EP,Abrams B.Epidemiology of gestational weight gain and body weight changes after pregnancy[J].Epidemiol Rev,2000,22(2):261-274.
[2]Endres LK,Straub H,McKinney C,et al.Postpartum weight retention risk factors and relationship to obesity at 1 year[J].Obstet Gynecol,2015,125(1):144-152.
[3]王杰,杨振宇,庞学红,等.2013年中国乳母产后体重滞留状况及其影响因素[J].中华预防医学杂志,2016,50(12):1067-1073.WANG Jie,YANG Zhenyu,PANG Xuehong,et al.The status of postpartum weight retention and its associated factors among Chinese lactating women in 2013[J].Chinese Journal of Preventive Medicine,2016,50(12):1067-1073.
[4]潘丽莉,赖建强,曾果,等.城乡产后妇女体重滞留及影响因素分析[J].卫生研究,2012,41(3):504-507.PAN Lili,LAI Jianqiang,ZENG Guo,et al.Analysis of urban and rural women postpartum weight retention and influencing factors[J].Journal of Hgiene Reserch,2012,41(3):504-507.
[5]陈亮.妇女产后一年内体重滞留及其影响因素的队列研究[D].合肥:安徽医科大学,2013.CHEN Liang.Influence factors on postpartum weight retention among women during one year after childbirth:A prospective cohort study[D].Hefei:Anhui Medical University,2013.
[6]Linne Y,Dye L,Barkeling B,et al.Long-term weight development in women:a 15-year follow-up of the effects of pregnancy[J].Obes Res,2004,12(7):1166-1178.
[7]Chescheir NC.Global obesity and the effect on women’s health[J].Obstet Gynecol,2011,117(5):1213-1222.
[8]Rong K,Yu K,Han X,et al.Pre-pregnancy BMI,gestational weight gain and postpartum weight retention:a Meta-analysis of observational studies[J].Public Health Nutrition,2015,18(12):2172-2182.
[9]Shao HH,Hwang LC,Huang JP,et al.Postpartum weight retention risk factors in a taiwanese cohort study[J].Obes Facts,2018,11(1):37-45.
[10]Zanotti J,Capp E,Wender MC.Factors associated with postpartum weight retention in a Brazilian cohort[J].Rev Bras Ginecol Obstet,2015,37(4):164-171.
[11]Kapinos KA,Yakusheva O,Weiss M.Cesarean deliveries and maternal weight retention[J].BMC Pregnancy Childbirth,2017,17(1):343.
[12]高哈尔.母乳喂养时间与产后体重滞留的研究进展[J].卫生研究,2015,44(6):1019-1022.GAO Haer.Research progress of breastfeeding time and postpartum weight retention[J].Journal of Hgiene Reserch,2015,44(6):1019-1022.
[13]Zeger SL,Liang KY,Albert PS.Models for longitudinal data:a generalized estimating equation approach[J].Biometrics,1988,44(4):1049-1060.
[14]赵振,潘晓平,张俊辉.广义估计方程在纵向资料中的应用[J].现代预防医学,2006,33(5):707-708.ZHAO Zhen,PAN Xiaoping,ZHANG Junhui.Application of generalized estimating equations in longitudinal data[J].Modern Preventive Medicine,2006,33(5):707-708.
[15]Holland E,Moore ST,Doyle CD,et al.Self-reported pre-pregnancy weight versus weight measured at first prenatal visit:effects on categorization of pre-pregnancy body mass index[J].Matern Child Health J,2013,17(10):1872-1878.
[16]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):5-10.Coorperative Meta-analysis Group of China Obesity Task Force.Predictive values of body mass index and waist circumference to risk factors of related disease in Chinese adult population[J].Chinese Journal of Epidemiology,2002,23(1):5-10.
[17]Lee DT,Yip SK,Chiu HF,et al.Detecting postnatal depression in Chinese women.Validation of the Chinese version of the Edinburgh Postnatal Depression Scale[J].Br J Psychiatry,1998,172:433-437.
[18]仇剑崟,王祖承,罗来敏,等.爱丁堡产后抑郁量表的临床应用[J].上海精神医学,2001,13(4):219-221.QIU Jianyin,WANG Zucheng,LUO Laimin,et al.The clinical use of Edinburgh Postnatal Depression Scale[J].Shanghai Archives of Psychiatry,2001,13(4):219-221.
[19]沙婷婷,颜艳,高晓,等.基于结构方程模型探讨长沙市开福区产妇产后抑郁现状及其影响因素[J].中南大学学报(医学版),2017,42(10):1191-1197.SHA Tingting,YAN Yan,GAO Xiao,et al.Influential factors for postpartum depression based on the structural equation model in Kaifu District in Changsha[J].Journal of Central South University.Medical Science,2017,42(10):1191-1197.
[20]庞学红,滕越,王杰,等.北京市妇女产后体重滞留的影响因素调查[J].卫生研究,2016,45(1):111-113.PANG Xuehong,TENG Yue,WANG Jie,et al.Analysis of urban and rural women postpartum weight retention and influencing factors[J].Journal of Hygiene Research,2016,45(1):111-113.
[21]杨建洲,陈云霞,宋雯霞,等.山西东南部地区妇女产后体重滞留现状及影响因素[J].中国公共卫生,2018,34(7):946-948.YANG Jianzhou,CHEN Yunxia,SONG Wenxia,et al.Prevalence and influencing factors of postpartum weight retention among women in southeastern Shanxi province[J].Chinese Journal of Public Health,2018,34(7):946-948.
[22]Kac G,Benicio MH,Velasquez-Melendez G,et al.Gestational weight gain and prepregnancy weight influence postpartum weight retention in a cohort of brazilian women[J].J Nutr,2004,134(3):661-666.
[23]He X,Zhu M,Hu C,et al.Breast-feeding and postpartum weight retention:a systematic review and meta-analysis[J].Public Health Nutr,2015,18(18):3308-3316.
[24]秦凤云,罗艳,胡传来,等.产妇久坐行为对产后一年体重滞留影响的研究[J].中华流行病学杂志,2015,36(7):743-746.QIN Fengyun,LUO Yan,HU Chuanlai,et al.Influence of sedentary behavior on weight retention among postpartum women within one year after childbirth[J].Chinese Journal of Epidemiology,2015,36(7):743-746.
[25]Tzeng YL,Chen SL,Chen CF,et al.Sleep trajectories of women undergoing elective cesarean section:Effects on body weight and psychological well-being[J].PLoS One,2015,10(6):e129094.
[26]Natamba BK,Sanchez SE,Gelaye B,et al.Concordance between selfreported pre-pregnancy body mass index(BMI)and BMI measured at the first prenatal study contact[J].BMC Pregnancy Childbirth,2016,16(1):187.
[27]Gunderson EP,Abrams B.Epidemiology of gestational weight gain and body weight changes after pregnancy[J].Epidemiol Rev,2000,22(2):261-274.