膳食与运动管理对超重和肥胖孕妇妊娠结局的影响
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摘要
目的探讨膳食与运动管理在超重和肥胖孕妇中的应用效果及对妊娠结局的影响。方法选择2017年1月-2018年1月在九江市妇幼保健院建档保健且孕前体质指数(BMI)≥24 kg/m2单胎孕妇120例,按随机数字法分为对照组60例和观察组60例。对照组采用普通孕期宣教,观察组接受个体化指导,包括膳食运动管理,分娩后对管理效果进行评估。记录并统计两组剖宫产、阴道助产、自然分娩及流产率,死胎、早产儿、低体质量出生儿、巨大儿、新生儿窒息及产后出血发生率,孕期增重、新生儿体质量、身长、1 min及5 min Apgar评分,采用SPSS Pearson相关性分析软件对肥胖与妊娠结局进行相关性分析,比较两组干预效果及对妊娠结局的影响。结果观察组剖宫产、流产率均低于对照组(P<0. 05);观察组自然分娩率高于对照组(P<0. 05);观察组早产儿、低体质量出生儿、巨大儿、新生儿窒息及产后出血发生率均低于对照组(P<0. 05);两组新生儿体质量、身长、1 min及5 min Apgar评分比较差异无统计学意义(P>0. 05);观察组孕期增重小于对照组(P<0. 05)。SPSS Pearson相关性分析结果表明:肥胖与低体质量出生儿、巨大儿、新生儿窒息及产后出血呈正相关性(P<0. 05)。结论膳食与运动管理用于超重和肥胖孕妇中有助于改善妊娠结局,降低剖宫产率,值得推广应用。
Objective To investigate the effects of diet and exercise management on overweight and obese pregnant women and its effect on pregnancy outcomes. Methods From Jan. 2017 to Jan. 2018,120 cases of pregnant women with single-item birth weight BMI ≥24 kg/m2 were enrolled and divided into control group( n = 60) and observation group( n = 60). The control group was given ordinary prenatal education,and the observation group was treated with individualized guidance,including dietary and pregnancy exercise management,and the management effect was evaluated after delivery. Record,the cesarean section,vaginal delivery,natural delivery and miscarriage rate of all the subjects were counted; the incidence of stillbirth,premature infants,low birth weight infants,macrosomia,neonatal asphyxia,and postpartum hemorrhage were recorded. The weight gain during pregnancy,neonatal weight,length,and 1 min and 5 min Apgar scores were all recorded. SPSS Pearson correlation analysis was used to analyze the correlation between obesity and pregnancy outcomes,and compare the effects of two groups. Results The cesarean section and miscarriage rate in observation group were lower than those in control group( P<0. 05). The natural delivery rate in observation group was higher than that in control group( P<0. 05). The incidences of preterm infants,low-birth-weight infants,macrosomia,neonatal asphyxia and postpartum hemorrhage in observation group was lower than those of control group( P<0. 05); there were no significant differences in the weight,length,1 min and 5 min Apgar scores between the two groups( P>0. 05); In observation group,weight less was less than that of control group( P< 0. 05). Obesity was positively correlated with low birth weight infants,macrosomia,neonatal asphyxia,and postpartum hemorrhage( P<0. 05). Conclusion Diet and exercise management could be used to improve pregnancy outcomes and reduce cesarean section rate in overweight and obese pregnant women. It is worthy of popularization and application.
Objective To investigate the effects of diet and exercise management on overweight and obese pregnant women and its effect on pregnancy outcomes. Methods From Jan. 2017 to Jan. 2018,120 cases of pregnant women with single-item birth weight BMI ≥24 kg/m2 were enrolled and divided into control group( n = 60) and observation group( n = 60). The control group was given ordinary prenatal education,and the observation group was treated with individualized guidance,including dietary and pregnancy exercise management,and the management effect was evaluated after delivery. Record,the cesarean section,vaginal delivery,natural delivery and miscarriage rate of all the subjects were counted; the incidence of stillbirth,premature infants,low birth weight infants,macrosomia,neonatal asphyxia,and postpartum hemorrhage were recorded. The weight gain during pregnancy,neonatal weight,length,and 1 min and 5 min Apgar scores were all recorded. SPSS Pearson correlation analysis was used to analyze the correlation between obesity and pregnancy outcomes,and compare the effects of two groups. Results The cesarean section and miscarriage rate in observation group were lower than those in control group( P<0. 05). The natural delivery rate in observation group was higher than that in control group( P<0. 05). The incidences of preterm infants,low-birth-weight infants,macrosomia,neonatal asphyxia and postpartum hemorrhage in observation group was lower than those of control group( P<0. 05); there were no significant differences in the weight,length,1 min and 5 min Apgar scores between the two groups( P>0. 05); In observation group,weight less was less than that of control group( P< 0. 05). Obesity was positively correlated with low birth weight infants,macrosomia,neonatal asphyxia,and postpartum hemorrhage( P<0. 05). Conclusion Diet and exercise management could be used to improve pregnancy outcomes and reduce cesarean section rate in overweight and obese pregnant women. It is worthy of popularization and application.
引文
[1]张彩霞,鲁影,徐铭,等.东莞市孕中期妇女膳食营养状况与妊娠结局的追踪研究[J].卫生研究, 2016, 45(4):670-676.
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[6]王丽萍,黄金,杨卉.口服葡萄糖耐量试验不同时间点血糖水平对妊娠期糖尿病诊断结果的差异及妊娠结局的影响研究[J].中国全科医学,2016,19(32):3918-3922.
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[11]邱静,佟志刚,裘晓华.孕期抗菌药物对孕妇妊娠结局影响分析[J].中华医院感染学杂志,2017,27(1):175-178.
[12] Wang C,Wei Y,Zhang X,et al. Effect of regular exercise commenced in early pregnancy on the incidence of gestational diabetes mellitus in overweight and obese pregnant women:A randomized controlled trial[J]. Diabetes Care,2016,39(10):e163.
[13]赵敏,郑文捷,李晓东,等.黄体酮注射液与阴道缓释凝胶对实施体外受精与胚胎移植技术孕妇妊娠结局的影响比较:Meta分析[J].福建医科大学学报,2017,51(1):61-67.
[14]苏敏,张映辉,劳力,等.围产期孕妇B群链球菌感染对妊娠结局影响分析[J].中华医院感染学杂志,2016,26(20):4701-4703.
[15]杨建敏,冯磊,张辉,等.妊娠期高血压孕妇宫颈感染对妊娠结局及术后感染的影响[J].中华医院感染学杂志,2017,27(12):2805-2808.
[16] Gomez-Arango LF,Barrett HL,Mcintyre HD,et al. Connections between the gut microbiome and metabolic hormones in early pregnancy in overweight and obese women[J]. Diabetes,2016,65(8):2214.
[17]张泽琛,滕越,王杰,等.营养干预对妊娠期糖尿病患者体重与妊娠结局的影响[J].卫生研究,2016,45(2):337-340.
[18]谢俊豪,刘玉环,黄勤.妊娠期低甲状腺素血症对妊娠结局影响的回顾性分析[J].解放军医学杂志,2017,42(3):211-216.
[19]杨小兰,李娟,李伟强,等.围产期孕妇感染B群链球菌对母婴预后的临床影响研究[J].中华医院感染学杂志,2016,26(20):4698-4700.
[20]刘新华,易念华,游川,等.运动干预对孕妇身心健康状况影响的研究[J].中国体育科技,2016,52(1):60-67.
[2]赵明,李光辉.规范化管理和治疗的妊娠期糖尿病与巨大儿发生风险的关系研究[J].中国全科医学,2016,19(26):3140-3143.
[3] Flynn AC,Dalrymple K,Barr S,et al. Dietary interventions in overweight and obese pregnant women:a systematic review of the content,delivery,and outcomes of randomized controlled trials[J].Nut Rev,2016,74(5):312-328.
[4]李利平,姜宏卫,庞秋霞,等.国际糖尿病与妊娠研究组标准对妊娠期糖尿病患者母婴结局的影响[J].中国糖尿病杂志,2016,24(5):416-418.
[5]徐一鸣,韩宁,刘琰,等.孕妇生殖道B族链球菌感染对妊娠结局的影响研究[J].中华医院感染学杂志,2016,26(9):2128-2130.
[6]王丽萍,黄金,杨卉.口服葡萄糖耐量试验不同时间点血糖水平对妊娠期糖尿病诊断结果的差异及妊娠结局的影响研究[J].中国全科医学,2016,19(32):3918-3922.
[7]张菲菲,程海东,王春芳.孕前体质指数及孕期体重增长对妊娠过程及结局的影响[J].现代妇产科进展,2017,26(10):756-759.
[8] Bradford BF,Thompson J,Heazell AEP,et al. Understanding the associations and significance of fetal movements in overweight or obese pregnant women:a systematic review[J]. Acta Obstet Gynecol Scand,2018,97(1):13-24.
[9]宋月华,蒋湘,刘铭,等. IOM孕期体质量控制标准对上海地区孕妇的适用情况初探[J].实用妇产科杂志,2016,32(6):441-444.
[10]范文,李东娅,杨晓玲,等.生长激素在超重及肥胖不孕患者IVF-ET中的应用价值[J].实用妇产科杂志, 2016, 32(10):774-777.
[11]邱静,佟志刚,裘晓华.孕期抗菌药物对孕妇妊娠结局影响分析[J].中华医院感染学杂志,2017,27(1):175-178.
[12] Wang C,Wei Y,Zhang X,et al. Effect of regular exercise commenced in early pregnancy on the incidence of gestational diabetes mellitus in overweight and obese pregnant women:A randomized controlled trial[J]. Diabetes Care,2016,39(10):e163.
[13]赵敏,郑文捷,李晓东,等.黄体酮注射液与阴道缓释凝胶对实施体外受精与胚胎移植技术孕妇妊娠结局的影响比较:Meta分析[J].福建医科大学学报,2017,51(1):61-67.
[14]苏敏,张映辉,劳力,等.围产期孕妇B群链球菌感染对妊娠结局影响分析[J].中华医院感染学杂志,2016,26(20):4701-4703.
[15]杨建敏,冯磊,张辉,等.妊娠期高血压孕妇宫颈感染对妊娠结局及术后感染的影响[J].中华医院感染学杂志,2017,27(12):2805-2808.
[16] Gomez-Arango LF,Barrett HL,Mcintyre HD,et al. Connections between the gut microbiome and metabolic hormones in early pregnancy in overweight and obese women[J]. Diabetes,2016,65(8):2214.
[17]张泽琛,滕越,王杰,等.营养干预对妊娠期糖尿病患者体重与妊娠结局的影响[J].卫生研究,2016,45(2):337-340.
[18]谢俊豪,刘玉环,黄勤.妊娠期低甲状腺素血症对妊娠结局影响的回顾性分析[J].解放军医学杂志,2017,42(3):211-216.
[19]杨小兰,李娟,李伟强,等.围产期孕妇感染B群链球菌对母婴预后的临床影响研究[J].中华医院感染学杂志,2016,26(20):4698-4700.
[20]刘新华,易念华,游川,等.运动干预对孕妇身心健康状况影响的研究[J].中国体育科技,2016,52(1):60-67.