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目的探讨上海地区产妇孕期体重增长的适宜范围及其与出生体重之间的关系。方法收集上海交通大学医学院附属仁济医院产科和上海市长宁区妇幼保健院产科分娩的自然妊娠、单胎、足月产产妇资料。采集孕妇自身指标(年龄、孕周、文化程度、身高、孕前体重、分娩前体重、受孕方式、产次、既往疾病史)和胎儿指标(出生孕周、分娩方式、胎儿性别、出生体重、出生身长)。体质指数(body mass index,BMI)=体重(kg)/身高(m)2。孕妇妊娠前BMI≥24.0 kg/m2为超重,<18.4 kg/m2为低体重。足月分娩胎儿出生体重4 000 g为巨大儿。结果共收集1 103人产妇纳入本研究(低体重组192人、正常体重组761人、超重组150人)。巨大儿总发生率为6.3%。随着产妇年龄的增加,BMI也逐步升高。低体重组和正常体重组孕期体重增长明显高于超重组产妇,前两组之间无明显差异低体重组(15.4±4.3)kg、正常体重组(15.5±5.1)kg、超重组(13.0±6.0)kg;虽然超重组产妇体重增长较少,但胎儿出生体重却明显高于其他2组产妇低体重组(3 261.2±341.9)g、正常体重组(3 387.9±383.7)g、超重组(3 469.6±408.2)g。低体重组孕妇自然分娩率最高(57.8%),其次为正常体重组(48.6%),超重组最低(40.0%)。采用四分位数方法,孕前低体重组和正常体重组的孕期体重适宜增长范围为12.0~18.5 kg,超重组则为9.0~16.0 kg。二项Logistic回归分析显示孕前BMI和孕期体重增长是巨大儿发生的危险因素。结论孕前BMI和孕期体重增长是巨大儿发生的危险因素。控制孕前BMI和孕期体重增长才能有效降低巨大儿的发生。
Objective To investigate the appropriate range of weight gain during pregnancy in Shanghai and its relationship with birth weight. Methods The data of natural pregnancy, single birth and full-term labor were collected from obstetrics and gynecology department of Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and maternity and child care center of Changning District of Shanghai. The pregnant women ’s own indexes (age, gestational age, educational level, height, body weight before pregnancy, body weight before delivery, mode of pregnancy, birth time and past disease history) and fetus indicators (gestational age at birth, mode of delivery, fetal sex, height). Body mass index (BMI) = weight (kg) / height (m) 2. Pregnant women before pregnancy BMI ≥ 24.0 kg / m2 is overweight, <18.4 kg / m2 is low body weight. Full-term childbirth birth weight of 4 000 g for the giant children. Results A total of 1 103 maternal women were enrolled in this study (192 in the low body weight group, 761 in the normal body weight group and 150 in the overweight group). The overall incidence of huge children was 6.3%. With the increase of maternal age, BMI also gradually increased. The weight gain of pregnant women in low-weight group and normal weight group was significantly higher than that of over-weight group (15.4 ± 4.3) kg, normal weight group (15.5 ± 5.1) kg and overweight group (13.0 ± 6.0) kg; while the weight gain of the overweight group was less, the birth weight of the fetus was significantly higher than that of the other 2 groups (3 261.2 ± 341.9 g), normal body weight group (3 387.9 ± 383.7 g), overweight group 3 469.6 ± 408.2) g. Low birth weight pregnant women, the highest rate of natural delivery (57.8%), followed by the normal weight group (48.6%), the lowest overweight group (40.0%). With the quartile method, pre-pregnancy low-weight group and normal weight group gestational weight range for the 12.0 ~ 18.5 kg, overweight group was 9.0 ~ 16.0 kg. Logistic regression analysis showed that pre-pregnancy BMI and weight gain during pregnancy were risk factors for macrosomia. Conclusion The pre-pregnancy BMI and weight gain during pregnancy are risk factors for macrosomia. Control of pre-pregnancy BMI and pregnancy weight gain can effectively reduce the occurrence of giant children.