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18省24家医疗机构孕妇妊娠期增重的流行病学特征及与不良妊娠结局关联研究

Epidemiological characteristics of gestational weight gain among Chinese pregnant women and its association with adverse pregnancy outcomes in 24 medical institutions across 18 provinces

    摘要
  • 摘要:
    目的 探讨孕妇妊娠期增重（gestational weight gain，GWG）的流行病学特征和影响因素，分析GWG与不良妊娠结局的关联。
    方法 本研究为回顾性队列研究，研究对象为2019年9月1日至10月31日在18个省（直辖市、自治区）24家医疗机构分娩的低风险妊娠孕妇及其新生儿，根据孕妇孕前体质指数（body mass index，BMI）分为体重过低、正常、超重和肥胖4组，根据地区分为华北、东北、华中、华东、华南、西南、西北7组。采用多重线性回归筛选GWG的影响因素，采用多重logistic回归分析GWG与不良妊娠结局发生的关联。
    结果 共纳入9 075例孕妇，孕前体重过低、体重正常、超重和肥胖孕妇占比分别为17.1%（1 549/9 075）、66.4%（6 025/9 075）、13.7%（1 245/9 075）和2.8%（256/9 075）。孕妇年龄、孕前BMI、文化程度、产次等均与GWG呈负相关（P < 0.05）。GWG的地理分布具有“北高南低”的特征，以华北地区为参照，东北和西北地区的GWG更高，华中、华东、华南和西南地区的GWG则更低。GWG与大于胎龄儿和剖宫产的风险呈正相关，与小于胎龄儿的发生风险呈负相关。
    结论 GWG会受到孕妇个体特征的影响，调查人群孕前BMI和GWG具有显著的“北高南低”特征，GWG与多种不良围产结局显著相关。因此，在制定我国妊娠期适宜增重范围时，需要充分考虑GWG的流行病学特征，建立更加科学合理的妊娠期增重推荐范围。同时也需要科学调整孕妇妊娠期饮食结构，提倡适当运动，控制孕期增重，以降低不良妊娠结局的发生风险。

     

    Abstract:
    Objective To explore the epidemiological characteristics and influencing factors of gestational weight gain (GWG) among Chinese pregnant women, and to analyze the association between GWG and adverse pregnancy outcomes.
    Methods This retrospective cohort study included low-risk pregnant women and their newborns delivered between September 1 and October 31, 2019, at 24 hospitals across 18 provinces (municipality, autonomous region) in China. The participants were divided into 4 groups of underweight, normal weight, overweight, and obesity based on their pre-pregnancy body mass index (BMI), and 7 groups of north, northeast, central, east, south, southwest, and northwest China based on region, respectively. Multivariable linear regression was used to identify the influencing factors of GWG. Multivariable logistic regression was used to analyze the association between GWG and the occurrence of adverse pregnancy outcomes.
    Results A total of 9 075 pregnant women were included in this study. The percentage of pre-pregnancy underweight, normal weight, overweight and obese pregnant women were 17.1% (1 549/9 075), 66.4% (6025/9 075), 13.7% (1 245/9 075), and 2.8% (256/9 075), respectively. Age, pre-pregnancy BMI, education level, and parity were negatively associated with GWG. The geographical distribution of GWG was characterized by "high in the north and low in the south". With north China as the reference, there was higher GWG in northeast and northwest China, and lower GWG in central, east, south and southwest China. GWG was positively associated with the risk of cesarean section in large for gestational age infants, but negatively correlated with the risk of cesarean section in small for gestational age infants.
    Conclusion GWG was influenced by maternal individual characteristics. Both pre-pregnancy BMI and GWG were significantly higher in the north and lower in the south in the surveyed population. GWG was significantly associated with various adverse perinatal outcomes. Therefore, it is essential to take into account the epidemiological characteristics of GWG when formulating appropriate GWG recommendations in China, so as to establish a more scientific and reasonable recommended range of GWG. In addition, it is necessary to scientifically adjust the dietary structure, promote appropriate exercise, and manage GWG in order to reduce the risk of adverse pregnancy outcomes.

     

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