[关于美国医学研究所2009年妊娠期间体重增加指南对中国足月单胎妊娠妇女临床适用性的调查]
[Investigation into the clinical suitability of Institute of Medicine 2009 guidelines regarding weight gain during pregnancy for women with full term singleton fetus in China].
作者信息
Yang Yan-dong, Yang Hui-xia
机构信息
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
出版信息
Zhonghua Fu Chan Ke Za Zhi. 2012 Sep;47(9):646-50.
OBJECTIVE
To study whether the current Institute of Medicine (IOM) pregnancy weight gain recommendations vary by pre-pregnancy body mass index (BMI) was suitable to Chinese people.
METHODS
A study was conducted on 4736 term singleton live birth gravidas, who were diagnosed normal glucose metabolism and delivered in Peking University First Hospital in 2005 and 2009, by reviewing the medical records. Based on the pre-pregnant BMI, the selected cases were divided into 3 groups: low body mass group (BMI < 18.5 kg/m(2), n = 465), normal body mass group (BMI 18.5 - 24.9 kg/m(2), n = 3549), over body mass group (BMI ≥ 25 kg/m(2), n = 722). All the cases were divided into 3 subgroups based on pregnancy weight gain as below, within, and above the IOM recommendations in each pre-pregnant BMI group. Totally 4736 newborns were divided by birth weight into 3 groups: normal birth weight group (weight 2500 - 4000 g, n = 4339), macrosomia group (weight ≥ 4000 g, n = 359) and low birth weight group (weight < 2500 g, n = 38). The difference of age, gestational age, pre-pregnant weight, pre-pregnant BMI and history of delivery of cases between 2005 and 2009 were analyzed. The difference of pregnancy outcome of women whose gestational weight gain was below, within, and above the IOM recommendations was analyzed.
RESULTS
(1) Compared to mothers with pregnancy weight gain within IOM recommendations in low body mass group, risk of low birth weight in offspring was elevated tendency with pregnancy weight gain below IOM recommendations (OR = 3.71, 95%CI: 0.97 - 14.12, P = 0.055). (2) In normal body mass group, compared to women with pregnancy weight gain within IOM recommendations, risk of macrosomia in offspring was elevated with pregnancy weight gain above IOM recommendations (OR = 2.14, 95%CI: 1.62 - 2.83, P < 0.01). (3) In over body mass group, compared to women with pregnancy weight gain within IOM recommendations, risk of macrosomia in offspring was elevated (OR = 3.25, 95%CI: 1.65 - 6.39, P = 0.001) and risk of hypertensive disorders complicating pregnancy was high (OR = 1.79, 95%CI: 1.04 - 3.09, P = 0.037) in women with pregnancy weight gain above IOM recommendations.
CONCLUSION
The current IOM pregnancy weight gain recommendations vary by pre-pregnancy BMI may be suitable to Chinese people.
目的
研究美国医学研究所（IOM）目前的孕期体重增加建议是否因孕前体重指数（BMI）而异，是否适用于中国人。
方法
通过查阅病历，对2005年和2009年在北京大学第一医院分娩的4736例足月单胎活产孕妇进行研究，这些孕妇被诊断为糖代谢正常。根据孕前BMI，将入选病例分为3组：低体重组（BMI<18.5kg/m²，n = 465）、正常体重组（BMI 18.5 - 24.9kg/m²，n = 3549）、超重组（BMI≥25kg/m²，n = 722）。在每个孕前BMI组中，根据孕期体重增加情况将所有病例分为低于、符合和高于IOM建议的3个亚组。4736例新生儿按出生体重分为3组：正常出生体重组（体重2500 - 4000g，n = 4339）、巨大儿组（体重≥4000g，n = 359）和低出生体重组（体重<2500g，n = 38）。分析2005年和2009年病例的年龄、孕周、孕前体重、孕前BMI和分娩史的差异。分析孕期体重增加低于、符合和高于IOM建议的女性的妊娠结局差异。
结果
（1）与低体重组中孕期体重增加符合IOM建议的母亲相比，孕期体重增加低于IOM建议的后代低出生体重风险有升高趋势（OR = 3.71，95%CI：0.97 - 14.12，P = 0.055）。（2）在正常体重组中，与孕期体重增加符合IOM建议的女性相比，孕期体重增加高于IOM建议的后代巨大儿风险升高（OR = 2.14，95%CI：1.62 - 2.83，P<0.01）。（3）在超重组中，与孕期体重增加符合IOM建议的女性相比，孕期体重增加高于IOM建议的女性后代巨大儿风险升高（OR = 3.25，95%CI：1.65 - 6.39，P = 0.001），妊娠合并高血压疾病风险也较高（OR = 1.79，95%CI：1.04 - 3.09，P = 0.037）。
结论
目前IOM根据孕前BMI制定的孕期体重增加建议可能适用于中国人。
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