Yeo SeonAe, Crandell Jamie L, Jones-Vessey Kathleen
1 School of Nursing, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
2 Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
J Womens Health (Larchmt). 2016 Feb;25(2):117-23. doi: 10.1089/jwh.2015.5468. Epub 2016 Jan 7.
The goal of prenatal care is to maximize health outcomes for a woman and her fetus. We examined how prenatal care is associated with meeting the 2009 Institute of Medicine (IOM) guidelines for gestational weight gain.
The study used deidentified birth certificate data supplied by the North Carolina State Center for Health Statistics. The sample included 197,354 women (≥18 years) who delivered singleton full-term infants in 2011 and 2012.
A generalized multinomial model was used to identify how adequate prenatal care was associated with the odds of gaining excessive or insufficient weight during pregnancy according to the 2009 IOM guidelines. The model adjusted for prepregnancy body size, sociodemographic factors, and birth weight.
A total of 197,354 women (≥18 years) delivered singleton full-term infants. The odds ratio (OR) for excessive weight gain was 2.44 (95% CI 2.37-2.50) in overweight and 2.33 (95% CI 2.27-2.40) in obese women compared with normal weight women. The OR for insufficient weight gain was 1.15 (95% CI 1.09-1.22) for underweight and 1.34 (95% CI 1.30-1.39) for obese women compared with normal weight women. Prenatal care at the inadequate or intermediate levels was associated with insufficient weight gain (OR: 1.32, 95% CI 1.27-1.38; OR: 1.15, 95% CI 1.09-1.21, respectively) compared with adequate prenatal care. Women with inadequate care were less likely to gain excessive weight (OR: 0.88, 95% CI 0.86-0.91).
Whereas prenatal care was effective for preventing insufficient weight gain regardless of prepregnancy body size, educational background, and racial/ethnic group, there were no indications that adequate prenatal care was associated with reduced risk for excessive gestational weight gain. Further research is needed to improve prenatal care programs for preventing excess weight gain.
产前护理的目标是使孕妇及其胎儿的健康结果最大化。我们研究了产前护理与达到2009年医学研究所（IOM）关于孕期体重增加指南之间的关联。
该研究使用了北卡罗来纳州卫生统计中心提供的匿名出生证明数据。样本包括197354名在2011年和2012年分娩单胎足月婴儿的18岁及以上女性。
使用广义多项模型来确定根据2009年IOM指南，充分的产前护理与孕期体重增加过多或不足的几率之间的关联。该模型对孕前身体大小、社会人口学因素和出生体重进行了调整。
共有197354名18岁及以上女性分娩了单胎足月婴儿。与体重正常的女性相比，超重女性体重增加过多的优势比（OR）为2.44（95%CI 2.37 - 2.50），肥胖女性为2.33（95%CI 2.27 - 2.40）。与体重正常的女性相比，体重过轻女性体重增加不足的OR为1.15（95%CI 1.09 - 1.22），肥胖女性为1.34（95%CI 1.30 - 1.39）。与充分的产前护理相比，不足或中等水平的产前护理与体重增加不足相关（OR分别为：1.32，95%CI 1.27 - 1.38；1.15，95%CI 1.09 - 1.21）。护理不足的女性体重增加过多的可能性较小（OR：0.88，95%CI 0.86 - 0.91）。
尽管无论孕前身体大小、教育背景和种族/族裔群体如何，产前护理在预防体重增加不足方面都有效，但没有迹象表明充分的产前护理与降低孕期体重增加过多的风险相关。需要进一步研究以改进预防体重增加过多的产前护理项目。
