Department of Nutrition, Aerospace Center Hospital, Beijing, PR China.
Department of Obstetrics and Gynecology, Aerospace Center Hospital, Beijing, PR China.
PeerJ. 2022 Mar 8;10:e13067. doi: 10.7717/peerj.13067. eCollection 2022.
It is unclear whether weight management is still effective for pregnant women with excessive weight gain in the second or third trimester in China. This study adopted individualized weight management intervention for pregnant women with abnormal weight gain in the second or third trimester, to analyze the effect of intervention by observing the gestational weight gain and perinatal outcomes. This randomized controlled trial was performed at Aerospace Center Hospital. The obstetrician determined whether the pregnant women gained too much weight in the second or third trimester according to the Institute of Medicine guidelines, and randomly divided the pregnant women who gained too much weight in the second or third trimester into the intervention group or the control group according to the inclusion and exclusion criteria. The pregnant women in the intervention group and in the control group all received routine prenatal examination and diet nutrition education by the doctors in the Department of Obstetrics and Gynecology. The intervention group underwent individualized weight management, including individualized diet, exercise, psychological assessment, cognitive intervention and continuous communication, the whole process is tracked and managed by professional nutritionists. The obstetrician collected the prenatal examination data and pregnancy outcome data of all enrolled pregnant women. The primary outcome measure was weight gain during pregnancy. A generalized linear model and a logistic regression model were used to compare the outcomes between the two groups. In total, 348 pregnant women participated in this study with 203 in the intervention group and 145 in the control group. The whole gestational weight gain in the intervention group (15.8 ± 5.4 Kg) was lower than that in the control group (17.5 ± 3.6 Kg; adjusted = - 1.644; 95% CI [-2.660--0.627]; = 0.002). The percent of pregnant women with excessive weight gainbefore delivery was 54.2% (110/203) in the intervention group, which was lower than 69.7% (101/145) in the control group (adjusted RR = 0.468; 95% CI [0.284-0.769] = 0.003). The pregnant women given the individualized weight management intervention from the second to the third trimester experienced less weight gain than that from the third trimester (15.5 ± 5.6 Kg 16.2 ± 5.2 Kg), but without significant difference ( = 0.338). Lower rates of GDM, preeclampsia and gestational hypertension, higher rates of fetal distress and puerperal infection were observed in the intervention group than in the control group (all < 0.05). Individualized weight management during the second or third trimesters is still beneficial for pregnant women who gain excessive weight and can decrease the associated adverse outcomes.
在中国，对于孕中期或孕晚期体重增长过多的孕妇，体重管理是否仍然有效尚不清楚。本研究采用个体化体重管理干预措施对孕中期或孕晚期体重增长异常的孕妇进行干预，通过观察妊娠期体重增加和围产结局来分析干预效果。这是一项在航天中心医院进行的随机对照试验。产科医生根据医学研究所的指南判断孕妇在孕中期或孕晚期体重增加是否过多，并根据纳入和排除标准将体重增加过多的孕妇随机分为干预组或对照组。干预组和对照组的孕妇均由妇产科医生进行常规产前检查和饮食营养教育。干预组孕妇接受个体化体重管理，包括个体化饮食、运动、心理评估、认知干预和持续沟通，整个过程由专业营养师进行跟踪和管理。产科医生收集所有入组孕妇的产前检查数据和妊娠结局数据。主要结局指标是孕期体重增加。使用广义线性模型和逻辑回归模型比较两组间的结局。共有 348 名孕妇参与了这项研究，其中干预组 203 名，对照组 145 名。干预组的总妊娠期体重增加（15.8±5.4kg）低于对照组（17.5±3.6kg）；调整后=−1.644；95%置信区间[-2.660--0.627]；=0.002）。干预组孕妇分娩前体重增长过多的比例为 54.2%（110/203），低于对照组的 69.7%（101/145）（调整后的 RR=0.468；95%置信区间[0.284-0.769]；=0.003）。从孕中期到孕晚期接受个体化体重管理干预的孕妇体重增加少于仅从孕晚期接受该干预的孕妇（15.5±5.6kg比 16.2±5.2kg），但差异无统计学意义（=0.338）。干预组孕妇的妊娠期糖尿病、子痫前期和妊娠高血压、胎儿窘迫和产褥感染的发生率低于对照组（均<0.05）。
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