Dubois S, Coulombe C, Pencharz P, Pinsonneault O, Duquette M P
Bureau of Biostatistics and Computer Applications, Health Protection Branch, Health Canada, Ottawa, Ontario, Canada.
J Am Diet Assoc. 1997 Aug;97(8):871-8. doi: 10.1016/S0002-8223(97)00212-5.
To determine the extent to which birth weight can be increased and the risk for adverse pregnancy outcome decreased when pregnant adolescents participated in the Higgins Nutrition Intervention Program; and to describe the dietary components of the program, including their variation as a function of diagnosed risk for adverse pregnancy outcome.
Retrospective cohort study involving review of medical charts.
SUBJECTS/SETTING: Developed as an adjunct to routine prenatal care, the Higgins Nutrition Intervention Program consists of an assessment of each pregnant adolescent's risk profile for adverse pregnancy outcomes and an individualized nutritional rehabilitation program based on that profile. The intervention group for this evaluation consisted of 1,203 pregnant adolescents who participated in the Higgins program at the Montreal Diet Dispensary between 1981 and 1991. The nonintervention group consisted of a randomly selected group of 1,203 pregnant adolescents known not to have participated in the program.
Birth weight; rates of low birth weight, very low birth weight, preterm delivery, fetal growth retardation, perinatal morbidity and mortality; and maternal morbidity.
Means and proportions were used to describe risk profiles and pregnancy outcomes in the two groups. Analysis of covariance and logistic regression were used to compare pregnancy outcomes while controlling for the effect of key confounding variables.
Results from multivariable analyses showed that infants in the intervention group weighed an average of 55 g more (P < .05) than infants in the nonintervention group; their low-birth-weight rate was 39% lower (P < .001) and their very-low-birth-weight rate was 56% lower (P < .01). Individually determined dietary prescriptions for the adolescents in the intervention group recommended increases in daily consumption averaging approximately 900 kcal energy and 52 g protein. The lowest daily increases (approximately 150 kcal energy and 2 g protein) were recommended to the group with no diagnosed risks; the greatest increases (approximately 1,300 kcal energy and 76 g protein) were recommended to the group with multiple risk conditions. Although none of the risk/intervention groups achieved their prescribed increases during intervention, increases in actual intake generally followed the pattern of the prescribed increases; that is, the greater the prescribed increase, the greater the actual increase.
These results suggest that the Higgins Nutrition Intervention Program, in which nutrition intervention is individualized as a function of diagnosed risk, significantly improves the outcome of adolescent pregnancy.
确定怀孕青少年参与希金斯营养干预项目时出生体重能增加的程度以及不良妊娠结局风险降低的程度；并描述该项目的饮食组成部分，包括其随诊断出的不良妊娠结局风险的变化情况。
涉及查阅病历的回顾性队列研究。
研究对象/研究地点：作为常规产前护理的辅助项目开发的希金斯营养干预项目，包括对每位怀孕青少年不良妊娠结局的风险状况进行评估，并基于该状况制定个性化的营养康复计划。本评估的干预组由1981年至1991年间在蒙特利尔饮食诊所参与希金斯项目的1203名怀孕青少年组成。非干预组由随机挑选的1203名已知未参与该项目的怀孕青少年组成。
出生体重；低出生体重、极低出生体重、早产、胎儿生长受限、围产期发病率和死亡率；以及孕产妇发病率。
使用均值和比例来描述两组的风险状况和妊娠结局。在控制关键混杂变量影响的同时，使用协方差分析和逻辑回归来比较妊娠结局。
多变量分析结果显示，干预组婴儿的平均体重比非干预组婴儿重55克（P < 0.05）；其低出生体重率低39%（P < 0.001），极低出生体重率低56%（P < 0.01）。为干预组青少年单独确定的饮食处方建议每日摄入量平均增加约900千卡能量和52克蛋白质。对于未诊断出风险的组，建议的每日最低增加量（约150千卡能量和2克蛋白质）；对于有多种风险状况的组，建议的增加量最大（约1300千卡能量和76克蛋白质）。尽管在干预期间没有一个风险/干预组达到规定的增加量，但实际摄入量的增加总体上遵循规定增加量的模式；也就是说，规定增加量越大，实际增加量就越大。
这些结果表明，希金斯营养干预项目根据诊断出的风险进行个体化营养干预，显著改善了青少年妊娠结局。
