孕期个体化运动指导对初产妇分娩方式的影响

The effect of individualized exercise guidance during pregnancy on the mode of delivery in primipara

摘要

目的 探究孕期个体化运动指导对初产妇分娩方式的影响及可能的影响机制。方法 招募2021年12月至2022年9月于河北省邢台市信都区中心医院规律产检及分娩的初产妇,排除伴有妊娠合并症和并发症、运动禁忌症者,共纳入160名孕妇,随机数表法分成干预组和对照组。两组孕妇均接受常规产科护理和健康宣教,干预组在此基础上接受专业老师制定的个体化运动方案。主要结局指标为分娩方式。结果 干预组的剖宫产率为13.92%,对照组为34.18%,差异具有统计学意义(χ²=7.80,P<0.05)。干预组的妊娠期平均体重增长值为(11.71±2.69)kg,对照组为(14.60±5.06)kg,干预组的妊娠期体重增长过度的发生率为26.58%,对照组为56.96%,差异均具有统计学意义(χ²=15.02,P<0.05)。通过中介效应模型,发现分娩意愿介导了孕期个体化运动指导对分娩方式的影响(Z_m=1.86,P<0.05)。结论 孕期个体化运动指导不仅有助于降低剖宫产率,还可以控制孕期体重合理增长,分娩意愿可能是运动干预降低剖宫产率的中介因素。

Abstract

Objective To explore the impact of individualized exercise guidance during pregnancy on the mode of delivery in primiparas and its potential mechanisms. Methods A total of 160 primiparas who had regular prenatal check-ups and deliveries at Xindu District Central Hospital of Xingtai City, Hebei Province were recruited from December 2021 to September 2022. Those with pregnancy complications, comorbidities, or contraindications to exercise were excluded. The participants were randomly divided into an intervention group and a control group using a random number table. Both groups of pregnant women received routine obstetric care and health education, and the intervention group received individualized exercise programs formulated by professional teachers on this basis. The primary outcome was the mode of delivery. Results The cesarean section rate in the intervention group was 13.92%, compared to 34.18% in the control group, with a statistically significant difference (χ²=7.80, P<0.05). The average weight gain during pregnancy was 11.71±2.69 kg in the intervention group and 14.60±5.06 kg in the control group. The incidence of excessive weight gain during pregnancy was 26.58% in the intervention group and 56.96% in the control group, both showing statistically significant differences (χ²=15.02, P<0.05). A mediation effect model revealed that delivery intention mediated the impact of individualized exercise guidance on the mode of delivery (Z_m=1.86, P<0.05). Conclusion Individualized exercise guidance during pregnancy can not only reduce the rate of cesarean section, but also control the reasonable increase of pregnancy weight. Delivery intention may serve as a mediating factor in the effect of exercise intervention on reducing the cesarean section rate.

关键词

妊娠期 / 运动干预 / 初产妇 / 剖宫产 / 中介效应

Key words

pregnancy period / exercise intervention / primipara / caesarean section / mediating effect

参考文献

[1] Li H T, Hellerstein S, Zhou Y B, et al. Trends in cesarean delivery rates in China, 2008-2018[J]. JAMA, 2020, 323(1): 89-91.

[2] Betran A P, Torloni M R, Zhang J J, et al. WHO statement on caesarean section rates[J]. BJOG, 2016, 123(5): 667-670.

[3] 阮焱, 张为远. 剖宫产的现状及剖宫产率高居不下的原因[J]. 实用妇产科杂志, 2015, 31(4): 241-243.

[4] Weibel S, Neubert K, Jelting Y, et al. Incidence and severity of chronic pain after caesarean section: a systematic review with meta-analysis[J]. Eur J Anaesthesiol, 2016, 33(11): 853-865.

[5] Owe K M, Nystad W, Stigum H, et al. Exercise during pregnancy and risk of cesarean delivery in nulliparous women: a large population-based cohort study[J]. Am J Obstet Gynecol, 2016, 215(6): 791.e1-791.e13.

[6] Teede H J, Bailey C, Moran L J, et al. Association of antenatal diet and physical activity-based interventions with gestational weight gain and pregnancy outcomes: a systematic review and meta-analysis[J]. JAMA Intern Med, 2022, 182(2): 106-114.

[7] 中国妇幼保健协会妊娠合并糖尿病专业委员会, 中华医学会妇产科学分会产科学组. 妊娠期运动专家共识(草案)[J]. 中华围产医学杂志, 2021, 24(9): 641-645.

[8] Syed H, Slayman T, DuChene Thoma K. ACOG committee opinion No. 804: physical activity and exercise during pregnancy and the postpartum period[J]. Obstet Gynecol, 2021, 137(2): 375-376.

[9] Borg G A. Psychophysical bases of perceived exertion[J]. Med Sci Sports Exerc, 1982, 14(5): 377-381.

[10] 中华人民共和国国家卫生健康委员会. «妊娠期妇女体重增长推荐值标准»[EB/OL]. http://www.nhc.gov.cn/wjw/fyjk/202208/864ddc16511148819168305d3e576de9.shtml, 2022-8-18/2023-10-19.

[11] 叶琪, 赵志玲, 魏占超. 孕期运动门诊背景下孕中晚期孕妇的运动干预及效果研究[J]. 四川医学, 2022, 43(11): 1061-1065.

[12] Baron R M, Kenny D A. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations[J]. J Pers Soc Psychol, 1986, 51(6): 1173-1182.

[13] Mackinnon D P, Cox M C. Commentary on “mediation analysis and categorical variables: the final frontier” by dawn Iacobucci[J]. J Consum Psychol, 2012, 22(4): 600-602.

[14] Mottola M F, Davenport M H, Ruchat S M, et al. 2019 Canadian guideline for physical activity throughout pregnancy[J]. Br J Sports Med, 2018, 52(21): 1339-1346.

[15] 杨俊娟, 郭华峰, 张新华, 等. 孕妇对盆底功能认知度及分娩方式选择情况的调查分析[J]. 中国妇幼健康研究, 2018, 29(7): 940-943.

[16] 简玉辉. 剖宫产与自然分娩产妇产后生活质量比较[J]. 中国妇幼健康研究, 2019, 30(1): 115-118.

[17] 韩璐阳, 陈丹青. 孕期运动研究进展[J]. 国际妇产科学杂志, 2016, 43(5): 556-560.

[18] Zhao Y, Wu J, Yang H, et al. Factors associated with childbirth self-efficacy: a multicenter cross-sectional study in China[J]. Midwifery, 2021, 93: 102883.

[19] 高辉. 分娩自我效能理论在初产妇分娩中的应用[J]. 中华现代护理杂志, 2015, 21(2): 176-178.

[20] Lowe N K. Maternal confidence for labor: development of the childbirth self-efficacy inventory[J]. Research in Nursing & Health, 1993, 16(2): 141-149.

[21] Salomonsson B, Gullberg M T, Alehagen S, et al. Self-efficacy beliefs and fear of childbirth in nulliparous women[J]. J Psychosom Obstet Gynaecol, 2013, 34(3): 116-121.

基金资助

中国医学科学院医学与健康科技创新工程项目(2020-I2M-2-009)

中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-023)

中国医学科学院中央级公益性科研院所基本科研业务费临床与转化医学研究基金项目(2019XK320007)