妊娠期体重增加不当对孕产妇及其婴儿不良结局的影响--一项早产孕产妇队列的多中心回顾性研究

Effect of improper weight gain during pregnancy on adverse outcomes of pregnant women and their infants:a multicenter retrospective study of a cohort of preterm pregnant women

摘要

目的 评估妊娠期体重增加(GWG)不当与早产孕妇不良母婴结局及早产儿并发症发生风险之间的关系。方法 采用多中心回顾性队列研究设计,收集2023年1月至2024年12月期间于新疆地区共5家医院收治的早产孕妇及其新生儿临床资料。按照孕妇GWG情况分为GWG适宜组(n=1 508)、GWG过少组(n=455)和GWG过多组(n=858),以GWG适宜组为参照组,建立多元逻辑回归模型分析GWG对不良母婴结局及早产儿严重并发症的影响。结果 GWG过多组孕妇的平均年龄高于GWG过少及适宜组(F值为5.017,P<0.05)。GWG适宜组孕妇的孕周高于GWG过少及过多组(H值为113.115,P<0.05)。GWG过多组发生剖宫产(aOR:1.370,95%CI:1.070~1.754)、妊娠期高血压(aOR:1.337,95%CI:1.083~1.652)和先兆子痫(aOR:1.230,95%CI:1.018~1.486)、妊娠期糖尿病(aOR:1.335,95%CI:1.049~1.698)的风险增加(P<0.05)。GWG过少人群发生先兆子痫(aOR:0.743,95%CI:0.574~0.963)的风险降低(P<0.05)。GWG过多组、GWG过少组早产儿在出生体重、身长、头围方面与GWG适宜组相比均较小,差异具有统计学意义(H值分别为108.003、76.862、89.875,P<0.05)。与GWG适宜组相比较,GWG过多组早产儿发生早发败血症的风险增加了66.2%(aOR:1.662,95%CI:1.255~2.202),发生中重度支气管肺发育不良的风险增加了74.6%(aOR:1.746,95%CI:1.149~2.654)。结论 妊娠期体重增加过多人群的妊娠期高血压、剖宫产、先兆子痫及妊娠期糖尿病的发生风险增加。孕期需加强体重管理以改善不良妊娠结局的发生风险。

Abstract

Objective The relationship between improper gestational weight gain (GWG) and adverse maternal and neonatal outcomes and the risk of severe complications in preterm infants among preterm pregnant women. Methods A multicenter retrospective cohort study design was adopted to collect clinical data of preterm pregnant women and their newborns from 5 hospitals in Xinjiang region from January 2023 to December 2024.The pregnant women were divided into the GWG appropriate group (n=1 508),the GWG insufficient group (n=455),and the GWG excessive group (n=858).The GWG appropriate group was used as the reference group,and a multiple logistic regression model was established to analyze the impact of GWG on adverse maternal and neonatal outcomes and severe complications in preterm infants. Results The average age of pregnant women in the GWG excessive group was higher than that in the GWG insufficient and appropriate groups (F=5.017,P<0.05).The gestational weeks of pregnant women in the GWG appropriate group were higher than those in the GWG insufficient and excessive groups (H=113.115,P<0.05).The risk of cesarean section (aOR=1.370,95%CI:1.070-1.754),gestational hypertension (aOR=1.337,95%CI:1.083-1.652),preeclampsia (aOR=1.230,95%CI:1.018-1.486),and gestational diabetes mellitus (aOR=1.335,95%CI:1.049-1.698,P<0.05) was increased in the GWG excessive group.The risk of preeclampsia in the GWG insufficient group was reduced (aOR=0.743,95%CI:0.574-0.963,P<0.05).The preterm infants in the GWG excessive and GWG insufficient groups had smaller birth weight,length,and head circumference compared to the GWG appropriate group,and the differences were statistically significant (H=108.003,76.862,and 89.875,respectively,P<0.05).Compared with the GWG appropriate group,the risk of early-onset sepsis in preterm infants in the GWG excessive group increased by 66.2% (aOR=1.662,95%CI:1.255-2.202),and the risk of moderate to severe broncho-pulmonary dysplasia increased by 74.6% (aOR=1.746,95%CI:1.149-2.654). Conclusion The risk of gestational hypertension,cesarean section,preeclampsia,and gestational diabetes mellitus in the group with excessive GWG is increased.During pregnancy,weight management should be strengthened to reduce the risk of adverse pregnancy outcomes.

关键词

妊娠期体重增加 / 早产 / 母婴结局 / 并发症

Key words

gestational weight gain / preterm birth / maternal-infant outcomes / complication

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基金资助

新疆维吾尔自治区“天山英才”培养计划医药卫生高层次人才培养项目(TSYC202401A020)