高级检索

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

两次妊娠间体重变化与不良出生结局关联

武丽 刘晴 樊高杰 陈凯 王璐琳 夏建红 王友洁

武丽, 刘晴, 樊高杰, 陈凯, 王璐琳, 夏建红, 王友洁. 两次妊娠间体重变化与不良出生结局关联[J]. 中国公共卫生. doi: 10.11847/zgggws1138312
引用本文: 武丽, 刘晴, 樊高杰, 陈凯, 王璐琳, 夏建红, 王友洁. 两次妊娠间体重变化与不良出生结局关联[J]. 中国公共卫生. doi: 10.11847/zgggws1138312
WU Li, LIU Qing, FAN Gao-jie, . Association of interpregnancy weight change with adverse birth outcome: an analysis based on delivery records of Guangdong province[J]. Chinese Journal of Public Health. doi: 10.11847/zgggws1138312
Citation: WU Li, LIU Qing, FAN Gao-jie, . Association of interpregnancy weight change with adverse birth outcome: an analysis based on delivery records of Guangdong province[J]. Chinese Journal of Public Health. doi: 10.11847/zgggws1138312

两次妊娠间体重变化与不良出生结局关联

doi: 10.11847/zgggws1138312
基金项目: 国家自然科学基金(82073660)
详细信息
    作者简介:

    武丽(1985 – ),女,山东泰安人,副主任医师,研究生,研究方向:妇幼保健

    通讯作者:

    夏建红,E-mail:xixixia58@126.com ;王友洁,E-mail:wangyoujie@mails.tjmu.edu.cn

  • (刘晴为本文并列第一作者)
  • 中图分类号: R 172

Association of interpregnancy weight change with adverse birth outcome: an analysis based on delivery records of Guangdong province

  • 摘要:   目的  探讨妇女连续两次妊娠间孕前体重变化与早产、低出生体重、巨大儿、小于胎龄儿及大于胎龄儿的关系。  方法  基于广东省妇幼卫生信息系统,收集2015 — 2020年具有两次分娩记录的6 589名孕妇及其分娩婴儿的资料,将生育间体质指数(BMI)变化分为4组(<– 1、 – 1~、1~、 ≥ 3),使用logistic回归模型分析两次妊娠间孕前BMI变化与不良出生结局的关联。  结果   本研究纳入的6 589名孕产妇及其子女早产、低出生体重儿、巨大儿、小于胎龄儿、大于胎龄儿的发生率分别为5.6 %、4.7 %、2.4 %、11.4 %和5.4 %。logistic回归结果显示,相对于BMI变化 − 1~的参照组,BMI变化1~组发生巨大儿风险增加66 %(OR = 1.66,95 % CI = 1.13~2.24),BMI变化 ≥ 3组发生巨大儿、大于胎龄儿的风险分别增加131 %(OR = 2.31,95 % CI = 1.42~3.70)、87 %(OR = 1.87,95 % CI = 1.33~2.60)。BMI每增加1,小于胎龄儿风险降低7 %(OR = 0.93,95 % CI = 0.89~0.97)。各组发生早产、低出生体重的风险与对照组相比差异均无统计学意义(P>0.05)。  结论  两次妊娠间体重的增长与巨大儿及大于胎龄儿的风险增加相关。应加强对妇女妊娠期及分娩后的体重管理,以降低二胎巨大儿、大于胎龄儿的发生风险。
    1)  (刘晴为本文并列第一作者)
  • 图  1  两次妊娠间BMI变化与不良出生结局的分层分析

    表  1  两次妊娠间BMI变化分组孕妇及新生儿基本情况

    变量< – 1 – 1~ 1~  ≥ 3P
    人数%人数%人数%人数%
    母亲基本情况
     文化程度 a
      初中及以下52255.5119945.081346.534957.30.821
      高中25326.974728.046526.615225.0
      大学及以上16617.672127.047026.910817.7
     产次 b
      252752.8184263.1120662.440061.10.001
      > 247247.3107736.972637.625538.9
     分娩方式 c
      阴道分娩85285.3244886.4161985.451481.10.029
      剖宫产14714.738713.727614.612018.9
     前一次分娩方式 d
      顺产82686.3244589.1163489.253886.50.639
      剖宫产13113.729910.919810.88410.1
    新生儿基本情况
     新生儿性别
      男性53452.6164055.6110856.534151.50.809
      女性48147.4131244.485243.532148.5
     不良妊娠结局
      早产414.01796.11075.5406.00.219
      低出生体重474.61465.0864.4335.00.985
      巨大儿181.8541.8603.1294.4< 0.001
      小于胎龄儿12212.035612.121210.8629.40.077
      大于胎龄儿494.81394.71085.5578.60.002
     前一次不良妊娠结局
      早产414.01796.11075.5406.00.67
      低出生体重525.11454.91065.4294.40.896
      巨大儿181.8431.5291.5162.40.461
      小于胎龄儿17116.947116.030115.48512.80.025
      大于胎龄儿484.7 1113.7 713.6 253.80.198
      注: a 缺失624例,b 缺失94例,c 缺失226例,d 缺失434例。
    下载: 导出CSV

    表  2  两次妊娠间BMI变化与不良出生结局关联的logistic回归分析

    不良出生结局BMI每增加1两次妊娠间BMI变化P
    OR95 % CI<−1 −1~ 1~  ≥ 3
    OR95 % CI OR95 % CI OR95 % CI OR95 % CI
    早产1.000.95~1.060.720.50~1.03Ref0.860.67~1.080.930.64~1.320.743
    低出生体重0.960.90~1.031.090.76~1.56Ref0.820.61~1.080.950.63~1.410.243
    巨大儿1.211.21~1.300.620.34~1.09Ref1.661.13~2.242.311.42~3.70<0.001
    小于胎龄儿0.930.89~0.971.170.92~1.49Ref0.880.73~1.070.780.57~1.040.008
    大于胎龄儿1.151.09~1.21 0.730.50~1.04 Ref 1.160.89~1.51 1.871.33~2.60<0.001
      注:调整母亲文化程度、分娩时年龄、产次、分娩方式、前一次妊娠孕前BMI、前一次妊娠不良结局、生育间隔。
    下载: 导出CSV

    表  3  两次妊娠间BMI变化与不良出生结局关联的敏感性分析

    不良出生结局BMI每增加1两次妊娠间BMI变化P
    OR95 % CI<– 1 – 1~1~ ≥ 3
    OR95 % CIOR95 % CIOR95 % CIOR95 % CI
    排除填补数据(n = 5442)
     早产 1.01 0.95~1.07 0.85 0.57~1.24 Ref 0.92 0.74~1.27 1.00 0.67~1.48 0.752
     低出生体重 0.97 0.90~1.04 1.06 0.71~1.58 Ref 0.78 0.57~1.07 1.01 0.65~1.54 0.381
     巨大儿 1.22 1.12~1.32 0.56 0.28~1.05 Ref 1.67 1.09~2.56 2.08 1.19~3.54 < 0.001
     小于胎龄儿 0.94 0.90~0.99 1.05 0.81~1.36 Ref 0.87 0.71~1.07 0.82 0.60~1.10 0.072
     大于胎龄儿 1.15 1.08~1.22 0.66 0.43~0.99 Ref 1.11 0.82~1.51 1.72 1.18~2.50 < 0.001
    排除高龄产妇(n = 6307)
     早产 1.01 0.98~1.04 0.68 0.45~1.00 Ref 0.86 0.66~1.12 0.94 0.64~1.36 0.569
     低出生体重 0.97 0.93~1.00 1.08 0.74~1.55 Ref 0.84 0.56~1.78 0.99 0.65~1.46 0.349
     巨大儿 1.12 1.06~1.19 1.02 0.56~1.78 Ref 1.90 1.27~2.84 2.54 1.52~4.16 < 0.001
     小于胎龄儿 0.99 0.94~1.06 0.94 0.74~1.18 Ref 1.04 0.85~1.26 1.12 0.81~1.55 0.297
     大于胎龄儿 1.18 1.08~1.28   1.03 0.72~1.46   Ref   1.23 0.94~1.62   1.94 1.38~2.73 < 0.001
      注:调整母亲文化程度、分娩时年龄、产次、分娩方式、前一次妊娠孕前BMI、前一次妊娠不良结局、生育间隔。
    下载: 导出CSV
  • [1] Barker DJP, Eriksson JG, Forsén T, et al. Fetal origins of adult disease: strength of effects and biological basis[J]. International Journal of Epidemiology, 2002, 31(6): 1235 – 1239. doi: 10.1093/ije/31.6.1235
    [2] Poston L, Caleyachetty R, Cnattingius S, et al. Preconceptional and maternal obesity: epidemiology and health consequences[J]. The Lancet Diabetes and Endocrinology, 2016, 4(12): 1025 – 1036. doi: 10.1016/S2213-8587(16)30217-0
    [3] Aune D, Saugstad OD, Henriksen T, et al. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta - analysis[J]. JAMA, 2014, 311(15): 1536 – 1546. doi: 10.1001/jama.2014.2269
    [4] Goldstein RF, Abell SK, Ranasinha S, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta - analysis[J]. JAMA, 2017, 317(21): 2207 – 2225. doi: 10.1001/jama.2017.3635
    [5] 彭安娜, 张斌, 李娜, 等. 孕前超重/肥胖与婴儿不良出生结局关系前瞻性队列研究[J]. 中国公共卫生, 2019, 35(2): 162 – 166. doi: 10.11847/zgggws1118878
    [6] Jain AP, Gavard JA, Rice JJ, et al. The impact of interpregnancy weight change on birthweight in obese women[J]. American Journal of Obstetrics and Gynecology, 2013, 208(3): 205.e1 – 205.e7. doi: 10.1016/j.ajog.2012.12.018
    [7] Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population - based study[J]. The Lancet, 2006, 368(9542): 1164 – 1170. doi: 10.1016/S0140-6736(06)69473-7
    [8] Wallace JM, Bhattacharya S, Campbell DM, et al. Inter - pregnancy weight change impacts placental weight and is associated with the risk of adverse pregnancy outcomes in the second pregnancy[J]. BMC Pregnancy and Childbirth, 2014, 14: 40. doi: 10.1186/1471-2393-14-40
    [9] Girsen AI, Mayo JA, Wallenstein MB, et al. What factors are related to recurrent preterm birth among underweight women?[J]. The Journal of Maternal-Fetal and Neonatal Medicine, 2018, 31(5): 560 – 566. doi: 10.1080/14767058.2017.1292243
    [10] Merlino A, Laffineuse L, Collin M, et al. Impact of weight loss between pregnancies on recurrent preterm birth[J]. American Journal of Obstetrics and Gynecology, 2006, 195(3): 818 – 821. doi: 10.1016/j.ajog.2006.06.043
    [11] Benjamin RH, Littlejohn S, Canfield MA, et al. Interpregnancy change in body mass index and infant outcomes in Texas: a population - based study[J]. BMC Pregnancy and Childbirth, 2019, 19(1): 119. doi: 10.1186/s12884-019-2265-z
    [12] McBain RD, Dekker GA, Clifton VL, et al. Impact of inter - pregnancy BMI change on perinatal outcomes: a retrospective cohort study[J]. EuropeanJournal of Obstetrics and Gynecology and Reproductive Biology, 2016, 205: 98 – 104. doi: 10.1016/j.ejogrb.2016.07.487
    [13] Bender W, Hirshberg A, Levine LD. Interpregnancy body mass index changes: distribution and impact on adverse pregnancy outcomes in the subsequent pregnancy[J]. American Journal of Perinatology, 2019, 36(5): 517 – 521. doi: 10.1055/s-0038-1670634
    [14] 张晓辉, 陈艳敏, 孙瑜, 等. 浙江省出生缺陷人群监测地区不同生育政策时期生育情况分析[J]. 中华预防医学杂志, 2020, 54(5): 519 – 522. doi: 10.3760/cma.j.cn112150-20190706-0054
    [15] 陈友华, 孙永健. “三孩”生育新政: 缘起、预期效果与政策建议[J]. 人口与社会, 2021, 37(3): 1 – 12.
    [16] Regan AK, Gissler M, Magnus MC, et al. Association between interpregnancy interval and adverse birth outcomes in women with a previous stillbirth: an international cohort study[J]. The Lancet, 2019, 393(10180): 1527 – 1535. doi: 10.1016/S0140-6736(18)32266-9
    [17] Sorbye LM, Skjaerven R, Klungsoyr K, et al. Gestational diabetes mellitus and interpregnancy weight change: a population - based cohort study[J]. PLoS Medicine, 2017, 14(8): e1002367. doi: 10.1371/journal.pmed.1002367
    [18] Kerényi Z, Tamas G, Kivimaki M, et al. Maternal glycemia and risk of large - for - gestational - age babies in a population-based screening[J]. Diabetes Care, 2009, 32(12): 2200 – 2205. doi: 10.2337/dc09-1088
    [19] 齐秀英, 王楠. 巨大儿发生率及相关危险因素研究[J]. 中国公共卫生, 2005, 21(10): 1162 – 1163. doi: 10.3321/j.issn:1001-0580.2005.10.005
    [20] Kominiarek MA, PeacemanAM. Gestational weight gain[J]. American Journal of Obstetrics and Gynecology, 2017, 217(6): 642 – 651. doi: 10.1016/j.ajog.2017.05.040
    [21] 何静, 叶青, 王志勇, 等. 南京市城区居民身高、体重和腰围自我报告值与客观测量值的一致性分析[J]. 中华疾病控制杂志, 2018, 22(2): 208 – 210转214. doi: 10.16462/j.cnki.zhjbkz.2018.02.026
  • 加载中
图(1) / 表(3)
计量
  • 文章访问数:  27
  • HTML全文浏览量:  11
  • PDF下载量:  2
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-02-24
  • 网络出版日期:  2023-01-10

目录

    /

    返回文章
    返回