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

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

武丽^{1, （},
刘晴²,
樊高杰²,
陈凯²,
王璐琳²,
夏建红^1, ,,
王友洁²

1.
广东省妇幼保健院妇女群体保健科，广州 510000
2.
华中科技大学同济医学院公共卫生学院儿少卫生与妇幼保健学系

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
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- 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

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

WU Li^{1, （},
LIU Qing²,
FAN Gao-jie²,

1.
Guangdong Provincial Women and Children Hospital, Guangzhou, Guangdong Province 51000, China

摘要

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。
- 早产 /
- 低出生体重 /
- 巨大儿 /
- 小于胎龄儿 /
- 大于胎龄儿 /
- 体重变化
Abstract: Objective To investigate associations of interpregnancy weight change with preterm birth, low birth weight, macrosomia, small for gestational age (SGA), and large for gestational age (LGA). Methods The data on 6 589 pregnant women having two or more singleton live births during 2015 – 2020 and their newborns were extracted from the Maternal and Child Health Information System of Guangdong province. The pregnant women were assigned into four groups according to the changes in their interpregnancy body mass index (BMI) of ＜−1, −1 – ＜1 , 1 – ＜3, and ≥ 3 kg/m². Logistic regression model was used to assess the associations of interpregnancy BMI change with adverse birth outcomes. Results In all the newborns, the proportion was 5.5% for preterm birth, 4.7% for low birth weight, 2.4% for macrosomia, 11.4% for SGA, and 5.4% for LGA, respectively. The results of logistic regression analysis showed that compared to those with the interpregnancy BMI change of −1 – < 1, the pregnant women having the change of 1 – < 3 have an increased risk of giving a birth to a macrosomia (odds ratio [OR] = 1.66, 95% confidence interval [95% CI]: 1.13 – 2.24); the women with the interpregnancy BMI change of 3 and more have an increased risk of giving a birth to a macrosomia (OR = 2.31, 95% CI: 1.42 – 3.70) and to a LGA infant (OR = 1.87, 95% CI: 1.33 – 2.60); while, each increase of 1 kg/m² in interpregnancy BMI is associated with a 7% decreased risk of SGA (OR = 0.93, 95% CI: 0.89 – 0.97). No significant association of interpregnancy BMI change with preterm birth or low birth weight was observed (P > 0.05). Conclusion Pregnant women′s interpregnancy weight gain is associated with increased risks of macrosomia and LGA of their newborns. The results suggest that body weight control during pregnancy and after delivery need to be promoted among pregnant women.
- preterm birth /
- low birth weight /
- macrosomia /
- small for gestational age /
- large for gestational age /
- weight change
注释:

1) （刘晴为本文并列第一作者）

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图 1 两次妊娠间BMI变化与不良出生结局的分层分析

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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～		≥ 3		P值
变量	人数	%	人数	%	人数	%	人数	%	P值
母亲基本情况
文化程度 ^a
初中及以下	522	55.5	1199	45.0	813	46.5	349	57.3	0.821
高中	253	26.9	747	28.0	465	26.6	152	25.0
大学及以上	166	17.6	721	27.0	470	26.9	108	17.7
产次 ^b
2	527	52.8	1842	63.1	1206	62.4	400	61.1	0.001
> 2	472	47.3	1077	36.9	726	37.6	255	38.9	0.001
分娩方式 ^c
阴道分娩	852	85.3	2448	86.4	1619	85.4	514	81.1	0.029
剖宫产	147	14.7	387	13.7	276	14.6	120	18.9	0.029
前一次分娩方式 ^d
顺产	826	86.3	2445	89.1	1634	89.2	538	86.5	0.639
剖宫产	131	13.7	299	10.9	198	10.8	84	10.1	0.639
新生儿基本情况
新生儿性别
男性	534	52.6	1640	55.6	1108	56.5	341	51.5	0.809
女性	481	47.4	1312	44.4	852	43.5	321	48.5	0.809
不良妊娠结局
早产	41	4.0	179	6.1	107	5.5	40	6.0	0.219
低出生体重	47	4.6	146	5.0	86	4.4	33	5.0	0.985
巨大儿	18	1.8	54	1.8	60	3.1	29	4.4	< 0.001
小于胎龄儿	122	12.0	356	12.1	212	10.8	62	9.4	0.077
大于胎龄儿	49	4.8	139	4.7	108	5.5	57	8.6	0.002
前一次不良妊娠结局
早产	41	4.0	179	6.1	107	5.5	40	6.0	0.67
低出生体重	52	5.1	145	4.9	106	5.4	29	4.4	0.896
巨大儿	18	1.8	43	1.5	29	1.5	16	2.4	0.461
小于胎龄儿	171	16.9	471	16.0	301	15.4	85	12.8	0.025
大于胎龄儿	48	4.7	111	3.7	71	3.6	25	3.8	0.198
注： a 缺失624例，b 缺失94例，c 缺失226例，d 缺失434例。

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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 值
	OR 值	95 % CI	＜−1		−1～		1～		≥ 3
	OR 值	95 % CI	OR 值	95 % CI	OR 值	95 % CI	OR 值	95 % CI	OR 值	95 % CI
早产	1.00	0.95～1.06	0.72	0.50～1.03	Ref		0.86	0.67～1.08	0.93	0.64～1.32	0.743
低出生体重	0.96	0.90～1.03	1.09	0.76～1.56	Ref		0.82	0.61～1.08	0.95	0.63～1.41	0.243
巨大儿	1.21	1.21～1.30	0.62	0.34～1.09	Ref		1.66	1.13～2.24	2.31	1.42～3.70	＜0.001
小于胎龄儿	0.93	0.89～0.97	1.17	0.92～1.49	Ref		0.88	0.73～1.07	0.78	0.57～1.04	0.008
大于胎龄儿	1.15	1.09～1.21	0.73	0.50～1.04	Ref		1.16	0.89～1.51	1.87	1.33～2.60	＜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。

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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 值
	OR 值	95 % CI	<– 1		– 1～		1～		≥ 3
	OR 值	95 % CI	OR 值	95 % CI	OR 值	95 % CI	OR 值	95 % CI	OR 值	95 % 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。

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