Association of interpregnancy weight change with adverse birth outcome: an analysis based on delivery records of Guangdong province
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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。 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. -
Key words:
- preterm birth /
- low birth weight /
- macrosomia /
- small for gestational age /
- large for gestational age /
- weight change
1) (刘晴为本文并列第一作者) -
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 人数 % 人数 % 人数 % 人数 % 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 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 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 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 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。 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 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。 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 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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