摘要
背景妊娠期体质量适度增加对母婴健康至关重要,我国临床长期以来采用美国医学研究所(IOM)标准评估孕妇妊娠期体质量增长。自2022年10月以来我国正式颁布并采用中国卫生行业标准《妊娠期妇女体重增长推荐值标准:WS/T 801-2022》评估孕妇体质量增长。目的比较采用中国卫生行业标准与IOM推荐范围评价我国单胎孕妇妊娠期体质量增长分布及不良妊娠结局发生情况,从而为中国卫生行业标准的国内应用提供临床证据。方法本研究数据来自前瞻性队列研究,研究对象为2020年5月—2021年9月于首都医科大学附属北京妇产医院分娩并参加北京出生队列研究(注册号ChiCTR220058395)的单胎孕妇。收集研究对象基线信息,并从临床病历系统收集妊娠期并发症发生情况及妊娠结局。参照中国卫生行业标准与美国IOM推荐的单胎孕妇妊娠期增重推荐值,比较不同标准下孕妇增重分布情况;并将孕妇划分为增重不足(IOM+WS)、增重不足(IOM)+适宜(WS)、增重适宜(IOM+WS)、增重适宜(IOM)+过多(WS)、增重过多(IOM+WS)组,分析校正混杂因素后各增重组的不良妊娠结局〔大于胎龄儿(LGA)、小于胎龄儿(SGA)、巨大儿、低出生体质量儿、早产儿〕发生风险。结果研究共纳入11839例单胎妊娠孕妇。按照美国IOM标准,增重不足(IOM)、增重适宜(IOM)及增重过多(IOM)孕妇占比分别为36.7%(4339/11839)、38.9%(4601/11839)、24.5%(2899/11839);按照中国卫生行业标准,增重不足(WS)、增重适宜(WS)及增重过多(WS)孕妇占比分别为16.2%(1913/11839)、45.0%(5332/11839)及38.8%(4594/11839)。增重不足(IOM+WS)组、增重不足(IOM)+适宜(WS)组、增重适宜(IOM+WS)组、增重适宜(IOM)+过多(WS)组、增重过多(IOM+WS)组孕妇占比分别为16.2%(1913/11839)、20.5%(2426/11839)、24.6%(2907/11839)、14.3%(1694/11839)、24.5%(2899/11839)。多因素Logistic回归分析结果显示,增重适宜(IOM)+过多(WS)组发生总体不良妊娠结局的风险高于增重适宜(IOM+WS)组〔aOR=1.23,95%CI(1.07,1.41),P<0.05〕。增重不足(IOM)+适宜(WS)组发生总体不良妊娠结局的风险与增重适宜(IOM+WS)组差异无统计学意义〔aOR=1.02,95%C(I 0.89,1.16),P<0.05〕。孕早、中期增重过多(IOM+WS)组发生LGA、巨大儿、剖宫产及总体不良妊娠结局的风险高于增重适宜(IOM+WS)组(P<0.05)。结论采用中国卫生行业标准将有更多孕妇符合增重适宜范围,其妊娠结局亦优于采用美国IOM标准。因此,中国卫生行业标准更适用于我国孕妇体质量管理,其中孕早、中期避免增重过多更为重要。
Background Adequate gestational weight gain(GWG)is critical for maternal and child health.The Institute of Medicine(IOM)standard has long been adopted in clinical practice to guide GWG in China.Since October 2022,China has officially promulgated and adopted the Standard of Recommendation for Weight Gain during Pregnancy Period(WS/T 801-2022)(herein after referred to as SRWGPP)to guide GWG.Objective To compare the distribution of GWG recommended by the SRWGPP and IOM used for Chinese singleton pregnant women and associated adverse pregnancy outcomes,providing clinical evidence for further application of the SRWGPP.Methods The data of this study were from a prospective cohort study involving singleton pregnant women who gave birth in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from May 2020 to September 2021 and participated in the Beijing Birth Cohort Study(registration number:ChiCTR220058395).Baseline information was collected from the participants,and the incidence of pregnancy complications and outcomes was obtained from the clinical health record system.We compared the distribution of GWG of the participants based on the criteria by the SRWGPP and the IOM guidelines.Then we divided the participants into five groups:insufficient weight gain(IOM+IW),insufficient weight gain+appropriate weight gain(IOM+IW+AW),appropriate weight gain(IOM+AW),appropriate weight gain+excessive weight gain(IOM+AW+EW),and excessive weight gain(IOM+EW).The risk of adverse pregnancy outcomes〔large for gestational age(LGA),small for gestational age(SGA),macrosomia,low birth weight,and preterm birth〕was analyzed after adjusting for confounding factors.Results A total of 11839 singleton pregnant women were included.The proportions of women with insufficient,appropriate,and excessive GWG were 36.7%(4339/11839),38.9%(4601/11839),and 24.5%(2899/11839),respectively,according to the IOM standard,and were 16.2%(1913/11839),45.0%(5332/11839),and 38.8%(4594/11839),respectively,according to the SRWGPP.The proportions of pregnant women in groups of IOM+IW,IOM+IW+AW,IOM+AW,IOM+AW+EW and IOM+EW were 16.2%(1913/11839),20.5%(2426/11839),24.6%(2907/11839),14.3%(1694/11839)and 24.5%(2899/11839),respectively.The results from multivariate Logistic regression analysis showed that the risk of overall adverse pregnancy outcomes in IOM+AW+EW group was higher than that in IOM+AW group〔aOR=1.23,95%CI(1.07,1.41),P<0.05〕.There was no difference in the risk of overall adverse pregnancy outcomes between IOM+IW+AW group and IOM+AW group〔aOR=1.02,95%CI(0.89,1.16),P<0.05〕.The risk of LGA,macrosomia,cesarean section,or the overall adverse pregnancy outcomes was higher in IOM+EW group than that in IOM+AW group either in the first or second trimesters(P<0.05).Conclusion The adoption of the SRWGPP will allow more pregnant women to meet the appropriate range for GWG,and their pregnancy outcomes will be better than those using the IOM standard.Therefore,the SRWGPP is more applicable to Chinese pregnant women for pregnancy weight management.Especially,it is critical to avoid excessive GWG in the first and second trimesters.
作者
张莉
郑薇
王佳
袁仙仙
韩卫玲
黄俊花
田志红
李光辉
ZHANG Li;ZHENG Wei;WANG Jia;YUAN Xianxian;HAN Weiling;HUANG Junhua;TIAN Zhihong;LI Guanghui(Division of Perinatal Endocrinology and Metabolism,Beijing Obstetrics and Gynecology Hospital,Capital Medical University/Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)
出处
《中国全科医学》
CAS
北大核心
2023年第24期2959-2967,共9页
Chinese General Practice
基金
北京市教育委员会科技计划一般项目(KM202110025007)
北京市医院管理中心“登峰”人才培养计划项目(DFL20191402)。
