目的 探讨中国妇女孕期增重与出生结局的关联。方法 收集孕妇孕前BMI、产前体重及出生结局信息,计算孕期总增重,分别根据我国卫生标准WS/T 801-2022与美国IOM 2009指南判定增重不足、适宜或过多;评估的不良出生结局包括：小体型脆弱新生儿（SVN：小于胎龄儿、早产、或低出生体重之和）和大体型儿（大于胎龄儿或巨大儿）;Logistic回归分析孕期增重与不良出生结局的关联,估计比值比（OR）及95%置信区间（CI）。结果 共8126对母婴纳入本研究。按WS/T801标准,孕期增重不足、适宜、过多的占比分别为7.6%、42.3%、50.1%;按IOM 2009标准,孕期增重不足、适宜、过多的占比分别为23.7%、42.1%、34.2%;12.7%的婴儿为SVN,12.8%为大体型儿,合计24.5%为不良出生结局。基于WS/T801,与孕前BMI正常且增重适宜组相比,孕前消瘦及BMI正常人群中,增重不足组发生SVN的OR（95%CI）分别为2.00（1.38,2.90）和1.77（1.32,2.36）;增重过多组大体型儿的分别为1.66（1.18,2.34）、2.21（1.84,2.65）,孕前超重/肥胖组孕期增重过多者大体型儿的OR（95%CI）为3.38（2.73,4.18）;孕前BMI正常和孕前超重/肥胖组,增重过多者发生不良出生结局的OR（95%CI）分别为1.15（1.01,1.32）和1.53（1.29,1.82）,孕前消瘦和BMI正常组,增重不足者不良出生结局的OR（95%CI）为1.33 (1.01, 1.74)和1.47（1.03,2.10）。基于IOM标准,孕前超重或肥胖且孕期增重适宜组发生不良出生结局的OR（95%CI）为1.38（1.10,1.72）。结论 WS/T 801及IOM标准均可降低不良出生结局的发生风险,WS/T 801标准更有利于指导中国妇女预防SVN和大体型儿,从而获得良好出生结局。
Abstract
Objective To explore the association between gestational weight gain (GWG) and birth outcomes among Chinese women. Methods We collected data on pre-pregnancy BMI, prenatal weight, and birth outcomes. Total GWG was calculated and categorized as insufficient, appropriate, or excessive based on the Chinese health standard (WS/T 801-2022) and the IOM 2009 guidelines. Adverse birth outcomes included small vulnerable newborns (SVN: small for gestational age, low birth weight, or preterm birth), large-sized newborns (large for gestational age or macrosomia). Logistic regression analyses were performed to examine the associations between GWG and adverse birth outcomes, with odds ratios (ORs) and 95% confidence intervals (CIs) estimated. Results A total of 8,126 mother-infant pairs were included in the study. According to the WS/T 801, 7.6%, 42.3%, and 50.1% of the women had insufficient, appropriate, or excessive GWG, respectively, while under the IOM 2009, these proportions were 23.7%, 42.1%, and 34.2%, respectively. Among infants, 12.7% were SVN, 12.8% were large-sized newborns, and 24.5% presented with adverse birth outcomes. Based on the WS/T801, compared with the normal pre-pregnancy BMI and appropriate weight gain group, the OR (95% CI) for SVN in the pre-pregnancy underweight and normal BMI groups with insufficient weight gain were 2.00 (1.38, 2.90) and 1.77 (1.32, 2.36), respectively. For large-sized newborns, the OR (95% CI) in the excessive weight gain group were 1.66 (1.18, 2.34) and 2.21 (1.84, 2.65), respectively. In the pre-pregnancy overweight/obese group, the OR (95% CI) for large-sized newborns among those with excessive weight gain during pregnancy was 3.38 (2.73, 4.18). Among the normal pre-pregnancy BMI group and the pre-pregnancy overweight/obese group, the OR (95% CI) for adverse birth outcomes in those with excessive weight gain were 1.15 (1.01, 1.32) and 1.53 (1.29, 1.82), respectively. In the pre-pregnancy underweight and normal BMI groups, the OR (95% CI) for adverse birth outcomes in those with insufficient weight gain were 1.33 (1.01, 1.74) and 1.47 (1.03, 2.10), respectively. Based on the IOM criteria, the OR (95% CI) for adverse birth outcomes in the pre-pregnancy overweight or obese group with appropriate weight gain was 1.38 (1.10, 1.72). Conclusion Both the WS/T 801 and IOM 2009 criteria can reduce the risk of adverse birth outcomes. The WS/T 801 standard is more conducive to guiding Chinese women in preventing SVN and large-sized newborns, and thereby achieving favorable birth outcomes.
关键词
孕期增重 /
出生结局 /
增重标准
Key words
gestational weight gain /
birth outcome /
weight gain criteria
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基金
科技基础资源调查专项《孕产妇营养与健康体格检查数据采集》（No.2019FY101003）
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