不同孕前体重指数产妇孕期体重增加适宜值及对巨大儿发生的预测价值

刘小芳 杨波 杨碧英 骆妙青 王旭 陈风华

[摘要] 目的 探討不同孕前体重指数（BMI）产妇孕期体重增加适宜值，利用孕期体重增加适宜值预测巨大儿发生。 方法 选取2016年1月～2017年12月就诊于广州市花都区人民医院产科的妊娠妇女500例，按孕前BMI分为低BMI组（A组，149例，BMI<18.5 kg/m2），正常BMI组（B组，225例，18.5 kg/m2≤BMI<25.0 kg/m2）和高BMI组（C组，126例，BMI≥25.0 kg/m2）。统计三组产妇新生儿结局巨大儿发生率，观察孕期增重与巨大儿发生的相关性，观察三组产妇孕期增重适宜值与IOM推荐范围一致性。利用孕妇体重增加适宜值对巨大儿的发生进行预测。 结果 A组和C组GWG与IOM推荐适宜值相同，分别为12.5～18.0 kg、7.0 ～11.5 kg；B组GWG与IOM推荐适宜值不同，适合B组的适宜值为10.5～15.0 kg；ROC曲线下面积分别为0.693、0.719和0.690，阳性预测值分别为70.73%、58.62%和59.02%，阴性预测值分别为73.42%、74.19%和76.27%。 结论 IOM推荐孕期增重范围并不完全适宜于本地区产妇，根据地区产妇体质特点修订适宜的孕期体重增加值能够更好的预测巨大儿的发生并降低不良分娩结局发生率。

[关键词] 孕期增重；巨大儿；预测

[中图分类号] R714.3 [文献标识码] A [文章编号] 1673-7210（2018）05（c）-0104-04

The optimum value of weigh gain during pregnancy for the maternal with different pre-pregnant body mass index and the prediction value of the macrosomia

LIU Xiaofang1 YANG Bo1 YANG Biying1 LUO Miaoqing1 WANG Xu2 CHEN Fenghua3

1.Department of Nutritional， Huadu District People's Hospital of Guangzhou 510800， China； 2.Department of Child Healthcare， Huadu District People's Hospital of Guangzhou 510800， China； 3.Department of Obstetric， Huadu District People's Hospital of Guangzhou 510800， China

[Abstract] Objective To research the suitable pregnancy weight gain value of the maternal with different pre-pregnancy body mass index （BMI）， predict the appearence probability of the macrosomia using the suitable pregnancy weight gain value. Methods From January 2016 to December 2016， 500 cases of maternal who gave birth in Huadu District People's Hospital of Guangzhou were recruited into this study. According to the pre-pregnancy body mass index， these maternal were divided into low BMI group （group A， 149 cases， BMI<18.5 kg/m2）， normal BMI group （group B， 225 cases， 18.5 kg/m2≤BMI<25.0 kg/m2） and high BMI group （group C， 126 cases， BMI≥25.0 kg/m2）. The incidence of macrosomia in three groups was counted. The relationship between macrosomia incidence and weight gain during pregnancy was investigated. The consistency of the suitable pregnancy weight gain value and the IOM recommendation value about the three groups was observed. The occurrence of macrosomia was predicted by using the suitable pregnancy weight gain value. Results The suitable pregnancy weight gain value of group A and C had the same value with the value recommended by IOM， was 12.5-18.0 kg and 7.0-11.5 kg respectively. The suitable pregnancy weight gain value of group B was different with the IOM recommended value. The suitable pregnancy weight gain value for the group B was 10.5-15.0 kg. The area under the ROC curve was 0.693， 0.719 and 0.690 respectively. The positive predictive value was 70.73%， 58.62% and 59.02%. The negative predictive value was 73.42%， 74.19% and 76.27% respectively. Conclusion The IOM recommended pregnancy weight gain value is not suitable for the maternal in our region. Based on the characteristics of maternal physical modernised in the added value of pregnancy weight can better predict the occurrence of macrosomia and reduce the incidence of adverse birth outcomes.

[Key words] Pre-pregnancy body mass index； Pregnancy weight gain； Macrosomia； Predict

孕前体重指数（BMI）、孕期增重范围（GWG）与妊娠结局关系密切，孕前肥胖及GWG过多是过期妊娠（LGA）[1-2]、剖宫产[3]及巨大儿[4]的危险因素。适宜的孕前体重及GWG是获得良好妊娠结局的重要手段[5]。国际上广泛使用的GWG标准是美国医学研究院（IOM）2009年修订的孕期增重指南[6]，该指南根据孕前BMI将孕妇分组（WHO标准）并对各组推荐了适宜增重值。研究表明[7]，饮食和生活方式的咨询指导能够改善孕妇IOM指南遵从率，调整孕妇孕期体重增加范围，妊娠期高血压及糖尿病发生率显著降低。但我国目前尚无孕期增重适宜值推荐标准，考虑到各地区产妇体质差异，故IOM的推荐值是否适用于本地区孕妇有待商榷，因此建立适于本地区孕妇的孕期增重适宜值推荐标准显得尤为重要。本研究通过对孕期体重的监测和BMI分级，分析不同GWG、BMI分级与巨大儿的发生关系，以提出不同BMI条件下孕期的适宜增重值，同时，利用孕妇体重增加适宜值对巨大儿的发生进行预测。

1 资料与方法

1.1 一般资料

在2016年1月～2017年12月就诊于广州市花都区人民医院（以下简称“我院”）产科的妊娠妇女。纳入标准：①年龄18～35周岁；②单胎妊娠的初产妇；……