巨大兒孕婦血脂水平變化及其臨床意義
發(fā)布時間：2018-08-06 09:08
【摘要】：目的:巨大兒是指出生體重達到或超過4000g的新生兒,是常見的產(chǎn)科并發(fā)癥之一,嚴重威脅著母嬰健康。近年來,隨著生活水平的提高,孕期營養(yǎng)過剩問題日趨增多,巨大兒的發(fā)生率也逐年上升。加強對巨大兒預(yù)測預(yù)防是保障母兒安全的關(guān)鍵措施之一。巨大兒的影響因素眾多,除了孕期高血糖因素以外,還包括遺傳、孕產(chǎn)次、分娩孕周、孕前體重及孕期增重等。由于正常妊娠期常表現(xiàn)為血脂水平升高,而妊娠期血脂水平與胎兒體重關(guān)系報道較少。本研究通過對巨大兒孕婦的一般資料及其孕期血脂水平進行分析,探究孕期脂質(zhì)代謝對巨大兒發(fā)生的影響,提高對巨大兒的預(yù)測預(yù)防水平,減少圍產(chǎn)期并發(fā)癥。方法:回顧性收集2014年1月1日至2014年12月31日于浙江大學醫(yī)學院附屬婦產(chǎn)科醫(yī)院定期產(chǎn)檢并分娩的孕婦,排除非自然受孕、雙胎或多胎、低出生體重兒、高血壓、糖尿病等合并癥及并發(fā)癥孕婦,共有7310名正常孕婦納入本次研究,這些孕婦包括巨大兒413例(實驗組),正常體重兒6897例(對照組),比較兩組年齡、孕產(chǎn)史、孕前BMI、孕期增重、分娩孕周及中孕期和晚孕期血脂水平。實驗組再根據(jù)年齡、孕產(chǎn)史、孕前BMI、孕期增重進行分組,分別比較各組間的孕期血脂水平。采用二項Logistic回歸分析評價各項因素與巨大兒發(fā)生的相關(guān)性。結(jié)果:1.兩組一般資料比較:實驗組年齡、孕期增重、分娩孕周均大于對照組,分別為 29.5±3.5 歲與 29.1±3.3 歲,16.63±4.44kg 與 14.65±3.93kg,40±1.6 周與 39±1.3周,差異均有統(tǒng)計學意義(P0.05)。實驗組與對照組經(jīng)產(chǎn)婦分別為110例(26.63%)與 1654 例(23.98%),孕前 BMI 分別為 21.41±3.04kg/m2 與 20.69±27.64kg/m2,差異均無統(tǒng)計學差異(P0.05)。2.兩組孕期血脂比較:實驗組中、晚孕期TG均高于對照組,分別為2.32±0.85mmol/L 與 2.15±0.84mmol/L,3.85±1.70mmol/L 與 3.32±1.65mmol/L;而實驗組中、晚孕期HDL均低于對照組,分別為2.29±0.48mmol/L與2.41± 0.66mmol/L,1.94±0.46mmol/L 與 2.15±0.59mmol/L,差異均有統(tǒng)計學意義(P0.05)。兩組間中、晚孕期TC與LDL的差異均無統(tǒng)計學意義(P0.05)。3.巨大兒孕婦年齡與血脂的關(guān)系:實驗組按年齡分為25歲組、25-29歲組、30-34歲組和35歲四組,35歲組中孕期TG為2.72±0.83mmol/L,高于25歲組、25-29歲組與30-34歲組;而30-34歲組中孕期TG為2.39±1.00mmol/L,高于25歲組,差異均有統(tǒng)計學意義(P0.05)。35歲組與30-34歲組晚孕期TG分別為 4.06±1.92mmol/L 與 4.49±1.80mmol/L,均高于25 歲組與 25-29 歲組,差異均有統(tǒng)計學意義(P0.05)。4.巨大兒孕婦孕產(chǎn)史與血脂的關(guān)系:將實驗組分為初產(chǎn)婦和經(jīng)產(chǎn)婦,經(jīng)產(chǎn)婦中孕期TG高于初產(chǎn)婦,分別為2.49±0.97mmol/L與2.25±0.79mmol/L,差異有統(tǒng)計學意義(P0.05)。而晚孕期TG差異無統(tǒng)計學意義(P0.05)。5.巨大兒孕婦孕前BMI和孕期增重與血脂的關(guān)系:將實驗組按孕前BMI水平分為消瘦組、正常組、超重組和肥胖組,比較四組間孕期血脂水平,結(jié)果表明差異均無統(tǒng)計學意義(P0.05)。另將實驗組按照孕期增重情況分為GWG過少組、GWG適宜組、GWG過多組,比較三組間孕期血脂水平,結(jié)果表明也均無統(tǒng)計學差異(P0.05)。6.巨大兒的相關(guān)因素分析:經(jīng)logistic分析表明,年齡(OR=1.072,95%CI 1.040-1.105,P0.05),孕期增重(OR=1.108,95%CI 1.083-1.134,P0.05),分娩孕周(OR=1.676,95%CI 1.521-1.847,P0.05)、晚孕期 TG(OR=1.067,95%CI 1.011-1.127,P0.05)、晚孕期 HDL(OR=0.496,95%CI 0.372-0.660,P0.05)均是巨大兒的獨立影響因素。結(jié)論:1.隨著孕婦年齡、孕期增重、分娩孕周、孕期TG增加,巨大兒發(fā)生率增加;2.巨大兒孕婦TG與年齡及孕產(chǎn)次相關(guān),高齡經(jīng)產(chǎn)婦有較高的TG;3.在正常妊娠中,年齡、孕期增重、分娩孕周及晚孕期TG水平是巨大兒的危險因素,而晚孕期HDL水平是巨大兒的保護因素;4.孕期加強營養(yǎng)管理、控制體重過度增長、降低血脂水平、適時終止妊娠均有利于降低巨大兒的發(fā)生率,保障母嬰健康。
[Abstract]:Objective: gigantic infant is one of the most common obstetric complications, which is one of the common obstetric complications, which is one of the common obstetric complications. In recent years, with the improvement of the living standard, the problem of excess nutrition in pregnancy is increasing, and the incidence of giant children is increasing year by year. Strengthening the prediction and prevention of giant children is the key to ensure the safety of mother and child. One of the key measures. There are many factors affecting the great children. Besides the pregnancy hyperglycemia factors, it includes heredity, pregnancy, pregnancy, pregnancy weight and weight gain during pregnancy. Due to normal pregnancy, the level of blood lipid is often elevated, but the relationship between the level of blood lipid and fetal weight in pregnancy is less. The general data and the level of blood lipid during pregnancy were analyzed to explore the effect of lipid metabolism on the occurrence of giant infants, to improve the prediction and prevention level of the giant infants and to reduce the perinatal complications. Methods: a retrospective collection of pregnant women from January 1, 2014 to December 31, 2014 at the affiliated gynecologic and obstetrics hospital of the Medical College of Zhejiang University was collected and delivered regularly. Excluding unnatural pregnancy, double or multiple births, low birth weight infants, hypertension, diabetes and other complications and complications, 7310 normal pregnant women were included in this study, including 413 cases of large infants (experimental group), 6897 normal weight infants (control group), two groups of age, pregnancy history, pre pregnancy BMI, weight gain during pregnancy, pregnancy week and pregnancy. The level of blood lipid in the middle pregnancy and the late pregnancy. The experimental group was divided into groups according to age, pregnancy history, pre pregnancy BMI and pregnancy weight gain. The blood lipid levels in pregnancy were compared respectively. Two Logistic regression analysis was used to evaluate the correlation between the factors and the occurrence of gigantic infants. Results: the general data of the 1. two groups were compared: the age of the experimental group, the weight gain during pregnancy and childbirth. The gestational weeks were 29.5 + 3.5 years old and 29.1 + 3.3 years old, 16.63 + 4.44kg and 14.65 3.93kg, 40 + 1.6 weeks and 39 + 1.3 weeks, the difference was statistically significant (P0.05). The experimental group and the control group were 110 (26.63%) and 1654 cases (23.98%) respectively. The difference between pre pregnancy and pre pregnancy was 3.04kg/m2 and 27.64kg/m2, respectively. No statistical difference (P0.05).2. two groups during pregnancy blood lipid comparison: in the experimental group, the late pregnancy TG was higher than the control group, 2.32 + 0.85mmol/L and 2.15 + 0.84mmol/L, 3.85 + 1.70mmol/L and 3.32 + 1.65mmol/L, while in the experimental group, the late pregnancy HDL was lower than the control group, 2.29 + 0.48mmol/L and 2.41 + 0.66mmol/L, 1.94 + 0.46mmol/L and 2, respectively. .15 + 0.59mmol/L, the difference was statistically significant (P0.05). There was no significant difference between TC and LDL during the late pregnancy (P0.05) the relationship between age and blood lipid in pregnant.3. giant infants: the experimental group was divided into 25 year old group, 25-29 year old group, 30-34 year old group and 35 year old four group, and 35 year old group during pregnancy TG was 2.72 + 0.83mmol/L, higher than the 25 year old group, 25-29 years old group. In the 30-34 year old group, the TG in the 30-34 year old group was 2.39 + 1.00mmol/L, which was higher than that in the 25 year old group. The difference was statistically significant (P0.05) and TG was 4.06 + 1.92mmol/L and 4.49 + 1.80mmol/L in the late pregnancy of the 30-34 year old group. The difference was statistically significant (P0.05) the maternal history and blood lipid of the pregnant women of.4. gigantic infants. Relationship: the experimental group was divided into primipara and parturients. The TG in pregnant women was 2.49 + 0.97mmol/L and 2.25 + 0.79mmol/L during pregnancy, and the difference was statistically significant (P0.05). There was no statistical significance (P0.05) the relationship between pre pregnancy BMI and gestational weight gain of pregnant women with.5. in pregnant women (P0.05) in the late pregnancy (P0.05): the experimental group was divided according to the level of pre pregnancy BMI. For the thinner group, the normal group, the super recombination and the obese group, the blood lipid levels were compared between the four groups. The results showed that the difference was not statistically significant (P0.05). In addition, the experimental group was divided into GWG group according to the weight gain of pregnancy, GWG suitable group and GWG group, and compared the level of blood lipid in pregnancy between the three groups, the results showed no statistical difference (P0.05).6. giant. Analysis of related factors: logistic analysis showed that age (OR=1.072,95%CI 1.040-1.105, P0.05), pregnancy weight gain (OR=1.108,95%CI 1.083-1.134, P0.05), birth gestational week (OR=1.676,95%CI 1.521-1.847, P0.05), TG (OR=1.067,95%CI), and late pregnancy were both the independence of the giant children. Conclusions: 1. with the age of pregnant women, weight gain during pregnancy, pregnancy week, TG in pregnancy and increased incidence of gigantic infants; 2. pregnant women are related to age and pregnancy and maternal age. The age of pregnant women is higher TG; 3. in normal pregnancy, age, weight gain during pregnancy, pregnancy week and late pregnancy TG level are the risk factors of gigantic infants, and HD in late pregnancy, HD The level of L is the protective factor for the giant infants; in the 4. pregnancy, strengthening the nutrition management, controlling the excessive growth of weight, reducing the level of blood lipid, and ending the pregnancy at the right time are beneficial to reduce the incidence of giant infants and protect the health of mother and child.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.7
，
本文編號：2167234
[Abstract]:Objective: gigantic infant is one of the most common obstetric complications, which is one of the common obstetric complications, which is one of the common obstetric complications. In recent years, with the improvement of the living standard, the problem of excess nutrition in pregnancy is increasing, and the incidence of giant children is increasing year by year. Strengthening the prediction and prevention of giant children is the key to ensure the safety of mother and child. One of the key measures. There are many factors affecting the great children. Besides the pregnancy hyperglycemia factors, it includes heredity, pregnancy, pregnancy, pregnancy weight and weight gain during pregnancy. Due to normal pregnancy, the level of blood lipid is often elevated, but the relationship between the level of blood lipid and fetal weight in pregnancy is less. The general data and the level of blood lipid during pregnancy were analyzed to explore the effect of lipid metabolism on the occurrence of giant infants, to improve the prediction and prevention level of the giant infants and to reduce the perinatal complications. Methods: a retrospective collection of pregnant women from January 1, 2014 to December 31, 2014 at the affiliated gynecologic and obstetrics hospital of the Medical College of Zhejiang University was collected and delivered regularly. Excluding unnatural pregnancy, double or multiple births, low birth weight infants, hypertension, diabetes and other complications and complications, 7310 normal pregnant women were included in this study, including 413 cases of large infants (experimental group), 6897 normal weight infants (control group), two groups of age, pregnancy history, pre pregnancy BMI, weight gain during pregnancy, pregnancy week and pregnancy. The level of blood lipid in the middle pregnancy and the late pregnancy. The experimental group was divided into groups according to age, pregnancy history, pre pregnancy BMI and pregnancy weight gain. The blood lipid levels in pregnancy were compared respectively. Two Logistic regression analysis was used to evaluate the correlation between the factors and the occurrence of gigantic infants. Results: the general data of the 1. two groups were compared: the age of the experimental group, the weight gain during pregnancy and childbirth. The gestational weeks were 29.5 + 3.5 years old and 29.1 + 3.3 years old, 16.63 + 4.44kg and 14.65 3.93kg, 40 + 1.6 weeks and 39 + 1.3 weeks, the difference was statistically significant (P0.05). The experimental group and the control group were 110 (26.63%) and 1654 cases (23.98%) respectively. The difference between pre pregnancy and pre pregnancy was 3.04kg/m2 and 27.64kg/m2, respectively. No statistical difference (P0.05).2. two groups during pregnancy blood lipid comparison: in the experimental group, the late pregnancy TG was higher than the control group, 2.32 + 0.85mmol/L and 2.15 + 0.84mmol/L, 3.85 + 1.70mmol/L and 3.32 + 1.65mmol/L, while in the experimental group, the late pregnancy HDL was lower than the control group, 2.29 + 0.48mmol/L and 2.41 + 0.66mmol/L, 1.94 + 0.46mmol/L and 2, respectively. .15 + 0.59mmol/L, the difference was statistically significant (P0.05). There was no significant difference between TC and LDL during the late pregnancy (P0.05) the relationship between age and blood lipid in pregnant.3. giant infants: the experimental group was divided into 25 year old group, 25-29 year old group, 30-34 year old group and 35 year old four group, and 35 year old group during pregnancy TG was 2.72 + 0.83mmol/L, higher than the 25 year old group, 25-29 years old group. In the 30-34 year old group, the TG in the 30-34 year old group was 2.39 + 1.00mmol/L, which was higher than that in the 25 year old group. The difference was statistically significant (P0.05) and TG was 4.06 + 1.92mmol/L and 4.49 + 1.80mmol/L in the late pregnancy of the 30-34 year old group. The difference was statistically significant (P0.05) the maternal history and blood lipid of the pregnant women of.4. gigantic infants. Relationship: the experimental group was divided into primipara and parturients. The TG in pregnant women was 2.49 + 0.97mmol/L and 2.25 + 0.79mmol/L during pregnancy, and the difference was statistically significant (P0.05). There was no statistical significance (P0.05) the relationship between pre pregnancy BMI and gestational weight gain of pregnant women with.5. in pregnant women (P0.05) in the late pregnancy (P0.05): the experimental group was divided according to the level of pre pregnancy BMI. For the thinner group, the normal group, the super recombination and the obese group, the blood lipid levels were compared between the four groups. The results showed that the difference was not statistically significant (P0.05). In addition, the experimental group was divided into GWG group according to the weight gain of pregnancy, GWG suitable group and GWG group, and compared the level of blood lipid in pregnancy between the three groups, the results showed no statistical difference (P0.05).6. giant. Analysis of related factors: logistic analysis showed that age (OR=1.072,95%CI 1.040-1.105, P0.05), pregnancy weight gain (OR=1.108,95%CI 1.083-1.134, P0.05), birth gestational week (OR=1.676,95%CI 1.521-1.847, P0.05), TG (OR=1.067,95%CI), and late pregnancy were both the independence of the giant children. Conclusions: 1. with the age of pregnant women, weight gain during pregnancy, pregnancy week, TG in pregnancy and increased incidence of gigantic infants; 2. pregnant women are related to age and pregnancy and maternal age. The age of pregnant women is higher TG; 3. in normal pregnancy, age, weight gain during pregnancy, pregnancy week and late pregnancy TG level are the risk factors of gigantic infants, and HD in late pregnancy, HD The level of L is the protective factor for the giant infants; in the 4. pregnancy, strengthening the nutrition management, controlling the excessive growth of weight, reducing the level of blood lipid, and ending the pregnancy at the right time are beneficial to reduce the incidence of giant infants and protect the health of mother and child.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.7
，
本文編號：2167234
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