【摘要】：目的:調(diào)查禹城市人民醫(yī)院產(chǎn)一科住院分娩的農(nóng)村婦女孕期肥胖情況,分析其對(duì)母嬰結(jié)局的影響,探討孕期管理體重的方法以降低不良妊娠結(jié)局,保障母兒安全。方法:本研究采用回顧性隊(duì)列研究,于孕婦住院期間,通過查閱孕期保健手冊(cè)和住院病歷以及與孕婦會(huì)談的方式獲得相關(guān)信息,如孕婦年齡、身高、孕前體重、分娩前體重及母嬰結(jié)局等,由經(jīng)過培訓(xùn)的調(diào)查員填寫本研究專用的《農(nóng)村孕婦妊娠、分娩情況調(diào)查表》,收集資料完整的單胎妊娠農(nóng)村初產(chǎn)婦896例。根據(jù)孕前BMI將孕婦分為孕前消瘦組(BMI18.5kg/m2;n=62)、孕前體重正常組(18.5 kg/m2≤BMI24 kg/m2;n=601)、孕前超重組(24 kg/m2≤BMI28 kg/m2;n=176)、孕前肥胖組(BMI≥28kg/mm2;n=57)。按孕期總增重15kg,孕期BMI增幅≥6為孕期體重增加過度為切點(diǎn)將孕婦分為孕期體重增加適宜組及孕期體重增長(zhǎng)過度組。比較分析各組孕婦孕期肥胖情況對(duì)母嬰結(jié)局的影響。所有數(shù)據(jù)均利用SPSS19.0統(tǒng)計(jì)學(xué)軟件進(jìn)行分析和處理。結(jié)果:1.對(duì)母體的影響:孕前超重+肥胖組與孕前體重正常組相比,孕期體重增長(zhǎng)過度組與孕期體重增加適宜組相比,其妊娠期高血壓疾病、妊娠期糖尿病、剖宮產(chǎn)、產(chǎn)后出血的發(fā)生率均明顯增加。在妊娠期高血壓疾病的發(fā)生率上,孕前超重+肥胖組是孕前正常體重組的5.956倍(0R,5.956;95%%CI,3.474-10.213),孕期體重增長(zhǎng)過度組是孕期體重增加適宜組的2.777倍(OR,2.777;95%CI,1.558-4.950);在妊娠期糖尿病的發(fā)生率上,孕前超重+肥胖組是孕前正常體重組的4.212倍(0R,4.212;95%CI,2.547-6.964),孕期體重增長(zhǎng)過度組是孕期體重增加適宜組的3.084倍(0R,3.084;95%CI,1.741-5.466);在剖宮產(chǎn)的發(fā)生率上,孕前超重+肥胖組是孕前正常體重組的2.871倍(0R,2.871;95%CI,2.103-3.919),孕期體重增長(zhǎng)過度組是孕期體重增加適宜組的3.317倍(OR,3.317;95%CI,2.470-4.456);在產(chǎn)后出血的發(fā)生率上,孕前超重+肥胖組是孕前正常體重組的5.234倍(0R,5.234;95%CI,2.919-9.385),孕期體重增長(zhǎng)過度組是孕期體重增加適宜組的2.914倍(0R,2.914;95%CI,1.580-5.374)。經(jīng)卡方檢驗(yàn),差異顯著,均有統(tǒng)計(jì)學(xué)意義(P0.01)。2.對(duì)胎兒的影響:孕前超重+肥胖組與孕前體重正常組相比,孕期體重增長(zhǎng)過度組與孕期體重增加適宜組相比,其巨大兒發(fā)生率明顯增加,孕前超重+肥胖組是孕前正常體重組的9.454倍(0R,9.454;95%CI,6.342-14.093),孕期體重增長(zhǎng)過度組是孕期體重增加適宜組的5.108倍(0R,5.108;95%CI,3.248-8.034),經(jīng)卡方檢驗(yàn),差異顯著,有統(tǒng)計(jì)學(xué)意義(P0.01);孕前肥胖者新生兒窒息的發(fā)生率是孕前體重正常的0.790倍(0R,0.790;95%CI,0.255-2.448),經(jīng)卡方檢驗(yàn)無統(tǒng)計(jì)學(xué)意義(X2=0.168,P0.05),孕期體重增加過度者新生兒窒息的發(fā)生率是孕期體重增加適宜的1.755倍(0R,1.755;95%CI,0.750-4.110),經(jīng)卡方檢驗(yàn)無統(tǒng)計(jì)學(xué)意義(X2=1.721,P0,05)。3.孕前超重及肥胖組中,孕期體重增長(zhǎng)過度發(fā)生妊娠期高血壓、妊娠期糖尿病、剖宮產(chǎn)、產(chǎn)后出血、巨大兒的風(fēng)險(xiǎn)分別是孕期體重增長(zhǎng)適宜的1.24倍(95%CI,1.113-1.388)、1.14倍(95%CI,1.023-1.280)、1.37倍(95%CI,1.029-1.833)、1.13倍(95%CI,1.019-1.243)、2.05倍(95%CI,1.653-2.545),經(jīng)檢驗(yàn)有統(tǒng)計(jì)學(xué)意義。4.孕前超重+肥胖組與孕前體重正常組相比,孕期體重增長(zhǎng)過度組與孕期體重增長(zhǎng)適宜組相比,因巨大兒行剖宮產(chǎn)的風(fēng)險(xiǎn)均增加,經(jīng)卡方檢驗(yàn),有統(tǒng)計(jì)學(xué)意義(P0.01;P0.05);因難產(chǎn)行剖宮產(chǎn)的風(fēng)險(xiǎn)均降低,經(jīng)卡方檢驗(yàn),差異顯著,有統(tǒng)計(jì)學(xué)意義(P0.01);而因妊娠期高血壓疾病、胎兒窘迫、胎位不正行剖宮產(chǎn)的風(fēng)險(xiǎn)兩組差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:孕前肥胖與孕期體重增長(zhǎng)過度增加了妊娠期高血壓疾病、妊娠期糖尿病、剖宮產(chǎn)、產(chǎn)后出血、巨大兒的發(fā)生率,是導(dǎo)致農(nóng)村孕婦不良妊娠結(jié)局的危險(xiǎn)因素。為了母嬰健康,應(yīng)加強(qiáng)農(nóng)村肥胖孕婦的體重管理,包括孕前及孕期體重增長(zhǎng),將體重控制在適宜標(biāo)準(zhǔn)范圍內(nèi),以降低妊娠不良結(jié)局的發(fā)生。
[Abstract]:Objective: To investigate the situation of the obesity of rural women who have been hospitalized in the hospital of Yucheng People's Hospital and to analyze their influence on the outcome of mother-to-child and to explore the methods of the management of body weight during pregnancy to reduce the outcome of the poor pregnancy and to guarantee the safety of the mother and child. Methods: The retrospective cohort study was used in this study to obtain relevant information, such as the age, height, weight of the pregnant woman, the weight before delivery and the outcome of the mother and child, during the period of the pregnant woman's stay in the hospital. The survey of pregnant and delivery of pregnant women in rural pregnant women, which was dedicated to the study, was completed by trained investigators, and 896 cases of single-pregnancy rural women with complete information were collected. The pregnant women were divided into the pregestational age group (BMI18.5 kg/ m2; n = 62) according to the pre-pregnancy BMI; the normal weight of the pregestational weight (18.5 kg/ m2; BMI24 kg/ m2; n = 601); the pre-pregnancy super-recombinant (24 kg/ m2; BMI28 kg/ m2; n = 176); and the pregestational obesity group (BMI = 28 kg/ mm2; n = 57). According to the total weight gain of 15 kg during pregnancy and the increase of BMI in pregnant period, the pregnant women were divided into the appropriate group of weight gain during pregnancy and the weight gain of the pregnant women during pregnancy. The effect of the weight of the pregnant women on the mother-to-child outcome was compared and analyzed. All data were analyzed and processed using the SPSS19.0 statistical software. Results:1. The influence of the maternal body: the pre-pregnancy overweight + obese group and the pre-pregnant body weight normal group, the weight gain of the pregnant women increased over the pre-pregnancy weight gain group, the pregnancy-induced hypertension disease, the gestational diabetes, the cesarean section and the post-partum hemorrhage increased significantly compared with the suitable group in the pre-pregnancy weight gain group. The pre-pregnancy overweight + obesity group was 5.956 times (0R, 5.956;95% CI, 3.474-10.213) of the pre-pregnancy normal body, and the weight gain during pregnancy was 2.777-fold (OR, 2.777;95% CI, 1.558-4.950) in the appropriate group during pregnancy, and the rate of gestational diabetes, The pre-pregnancy overweight + obesity group was 4.212-fold (0R, 4.212;95% CI, 2.547-6.964) of the normal body of pre-pregnancy, and the weight-increasing group during pregnancy was 3.084-fold (0R, 3.084;95% CI, 1.741-5.466) in the appropriate group during pregnancy; at the rate of cesarean section, The pre-pregnancy overweight + obesity group was 2.871-fold (0R, 2.871;95% CI, 2.103-3.919) of the normal body of pre-pregnancy, and the weight-increasing group during pregnancy was 3.317-fold (OR, 3.317;95% CI, 2.470-4.456) in the appropriate group during pregnancy, and in the incidence of postpartum hemorrhage, The pre-pregnancy overweight + obesity group was 5.234-fold (0R, 5.234;95% CI, 2.919-9.385) of the pre-pregnancy normal body, and the weight gain during pregnancy was 2.914-fold (0R, 2.914;95% CI, 1.580-5.374) in the appropriate group during pregnancy. The difference was significant in Chi-square test (P0.01). The effect on the fetus: compared with the normal group in the pre-pregnant and overweight + obese group, the high incidence of the large infant in the pre-pregnant and overweight + obese group was 9.454-fold (0R, 9.454;95% CI, 6.342-14.093) of the pre-pregnancy normal body. The weight gain during pregnancy was 5.108-fold (0R, 5.108;95% CI, 3.248-8.034) in the appropriate group during pregnancy, and the difference was significant in the chi-square test (P0.01); the incidence of neonatal asphyxia in the pregestational obesity was 0.790-fold (0R, 0.790;95% CI, 0.255-2.448) of the pre-pregnancy weight. No statistical significance was found in the chi-square test (X2 = 0.168, P0.05). The incidence of neonatal asphyxia was 1.755 times (0R, 1.755;95% CI, 0.750-4.110) of weight gain during pregnancy, and no statistical significance was found in the chi-square test (X2 = 1.721, P0.05). The risk of over-pregnancy, gestational diabetes, cesarean section, and post-partum hemorrhage during pregnancy was 1.24-fold (95% CI, 1.113-1.388), 1.14-fold (95% CI, 1.023-1.280), 1.37-fold (95% CI, 1.029-1.833), 1.13-fold (95% CI, 1.019-1.243), 2.05 times (95% CI, 1.653-2.545), with statistical significance. In the pre-pregnant and overweight + obese group, compared with the normal group in the pre-pregnant weight group, the weight gain in the pregnant period increased with the appropriate group in the pre-pregnancy weight-increasing group, and the risk of the caesarean section in the large-child line increased, and the result of the chi-square test is statistically significant (P0.01; P0.05); and the risk of the cesarean section is reduced due to the difficult production line, The difference between the two groups was significant (P0.01), and there was no significant difference between the two groups (P0.05). Conclusion: The pre-pregnancy obesity and the increase of the weight of the pregnant women have increased the pregnancy-induced hypertension, the gestational diabetes, the cesarean section, the post-partum hemorrhage, the incidence of the great child, which is the risk factor leading to the poor pregnancy outcome of the pregnant women in the rural areas. In order to mother and child health, the weight management of pregnant women in rural areas should be strengthened, including pre-pregnancy and body weight increase, and the body weight should be controlled within a suitable standard to reduce the occurrence of poor pregnancy outcomes.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714

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6 高文削;孕前體重指數(shù)和孕期體重增長(zhǎng)水平與妊娠期代謝綜合征發(fā)病的相關(guān)性[D];鄭州大學(xué);2014年

7 燕素英;孕前及孕期體重與產(chǎn)科并發(fā)癥及妊娠結(jié)局的關(guān)系[D];山西醫(yī)科大學(xué);2010年

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