本文選題：能量平衡 + 能量攝入　； 參考：《華中科技大學(xué)》2014年博士論文

【摘要】：目的 本研究旨在調(diào)查了解蘭州地區(qū)妊娠中期孕婦能量攝入、消耗及儲(chǔ)存的流行特征,探究孕中期能量失衡及相關(guān)因素對(duì)妊娠期高血壓綜合征(PIH)、妊娠期糖尿病(GDM)、妊娠期膽汁淤積癥(ICP)(統(tǒng)稱妊娠特有疾病)發(fā)病的影響,為預(yù)防妊娠中期能量失衡和降低妊娠特有疾病發(fā)生提供科學(xué)參考依據(jù),促進(jìn)母嬰健康協(xié)調(diào)發(fā)展。 方法 于2009年7月一2012年6月選取甘肅省婦幼保健院圍產(chǎn)門診接受產(chǎn)前檢查的1668名妊娠中期(孕13-27周)孕婦為研究對(duì)象,運(yùn)用動(dòng)態(tài)觀察隊(duì)列研究方法開展流行病學(xué)調(diào)查,以孕婦一般情況調(diào)查問卷、半定量食物頻率問卷、體力活動(dòng)調(diào)查問卷為調(diào)查工具,通過孕期營(yíng)養(yǎng)軟件估算能量日均理論需要量(ER)、能量日均實(shí)際攝入量(EI),使用體力活動(dòng)權(quán)重系數(shù)法估算能量日均實(shí)際消耗量(EE),運(yùn)用生物電阻抗法測(cè)定受試者體成分以了解能量?jī)?chǔ)存狀況,綜合評(píng)估孕婦妊娠中期能量平衡流行特征；追訪妊娠結(jié)局,運(yùn)用巢式病例對(duì)照研究方法(以年齡、妊娠能量測(cè)評(píng)時(shí)孕周作為匹配條件,1：2匹配),分別探討妊娠中期能量攝入、消耗、儲(chǔ)存及相關(guān)因素對(duì)PIH、GDM、ICP的影響,尋找獨(dú)立危險(xiǎn)因素。使用SPSS20.0進(jìn)行統(tǒng)計(jì)分析,以P0.05判定為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.觀察隊(duì)列妊娠中期能量平衡流行特征 蘭州地區(qū)孕婦影響能量攝入的主要問題有：妊娠中期豆制品和水產(chǎn)品食用頻率偏低；與中國(guó)居民膳食營(yíng)養(yǎng)素參考攝入量相比,飲食日均攝入的葉酸和碘水平明顯偏低,磷水平偏高,蛋白質(zhì)供能比略高,碳水化合物供能比略低；影響能量消耗的主要問題有：孕中期活動(dòng)水平普遍表現(xiàn)不足,25-29歲組日均EE最低(P0.05)。孕婦能量攝入、消耗及儲(chǔ)存量均隨妊娠進(jìn)展不斷增長(zhǎng),妊娠中期EIEREE (P0.05);高齡、基礎(chǔ)體重過低或肥胖孕婦以及孕23-27周階段更易發(fā)生能量失衡(P0.001)。 2.妊娠中期能量失衡等相關(guān)因素對(duì)PIH發(fā)病的影響 單因素分析結(jié)果顯示,與對(duì)照組相比,PIH病例組家庭人均月收入高、孕婦妊娠早期被動(dòng)吸煙率高、孕前BMI和妊娠中期BMI均高；妊娠中期維生素A水平、鐵日均攝入水平相對(duì)較低而鈉攝入水平相對(duì)較高；體脂百分比(PBF)、體脂重(FM)、去脂體重指數(shù)(FFMI)及EE均高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。多因素條件Logistic回歸分析結(jié)果表明,孕婦孕前BMI升高(OR=2.28,95%CI:1.31-3.95)孕早期被動(dòng)吸煙率增加(OR=5.46,95%CI:1.06-28.17)及孕中期FM增高(OR=2.41,95%CI.1.36—4.28)是PIH發(fā)病的危險(xiǎn)因素。 3.妊娠中期能量失衡等相關(guān)因素對(duì)GDM發(fā)病的影響 單因素分析結(jié)果顯示,與對(duì)照組相比,GDM病例組孕婦孕前BMI和妊娠中期BMI較高,家庭人均月收入和孕婦文化程度較高,經(jīng)產(chǎn)婦比例高而既往人工流產(chǎn)次數(shù)略低,妊娠中期出現(xiàn)睡眠問題者較多,中等強(qiáng)度體力活動(dòng)水平較低,而蛋白質(zhì)攝入量、蛋白質(zhì)供能比、FM和EI均高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。多因素條件Logistic回歸分析結(jié)果表明,孕婦孕前BMI (OR=2.71,95%CI:1.71-4.02)、家庭人均月收入(OR=1.73,95%CI:1.36-2.74)、產(chǎn)次增加(OR=1.63,95%CI:1.26-2.44)以及孕期蛋白質(zhì)能量攝入過多(OR=1.65,95%CI:1.01-2.72)、蛋白質(zhì)供能比增加(OR=2.48,95%CI:1.70-6.34)、妊娠中期FM增高(OR=4.07,95%CI:2.86-10.88)是GDM發(fā)病的危險(xiǎn)因素。 4.妊娠中期能量失衡等相關(guān)因素對(duì)ICP發(fā)病的影響 單因素分析結(jié)果顯示,與對(duì)照組相比,ICP病例組經(jīng)產(chǎn)婦比例高、既往多次自然流產(chǎn)和人工流產(chǎn)次數(shù)高；妊娠中期PBF和FM較高,脂肪供能百分比、碳水化合物供能百分比較高,而日均膳食纖維攝入和鋅攝入水平較低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。多因素條件Logistic回歸分析結(jié)果表明,孕婦既往自然流產(chǎn)次數(shù)多(OR=3.56,95%CI：1.75—8.45)和妊娠中期FM增高(OR=3.09,95%CI:1.22-7.78)是ICP發(fā)病的危險(xiǎn)因素。 5.妊娠中期能量失衡對(duì)PIH、GDM、ICP發(fā)病的影響 妊娠中期短期的能量失衡對(duì)PIH, GDM. ICP發(fā)病無影響(P0.05),長(zhǎng)期過度的能量正平衡狀態(tài)會(huì)導(dǎo)致體內(nèi)脂肪蓄積過度,當(dāng)體脂重指數(shù)(FMI)≥7.1kg/m2(Median)時(shí),PIH發(fā)病危險(xiǎn)度增加2.65倍,GDM發(fā)病危險(xiǎn)度增加5.16倍。當(dāng)FMI≥8.6kg/m2時(shí)(P75值),PIH發(fā)病危險(xiǎn)度增加4.38倍,GDM發(fā)病危險(xiǎn)度增加15.38倍,ICP發(fā)病危險(xiǎn)度增加1.84倍。 結(jié)論 1蘭州地區(qū)孕婦豆制品和海產(chǎn)品食用頻率低,孕中期應(yīng)額外適度補(bǔ)充葉酸、碘、鈣和鋅等營(yíng)養(yǎng)補(bǔ)充劑；重點(diǎn)加強(qiáng)高齡和孕23-27周孕婦的能量攝入及消耗指導(dǎo),提倡孕期適度加強(qiáng)體力活動(dòng)以維持良好的能量平衡狀態(tài)。 2維持適宜的孕前BMI水平、妊娠早期降低被動(dòng)吸煙環(huán)境暴露及防止妊娠中期脂肪堆積過快可降低PIH的發(fā)病風(fēng)險(xiǎn)。維持適宜的孕前BMI水平、減少生育次數(shù)、適度控制蛋白質(zhì)攝入及防止妊娠中期脂肪堆積過快可降低GDM的發(fā)病風(fēng)險(xiǎn)。減少既往自然流產(chǎn)次數(shù)和防止妊娠中期脂肪堆積過快可降低ICP的發(fā)病風(fēng)險(xiǎn)。 3FMI升高是PIH、GDM及ICP發(fā)病的獨(dú)立危險(xiǎn)因素,體內(nèi)脂肪組織增多對(duì)GDM發(fā)病的影響最大,控制體內(nèi)脂肪過度增長(zhǎng)是降低妊娠特有疾病發(fā)病率的關(guān)鍵。
[Abstract]:Purpose

The purpose of this study was to investigate the prevalence of energy intake , consumption and storage of pregnant women in the mid - trimester of pregnancy , to explore the effects of energy imbalance and related factors on the pathogenesis of pregnancy induced hypertension syndrome ( PIH ) , gestational diabetes mellitus ( dm ) , pregnancy - induced stasis ( ICP ) ( collectively referred to as pregnancy - specific diseases ) , to provide scientific reference for the prevention of mid - term energy imbalance in pregnancy and to reduce the occurrence of pregnancy - specific diseases , and to promote the healthy and coordinated development of mother - to - child health .

method

In July , 2012 , 1668 pregnant women ( 13 - 27 weeks ) who received prenatal examination were selected from the perinatal clinics of maternal and child health care centers in Gansu Province . The epidemiological investigation was carried out by using the dynamic observation cohort study . The energy daily average theoretical requirement ( ER ) , energy daily average intake ( EI ) were estimated by means of the maternal nutrition software , the energy daily average consumption ( EE ) was estimated by using the physical activity weight coefficient method , and the body composition of the subject was determined by using the bioresistance method to understand the energy storage condition , and the epidemic characteristics of the mid - term energy balance of the pregnant women were comprehensively evaluated ;
The effects of energy intake , consumption , storage and related factors on PIH , gdm and ICP in the medium term of pregnancy were investigated by using the nested case control method ( matched condition , 1 : 2 matching condition at the time of pregnancy and energy measurement ) , and the effects of energy intake , consumption , storage and related factors on PIH , gdm and ICP were studied respectively . The statistical analysis was made by SPSS 20.0 , and the difference was statistically significant .

Results

1 . Observation of the Epidemic Characteristics of Mid - term Energy Balance in Cohort Pregnancy

The main problems affecting energy intake in pregnant women in Lanzhou area are : low consumption of soybean products and aquatic products during pregnancy ;
Compared with the reference intake of dietary nutrients of Chinese residents , the dietary intake of folic acid and iodine was significantly lower , the phosphorus level was higher , the protein supply ratio was slightly higher , and the carbohydrate supply ratio was slightly lower ;
The main problems affecting energy consumption were : the level of middle - term activity of pregnant women was not enough , the average EE was lowest in 25 - 29 years ( P0.05 ) . The energy intake , consumption and storage of pregnant women all increased with the progress of pregnancy , EIEREE in the middle of pregnancy ( P0.05 ) , advanced age , low basal body weight or obese pregnant women and 23 - 27 weeks of pregnancy were more vulnerable to energy imbalance ( P0.001 ) .

2 . Effects of related factors on the pathogenesis of PIH during the mid - term energy imbalance of pregnancy

The results of single factor analysis showed that the average monthly income per person in PIH group was higher than that of the control group , the passive smoking rate was higher in the early stage of pregnancy , the BMI at the early stage of pregnancy and the mid - term BMI were higher in PIH group .
The levels of vitamin A and iron daily average intake were relatively low and the level of sodium intake was relatively high in the middle period of pregnancy .
( OR = 2.28 , 95 % CI : 1.31 - 3.95 ) , the passive smoking rate increased ( OR = 5.46 , 95 % CI : 1.06 - 28.17 ) and the mid - trimester FM ( OR = 2.41 , 95 % CI . 1.36 - 4.28 ) were the risk factors of PIH .

3 . Effects of related factors , such as the mid - term energy imbalance of pregnancy , on the onset of gdm

The results of single - factor analysis showed that the BMI and mid - term BMI of pregnant women were higher than those in the control group . The average monthly income of the family and the culture of the pregnant women were higher , the average monthly income of the family ( OR = 1 . 73 , 95 % CI : 1.36 - 2.74 ) , the increase of the protein supply ratio ( OR = 1 . 63 , 95 % CI : 1 . 70 - 6.34 ) , the increase of the mid - term FM ( OR = 4.07 , 95 % CI : 2.86 - 10.88 ) was a risk factor for the onset of gdm .

4 . Influence of factors related to the mid - term energy imbalance of pregnancy on the pathogenesis of ICP

The results of single factor analysis showed that compared with the control group , the proportion of women in ICP group was higher than that of control group , and the number of recurrent spontaneous abortion and induced abortion was high ;
There were significant differences in dietary fiber intake and zinc intake in pregnant women ( OR = 3.56 , 95 % CI : 1.75 - 8.45 ) and mid - pregnancy FM ( OR = 3.09 , 95 % CI : 1.22 - 7.78 ) , which were the risk factors of ICP .

5 . Effect of Mid - term energy imbalance on the pathogenesis of PIH , gdm and ICP

Short - term and short - term energy imbalance in pregnancy is associated with PIH and gdm . When FMI was 鈮，

本文編號(hào)：1773610