孕婦肥胖和血脂水平對(duì)新生兒出生結(jié)局的影響
發(fā)布時(shí)間：2019-03-02 10:34
【摘要】：目的探討不同孕前體質(zhì)指數(shù)(body mass index, BMI)和孕期增重對(duì)母親血脂水平的影響，以及不同血脂水平對(duì)胎兒發(fā)育的影響，為合理控制孕期飲食、降低異常出生體重兒的發(fā)生率提供依據(jù)。 方法流行病學(xué)隊(duì)列研究方法：選擇在2011年1月~2012年7月在合肥市某婦幼保健院住院分娩的孕婦及其新生兒作為研究對(duì)象。利用回顧性調(diào)查的方式獲取整個(gè)孕期詳盡的保健記錄，前瞻性追蹤新生兒出生結(jié)局資料。資料信息用Epidata3.0軟件錄入，，數(shù)據(jù)分析采用SPSS16.0進(jìn)行。連續(xù)性資料描述用(x±s)表示，分類(lèi)資料用相對(duì)數(shù)表示。兩組間均數(shù)比較采用t檢驗(yàn)，多組間均數(shù)比較采用單因素方差分析或協(xié)方差分析，頻數(shù)分布比較采用χ2檢驗(yàn)；多元線性回歸分析血脂水平與新生兒發(fā)育指標(biāo)的關(guān)系，并調(diào)整孕婦年齡、孕前BMI、孕期增重、孕周等混雜因素，二分類(lèi)logistic回歸分析血脂水平與巨大兒發(fā)生率的關(guān)聯(lián)，并調(diào)整孕婦年齡、孕前BMI、孕期增重、孕周等一系列混雜因素。 結(jié)果孕婦肥胖、孕期血脂水平及其他母體因素均不同程度地對(duì)新生兒出生結(jié)局產(chǎn)生影響：(1)孕前超重肥胖組的孕婦分娩的新生兒出生體重、身長(zhǎng)、頭圍、胸圍高于孕前正常體重組和消瘦組(P0.05)。(2)孕期增重過(guò)多組的孕婦分娩的新生兒出生體重、身長(zhǎng)、頭圍、胸圍各項(xiàng)指標(biāo)高于孕期增重正常組和增重不足組，差異均具有統(tǒng)計(jì)學(xué)意義（均P0.01）。(3)與孕前體重正常且孕期增重正常組的孕婦相比，孕前體重正常且孕期增重過(guò)多組的孕婦和孕前超重肥胖且孕期增重過(guò)多組的孕婦分娩的新生兒出生體重、身長(zhǎng)、頭圍、胸圍均較大(P0.05)，孕前消瘦且孕期增重過(guò)少組的孕婦分娩的新生兒出生體重較輕(P0.05)，身長(zhǎng)較短(P0.01)。調(diào)整孕周、孕婦年齡和產(chǎn)次等混雜因素后，結(jié)果不變。(4)與孕前體重正常且孕期增重正常的孕婦相比，孕前消瘦且孕期增重過(guò)少的孕婦剖腹產(chǎn)發(fā)生率較低，孕前超重肥胖且孕期增重正�；蜻^(guò)多的孕婦剖腹產(chǎn)發(fā)生率較高(P0.05)。(5)孕前消瘦組、正常體重組和超重肥胖組的孕婦相比，總膽固醇(total cholesterol,TC)，高密度脂蛋白膽固醇(high-density lipoprotein cholesterol, HDL-C)，低密度脂蛋白膽固醇(low-density liprotern cholesterol,LDL-C)差異有統(tǒng)計(jì)學(xué)意義(P0.01)。孕前超重肥胖組的TC、HDL-C、LDL-C均低于孕前消瘦組和正常體重組(P0.05)。(6)孕期增重過(guò)多、正常和不足的三組孕婦甘油三酯(triglyceride, TG)、HDL-C水平差異有統(tǒng)計(jì)學(xué)意義。增重過(guò)多組TG水平高于增重不足組(P0.05)，HDL-C水平比孕期增重正常組低(P0.05)。(7)與正常待產(chǎn)組孕婦相比，妊娠期糖尿病組的TG水平明顯升高，妊娠高血壓綜合征組的孕婦TG水平升高，HDL-C水平降低(P0.05)。(8)孕晚期TG與新生兒出生體重正相關(guān)(P0.05)，HDL-C與新生兒出生體重、身長(zhǎng)、頭圍、胸圍負(fù)相關(guān)(P0.05)。(9)單因素logistic回歸分析TG與巨大兒發(fā)生率呈正相關(guān)，HDL-C與巨大兒發(fā)生率呈負(fù)相關(guān)。多因素logistic回歸分析調(diào)整孕婦年齡、孕前BMI等一系列混雜因素后，孕婦的HDL-C仍然是巨大兒發(fā)生的保護(hù)因素。 結(jié)論孕前BMI、孕期增重、產(chǎn)前BMI、孕晚期空腹血脂水平及其他社會(huì)學(xué)特征均對(duì)新生兒的發(fā)育指標(biāo)、巨大兒發(fā)生率、分娩方式等產(chǎn)生影響。孕前高BMI、孕期增重過(guò)多、產(chǎn)前高BMI、孕晚期高水平空腹血脂會(huì)提高新生兒出生體重、身長(zhǎng)、頭圍、胸圍值，增大巨大兒發(fā)生率和剖腹產(chǎn)率；不同孕前體重、孕期增重以及是否患有妊娠期糖尿病、妊娠期高血壓綜合征的孕婦其血脂水平的分布不同。孕晚期TG、HDL-C與新生兒發(fā)育有關(guān)，TG增加巨大兒發(fā)生風(fēng)險(xiǎn)，HDL-C降低巨大兒發(fā)生風(fēng)險(xiǎn)。
[Abstract]:Objective To study the effect of body mass index (BMI) and weight gain on the blood lipid level of the mother and the effect of different blood lipid levels on the development of the fetus, and to provide the basis for the rational control of the pregnant diet and reducing the incidence of abnormal birth weight. Methods: The method of epidemiological cohort study was to select pregnant women and their newborns who were hospitalized in a maternity and child care hospital in Hefei from January 2011 to July 2012 as the research group. For example, a retrospective survey was used to obtain a thorough health-care record throughout pregnancy, looking forward to follow-up of neonatal birth outcomes Material: The data information is entered by the Epidata3.0 software, and the data analysis adopts SPSS16.0. lines. Continuity data description (x {s)} means the phase-to-number table for categorical data The results showed that the average number of the two groups was t-test, and the average number of the two groups was compared with the one-factor analysis of variance or the covariance analysis. The frequency distribution was compared with the two-factor analysis. The relationship between the blood lipid level and the development index of the newborn was analyzed by the multiple linear regression, and the age of the pregnant women, the pre-pregnancy BMI and the pregnancy increase were adjusted. The association between the level of blood lipid and the incidence of macrosomia was analyzed by the two-classification logistic regression, and a series of confounders such as the age of the pregnant women, the pre-pregnancy BMI, the weight gain of the pregnant women and the gestational weeks were adjusted. Results: (1) The birth weight, length, head circumference and chest circumference of the pregnant women in the pre-pregnancy and overweight obese group were higher than that of the normal body and the wasting group (P0. (2) The weight of birth weight, body length, head circumference and chest circumference of the pregnant women who had weight gain during pregnancy were higher than those in the normal group and the weight gain group, and the difference was of statistical significance (mean P0. 01). (3) Compared with the pregnant women with normal body weight and normal weight gain during pregnancy, the weight of the pregnant women with normal body weight and the weight gain of the pregnant women in the first trimester of pregnancy and the weight gain of the pregnant women who are overweight and obese during pregnancy and the weight gain of the pregnant women in the first trimester of pregnancy are larger than that of the pregnant women who have been given birth, and the body length, the head circumference and the chest circumference are larger (P0. (05) The weight of birth weight of pregnant women who were emaciated before and during pregnancy (P0.05), and the length of body was shorter (P 0.05). 01). After adjustment of the confounding factors such as gestational weeks, pregnant women's age and birth, the knot (4) The incidence of caesarean section of pregnant women with less weight and weight gain before and during pregnancy is lower than that of pregnant women with normal weight and normal weight gain before and during pregnancy, and the incidence of caesarean section in pregnant women who is overweight and obese before pregnancy is higher than that of pregnant women with normal weight gain during pregnancy (P0. (5) The difference of total cholesterol (total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) was statistically significant (P 01) The TC, HDL-C and LDL-C of the overweight and obese group were lower than that of the pre-pregnant and normal body (P0. (6) There was a statistically significant difference in the levels of triglyceride (TG) and HDL-C in three groups of pregnant women with excessive weight gain, normal and insufficient weight gain during pregnancy. The weight gain of the group was higher than that in the underweight group (P0.05), and the level of HDL-C was lower than that of the normal weight gain group (P 0.05). (7) The level of TG in the gestational diabetes group was significantly higher than that of the pregnant women in the normal group, and the level of TG of the pregnant women in the pregnancy-induced hypertension group was increased, and the level of HDL-C decreased (P0. (8) The TG in the late pregnancy was positively correlated with the birth weight of the newborn (P0.05), and the HDL-C was negatively correlated with the birth weight of the newborn, the length of the body, the head circumference and the chest circumference (P0. (9) The single-factor logistic regression analysis showed that the incidence of TG was positively correlated with the incidence of macrosomia, and the incidence of HDL-C and macrosomia was in the same way. There was a negative correlation. After a series of confounding factors such as the age of the pregnant woman and the pre-pregnancy BMI were adjusted by the multi-factor logistic regression analysis, the HDL-C of the pregnant women was still the protection of the large infant. Nursing factors. Conclusion The pre-pregnancy BMI, the weight gain of pregnancy, the pre-natal BMI, the level of fasting blood lipid in the late pregnancy and other social characteristics all affect the development index of the newborn, the incidence of the great child and the mode of delivery. The pregestational high BMI, the excessive weight gain, the pre-natal high BMI, the high-level fasting blood fat in the late pregnancy can increase the birth weight of the newborn, the length of the body, the head circumference, the chest circumference value, the increase of the incidence of the large infant and the rate of the caesarean section, the weight of the pre-pregnancy weight, the weight gain during the pregnancy, and whether or not it has the weight of the fetus. The level of blood lipid in pregnant women with stage 2 diabetes and pregnancy-induced hypertension The distribution of TG and HDL-C in the late pregnancy is related to the development of the newborn.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R153.1
本文編號(hào)：2432968
[Abstract]:Objective To study the effect of body mass index (BMI) and weight gain on the blood lipid level of the mother and the effect of different blood lipid levels on the development of the fetus, and to provide the basis for the rational control of the pregnant diet and reducing the incidence of abnormal birth weight. Methods: The method of epidemiological cohort study was to select pregnant women and their newborns who were hospitalized in a maternity and child care hospital in Hefei from January 2011 to July 2012 as the research group. For example, a retrospective survey was used to obtain a thorough health-care record throughout pregnancy, looking forward to follow-up of neonatal birth outcomes Material: The data information is entered by the Epidata3.0 software, and the data analysis adopts SPSS16.0. lines. Continuity data description (x {s)} means the phase-to-number table for categorical data The results showed that the average number of the two groups was t-test, and the average number of the two groups was compared with the one-factor analysis of variance or the covariance analysis. The frequency distribution was compared with the two-factor analysis. The relationship between the blood lipid level and the development index of the newborn was analyzed by the multiple linear regression, and the age of the pregnant women, the pre-pregnancy BMI and the pregnancy increase were adjusted. The association between the level of blood lipid and the incidence of macrosomia was analyzed by the two-classification logistic regression, and a series of confounders such as the age of the pregnant women, the pre-pregnancy BMI, the weight gain of the pregnant women and the gestational weeks were adjusted. Results: (1) The birth weight, length, head circumference and chest circumference of the pregnant women in the pre-pregnancy and overweight obese group were higher than that of the normal body and the wasting group (P0. (2) The weight of birth weight, body length, head circumference and chest circumference of the pregnant women who had weight gain during pregnancy were higher than those in the normal group and the weight gain group, and the difference was of statistical significance (mean P0. 01). (3) Compared with the pregnant women with normal body weight and normal weight gain during pregnancy, the weight of the pregnant women with normal body weight and the weight gain of the pregnant women in the first trimester of pregnancy and the weight gain of the pregnant women who are overweight and obese during pregnancy and the weight gain of the pregnant women in the first trimester of pregnancy are larger than that of the pregnant women who have been given birth, and the body length, the head circumference and the chest circumference are larger (P0. (05) The weight of birth weight of pregnant women who were emaciated before and during pregnancy (P0.05), and the length of body was shorter (P 0.05). 01). After adjustment of the confounding factors such as gestational weeks, pregnant women's age and birth, the knot (4) The incidence of caesarean section of pregnant women with less weight and weight gain before and during pregnancy is lower than that of pregnant women with normal weight and normal weight gain before and during pregnancy, and the incidence of caesarean section in pregnant women who is overweight and obese before pregnancy is higher than that of pregnant women with normal weight gain during pregnancy (P0. (5) The difference of total cholesterol (total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) was statistically significant (P 01) The TC, HDL-C and LDL-C of the overweight and obese group were lower than that of the pre-pregnant and normal body (P0. (6) There was a statistically significant difference in the levels of triglyceride (TG) and HDL-C in three groups of pregnant women with excessive weight gain, normal and insufficient weight gain during pregnancy. The weight gain of the group was higher than that in the underweight group (P0.05), and the level of HDL-C was lower than that of the normal weight gain group (P 0.05). (7) The level of TG in the gestational diabetes group was significantly higher than that of the pregnant women in the normal group, and the level of TG of the pregnant women in the pregnancy-induced hypertension group was increased, and the level of HDL-C decreased (P0. (8) The TG in the late pregnancy was positively correlated with the birth weight of the newborn (P0.05), and the HDL-C was negatively correlated with the birth weight of the newborn, the length of the body, the head circumference and the chest circumference (P0. (9) The single-factor logistic regression analysis showed that the incidence of TG was positively correlated with the incidence of macrosomia, and the incidence of HDL-C and macrosomia was in the same way. There was a negative correlation. After a series of confounding factors such as the age of the pregnant woman and the pre-pregnancy BMI were adjusted by the multi-factor logistic regression analysis, the HDL-C of the pregnant women was still the protection of the large infant. Nursing factors. Conclusion The pre-pregnancy BMI, the weight gain of pregnancy, the pre-natal BMI, the level of fasting blood lipid in the late pregnancy and other social characteristics all affect the development index of the newborn, the incidence of the great child and the mode of delivery. The pregestational high BMI, the excessive weight gain, the pre-natal high BMI, the high-level fasting blood fat in the late pregnancy can increase the birth weight of the newborn, the length of the body, the head circumference, the chest circumference value, the increase of the incidence of the large infant and the rate of the caesarean section, the weight of the pre-pregnancy weight, the weight gain during the pregnancy, and whether or not it has the weight of the fetus. The level of blood lipid in pregnant women with stage 2 diabetes and pregnancy-induced hypertension The distribution of TG and HDL-C in the late pregnancy is related to the development of the newborn.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R153.1
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