目的 分析母亲孕前体质量指数(BMI)和孕期增重(GWG)及其二者交互作用对巨大儿的影响,为孕前和孕期体重管理提供相关理论依据。方法 基于全国13个城市2015年6月—2018年11月调查的12 040名母亲及足月新生儿相关数据,根据中国超重肥胖标准和GWG标准,采用非条件多因素Logistic回归分析孕前BMI和GWG对巨大儿发生风险的单独和交互效应。结果 随着孕前BMI水平的增加,GWG均值逐渐降低(Ptrend<0.001)。调整其他混杂因素后,结果显示孕前超重/肥胖(OR=1.67, 95%CI: 1.35~2.05)和GWG过多(OR=1.78, 95%CI: 1.48~2.16)增加了巨大儿的发生风险。孕前超重/肥胖和GWG过多同时存在时,进一步增加了巨大儿发生风险,但未发现二者存在交互作用。结论 母亲孕前超重/肥胖和GWG过多是巨大儿的独立危险因素,但二者的交互作用无统计学意义。建议女性应保持孕前正常体质量和孕期适宜增重,特别是孕前超重/肥胖人群应保持更低的GWG,以降低子代巨大儿的发生风险。
Abstract
Objective To explore the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) during pregnancy and their additive interaction on macrosomia, and provide evidence for maternal weight management before and during pregnancy. Methods This study was based on the data of 12 040 pregnant women and full-term newborns surveyed in 13 cities of China from June 2015 to November 2018. According to China′s standards for overweight, obesity, and GWG, unconditional multivariate Logistic regression was performed to estimate the independent effect and additive interaction of pre-pregnancy BMI and GWG on macrosomia. Results With the increase of pre-pregnancy BMI category, the mean GWG decreased gradually (Ptrend<0.001). After adjusting for other confounding factors, the results showed that pre-pregnancy overweight/obesity (OR=1.67, 95%CI: 1.35 - 2.05) and excessive GWG (OR=1.78, 95%CI: 1.48 - 2.16) increased the risk of macrosomia. The coexistence of pre-pregnancy overweight/obesity and excessive GWG further increased the risk of macrosomia, but the additive interaction between them was not found. Conclusions Pre-pregnancy overweight/obesity and excessive GWG are independent risk factors for macrosomia, but the interaction between them is not statistically significant. It is suggested that pregnant woman should keep normal weight before pregnancy and gain appropriate weight during pregnancy, especially those who are overweight/obese before pregnancy should keep lower GWG to reduce the risk of macrosomia in offspring.
关键词
体质量指数 /
孕期增重 /
巨大儿 /
交互作用
Key words
body mass index /
gestational weight gain /
macrosomia /
interaction
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基金
国家卫生健康委员会妇幼健康服务司委托项目(2015-42);国家重点研发计划:生育健康及妇女儿童健康保障重点专项(2021YFC2701905)
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