基于社区早孕和儿童免疫接种登记信息探讨女性孕前体质指数与新生儿出生体质量的关系
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摘要
背景出生体质量影响母婴健康状况,其可能与女性孕前健康状况、体质指数(BMI)等因素相关。目的以上海市街道社区服务中心早孕登记信息和免疫接种登记信息为基础,了解上海市社区孕产妇健康状况和新生儿出生体质量情况并探讨女性孕前BMI与新生儿出生体质量的关系。方法本研究招录了2016年1—12月在上海市徐汇区华泾社区卫生服务中心早孕建卡的女性,且新生儿在该社区卫生服务中心注册进行儿童预防接种。根据该中心的早孕和儿童免疫接种登记信息,收集女性的一般资料(包括年龄、孕前BMI、孕次等)、新生儿一般资料(性别、出生体质量、胎龄等)。比较不同女性特征和新生儿特征的新生儿出生体质量,并采用Pearson相关分析和多元线性回归分析探讨女性孕前BMI与新生儿出生体质量的关系。结果不同性别、胎龄的新生儿出生体质量比较,差异有统计学意义(P<0.05);不同女性年龄、户籍地、孕次、孕前BMI的新生儿出生体质量比较,差异无统计学意义(P>0.05)。219例孕妇孕前平均BMI为(21.8±2.3)kg/m~2,新生儿平均出生体质量为(3 374.3±469.6)g。Pearson相关分析结果显示,女性孕前BMI与新生儿出生体质量无相关关系(r=0.072,P=0.290)。但上海户籍女性孕前BMI与新生儿出生体质量呈线性负相关(r=-0.273,P=0.007)。新生儿胎龄与其出生体质量呈线性正相关(r=0.485,P<0.001)。多元线性回归分析结果显示,新生儿性别、胎龄是出生体质量的影响因素(P<0.05)。结论本研究未发现女性孕前BMI与新生儿出生体质量相关,仅上海户籍女性孕前BMI与新生儿出生体质量呈线性负相关。
Background Neonatal birth weight influences the subsequent health of the infant and maternal postpartum health,which may be associated with maternal pre-pregnancy health and body mass index(BMI).Objective To investigate the status of maternal health and neonatal birth weight in community-based healthcare settings in Shanghai by reviewing early antenatal registration information and child's immunization information from a street community health center in Shanghai,and based on this,to examine the relationship between maternal pre-pregnancy BMI and neonatal birth weight.Methods We conducted this study in women and their infants recruited from Huajing Community Health Center(located Xuhui District in Shanghai) during January to December 2016.All the women received antenatal care after establishing an antenatal record card during early pregnancy and their infants received immunization services after establishing an immunization record card.We collected the general data of the women,such as age,pre-pregnancy BMI,gravidity,and the general data of their infants,including sex,birth weight,gestational age at birth and so on.Neonatal birth weight was analyzed by maternal and infant characteristics.Pearson correlation coefficient and multiple linear regression model were applied to estimate the relationship between maternal pre-pregnancy BMI and neonatal birth weight.Results The average pre-pregnancy BMI of the included 219 women was(21.8±2.3)kg/m2 and the average birth weight of their infants was(3 374.3±469.6) g.Neonatal birth weight differed significantly by sex and gestational age at birth(P<0.05),but did not by maternal age,place of hukou,gravidity,and pre-pregnancy BMI(P>0.05).Pearson correlation analysis showed that maternal pre-pregnancy BMI was not correlated with neonatal birth weight(r=-0.072,P=0.290) among the 219 mother-newborn pairs,but was negatively correlated with neonatal birth weight limited in Shanghai residents(r=-0.273,P=0.007).Gestational age at birth was positively correlated with neonatal birth weight(r=0.485,P<0.001).Sex and gestational age at birth of the infants were associated with neonatal birth weight by the multiple linear regression model(P<0.05).Conclusion No association between maternal pre-pregnancy BMI and neonatal birth weight was found in this study,but maternal pre-pregnancy BMI was negatively correlated with neonatal birth weight limited in Shanghai residents.
Background Neonatal birth weight influences the subsequent health of the infant and maternal postpartum health,which may be associated with maternal pre-pregnancy health and body mass index(BMI).Objective To investigate the status of maternal health and neonatal birth weight in community-based healthcare settings in Shanghai by reviewing early antenatal registration information and child's immunization information from a street community health center in Shanghai,and based on this,to examine the relationship between maternal pre-pregnancy BMI and neonatal birth weight.Methods We conducted this study in women and their infants recruited from Huajing Community Health Center(located Xuhui District in Shanghai) during January to December 2016.All the women received antenatal care after establishing an antenatal record card during early pregnancy and their infants received immunization services after establishing an immunization record card.We collected the general data of the women,such as age,pre-pregnancy BMI,gravidity,and the general data of their infants,including sex,birth weight,gestational age at birth and so on.Neonatal birth weight was analyzed by maternal and infant characteristics.Pearson correlation coefficient and multiple linear regression model were applied to estimate the relationship between maternal pre-pregnancy BMI and neonatal birth weight.Results The average pre-pregnancy BMI of the included 219 women was(21.8±2.3)kg/m2 and the average birth weight of their infants was(3 374.3±469.6) g.Neonatal birth weight differed significantly by sex and gestational age at birth(P<0.05),but did not by maternal age,place of hukou,gravidity,and pre-pregnancy BMI(P>0.05).Pearson correlation analysis showed that maternal pre-pregnancy BMI was not correlated with neonatal birth weight(r=-0.072,P=0.290) among the 219 mother-newborn pairs,but was negatively correlated with neonatal birth weight limited in Shanghai residents(r=-0.273,P=0.007).Gestational age at birth was positively correlated with neonatal birth weight(r=0.485,P<0.001).Sex and gestational age at birth of the infants were associated with neonatal birth weight by the multiple linear regression model(P<0.05).Conclusion No association between maternal pre-pregnancy BMI and neonatal birth weight was found in this study,but maternal pre-pregnancy BMI was negatively correlated with neonatal birth weight limited in Shanghai residents.
引文
[1]王烁,董彦会,王政和,等.1985-2014年中国7~18岁学生超重与肥胖流行趋势[J].中华预防医学杂志,2017,51(4):300-305.DOI:10.3760/cma.j.issn.0253-9624.2017.04.005.WANG S,DONG Y H,WANG Z H,et al.Trends in overweight and obesity among Chinese children of 7-18 years old during 1985-2014[J].Chinese Journal of Preventive Medicine,2017,51(4):300-305.DOI:10.3760/cma.j.issn.0253-9624.2017.04.005.
[2]周刚,李建彬,范雷,等.河南省15~24岁青年人群超重和肥胖流行现状[J].中国慢性病预防与控制,2015,23(2):88-91.ZHOU G,LI J B,FAN L,et al.The prevalence of overweight and obesity among residents aged 15-24 years old in Henan Province[J].Chinese Journal of Prevention and Control of Chronic Diseases,2015,23(2):88-91.
[3]李辉,于洋,夏秀兰,等.出生体重与儿童期肥胖[J].中国儿童保健杂志,2002,10(3):145-146.DOI:10.3969/j.issn.1008-6579.2002.03.001.LI H,YU Y,XIA X L,et al.Birth weight and childhood obesity[J].Chinese Journal of Child Health Care,2002,10(3):145-146.DOI:10.3969/j.issn.1008-6579.2002.03.001.
[4]戎芬,武俊青,李玉艳,等.出生体重与儿童期超重肥胖的关系[J].中国儿童保健杂志,2011,19(11):989-991.RONG F,WU J Q,LI Y Y,et al.Relationship between birth weight and overweight or obesity in childhood[J].Chinese Journal of Child Health Care,2011,19(11):989-991.
[5]CURHAN G C,WILLETT W C,RIMM E B,et al.Birth weight and adult hypertension,diabetes mellitus,and obesity in USmen[J].Circulation,1996,94(12):3246-3250.
[6]胡明晶,王子莲.近13年足月新生儿出生体重与分娩方式的关系[J].妇产与遗传(电子版),2012,2(1):28-30.DOI:10.3868/j.issn.2095-1558.2012.01.008.HU M J,WANG Z L.The relation neonatal birth weight and delivery mode in 13 years[J].Obstetrics-Gynecology and Genetics(Electronic Edition),2012,2(1):28-30.DOI:10.3868/j.issn.2095-1558.2012.01.008.
[7]梁嬛,沈婕,董欣然,等.中国城市人群孕期体重增加及其与新生儿出生体重的关系:一项多中心横断面研究[J].复旦学报(医学版),2016,43(3):291-296.LIANG H,SHEN J,DONG X R,et al.Gestational weight gain and its association with birth weight of newborn in the urban population of China:a multi-center cross-sectional survey[J].Fudan University Journal of Medical Sciences,2016,43(3):291-296.
[8]XIAO L,DING G,VINTURACHE A,et al.Associations of maternal pre-pregnancy body mass index and gestational weight gain with birth outcomes in Shanghai,China[J].Scientific Reports,2017,7:41073.DOI:10.1038/srep41073.
[9]中国肥胖问题工作组.中国成人超重和肥胖症预防与控制指南(节录)[J].营养学报,2004,26(1):1-4.DOI:10.3321/j.issn:0512-7955.2004.01.001.Working Group on Obesity of China.Guidelines for prevention and control of overweight and obesity in Chinese adults[J].Acta Nutrimenta Sinica,2004,26(1):1-4.DOI:10.3321/j.issn:0512-7955.2004.01.001.
[10]黄丽丽,贾朝霞,赵永鲜,等.2014年北京市低出生体质量儿和巨大儿发生现状及其影响因素调查研究[J].中国全科医学,2016,19(32):3979-3983.DOI:10.3969/j.issn.1007-9572.2016.32.016.HUANG L L,JIA Z X,ZHAO Y X,et al.Occurrence status and root cause analysis of low birth weight and fetal macrosomia of Beijing in 2014[J].Chinese General Practice,2016,19(32):3979-3983.DOI:10.3969/j.issn.1007-9572.2016.32.016.
[11]朱丽,张蓉,张淑莲,等.中国不同胎龄新生儿出生体重曲线研制[J].中华儿科杂志,2015,53(2):97-103.DOI:10.3760/cma.j.issn.0578-1310.2015.02.007.ZHU L,ZHANG R,ZHANG S L,et al.Chinese neonatal birth weight curve for different gestational age[J].Chinese Journal of Pediatrics,2015,53(2):97-103.DOI:10.3760/cma.j.issn.0578-1310.2015.02.007.
[12]STARLING A P,BRINTON J T,GLUECK D H,et al.Associations of maternal BMI and gestational weight gain with neonatal adiposity in the Healthy Start study[J].American Journal of Clinical Nutrition,2015,101(2):302-309.
[13]谢冬华,刘智昱.孕前体重指数与孕期体重增加和新生儿体重的关系研究[J].中国妇幼保健,2016,31(22):4637-4639.DOI:10.7620/zgfybj.j.issn.1001-4411.2016.22.11.XIE D H,LIU Z Y.Study on the relationship between pre-pregnancy body mass index,body weight gain during pregnancy and neonatal weight[J].Maternal&Child Health Care of China,2016,31(22):4637-4639.DOI:10.7620/zgfybj.j.issn.1001-4411.2016.22.11.
[14]沈婉蓉,谈韬,陆丽萍,等.孕期体重增长与出生体重关系研究[J].中国妇幼保健,2016,31(2):249-251.DOI:10.7620/zgfybj.j.issn.1001-4411.2016.02.09.SHEN W R,TAN T,LU L P,et al.The study on association between gestational weight gain and birth weight of neonates[J].Maternal&Child Health Care of China,2016,31(2):249-251.DOI:10.7620/zgfybj.j.issn.1001-4411.2016.02.09.
[15]林友结,蔡倩莹,徐云云,等.母亲孕前体质指数和孕期体重增加及其交互作用对新生儿出生体重的影响[J].中华流行病学杂志,2018,39(6):770-775.DOI:10.3760/cma.j.issn.0254-6450.2018.06.015.LIN Y J,CAI Q Y,XU Y Y,et al.Association and interaction of pre-pregnant body mass index and gestational weight gain of women on neonatal birthweight[J].Chinese Journal of Epidemiology,2018,39(6):770-775.DOI:10.3760/cma.j.issn.0254-6450.2018.06.015.
[16]PAPAZIAN T,ABI T G,SIBAI D,et al.Impact of maternal body mass index and gestational weight gain on neonatal outcomes among healthy Middle-Eastern females[J].PLoS One,2017,12(7):e0181255.DOI:10.1371/journal.pone.0181255.
[17]FOUELIFACK F Y,FOUEDJIO J H,FOUOGUE J T,et al.Associations of body mass index and gestational weight gain with term pregnancy outcomes in urban Cameroon:a retrospective cohort study in a tertiary hospital[J].BMC Res Notes,2015,8:806.DOI:10.1186/s13104-015-1765-9.
[18]丁桂凤,李惠敏,李慧君.孕期系统化营养干预对母婴不良妊娠结局的影响[J].中国妇幼保健,2017,32(18):4341-4345.DOI:10.7620/zgfybj.j.issn.1001-4411.2017.18.10.DING G F,LI H M,LI H J.Effect of systematic nutritional intervention during pregnancy on maternal and infant adverse outcomes[J].Maternal&Child Health Care of China,2017,32(18):4341-4345.DOI:10.7620/zgfybj.j.issn.1001-4411.2017.18.10.
[19]朱丽萍.上海市外来孕产妇保健管理现况与政策研究[D].上海:复旦大学,2006.
[20]PANAITESCU A M,SYNGELAKI A,PRODAN N,et al.Chronic hypertension and adverse pregnancy outcome:a cohort study[J].Ultrasound Obstet Gynecol,2017,50(2):228-235.DOI:10.1002/uog.17493.
[21]YAZDANI S,YOSOFNIYAPASHA Y,NASAB B H,et al.Effect of maternal body mass index on pregnancy outcome and newborn weight[J].BMC Res Notes,2012,5:34.
[22]CHOO V.WHO reassesses appropriate body-mass index for Asian populations[J].Lancet,2002,360(9328):235.DOI:10.1016/S0140-6736(02)09512-0.
[2]周刚,李建彬,范雷,等.河南省15~24岁青年人群超重和肥胖流行现状[J].中国慢性病预防与控制,2015,23(2):88-91.ZHOU G,LI J B,FAN L,et al.The prevalence of overweight and obesity among residents aged 15-24 years old in Henan Province[J].Chinese Journal of Prevention and Control of Chronic Diseases,2015,23(2):88-91.
[3]李辉,于洋,夏秀兰,等.出生体重与儿童期肥胖[J].中国儿童保健杂志,2002,10(3):145-146.DOI:10.3969/j.issn.1008-6579.2002.03.001.LI H,YU Y,XIA X L,et al.Birth weight and childhood obesity[J].Chinese Journal of Child Health Care,2002,10(3):145-146.DOI:10.3969/j.issn.1008-6579.2002.03.001.
[4]戎芬,武俊青,李玉艳,等.出生体重与儿童期超重肥胖的关系[J].中国儿童保健杂志,2011,19(11):989-991.RONG F,WU J Q,LI Y Y,et al.Relationship between birth weight and overweight or obesity in childhood[J].Chinese Journal of Child Health Care,2011,19(11):989-991.
[5]CURHAN G C,WILLETT W C,RIMM E B,et al.Birth weight and adult hypertension,diabetes mellitus,and obesity in USmen[J].Circulation,1996,94(12):3246-3250.
[6]胡明晶,王子莲.近13年足月新生儿出生体重与分娩方式的关系[J].妇产与遗传(电子版),2012,2(1):28-30.DOI:10.3868/j.issn.2095-1558.2012.01.008.HU M J,WANG Z L.The relation neonatal birth weight and delivery mode in 13 years[J].Obstetrics-Gynecology and Genetics(Electronic Edition),2012,2(1):28-30.DOI:10.3868/j.issn.2095-1558.2012.01.008.
[7]梁嬛,沈婕,董欣然,等.中国城市人群孕期体重增加及其与新生儿出生体重的关系:一项多中心横断面研究[J].复旦学报(医学版),2016,43(3):291-296.LIANG H,SHEN J,DONG X R,et al.Gestational weight gain and its association with birth weight of newborn in the urban population of China:a multi-center cross-sectional survey[J].Fudan University Journal of Medical Sciences,2016,43(3):291-296.
[8]XIAO L,DING G,VINTURACHE A,et al.Associations of maternal pre-pregnancy body mass index and gestational weight gain with birth outcomes in Shanghai,China[J].Scientific Reports,2017,7:41073.DOI:10.1038/srep41073.
[9]中国肥胖问题工作组.中国成人超重和肥胖症预防与控制指南(节录)[J].营养学报,2004,26(1):1-4.DOI:10.3321/j.issn:0512-7955.2004.01.001.Working Group on Obesity of China.Guidelines for prevention and control of overweight and obesity in Chinese adults[J].Acta Nutrimenta Sinica,2004,26(1):1-4.DOI:10.3321/j.issn:0512-7955.2004.01.001.
[10]黄丽丽,贾朝霞,赵永鲜,等.2014年北京市低出生体质量儿和巨大儿发生现状及其影响因素调查研究[J].中国全科医学,2016,19(32):3979-3983.DOI:10.3969/j.issn.1007-9572.2016.32.016.HUANG L L,JIA Z X,ZHAO Y X,et al.Occurrence status and root cause analysis of low birth weight and fetal macrosomia of Beijing in 2014[J].Chinese General Practice,2016,19(32):3979-3983.DOI:10.3969/j.issn.1007-9572.2016.32.016.
[11]朱丽,张蓉,张淑莲,等.中国不同胎龄新生儿出生体重曲线研制[J].中华儿科杂志,2015,53(2):97-103.DOI:10.3760/cma.j.issn.0578-1310.2015.02.007.ZHU L,ZHANG R,ZHANG S L,et al.Chinese neonatal birth weight curve for different gestational age[J].Chinese Journal of Pediatrics,2015,53(2):97-103.DOI:10.3760/cma.j.issn.0578-1310.2015.02.007.
[12]STARLING A P,BRINTON J T,GLUECK D H,et al.Associations of maternal BMI and gestational weight gain with neonatal adiposity in the Healthy Start study[J].American Journal of Clinical Nutrition,2015,101(2):302-309.
[13]谢冬华,刘智昱.孕前体重指数与孕期体重增加和新生儿体重的关系研究[J].中国妇幼保健,2016,31(22):4637-4639.DOI:10.7620/zgfybj.j.issn.1001-4411.2016.22.11.XIE D H,LIU Z Y.Study on the relationship between pre-pregnancy body mass index,body weight gain during pregnancy and neonatal weight[J].Maternal&Child Health Care of China,2016,31(22):4637-4639.DOI:10.7620/zgfybj.j.issn.1001-4411.2016.22.11.
[14]沈婉蓉,谈韬,陆丽萍,等.孕期体重增长与出生体重关系研究[J].中国妇幼保健,2016,31(2):249-251.DOI:10.7620/zgfybj.j.issn.1001-4411.2016.02.09.SHEN W R,TAN T,LU L P,et al.The study on association between gestational weight gain and birth weight of neonates[J].Maternal&Child Health Care of China,2016,31(2):249-251.DOI:10.7620/zgfybj.j.issn.1001-4411.2016.02.09.
[15]林友结,蔡倩莹,徐云云,等.母亲孕前体质指数和孕期体重增加及其交互作用对新生儿出生体重的影响[J].中华流行病学杂志,2018,39(6):770-775.DOI:10.3760/cma.j.issn.0254-6450.2018.06.015.LIN Y J,CAI Q Y,XU Y Y,et al.Association and interaction of pre-pregnant body mass index and gestational weight gain of women on neonatal birthweight[J].Chinese Journal of Epidemiology,2018,39(6):770-775.DOI:10.3760/cma.j.issn.0254-6450.2018.06.015.
[16]PAPAZIAN T,ABI T G,SIBAI D,et al.Impact of maternal body mass index and gestational weight gain on neonatal outcomes among healthy Middle-Eastern females[J].PLoS One,2017,12(7):e0181255.DOI:10.1371/journal.pone.0181255.
[17]FOUELIFACK F Y,FOUEDJIO J H,FOUOGUE J T,et al.Associations of body mass index and gestational weight gain with term pregnancy outcomes in urban Cameroon:a retrospective cohort study in a tertiary hospital[J].BMC Res Notes,2015,8:806.DOI:10.1186/s13104-015-1765-9.
[18]丁桂凤,李惠敏,李慧君.孕期系统化营养干预对母婴不良妊娠结局的影响[J].中国妇幼保健,2017,32(18):4341-4345.DOI:10.7620/zgfybj.j.issn.1001-4411.2017.18.10.DING G F,LI H M,LI H J.Effect of systematic nutritional intervention during pregnancy on maternal and infant adverse outcomes[J].Maternal&Child Health Care of China,2017,32(18):4341-4345.DOI:10.7620/zgfybj.j.issn.1001-4411.2017.18.10.
[19]朱丽萍.上海市外来孕产妇保健管理现况与政策研究[D].上海:复旦大学,2006.
[20]PANAITESCU A M,SYNGELAKI A,PRODAN N,et al.Chronic hypertension and adverse pregnancy outcome:a cohort study[J].Ultrasound Obstet Gynecol,2017,50(2):228-235.DOI:10.1002/uog.17493.
[21]YAZDANI S,YOSOFNIYAPASHA Y,NASAB B H,et al.Effect of maternal body mass index on pregnancy outcome and newborn weight[J].BMC Res Notes,2012,5:34.
[22]CHOO V.WHO reassesses appropriate body-mass index for Asian populations[J].Lancet,2002,360(9328):235.DOI:10.1016/S0140-6736(02)09512-0.