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目的探讨孕前体质指数(BMI)、孕期体重增长与妊娠期贫血的关系。方法回顾性分析9 746例孕妇临床资料。孕前BMI根据世界卫生组织指南分类,预期孕期增重(GWG)根据2009年美国医学会(IOM)标准计算。比较不同孕前BMI和GWG孕妇妊娠晚期轻度、中度以上贫血发生情况,以及妊娠期和产后血红蛋白变化情况,比较GWG过多组和过少组与正常组孕妇妊娠晚期贫血发生风险。结果产前贫血总的发生率为33.6%,轻度22.7%,中度以上10.9%。不同孕前BMI组妊娠早、中、晚期以及产后72 h平均血红蛋白水平分别为(124.1±12.8)g/L、(115.5±13.2)g/L、(115.1±13.0)g/L和(110.1±13.8)g/L。GWG过少组、正常组和过多组中,妊娠晚期轻度贫血和中度以上贫血的发生率差异均有统计学意义(χ2值分别为7.2、22.7,P<0.05)。与GWG正常组孕妇相比,孕前肥胖孕妇当GWG不足时,贫血发生风险增加3.41倍(OR=3.41,95%CI 1.03~11.3)。结论孕前肥胖孕妇当GWG不足时,分娩前贫血发生风险显著增加,GWG干预中应预防增重不足孕妇贫血的发生风险,特别是肥胖孕妇。
Objective To explore the relationship between pre-pregnancy body mass index (BMI), pregnancy weight gain and pregnancy-induced anemia. Methods The clinical data of 9 746 pregnant women were retrospectively analyzed. Pre-pregnancy BMI is classified according to WHO guidelines and the expected weight gain during pregnancy (GWG) is based on the 2009 IOM criteria. The incidence of mild to moderate third trimester gestation and the changes of hemoglobin during pregnancy and postpartum were compared between pregnant women with different pre-pregnancy BMI and GWG. The risk of third trimester anemia was compared between pregnant women with GWG excessively and those with too few GWG. Results The overall incidence of anemia was 33.6%, mild 22.7% and moderate 10.9%. The average hemoglobin levels in early pregnancy, middle and late pregnancy, and postpartum 72 h were (124.1 ± 12.8) g / L, (115.5 ± 13.2) g / L, (115.1 ± 13.0) g / L and (110.1 ± 13.8 ) g / L. There were significant differences in the incidences of mild and moderate-severe anemia in the third trimester of pregnancy (χ2 = 7.2, 22.7, P <0.05, respectively) in GWG-deficient group, normal group and excessive group. Compared with the normal pregnant women with GWG, the risk of anemia increased 3.41 times (OR = 3.41, 95% CI 1.03 ~ 11.3) when pregnant women with pre-pregnancy had insufficient GWG. Conclusion When pre-pregnancy obese pregnant women lack of GWG, the risk of anemia before delivery is significantly increased. In GWG intervention, the risk of anemia of pregnant women with insufficient weight gain should be prevented, especially in obese pregnant women.