孕期增重Z评分评估经产妇孕期增重程度对妊娠结局的影响OA
Gestational weight gain Z-score to evaluate the gestational weight gain in multiparous women and its impact on pregnancy outcomes
目的:采用孕期增重 Z 评分,评估不同孕前体质量指数(BMI)的经产妇在孕期增重程度对妊娠结局的影响.方法:选取 2024 年 1 月至 12 月在昆山市妇幼保健院定期产检并分娩的1014 例单胎妊娠孕妇,根据孕前 BMI 值分组,随访孕期体重增长变化,记录孕检情况、并发症及妊娠结局.应用针对不同孕前 BMI 的 Z 评分标准,将各孕周体重增长量转化为标准化的 Z 评分,并按 Z 评分<-1、-1～1、>1 分别分为增重不足、增重适宜和增重过多组,评估经产妇孕期增重程度对妊娠结局的影响.结果:Z 评分<-1 或>1均增加剖宫产(P=0.039)、妊娠期糖尿病(P=0.000)、早产(P=0.036)的风险;Z 评分过高的妊娠期高血压疾病构成比显著增加(19.23％vs 7.09％,P=0.046),巨大儿构成比也显著增加(19.23％vs 6.12％,P=0.040),差异均有统计学意义;而孕期增重程度与产后出血、胎膜早破、胎儿生长受限、胎儿宫内窘迫的差异无统计学意义(P>0.05).Logistic回归分析显示,在控制年龄、孕前 BMI 后,经产妇孕期增重不足(Z<-1)是剖宫产(OR=0.567,95％CI:0.334～0.962)和妊娠期糖尿病(OR=0.520,95％CI:0.377～0.717)的保护因素,是早产(OR=1.089,95％CI:1.048～1.132)的危险因素.经产妇孕期增重过多(Z>1)是剖宫产(OR=1.066,95％CI:1.031～1.102)、妊娠期高血压疾病(OR=1.196,95％CI:1.128～1.268)和妊娠期糖尿病(OR=1.110,95％CI:1.066～1.156)的危险因素.结论:经产妇孕期增重不足或过多均可导致不良妊娠结局的发生,Z 评分在评估孕期体重增长及动态观察随访体重变化方面具有一定的临床意义.
Objective:Use the pregnancy weight gain Z-score to evaluate the impact of different pre pregnancy body mass index(BMI)levels of weight gain on pregnancy outcomes in multiparous women.Method:A total of 1014 single pregnancy pregnant women who underwent regular prenatal check-ups and gave birth at Kunshan Maternal and Child Health Hospital from January to December 2024 were selected as the research subjects.They were grouped according to their pre-pregnancy BMI values,followed up on changes in weight gain during pregnancy,and recorded their pregnancy test results,complications,and pregnancy outcomes.Using a Z-score chart specific to pre-pregnancy BMI,standardize weight gain at different gestational weeks into Z-score values for specific gestational weeks,and divide Z-score values into three groups based on<-1,-1～1,and>1:insufficient weight gain,appropriate weight gain,and excessive weight gain.Evaluate the impact of postpartum weight gain on pregnancy outcomes.Results:Z score<-1 or>1 increased the risk of cesarean section(P=0.039),gestational diabetes(P=0.000),and premature delivery(P=0.036).The proportion of gestational hypertension with excessively high Z-scores increased(19.23％vs 7.09％,P=0.046),and the proportion of macrosomia also increased(19.23％vs 6.12％,P=0.040),with statistically significant differ-ences.There was no statistically significant difference(P>0.05)between the degree of weight gain during pregnancy and postpartum hemorrhage,premature rupture of membranes,fetal growth restriction,or intrauterine fetal distress.Logistic regression analysis showed that after controlling age and pre-pregnancy BMI,the lack of weight gain(Z<-1)during pregnancy was a protective factor for cesarean section(OR=0.567,95％CI:0.334～0.962)and diabetes dur-ing pregnancy(OR=0.520,95％CI:0.377～0.717),but it was a risk factor for premature de-livery(OR=1.089,95％CI:1.048～1.132).However,excessive weight gain during pregnancy(Z>1)was a risk factor for cesarean section(OR=1.066,95％CI:1.031～1.102),hyperten-sive disorder during pregnancy(OR=1.196,95％CI:1.128～1.268),and diabetes during pregnancy(OR=1.110,95％CI:1.066～1.156).Conclusion:Insufficient or excessive weight gain during pregnancy in multiparous women can lead to adverse pregnancy outcomes.The Z-score has certain clinical significance in evaluating weight gain during pregnancy and dynami-cally observing and following up on weight changes.
张琴静;怀莹莹;费晓萍
昆山市妇幼保健院妇产科,昆山 215300昆山市妇幼保健院妇产科,昆山 215300昆山市妇幼保健院妇产科,昆山 215300
医药卫生
经产妇妊娠期体重增长Z评分
Postpartum womenGestational Weight gainZ-score
《现代妇产科进展》 2026 (5)
353-356,4
昆山市市级科技专项(No:KSZ2518)
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