孕期增重与妊娠期高血压疾病的关联及阈值效应分析OA
Association between gestational weight gain and hypertensive disorders of pregnancy:an analysis of threshold effects
目的 探究孕期增重(GWG)与妊娠期高血压疾病(HDP)风险之间的关联.方法 从桂妇儿健康服务信息管理系统回顾性收集南宁市58 564名产妇的分娩和产前检查记录.采用多因素logistic回归和阈值效应分析评估GWG及孕期增重模式与HDP风险的关联,并用限制性立方样条来拟合GWG与HDP剂量反应关系.结果 患HDP有3345人(5.71％).调整协变量后,GWG每增加1 kg,HDP风险显著增加4％(OR=1.04,P＜0.001).GWG与HDP风险呈U型剂量反应关系,阈值效应的拐点为11.29 kg.当GWG＜11.29 kg时,GWG和HDP风险呈显著负相关(OR=0.96,P=0.003),亚组分析显示,年龄＜35岁、产期血红蛋白≥110 g/L、无妊娠期糖尿病及城镇孕妇的HDP风险随GWG的增加显著降低,其余亚组无显著关联.当GWG≥11.29 kg时,GWG与HDP风险呈显著正相关(OR=1.08,P＜0.001),各亚组效应与其一致,并且无效应修饰作用.与孕期持续增重适中的模式相比,孕期持续低增重模式、孕中晚期加速增重、孕中晚期快速高增重的孕妇HDP发生风险分别增加25％(OR=1.25,P＜0.001)、22％(OR=1.22,P＜0.001)、82％(OR=1.82,P＜0.001).结论 GWG 与 HDP 之间呈 U 型相关,GWG 过多或不足均与HDP风险增加相关.
Objective To explore association between gestational weight gain(GWG)and the risk of hypertensive disor-ders of pregnancy(HDP).Methods Delivery and antenatal examination records of 58 564 parturient women in Nanning City were retrospectively collected from the Gui Maternal and Child Health Service Information Management System.Multiva-riate logistic regression and threshold effect analysis were used to assess the associations between GWG,gestational weight gain patterns,and the risk of HDP.Additionally,restricted cubic splines were applied to fit the dose-response relationship between GWG and HDP.Results A total of 3345 women(5.71％)were diagnosed with HDP.After adjusting for covari-ates,each 1 kg increase in GWG was associated with a significant 4％increase in risk of HDP(OR=1.04,P＜0.001).A U-shaped dose-response relationship was observed between GWG and HDP risk,with the inflection point of the threshold effect at 11.29 kg.When GWG＜11.29 kg,there was a significant negative association between GWG and HDP risk(OR=0.96,P=0.003).Subgroup analysis showed that,except for the significantly reduced HDP risk with increasing GWG in women aged＜35 years,those with hemoglobin levels ≥110 g/L during pregnancy,those without gestational diabetes,and urban women,there were no significant associations in the remaining subgroups.When GWG≥11.29 kg,GWG was signifi-cantly positively associated with HDP risk(OR=1.08,P＜0.001),and this effect was consistent across all subgroups with-out significant effect modification.Compared with the pattern of sustained moderate weight gain during pregnancy,pregnant women with the patterns of sustained low weight gain during pregnancy,accelerated weight gain in the second and third trimesters,and rapid and high weight gain in the second and third trimesters had a 25％(OR=1.25,P＜0.001),22％(OR=1.22,P＜0.001),and 82％(OR=1.82,P＜0.001)increased risks of HDP,respectively.Conclusion There is a U-shaped relationship between GWG and HDP risk,both excessive and insufficient GWG are associated with an increased risk of HDP.
黄冬梅;韦明晓;刘顺;杨兴;毛良勤;王晓敏
广西医科大学公共卫生学院,广西南宁 530021广西南宁市妇幼保健院妇幼健康和计划生育服务部,广西南宁 530011广西医科大学公共卫生学院,广西南宁 530021广西南宁市妇幼保健院妇幼健康和计划生育服务部,广西南宁 530011广西南宁市妇幼保健院妇幼健康和计划生育服务部,广西南宁 530011广西医科大学公共卫生学院,广西南宁 530021
医药卫生
孕期增重妊娠期高血压疾病阈值效应母婴结局
weight gain during pregnancyhypertensive disorders of pregnancythreshold effectmaternal and neonatal perinatal outcomes
《右江医学》 2026 (5)
430-438,9
国家自然科学基金(82160623)
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