目的 分析中国孕妇的孕期体质量增加(GWG)与巨大儿发生率的关系,探讨基于巨大儿发生率的中国孕妇GWG的参考范围.方法 采用多中心、分层抽样调查方法,收集了14个省市区39家医院的112485例非早产(分娩孕周≥37周)分娩孕妇的临床数据,共61149例(54.36%,61149/112485)非早产、单胎、基本数据完整(包括身高、孕前体质量、GWG、新生儿出生体质量等)孕妇纳入本研究.采用多因素logistic回归法分析孕妇的身高、孕前体质指数(BMI)、GWG、合并妊娠期糖尿病及其新生儿性别等因素对巨大儿发生率的影响.设定正常孕妇的巨大儿发生率为5.0%~10.0%,计算不同孕前BMI孕妇的GWG参考范围.结果 本研究中巨大儿的总发生率为7.46%(4563/61149).通过非校正和校正的logistic回归法分析显示,巨大儿发生率与孕妇的身高、分娩孕周、孕前BMI、GWG、男性性别新生儿、初产妇及合并妊娠期糖尿病均存在明显的正相关(P均<0.05).以控制巨大儿发生率在5.0%~10.0%为目标,在低BMI孕妇(孕前BMI<18.5 kg/m2)、正常BMI孕妇(孕前BMI为18.5~24.9 kg/m2)、超重(孕前BMI为25.0~29.9 kg/m2)和肥胖(孕前BMI≥30.0 kg/m2)孕妇,其GWG的参考范围分别为20.0~25.0、10.0~20.0、0~10.0和0~5.0 kg.结论 本研究初步建立了基于巨大儿发生率的中国孕妇GWG的参考范围.%Objective To investigate the influence of gestational weight gain (GWG) on the incidence of macrosomia, and to establish the reference ranges of GWG based on the incidence of macrosomia. Methods A multicenter, cross-sectional study was conducted. Totally, 112485 women were recruited from 39 hospitals in 14 provinces in China. Totally, 61149 cases were eligible with singleton pregnancies and non-premature deliveries. The associations of pre-pregnancy body mass index (BMI), GWG, newborn gender and gestational diabetes with macrosomia were analyzed with logistic regression. The normal GWG ranges were calculated in all maternal BMI subgroups, based on the normal incidence of macrosomia was set as the range of 5.0% to 10.0%. Results In this study, the incidence of macrosomia was 7.46%(4563/611149). The macrosociam was positive related with maternal height, delivery week,pre-pregnancy BMI, GWG, gestational diabetes, primipara, and male babies significantly (P<0.05), based on unadjusted and adjusted logestic regression. The normal range of GWG 20.0-25.0, 10.0-20.0, 0-10.0 and 0-5.0 kg in subgroups of underweight (pre-pregnancy BMI<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obese (≥30.0 kg/m2), respectively. Conclusion The reference range of GWG in China based on the incidence of macrosomia is established.
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