孕期体重增长对母婴结局影响的临床研究

The Impact of Gestational Weight Gain on Maternal and Neonatal Outcomes: A Clinical Study

摘要: 目的：探讨不同孕期体重增长模式对母婴结局的影响，为临床孕期营养指导和体重管理提供循证依据。方法：回顾性分析3361名孕妇的临床资料，根据孕期总增重将其分为增重不足组(n = 798)、增重适宜组(n = 1517)和增重过多组(n = 1046)。比较三组孕妇的基线资料，并采用单因素分析及多因素Logistic回归分析，探讨孕期增重与剖宫产、早产、巨大儿、小于胎龄儿(SGA)及大于胎龄儿(LGA)等母婴结局的关联性。结果：三组孕妇在年龄、不良孕产史、孕前BMI、甲状腺疾病及妊娠期糖尿病(GDM)的分布上存在显著差异(P < 0.05)。单因素分析显示，增重过多组的剖宫产率(49.4%)、巨大儿(8.8%)及LGA (15.9%)发生率最高；增重不足组的早产率(5.3%)和SGA率(6.5%)较高。多因素Logistic回归校正混杂因素后显示，与增重适宜组相比，增重过多是巨大儿(OR = 2.16, 95% CI: 1.53~3.06)和LGA (OR = 2.18, 95% CI: 1.68~2.83)的独立危险因素；增重不足是早产(OR = 2.35, 95% CI: 1.59~3.47)的独立危险因素，同时是巨大儿(OR = 0.52, 95% CI: 0.31~0.88)和LGA (OR = 0.65, 95% CI: 0.45~0.93)的保护因素。结论：孕期体重增长过多或不足均是不良母婴结局的独立危险因素。建议在围产保健中实施个体化的体重管理与营养干预，以改善妊娠结局。

Abstract: Objective: To assess the association between patterns of gestational weight gain (GWG) and maternal and neonatal outcomes, providing evidence for clinical weight management and nutritional intervention during pregnancy. Methods: We conducted a retrospective cohort study of 3361 pregnant women, stratified by total GWG into inadequate (n = 798), adequate (n = 1517), and excessive (n = 1046) groups. Maternal baseline characteristics were compared. Univariate and multivariate logistic regression analyses were performed to identify independent associations between GWG categories and outcomes, including cesarean section, preterm birth, macrosomia, small-for-gestational-age (SGA), and large-for-gestational-age (LGA). Results: Baseline characteristics, including maternal age, adverse pregnancy history, pre-pregnancy BMI, thyroid disease, and gestational diabetes mellitus (GDM), differed significantly among the three groups (P < 0.05). Univariate analysis indicated that the excessive GWG group had the highest incidence of cesarean section (49.4%), macrosomia (8.8%), and LGA (15.9%). The inadequate GWG group was associated with a higher incidence of preterm birth (5.3%) and SGA (6.5%). After multivariate adjustment, excessive GWG remained independently associated with an increased risk of macrosomia (adjusted OR = 2.16, 95% CI: 1.53~3.06) and LGA (aOR = 2.18, 95% CI: 1.68~2.83). Inadequate GWG was an independent risk factor for preterm birth (aOR = 2.35, 95% CI: 1.59~3.47) and was associated with a reduced risk of macrosomia (aOR = 0.52, 95% CI: 0.31~0.88) and LGA (aOR = 0.65, 95% CI: 0.45~0.93). Conclusion: Both excessive and inadequate gestational weight gain are independent risk factors for adverse maternal and neonatal outcomes. Individualized weight management and nutritional guidance should be integral to routine prenatal care to optimize clinical outcomes.