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目的探讨在我国不同孕前BMI孕期理想的热能供给降低医学指征的剖宫产率的可行性。方法随机选取2003年7月—2006年7月济南市妇幼保健院进行常规产前检查并住院分娩的既往无心、肝、肾疾病,无慢性高血压、糖尿病等合并症及遗传性疾病的单胎初产妇1003例作为研究组,同时选取同期1258例作为对照组,根据孕前或孕12周前体重指数(BMI)分组,分别为正常体重组(BMI 18.5～22.9)、超重组(BMI23.0～24.9)、肥胖组(BMI≥25.0),研究组、对照组孕妇的年龄及BMI均无显著差异。根据孕前或孕12周前BMI的不同,制定不同的热能供给方案,对照组热能供给不限制。指导孕妇进行轻体力劳动,以上各组孕期进行系统的产前检查,定期B超检查,分别观察胎儿增长规律、孕期体重、孕期体重指数增加幅度、孕期并发症、分娩方式及新生儿出生体重。结果研究组的医学指征剖宫产率低于对照组,结果有显著性差异(P<0.05)。分娩方式经单因素筛选后进行多因素Logistic回归分析,表明:孕前体重、孕前体重指数、孕期体重增长幅度、孕期体重指数增长幅度与有正相关性。结论对孕前不同BMI孕妇,给予不同的热能供给方案,对降低医学指征的剖宫产率等取得了良好的临床效果。孕期个体化的热能供给切实可行。
Objective To explore the feasibility of reducing the cesarean section rate of medical indications with the ideal thermal energy supply in different pregnant pre-pregnancy BMI in China. Methods Randomly selected from July 2003 to July 2006 Jinan City Maternal and Child Health Hospital for routine prenatal care and hospital delivery in the past without heart, liver and kidney disease, chronic hypertension, diabetes and other complications and hereditary diseases, singletons 1003 cases of primiparas were selected as the study group, and 1258 cases of the same period were selected as the control group. According to the body mass index (BMI) before pregnancy or 12 weeks before pregnancy, they were divided into normal weight group (BMI 18.5-22.9), overweight group (BMI23.0 ~ 24.9), obese group (BMI≥25.0), pregnant women in study group and control group had no significant difference in age and BMI. According to pre-pregnancy or 12 weeks pregnant BMI before the different formula to develop different heat energy supply, the control group does not limit the supply of heat. To guide the pregnant women to do light physical labor. The above groups were systematically examined during pregnancy and regularly inspected by B ultrasound to observe the law of fetal growth, body weight during pregnancy, increase of body mass index during pregnancy, complications during pregnancy, mode of delivery, and birth weight of newborns. Results The cesarean section rate in the study group was lower than that in the control group, with significant difference (P <0.05). Multivariate Logistic regression analysis showed that there was a positive correlation between body weight before pregnancy, body mass index before pregnancy, weight gain during pregnancy and body mass index during pregnancy. Conclusions Different pregnant women with different BMI before pregnancy may be given different heat energy supply schemes and good clinical results in reducing the cesarean section rate of medical indications. Individualized during pregnancy heat supply is feasible.