妊娠妇女孕前体重指数和孕期增重现状及其对新生儿出生结局的影响

doi:10.12372/jcp.2025.24e0269

摘要/Abstract

摘要：

目的基于中国人群体重指数（BMI）分类方法及中国营养学会最新推荐的孕期增重范围，评估妊娠妇女孕前BMI和孕期增重现状，并探讨其对新生儿出生结局的影响。方法纳入2018年1月至2019年12月建档并定期随访产检的孕妇26 422例，描述研究对象孕前BMI和孕期增重及其亚组间人口学特征，采用单因素及多因素二分类logistic回归分析两者与多种新生儿结局（如巨大儿、低出生体重、早产、窒息）间的关系。最后通过热图探索孕前BMI和孕期增重对胎儿体重的综合影响。结果研究发现低体重孕妇和超重肥胖孕妇占比相似，分别为13.8%和14.7%；超过50%的孕妇孕期增重异常。孕期增重不足增加早产风险；孕前BMI过低或孕期增重不足增加小于胎龄儿（SGA）风险，而孕前BMI过高或孕期增重过多增加大于胎龄儿（LGA）及难产（剖宫产、产钳/胎吸）风险（P<0.05）。多因素分析未发现孕前BMI及孕期增重与新生儿窒息间的关系（P>0.05）。结论妊娠妇女孕期增重异常问题仍较突出，提示产科医护人员及社会需加强对孕妇孕期知识的普及和体重管理。临床工作中可利用热图评估个体发生异常胎儿体重及难产的风险，以降低不良结局。

关键词: 孕前体重指数, 孕期增重, 新生儿出生结局, 热图

Abstract:

Objective Based on the body mass index (BMI) classification of Chinese population and the latest recommended range of gestational weight gain by the Chinese Nutrition Society, this study aims to evaluate the pre-pregnancy BMI and gestational weight gain status of pregnant women and further explored explore their influence on neonatal birth outcomes. Methods A total of 26 422 pregnant women who received regular prenatal examination were selected from January 2018 to December 2019 were included. The pre-pregnancy BMI, gestational weight gain of the study subjects, and their demographic characteristics among subgroups were described. Univariate and multivariate binary logistic regression analyses were employed to investigate the relationships between pre-pregnancy BMI and gestational weight gain and various neonatal outcomes (such as macrosomia, low birth weight, preterm birth, and asphyxia). Finally, a heatmap was utilized to explore the combined effect of pre-pregnancy BMI and gestational weight gain on fetal weight. Result The study found that the proportions of underweight and overweight/obese pregnant women were 13.8% and 14.7%, respectively, indicating a similar distribution. More than 50% of the participants experienced abnormal gestational weight gain. Insufficient gestational weight gain was associated with an increased risk of preterm birth. A low pre-pregnancy BMI or insufficient gestational weight gain elevated the risk of small for gestational age (SGA), whereas a high pre-pregnancy BMI or excessive gestational weight gain increased the risk of large for gestational age (LGA) and dystocia (cesarean section, forceps/vacuum extraction) (P<0.05). Multivariate analysis did not reveal a significant association between pre-pregnancy BMI, gestational weight gain, and neonatal asphyxia (P>0.05). Conclusion Abnormal gestational weight gain remains a significant issue among pregnant women, suggesting that obstetric healthcare providers and society need to strengthen the dissemination of pregnancy knowledge and weight management for pregnant women. In clinical practice, heatmaps can be utilized to assess individual risks of abnormal fetal weight and dystocia, thereby reducing adverse outcomes.

Key words: pre-pregnancy body mass index, gestational weight gain, neonatal birth outcomes, heatmap

高婧, 秦飞, 李敏, 潘漪莲, 程璐明, 程蔚蔚. 妊娠妇女孕前体重指数和孕期增重现状及其对新生儿出生结局的影响[J]. 临床儿科杂志, 2025, 43(4): 243-250.

GAO Jing, QIN Fei, LI Min, PAN Yilian, CHENG Luming, CHENG Weiwei. The current status of pre-pregnancy body mass index and gestational weight gain in pregnant women and their impact on neonatal birth outcomes[J]. Journal of Clinical Pediatrics, 2025, 43(4): 243-250.

图/表 8

图1

表1

表2

表3

表4

表5

表6

图2

参考文献 26

[1]	Gul R, Iqbal S, Anwar Z, et al. Pre-pregnancy maternal BMI as predictor of neonatal birth weight[J]. PLoS One, 2020, 15(10): e240748.
[2]	亢云, 张娟娟, 李昭, 等. 西北地区孕妇孕前BMI及孕期增重适宜范围的探讨[J]. 中国妇幼健康研究, 2022, 33(3): 47-53.
	Kang Y, Zhang JJ, Li Z, et al. Study on pre-pregnancy BMI of pregnant women and the appropriate range of gestational weight gain in northwest China[J]. Zhongguo Fuyou Jiankang Yanjiu, 2022, 33(3): 47-53.
[3]	Ke JF, Liu S, Ge L, et al. Associations of maternal pre-pregnancy BMI and gestational weight gain with the risks of adverse pregnancy outcomes in Chinese women with gestational diabetes mellitus[J]. BMC Pregnancy Childbirth, 2023, 23(1): 414.
[4]	陈宜人, 王晶, 王鹏, 等. 母亲孕前体质量指数孕期增重与子代学龄前期体成分的关系[J]. 中国学校卫生, 2022, 43(7): 1090-1094.
	Chen YR, Wang J, Wang P, et al. Relationship between prepregnancy body mass index weight gain during pregnancy and offspring body composition during preschool age[J]. Zhongguo Xuexiao Weisheng, 2022, 43(7): 1090-1094.
[5]	《中国居民营养与慢性病状况报告(2020年)》: 我国超过一半成年居民超重或肥胖[J]. 中华医学信息导报, 2020, 35(24): 15.
	Report on nutrition and chronic diseases in China (2020): more than half of our adult population is overweight or obese[J]. Zhonghua Yixue Xinxi Daobao, 2020, 35(24): 15.
[6]	Lewandowska M. Maternal obesity and risk of low birth weight, fetal growth restriction, and macrosomia: multiple analyses[J]. Nutrients, 2021, 13(4):1213.
[7]	中国营养学会. T/CNSS-009-2021 中国妇女妊娠期体重监测与评价[EB/OL]. 2021.
	Chinese Nutrition Society. T/CNSS-009-2021 monitoring and evaluation of gestational weight in Chinese women[EB/OL]. 2021.
[8]	国际生命科学学会中国办事处中国肥胖问题工作组联合数据汇总分析协作组. 中国成人体质指数分类的推荐意见简介[J]. 中华预防医学杂志, 2001, 35(5): 349-350.
	International Life Sciences Society China Office China Obesity Working Group Joint Data Collection and Analysis Collaborative Group. A brief introduction of the recommendation on the classification of adult body mass index in China[J]. Zhonghua Yufang Yixue Zazhi, 2001, 35(5): 349-350.
[9]	谢幸, 孔北华, 段涛. 妇产科学[M]. 第9版. 北京: 人民卫生出版社, 2018.
	Xie X, Kong BH, Duan T. Obstetrics and Gynecology[M]. 9th ed. Beijing: People's Medical Publishing House, 2018.
[10]	朱丽, 张蓉, 张淑莲, 等. 中国不同胎龄新生儿出生体重曲线研制[J]. 中华儿科杂志, 2015, 53(2): 97-103.
	Zhu L, Zhang R, Zhang SL, et al. Establishment of birth weight curve for neonates at different gestational ages in China[J]. Zhonghua Erke Zazhi, 2015, 53(2): 97-103.
[11]	中华医学会围产医学分会新生儿复苏学组. 新生儿窒息诊断的专家共识[J]. 中华围产医学杂志, 2016(1): 3-6.
	Neonatal Resuscitation Group of the Perinatal Medicine Branch of the Chinese Medical Association. Expert consensus on the diagnosis of neonatal asphyxia[J]. Zhonghua Weichan Yixue Zazhi, 2016(1): 3-6.
[12]	Sun Y, Shen Z, Zhan Y, et al. Effects of pre-pregnancy body mass index and gestational weight gain on maternal and infant complications[J]. BMC Pregnancy Childbirth, 2020, 20(1): 390.
[13]	Xie D, Yang W, Wang A, et al. Effects of pre-pregnancy body mass index on pregnancy and perinatal outcomes in women based on a retrospective cohort[J]. Sci Rep, 2021, 11(1): 19863. doi: 10.1038/s41598-021-98892-y pmid: 34615905
[14]	Madendag Y, Aksoy U, Col MI, et al. Fetal front-abdominal wall thickness in the second trimester as a predictor of abnormal fetal growth[J]. J Matern Fetal Neonatal Med, 2022, 35(6): 1162-1168.
[15]	Lewandowska M. The role of maternal weight in the hierarchy of macrosomia predictors; overall effect of analysis of three prediction indicators[J]. Nutrients, 2021, 13(3): 801.
[16]	Liu L, Ma Y, Wang N, et al. Maternal body mass index and risk of neonatal adverse outcomes in China: a systematic review and meta-analysis[J]. BMC Pregnancy Childbirth, 2019, 19(1): 105.
[17]	刘英惠, 刘建蒙, 刘伟宏, 等. 孕前体重指数, 孕期体重增加与新生儿窒息的关系[J]. 中华流行病学杂志, 2008, 29(7): 661-667.
	Liu YH, Liu JM, Liu WH, et al. The relationship between pre-pregnancy body mass index, weight gain during pregnancy, and neonatal asphyxia[J]. Zhonghua Liuxingbingxue Zazhi, 2008, 29(7): 661-667.
[18]	Domanski G, Lange AE, Ittermann T, et al. Maternal pre-pregnancy underweight as a risk factor for the offspring: survey of neonates in pomerania[J]. Acta Paediatr, 2021, 110(5): 1452-1460.
[19]	Bianchi C, de Gennaro G, Romano M, et al. Pre-pregnancy obesity, gestational diabetes or gestational weight gain: Which is the strongest predictor of pregnancy outcomes?[J]. Diabetes Res Clin Pract, 2018, 144: 286-293.
[20]	Amyx M, Zeitlin J, Hermann M, et al. Maternal characteristics associated with gestational weight gain in France: a population-based, nationally representative study[J]. BMJ Open, 2021, 11(7): e49497.
[21]	Goldstein RF, Abell SK, Ranasinha S, et al. Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women[J]. BMC Med, 2018, 16(1): 153. doi: 10.1186/s12916-018-1128-1 pmid: 30165842
[22]	Baker JL, Olsen LW, Sorensen TI. Weight at birth and all-cause mortality in adulthood[J]. Epidemiology, 2008, 19(2): 197-203. doi: 10.1097/EDE.0b013e31816339c6 pmid: 18300695
[23]	Rogers I. Birth weight and obesity and fat distribution in later life[J]. Birth Defects Res A Clin Mol Teratol, 2005, 73(7): 485-486.
[24]	Szostak-Wegierek D, Szamotulska K. Fetal development and risk of cardiovascular diseases and diabetes type 2 in adult life[J]. Med Wieku Rozwoj, 2011, 15(3): 203-215. pmid: 22006475
[25]	Ahlgren M, Wohlfahrt J, Olsen LW, et al. Birth weight and risk of cancer[J]. Cancer, 2007, 110(2): 412-419. pmid: 17538980
[26]	Dewey KG, Begum K. Long-term consequences of stunting in early life[J]. Matern Child Nutr, 2011, 7 Suppl 3(Suppl 3): 5-18.

项目	低体重组	正常体重组	超重组	肥胖组	合计	P值
例数	3 640(13.8)	18 909(71.6)	3 423(13.0)	450(1.7)	26 422	-
年龄						< 0.01
<25	146(4.0)	378(2.0)	54(1.6)	11(2.4)	589
25~<30	1 698(46.7)	6 512(34.4)	896(26.2)	121(26.9)	9 227
30~<35	1 345(36.9)	8 054(42.6)	1 498(43.8)	186(41.3)	11 083
≥35	451(12.4)	3 965(21.0)	975(28.5)	132(29.3)	5 523
受孕方式						< 0.01
自然受孕	3 441(94.5)	17 307(91.5)	2 967(86.7)	381(84.7)	24 096
辅助生殖	199(5.5)	1 602(8.5)	456(13.3)	69(15.3)	2 326
产次						< 0.01
初产妇	2 848(78.2)	13 218(69.9)	2 224(65.0)	295(65.6)	18 585
经产妇	792(21.8)	5 691(30.1)	1 199(35.0)	155(34.4)	1 837
民族						0.30
汉族	3 589(98.6)	18 591(98.3)	3 361(98.2)	446(99.1)	25 987
其他	51(1.4)	318(1.7)	62(1.8)	4(0.9)	435
地区						<0.01
上海	2 268(62.3)	12 342(65.3)	2 354(68.8)	332(73.8)	17 296
其他	1 372(37.7)	6 567(34.7)	1 069(31.2)	118(26.2)	9 126
教育水平						< 0.01
本科以下	221(6.1)	1 224(6.5)	328(9.6)	55(12.2)	1 828
本科	2 655(72.9)	13 353(70.6)	2 535(74.0)	327(72.7)	18 870
本科以上	764(21.0)	4 332(22.9)	560(16.4)	68(15.1)	5 724
吸烟	29(0.8)	112(0.6)	24(0.7)	1(0.2)	166	0.32
饮酒	87(2.4)	426(2.3)	66(1.9)	7(1.6)	586	0.42

项目	增重不足组	增重适宜组	增重过多组	合计	P
例数	3 245(12.3)	13 165(49.8)	10 012(37.9)	26 422
年龄					<0.01
<25	47(1.4)	232(1.8)	310(3.1)	589
25~<30	933(28.8)	4 344(33.0)	3 950(39.4)	9 227
30~<35	1 377(42.4)	5 714(43.4)	3 992(39.9)	11 083
≥35	888(27.4)	2 875(21.8)	1 760(17.6)	5 523
受孕方式					<0.01
自然受孕	2 900(89.4)	11 967(90.9)	9 229(92.2)	24 096
辅助生殖	345(10.6)	1 198(9.1)	783(7.8)	2 326
产次					<0.01
初产妇	2 200(67.8)	9 089(69.0)	7 296(72.9)	18 585
经产妇	1 045(32.2)	4 076(31.0)	2 716(27.1)	1 837
民族					0.29
汉族	3 188(98.2)	12 936(98.3)	9 863(98.5)	25 987
其他	57(1.8)	229(1.7)	149(1.5)	435
地区					<0.01
上海	2 216(68.3)	8 744(66.4)	6 336(63.3)	17 296
其他	1 029(31.7)	4 421(33.6)	3 676(36.7)	9 126
教育水平					<0.01
本科以下	180(5.6)	742(5.6)	906(9.1)	1 828
本科	2 265(69.8)	9 325(70.8)	7 280(72.7)	18 870
本科以上	800(24.6)	3 098(23.5)	1 826(18.2)	5 724
吸烟	17(0.5)	77(0.6)	72(0.7)	166	0.32
饮酒	66(2.0)	292(2.2)	228(2.3)	586	0.72

项目	低体重组	正常体重组	超重组	肥胖组	χ²值	P
早产					13.27	<0.01
是	141(3.9)	776(4.1)	162(4.7)	32(7.1)
否	3 499(96.1)	18 133(95.9)	3 261(95.3)	418(92.9)
分娩方式					429.14	<0.01
自然顺产	2 192(60.2)	9 932(52.5)	1 371(40.1)	143(31.8)
剖宫产	1 272(35.0)	8 063(42.6)	1 931(56.4)	290(64.4)
胎吸/产钳	176(4.8)	914(4.8)	121(3.5)	17(3.8)
新生儿窒息					12.49	<0.01
是	39(1.1)	242(1.3)	67(2.0)	7(1.6)
否	3 601(98.9)	18 667(98.7)	3 356(98.0)	443(98.4)
胎儿体重					278.89	<0.01
低出生体重	104(2.9)	382(2.0)	67(2.0)	14(3.1)
正常体重	3 466(95.2)	17 515(92.6)	3 014(88.0)	377(83.8)
巨大儿	70(1.9)	1 012(5.4)	342(10.0)	59(13.1)
胎儿大小					500.05	<0.01
SGA	152(4.2)	444(2.3)	47(1.4)	7(1.6)
AGA	3 248(89.2)	16 085(85.1)	2 649(77.4)	307(68.2)
LGA	240(6.6)	2 380(12.6)	727(21.2)	136(30.2)

项目	增重不足组	增重适宜组	增重过多组	χ²值	P
早产	235(7.2)	600(4.6)	276(2.8)	130.50	<0.01
分娩方式				41.30	<0.01
自然顺产	1 762(54.3)	6 952(52.8)	4 924(49.2)
剖宫产	1 335(41.1)	5 609(42.6)	4 612(46.1)
胎吸/产钳	148(4.6)	604(4.6)	476(4.7)
新生儿窒息				0.89	0.64
是	38(1.2)	178(1.4)	139(1.4)
否	3 207(98.8)	12 987(98.6)	9 873(98.6)
出生体重				490.70	<0.01
低出生体重	151(4.6)	288(2.2)	128(1.3)
正常体重	3 017(93.0)	12 377(94.0)	8 978(89.7)
巨大儿	77(2.4)	500(3.8)	906(9.0)
胎儿大小				435.14	<0.01
SGA	146(4.5)	345(2.6)	159(1.6)
AGA	2 855(88.0)	11 392(86.5)	8 042(80.3)
LGA	244(7.5)	1 428(10.9)	1 811(18.1)

新生儿结局	低体重组	超重组	肥胖组
巨大儿
OR(95%CI)	0.34(0.27~0.44)	1.94(1.70~2.21)	2.62(1.97~3.47)
P	<0.01	<0.01	<0.01
LGA
OR(95%CI)	0.52(0.45~0.59)	1.77 (1.61~1.94)	2.82(2.29~3.47)
P	<0.01	<0.01	<0.01
低出生体重
OR(95%CI)	1.45(1.16~1.81)	0.93(0.71~1.21)	1.47(0.85~2.52)
P	<0.01	0.58	0.17
SGA
OR(95%CI)	1.79(1.48~2.17)	0.59(0.43~0.8)	0.67(0.32~1.42)
P	<0.01	<0.01	0.30
早产
OR(95%CI)	0.96(0.80~1.16)	1.11(0.93~1.32)	1.68(1.16~2.43)
P	0.70	0.23	<0.01
新生儿窒息
OR(95%CI)	0.87(0.62~1.23)	1.50(1.14~1.98)	1.19(0.56~2.54)
P	0.42	0.50	0.65