| Objective:To study the recommendations for total gestational weight gain(GWG)in different prepregnancy BMI women and provide a scientific reference for the formulation and improvement of the recommendations of China.Methods:The data of this study came from the project of "Chinese Pregnant Women Cohort Study,Peking Union Medical College,CPWCS-PUMC",which was a multicenter prospective cohort study conducted in 24 hospitals among 15 provinces in China.In this study,the women in first trimester were enrolled in the project from July 25,2017 to July 24,2018 and delivered before December 31,2018 were selected as the subjects and the relevant data were collected,including the demographic information,maternal and neonatal outcomes,maternal and infant-related complications.According to the classified standard of BMI in Chinese,the subjects were divided into four groups,including low weight group(BMI<18.5kg/m2),normal weight group(18.5<BMI<24.0kg/m2),overweight group(24.0<BMI<28.0kg/m2)and obesity group(BMI≥28.0kg/m2).In this study,two methods were used to calculate the recommendations.The first method was the Percentile Method(PM),and the second method was the Adverse Maternal and Fetal Outcomes Method(AM).The percentile method excluded the women with adverse pregnancy outcomes and complications,and the remaining women were selected as the subjects to drawn the frequency distribution table of the GWG according to different BMI groups,and then chosen one specific percentile interval as the recommendations.The second method took all pregnant women as the subjects,and the GWG was divided into 15 sub-layers among different prepregnancy BMI groups,then the adverse maternal and fetal outcomes in each sub-layer were described.Through comparing the occurrence of the adverse maternal and fetal outcomes in different sub-layers,the appropriate recommendations can be obtained.Finally,through comparing the total occurrence of the adverse events among different weight gain groups the appropriate recommendations can be recognized.Counting data was expressed in the form of ratio,metrological data was expressed in the form of mean±standard deviation and variance analysis was used in the analysis of multiple groups of measurement data.Significance test was performed with bilateral alpha=0.05.Results:1.General demographic characteristic of womenA total of 3172 women,with single child,were included and 97.16%of them were the Han nationality.The average age was 28.94±4.62 years old and.the age of them was mainly 25～years old,accounting for 46.44%,followed by 30～years old(28.63%),20～years old(10.03%),35～years old(9.49%),and over 40 years old and under 20 years old,accounting for 2.08%and 3.34%,respectively.The highest percent of educational level was university(56.24%),followed by high school(20.65%),junior middle school(15.54%),master(6.49%),primary school(0.60%)and doctor(0.47%).Unemployed women accounted for 29.29%,followed by commercial services,accounting for 19.14%.The family’s member numbers were mainly 2,3 and 4,accounting for 29.98%,22.26%and 22.86%respectively.The distribution of women in east,middle,west of China were 43.73%,31.40%,24.87%,36.03%respectively and north and south were 63.97%and 36.03%.The rural household registration accounted for 57.57%.The personal annual income of 40,000 to 50,000 yuan was the largest,accounting for 18%.The household annual income of 80,000 to 100,000 yuan was the largest,accounting for 20.84%.The proportion of normal BMI before pregnancy was 65.01%,followed by overweight(17.53%),low weight(13.24%)and obesity(4.22%).The most weight gain during pregnancy was 14.0-15.9kg,accounting for 19.42%,followed by 10.0-11.9kg,accounting for 15.48%.2.Distribution of prepregnancy BMI and gestational weight gainPrepregnancy BMI and GWG had statistical differences with maternal age,neonatal birth weight and gestational age and prepregnancy BMI was positively correlated with these three factors,meanwhile GWG was positively correlated with neonatal birth weight and gestational age but negatively correlated with maternal age.Prepregnancy BMI and GWG had no significant difference in east,middle and west distribution of China,but north and south distribution,and BMI and GWG in northern women were higher than that in southern women.Prepregnancy BMI and GWG also showed differences in delivery modes,and the cesarean section women with the largest BMI and GWG,while spontaneous delivery women with the smallest BMI and GWG.Moreover,there were statistical differences between prepregnancy BMI and women educational background,occupation,annual income and gestational hypertension but no statistical differences between GWG and the above four.However,there were statistical differences between GWG and gestational weeks,ethnic groups and household registration,but no statistical difference between prepregnancy BMI and the above three.It was can be seen a negative correlation between prepregnancy BMI and GWG.And there were no statistical differences between prenatal anemia and premature rupture of membranes and prepregnancy BMI and GWG.3.Recommendations for total weight gain during pregnancy(1)PM:In this study,the GWG between the 25th percentile and the 75th percentile(P25-P75)was selected as the reference range of the recommended GWG for women in different prepregnancy BMI groups.The results were as follows,low weight group:12.0～18.0kg(median:15kg),normal weight group:12.0～18.0kg(median:15kg),overweight group:10.0～16.0kg(median:13kg),obesity group:7.25～15.0kg(median:10kg).(2)AM:By comparing the occurrence of adverse pregnancy events in different prepregnancy BMI groups,the recommended weight gain of pregnant women was as follows:low weight group was 14.0～15.9kg,normal weight group was 12.0～13.9kg,overweight group was 8.0-9.9kg,and obesity group was<6.0kg.Conclusions:The recommendations for total GWG according to the different prepregnancy BMI groups sorted by low weight,normal weight,overweight and obesity were 14.0～15.9kg,12.0～13.9kg,8.0～9.9kg and less than 6.0kg,respectively. |
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