| Background and objective: HDP is one of the main causes of maternal and infant deaths worldwide.If it cannot be identified and intervened in a timely manner,it will pose a huge threat to the lives of mothers and children.At present,the etiology and pathogenesis of HDP have not been clearly elucidated.Studies have shown that pre-pregnancy BMI obesity and gestation weight gain(GWG)are independent risk factors for HDP.There have been many reports on the relationship between pre-pregnancy BMI and GWG and maternal and infant dysfunction.Studies on pregnancy outcomes,but there are few studies on pregnant women with HDP.Based on the above research background,this study tried to analyze the influence of pre-pregnancy BMI and GWG on the maternal and infant outcome of HDP pregnant women by collecting,collating and summarizing clinical case data,so as to guide HDP pregnant women in the management of pre-pregnancy BMI and GWG to improve HDP maternal and infant pregnancy ending.Research materials and methods: To retrospectively analyze the clinical data of pregnant women and newborns diagnosed with hypertension during pregnancy in our hospital from January 2019 to December 2020,and exclude twins and multiple births,severe heart,liver,and kidney disease before pregnancy,blood system and immune system Diseases,uterine malformations,etc.There were a total of 520 cases and 27 fetal deaths.A total of 493 live births were born.According to the WHO classification of BMI,the 520 pregnant women with HDP in this study were divided into 4 groups,namely the pre-pregnancy BMI low group(BMI<18.5kg/m2),the pre-pregnancy BMI normal group(18.5≤BMI < 24.9kg/m2),Pre-pregnancy BMI overweight(25≤BMI <29.9kg/m2),pre-pregnancy BMI obesity group(BMI≥30kg/m2).According to the GWG standards revised by the Institute of Medicine(IOM)in 2009: the GWG with low BMI before pregnancy is 12.5 to 18.0 kg,the normal GWG before pregnancy is 11.5 to 16.0 kg,and the BMI before pregnancy is overweight 7.0~11.5kg,BMI obesity before pregnancy is 5.0~9.0kg,GWG is divided into 3 groups.The group that meets the IOM standard is defined as the GWG normal group,the group that does not meet the IOM standard is the under-GWG group,and the group that exceeds the US IOM standard is the GWG excessive group.Grouped by different pre-pregnancy BMI or GWG.1.Compare the incidence of HDP,disease classification,and the distribution of BMI and GWG.2.According to different pre-pregnancy BMI and GWG groups,compare the general conditions of HDP pregnant women,maternal history,pregnancy complications/comorbidities,pregnancy outcome,birth conditions of newborns,height and weight of live births;fetal deaths The analysis,hospitalization test.Apply SPSS 23.0 to statistically analyze the data in this study,and test the normality of the measurement data.The measurement data that conforms to the normal distribution are expressed as mean ± standard deviation,the comparison between groups is analyzed by variance,and the measurement data of non-normal distribution is used in The number of digits(P25,P75)indicates that the rank sum test is used for comparison between groups;the count data is expressed by frequency and rate,and the comparison between groups is expressed by chi-square test.If the expected number of table data is less than 5,the Fisher’s exact probability method is used for data calculation.When P<0.05,the comparison result is considered to be statistically significant.Results: 1.The incidence of HDP has increased in the past two years,and the incidence of HDP in singleton pregnant women has also increased.2.The incidence of preeclampsia and severe preeclampsia in singleton HDP is higher.3.There were statistical differences in pregnancy times,parity times,abortion history,IVF,hospitalization days,and GWG growth among different BMI groups(P<0.05).IVF and BMI before pregnancy were statistically significant between different GWG groups(P<0.05).HDP pregnant women with IVF tend to have too much GWG.4.The difference in HDP classification of different BMI groups was statistically significant(P<0.05).The difference in HDP classification of different GWG groups was statistically significant(P<0.05).In each group,there were more preeclampsia and severe preeclampsia.The incidence of preeclampsia and severe preeclampsia in the under-BMI group and the overBMI group were higher than those in the normal group.5.Different BMI groups had statistical differences in the distribution of gestational diabetes,hypoalbuminemia,dyslipidemia,other medical diseases,premature rupture of membranes,abnormal placenta,and abnormal fetal position(P<0.05).Different GWG groups showed statistical differences in the distribution of premature delivery,gestational diabetes,hypoproteinemia,dyslipidemia,premature rupture of membranes,abnormal placenta,abnormal fetal position,and abnormal umbilical cord(P<0.05).6.There is no statistical difference in the distribution of gestational weeks of delivery in different BMI groups(P>0.05).Different GWG groups had statistical differences in the distribution of gestational weeks at delivery(P<0.05),and the gestational weeks of each component of GWG were mainly concentrated at ≥28 weeks.7.Different BMI groups had statistical differences in postpartum hemorrhage(P<0.05).The obesity group had the highest rate of postpartum hemorrhage(P<0.05).The comparison of different GWG groups in terms of delivery method,uterine weakness,and postpartum hemorrhage were statistically significant(P<0.05).With the increase of GWG,the rate of cesarean section is increasing.8.There are statistical differences in fetal growth restriction,fetal distress,and fetal death in different BMI groups(P<0.05).Different GWG groups were statistically significant in terms of neonatal asphyxia classification,fetal growth restriction,fetal distress,and fetal malformations(P<0.05).9.The comparison of birth weight and length of live births in different BMI groups and GWG groups was statistically significant(P<0.05).10.88.89% of the dead fetuses were delivered naturally,66.67% of the gestational weeks were ≤24 weeks at the time of delivery,of which 88.89% had a delivery weight less than 1500 g.In this study,the gestational weeks of dead fetuses were all less than 33+6 weeks.BMI obesity before pregnancy was correlated with fetal death(P<0.05).Fetal death is correlated with too little GWG(P<0.05).11.The comparison of albumin,lactate dehydrogenase,platelet,BNP,D-dimer,ALT,AST in different pre-pregnancy BMI groups was statistically significant(P<0.05).The values of BNP,D-dimer,ALT,AST,and TBA tend to increase with the increase of BMI.Albumin and platelets have a downward trend with the increase of BMI.12.The comparison between different GWG groups on albumin,lactate dehydrogenase,platelet,BNP,D-dimer,alkaline phosphatase and ALT was statistically significant(P<0.05).The albumin and platelets of the GWG normal group were the highest,and the albumin and platelets of the too few group were the lowest.The median of lactate dehydrogenase,BNP,ALT,and alkaline phosphatase in the GWG underweight group were higher than those of the other two groups.Conclusion:(1)The incidence of HDP in our hospital is increasing from 2019 to 2020.(2)Pregnant women with singleton HDP are more likely to have pre-pregnancy obesity and excessive GWG.(3)Singleton HDP pregnant women who are obese before pregnancy are more likely to have too much GWG.(4)Pre-pregnancy obesity and excessive GWG in singleton HDP pregnant women are correlated with the severity of HDP.(5)Pre-pregnancy overweight or obesity in singleton HDP pregnant women is correlated with the occurrence of pregnancy complications/complications in HDP pregnant women.(6)Pre-pregnancy obesity and excessive GWG in singleton HDP pregnant women are correlated with the occurrence of postpartum hemorrhage in pregnant women.(7)Pre-pregnancy low weight and low GWG in singleton HDP pregnant women are related to the occurrence of fetal growth restriction.(8)Pre-pregnancy BMI and GWG in singleton HDP pregnant women are correlated with the birth weight of live births.(9)Pre-pregnancy obesity and low GWG are associated with the death of singleton HDP pregnant women and fetuses.(10)BMI and GWG before pregnancy are correlated with the BNP and D-dimer values of singleton HDP pregnant women. |
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