| Objective:The nutritional status of pregnant women before and during pregnancy can directly or indirectly affect the outcome of pregnancy.Body mass index before pregnancy and gestational weight gain are important indicators of nutritional balance before and during pregnancy.This study explored the influence of pre-pregnancy body mass index,gestational weight gain and timely adjustment of weight on pregnancy outcome.We aimed to develop a pregnancy weight management plan for the first,second and third trimester,control weight in a reasonable growth and ultimately improve pregnancy outcomes.Methods:A retrospective analysis was conducted on 8,352 patients with live single births in the First Affiliated Hospital of Soochow University and the Fifth People's Hospital of Wujiang District from January 2016 to December 2018.Analyze the effects of pre-pregnancy body mass index,gestational weight gain,and weight gain rate on pregnancy outcomes using logistic regression.In addition,the influence of adjusting pregnancy weight gain on pregnancy outcome was explored.Results:Compared with pregnant women with normal pre-pregnancy mass,overweight and obesity before pregnancy increased the rate of cesarean section(OR=1.326,1.487,95%ci:1.118?1.573,1.057?2.092).(OR=1.522,3.057,95%ci:1,215-1.905,2.097-4.456);Increased risk of hypertension during pregnancy(OR=3.993,15.446,95%ci:3.119-5.112,10.80-22.16);Increased risk of gestational diabetes(OR=2.346,5.502,95%ci:1.909-2.882,3.877-7.909);Increased risk of preterm birth(OR=2.897,2.390,95%CI:1.933-4.342,1.034?5.528).Obesity before pregnancy increased the risk of labor prolongation and stagnation(OR=1.931,95%ci:1.079?3.459),low BMI before pregnancy increased the risk of children under gestational age(OR=1.489,95%ci:1.138?1.948),decreased cesarean section(OR=0.553,95%ci:0.487?0,629),children over gestational age(OR=0.369,95%ci:0.286?0.475),and gestational diabetes(OR=0.468,95%ci:Occurrence risk of 0.370?0.593).There was no correlation between BMI before pregnancy and postpartum hemorrhage.(2)Compared with the group suitable for weight gain during pregnancy,excessive weight gain increased the risk of cesarean section(OR=1.46,95%ci:1.320?1.621).(OR=1.877,95%ci:1.632?2.180);Increased risk of hypertension during pregnancy(OR=1.734,95%ci:.425?2.110);Increased risk of postpartum hemorrhage(OR=1.733,95%ci:1.435?2.093),increased risk of prolonged labor OR stagnation(OR=1.691,95%ci:1.375?2.080).Reduce the risk of gestational age(OR=0.525,95%CI:0.374?0.739);Reduced risk of preterm birth(OR=0.523,95%CI:0.300?0.780).Too little weight gain can reduce the risk of cesarean section(OR=0.840,95%ci:0.745?0.946).Reduced the risk of occurrence of children older than gestational age(OR=0.745,95%ci:0.625?0.936);(OR=1.852,95%ci:1.438?2.387)and increased risk of gestational diabetes(OR=1.266,95%ci:1.074?1.492).(3)When only the first stage of weight gain rate was abnormal in the early,middle and late stages of pregnancy,the excessive weight gain rate in the early,middle and late stages of pregnancy increased the risk of cesarean section(OR=1.916;3.850;4.920,95%ci:1.010?3.636;1.879?7.899;2.253?10.746);Excessive single-stage weight gain in early pregnancy increased the risk of gestational diabetes(OR=2.57,95%ci:1.008?6.688).Excessive single-stage weight gain rate in the second trimester increased the risk of greater than the gestational age(OR=3.775,95%ci:1.055?13.506).Slow rate of weight gain in the first and second trimester of pregnancy increased the risk of gestational age(OR=8.04;16.25,95%ci:1.021?63.349;1.320?200.19).(4)In the early,middle and late stages of pregnancy,accelerating the rate of weight gain in the middle and late stages of pregnancy when there is abnormal weight gain in the early stages of pregnancy OR accelerating the rate of weight gain in the late stages of pregnancy when there is abnormal weight gain in the middle and late stages of pregnancy can increase the risk of cesarean section(OR=1.228,95%ci:1.072?1.405).OR=1.377,95%ci:1.042?1.820;OR=1.675,95%ci:1.129?2.486;P=0.010).When the weight gain rate is abnormal in the early gestational period,the excessive weight gain rate in the middle and late gestational period can increase the risk of the occurrence of children over the gestational age(OR=1.964;2.184,95%ci:1.581?2.439;1.413?3.376).When the weight gain rate in early pregnancy is too fast,the rate in middle and late pregnancy can increase the risk of labor protraction and stagnation(OR=2.150,95%ci:1.557?2.968),and reduce the risk of gestational age(OR=0.409,95%ci:0.278?0.600).The risk of cesarean section(OR=0.716,95%ci:0.588?0.872)and gestational hypertension(OR=0.222,95%ci:0.123?0.401)was reduced when the weight gain rate in the early pregnancy was too fast.When the rate of weight gain was too slow in the early pregnancy,the rate of weight gain in the middle and late pregnancy increased the risk of gestational diabetes(OR=2.055,95%ci:1.182?3.572).When the weight gain rate in the early pregnancy is normal and the weight gain rate in the second pregnancy is too fast,the excess weight gain rate in the third pregnancy can increase the risk of hypertension in pregnancy(OR=32.35,95%ci:4.354?240.438),prolonged labor and stagnation(OR=18.06,95%ci:0.4.255?46.707).Conclusion:(1)Overweight and obesity before pregnancy were associated with cesarean section,gestational hypertension,gestational diabetes,premature delivery,and gestational age.Pre-pregnancy obesity is associated with prolonged or stagnant labor.Low BMI before pregnancy was associated with cesarean section,gestational diabetes mellitus,and the occurrence of infants older than or younger than gestational age.(2)There was a correlation between total weight gain during pregnancy and cesarean section,greater than gestational age,hypertensive diseases during pregnancy,postpartum hemorrhage,prolonged or stagnant labor.It is also correlated with the occurrence of small gestational age and premature birth.Total weight gain during pregnancy was correlated with the occurrence of gestational age infants and gestational diabetes mellitus,as well as cesarean section and gestational age infants.(3)The different rate of weight gain in different stages of pregnancy has certain influence on pregnancy outcome.The rapid rate of weight gain in early,middle and late stages of pregnancy was correlated with the occurrence of cesarean section.Rapid weight gain in early pregnancy is correlated with gestational diabetes.The fast rate of weight gain in the second trimester of pregnancy was correlated with the occurrence of babies larger than gestational age.The slow rate of weight gain in the first and second trimester of pregnancy was correlated with the occurrence of children of gestational age.(4)In the early,middle and third trimester of pregnancy,when there is abnormal weight gain rate in the early trimester of pregnancy,the adjustment of weight gain rate in the middle and third trimester can cause changes in pregnancy outcome.Similarly,when the weight gain rate in the early pregnancy is normal and the weight gain rate in the second pregnancy is abnormal,the weight gain rate in the third pregnancy can be adjusted to affect the pregnancy outcome and cause changes in the pregnancy outcome.When the rate of weight gain is abnormal in early or middle pregnancy,if the rate of weight gain is not corrected,the adverse outcome can be increased.And timely correction of the rate of weight gain can reduce the adverse outcome.(5)Women of childbearing age need to achieve good pregnancy outcomes through weight management before and during pregnancy. |
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