目的：探讨体重管理模式对初产妇孕期控制体重的效果,并评价其对分娩方式的影响。方法选择2009年10月至2013年10月在缙云县妇幼保健院参加孕期管理的单胎初产妇2730例作为研究对象(观察组),从怀孕早期即运用体重管理模式对所有孕妇进行健康教育、饮食调节、体重控制；并选择同期未接受体重管理的孕产妇1200例作为对照组。最终根据孕期体重增加数将观察组又分为：A组(体重增加12.5~15.0kg)2103例,B组(体重增加15.1~17.5kg)581例,C组(体重增加17.6~21.0kg)38例以及D组(体重增加大于21.0kg)8例。追踪监测各组孕妇的孕前、孕后BMI值、BMI值增加数、妊娠周数、分娩方式以及新生儿体重,并进行统计分析。结果观察组产妇分娩前体重、孕期体重增加数均显著低于对照组( t值分别为2.194、8.912,均P<0.05)。观察组A组、B组、C组、D组中,初产妇孕期BMI值增加数随之增加,差异具有统计学意义( t值分别为3.256、4.285、3.127,均P<0.05),且剖宫产率依次显著增加(χ2值分别为5.273、4.126、3.264,均P<0.05),各组新生儿体重正常率有显著性差异(χ2=88.550,P<0.05)。结论初产妇孕期体重的增长与剖宫产率和新生儿体重呈正相关,孕期体重增长过度会致使剖宫产率以及巨大儿的分娩率增加,从而增加分娩风险,故初产妇需要进行体重管理模式指导,控制其体重增长在适宜范围内。%Objective To explore the effect of weight management on maternal weight control and its influence on delivery mode. Methods From October 2009 to October 2013, 2 730 primiparas participating pregnancy management were selected from Maternal and Child Care Service Centre of Jinyun County in observation group, then they were given health education, diet regulation and weight control by using weight management mode since early pregnancy. At the same period 1 200 pregnant women who did not accept weight management were selected in control group. According to weight gain during pregnancy, the observation group was divided into group A ( weight gain ranged 12. 5-15. 0kg, 2 103 cases), group B (weight gain ranged 15. 1-17. 5kg, 581 cases), group C (weight gain ranged 17. 6-21. 0kg, 38 cases) and group D (weight gain more than 21. 0kg, 8 cases). BMI before and after pregnancy, BMI gain, gestational weeks, the mode of delivery and neonatal weight were recorded for statistical analysis. Results The maternal body weight before delivery and weight gain during pregnancy of the observation group were significantly lower than those in the control group ( t value was 2. 194 and 8. 912, respectively, both P<0. 05). With the increase of weight gain, the pregnancy BMI increased in group A,group B,group C and group D(t value was 3. 256, 4. 285 and 3. 127, respectively, all P<0. 05),and the cesarean section rate increased (χ2 value was 5. 273, 4. 126 and 3. 264, respectively, all P<0. 05). The difference in normal rate of neonatal weight (χ2 =88. 550,P<0. 05). Conclusion During pregnancy the primipara’ s weight gain is positively correlated with cesarean section rate and neonatal weight gain, while the excessive weight gain will lead to the increase of cesarean section rate and macrosomia births and thus the risk of delivery increases. Therefore, primiparas need to control their maternal weight gain in appropriate range.
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