【作者】 吴微微；

【导师】 赵正言；

【作者基本信息】 浙江大学 ， 儿科学， 2011， 硕士

【摘要】 目的：探讨义乌市产妇孕前BMI、孕期危险因素、孕期膳食营养状况对新生儿出生情况以及相关的孕晚期母血、新生儿脐血生化指标的影响,了解孕期宫内不良环境对胎儿造成的影响。方法：选取2010年1月1日至2010年8月1日在义乌市妇幼保健院行产前检查并在该医院分娩的孕36-37周的孕妇445例,对其进行孕期一般情况调查及抽血检验,随机抽取其中的54例进行膳食营养调查,待445例孕妇分娩后,抽取新生儿脐血进行检验,并对产妇进行新生儿出生情况调查,最终对产妇的孕前BMI、孕期危险因素、孕期膳食营养水平、胎儿分娩情况、新生儿出生体重、孕晚期母血、新生儿脐血相关生化指标等所有数据进行整理和统计分析。结果：根据445例调查对象的孕前不同BMI将其分为3组,其中消瘦组84例,正常组327例,肥胖组7例；根据孕期有无高危因素将其分为2组,其中高危组29例,对照组416例；产妇分娩时顺产230例,难产215例；有胎盘、羊水或脐带问题者213例,无胎盘、羊水或脐带问题者232例。445例新生儿中,低出生体重儿4例,正常出生体重儿420例,巨大儿21例。肥胖组高出生体重儿发生率和难产发生率均明显大于消瘦组和正常组,肥胖组所生新生儿出生体重显著大于消瘦组和正常组(P<0.01)。445例孕晚期母血样本中,ApoA/ApoB、胰岛素水平随着孕前BMI的增高而显著增高(P<0.01),HDL-CH水平随着孕前BMI的增高而显著降低(P<0.05),消瘦组脂蛋白a水平显著高于肥胖组(P<0.05)。445例脐血样本中,消瘦组脂蛋白a水平显著高于正常组(P<0.05),消瘦组甘油三酯水平显著高于肥胖组(P<0.05),消瘦组糖化血红蛋白水平显著高于肥胖组(P<0.05)。高危组所生新生儿平均出生体重大于对照组,低出生体重儿和高出生体重儿的发生率也高于对照组,难产率和伴胎盘、羊水、脐带问题的发生率也高于对照组,但均无显著性差异(P>0.05)。高危组与对照组之间母血、脐血各项生化指标均无显著性差异(P>0.05)。相对于低出生体重儿组和正常出生体重儿组,高出生体重儿组产妇孕期运动时间最少,但无显著性差异(P>0.05),高出生体重儿组产妇孕期收缩压平均值和舒张压平均值最高,且孕期收缩压平均值显著高于正常出生体重儿组孕期收缩压平均值(P<0.05)。低出生体重儿组、正常出生体重儿组和高出生体重儿组之间,母血、脐血各项生化指标均无显著性差异(P>0.05)。54例产妇孕期每日摄入总能量和碳水化合物未达到推荐摄入量,蛋白质和脂肪摄入量超过推荐摄入量；其中6例高出生体重儿的母亲与48例正常出生体重儿的母亲之间,孕期每日总能量和三大营养物质的摄入均无显著性差异(P>0.05)；母血、脐血10项生化指标异常者与对照者之间,孕期每日总能量和三大营养物质的摄入均无显著性差异(P>0.05)。结论：义乌市孕妇膳食以高蛋白高脂肪饮食为主；产妇孕前BMI与孕期高危因素对新生儿出生情况有影响,新生儿出生体重随孕前BMI的增高而显著增高；孕晚期母血与新生儿脐血HDL-CH水平随孕前BMI增高而显著降低,是较独立的MS预警因子。更多还原

【Abstract】 Objective:To approach the effect of puerperants’BMI before pregnant, intrauterine risk factors, nutrients intake during pregnancy on birth condition of fetus, biochemical indicators of maternal blood and biochemical indicators of cord blood, to find how disadvantage intrauterine environment affect fetus’growth.Methods:Analysis was made for 445 pregnant women in the maternal and child health hospital in Yiwu city from January 1st 2010 to August 1st 2010. The pregnant women were pregnant for 36 to 37 weeks, and did their prenatal check-up and dilivery in this hospital. Investigations were made on general state, birth condition, biochemical indicator of maternal blood and cord blood,54 cases of them did investigation of nutrients intake, then collected and arranged datas, recorded for statistical analysis.Results:Inside these 445 cases puerperants, there were 84 cases in marasmus group, 327 cases in normal group and 7 cases in obesitas group, there were 29 cases in high risk group and 416 cases in control group. During delivery,230 cases were eutocia, 215 cases were dystocia, there were 213 cases with placenta, amniotic fluid or umbilical cord problem, there were 232 cases without placenta, amniotic fluid and umbilical cord problem. Inside 445 cases newborns, there were 4 cases low birth weight infants,420 cases normal birth weight infants and 21 cases large for date infants. The large for date infants’ birth rate of obesitas group exceeded to marasmus group and normal group, the newborn birthweight of obesitas group significantly exceeded to marasmus group and normal group (P<0.01). In the results of biochemical indicators of 445 cases maternal blood, ApoA/ApoB and insulin significantly upgraded when BMI before pregnant upgraded(P<0.01), while HDL-CH significantly degraded when BMI before pregnant upgraded (P<0.05), lipoprotein-a of marasmus group was significantly higher than obesitas group (P<0.05). In the results of biochemical indicators of 445 cases cord blood, lipoprotein-a of marasmus group was significantly higher than normal group (P<0.05), triglyceride of marasmus group was significantly higher than obesitas group (P<0.05), glycosylated hemoglobin of marasmus group was significantly higher than obesitas group (P<0.05). The average newborn birth weight of high risk group exceeded to control group, so as the birth rate of low birth weight infant and large for date infant, but no significant differences between 2 groups. There were no significant differences on biochemical indicator of maternal blood and cord blood between high risk group and control group (P>0.05) Compared with low birth weight infants group and normal birth weight infants group, large for date infants group exercise least, and with the highest blood pressure during pregnancy, its average contractive pressure during pregnancy is significantly higher than normal birth weight infants group. There were no significant differences on biochemical indicator of maternal blood and cord blood between low birth weight infants group, normal birth weight infants group and large for date infants group (P>0.05).The total energy and carbohydrate intake of 54 investigated cases were less than recomm intake, the protein and fat intake were more than recomm intake. Inside these 54 cases, there were 6 large for date infants’mothers and 48 normal birth weight infants’ mothers, the total energy and three nutrient substances intake had no significant differences between this two groups (P>0.05).There were no significant differences on total energy and three nutrient substances intake between biochemical indicators abnormal group and biochemical indicators normal group (P>0.05)Conclusions:Pregnant women’s meal in Yiwu city contains high protein and high fat.The birth weight of infants upgrade while puerperants’BMI before pregnant upgrades. HDL-CH of maternal blood and cord blood significantly degrades while puerperants’ BMI before pregnant upgrades, its an independent early warning factor of MS.更多还原