Epidemiological Characteristics Of Energy Imbalance In Mid-pregnancy And Its Impacts On Pregnancy-induced Disease

Objective To investigate the energy intake (EI), energy expenditure (EE) and energy imbance epidemic features among mid-pregnancy women in Lanzhou of China, To explore the relationship between energy imbalance and other related factors in mid-pregnancy and the incidence of pregnancy induced hypertension (PIH), gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP). To find the risk factors of these diseases.Methods The dynamic cohort study and nested case-control study were performed to mid-pregnancy women (13-27gestational weeks) who enrolled from Gansu Provincial Maternal and Children Hospital (GPMCH) between July2009and June2012. A baseline surveys (mainly included a pregnancy women general information questionnaire, semi-quantitative food frequency questionnaire and maternal physical activity questionnaire) were carried out to find out their social-demographic features, lifestyles, reproductive history, dietary intakes, nutritions and physical activities, etc. Accompany with the questionnaires, we used bioelectrical impedance analysis (BIA) and nutritions softwares to evaluate maternal body compositions, ER, El and EE in second trimester. The energy positive balance (EPB) and energy negative balance (ENB) were calculated. The records of PIH, GDM and ICP were collected at the end of the delivery. The cases and controls of PIH, GDM and ICP were matched1:2by ages and gestational ages. The correlation between energy imbalance and PIH, GDM and ICP were analyzed. The statistical analyses were conducted by SPSS20.0software.Results1. The soy and aquatic products intakes were insufficient. The daily intake levels of iodine and folic acid were significantly lower than RNI among pregnancy women in Lanzhou city. The El was higher than ER and EE (P<0.05). The EE was lowest between25 to29ages. The higher age and BMI women were prone to got energy imbalance, as the women between23-27gestational ages.2. Univariate analysis showed that, compared with the control group, PIH cases had higher family incomes, higher passive smoking rate at first trimester, higher pre-pregnancy BMI, higher mid-pregnancy BMI, the lower vitamin A and iron intake levels but relatively higher sodium intake (P<0.05). Compared with control group, the PIH group in second trimester also had higher body fat percentage (PBF), higher body fat mass (FM), higher fat-free body mass index (FFMI) and higher mean daily energy intake, the differences was statistically significant (P<0.05). Multivariate logistic regression analysis showed that increased pre-pregnancy BMI (OR=2.28,95%CI:1.31-3.95), increased of passive smoking in first trimester (OR=5.46,95%CI:1.06-28.17) and high FM level in second trimester (OR=2.41,95%CI:1.36-4.28) were risk factors for incidence of PIH.3. Univariate analysis showed that, compared with the control group, GDM group had higher prepregnancy and mid-pregnancy BMI, the higher per capita family income and maternal education level(P<0.05). GDM group had higher multipara rate and more sleeping problem but slightly fewer induced abortions, more protein intake, higher energy from protein, more El, higher FM and lower moderate physical activity level in the second trimester. The differences were statistically significant (P<0.05). The logistic regression analysis showed that factors including high maternal pre-pregnancy BMI level (OR=2.71,95%CI:1.71-4.02), high family income (OR=1.73,95%CI:1.36-2.74), number of childbirth (OR=1.63,95%CI:1.26-2.44), excessive protein intakes (OR=1.647,95%CI:1.01-2.72), increased El from protein (OR=2.48,95%CI:1.70-6.34) and mid-pregnancy body fat weight (OR=4.07,95%CI:2.86-10.88) were all risk factors for incidence of GDM disease.4. Univariate analysis showed that the numbers of multiparas were higher in ICP group than the control group (P<0.05). More cases had multiple spontaneous abortions and more than twice induced abortions in ICP group (P<0.001). There were higher PBF, FM, increased El from fat and carbohydrates but lower dietary fiber and zinc intakes level in ICP group. The difference was statistically significant (P<0.05). Logistic regression analysis showed that the increase of spontaneous abortions and excessive FM (OR=3.09, 95%CI:1.22-7.78) were risk factors for the ICP disease.5. As a sign of obesity, FMI was a risk factor which was significantly associated with increased incidence of PIH, GDM, ICP. FMI≥7.1kg/m2(P50) was significantly associated with2.65-fold increase in risk for PIH and5.16-fold increase in risk for GDM. When FMI>8.6kg/m2(P75), there was4.38-fold increase in risk for PIH,15.38-fold increase in risk for GDM,1.84-fold increase in risk for ICP.Conclusions1. We recommended the balanced diet (including appropriate El from protein and carbohydrates), and the proposed increase in the frequency of intake of seafood, soy products, and physical activity level in mid-pregnancy women in Lanzhou city, especially in pregnancy women who were more man35years old and from23th gestational week. Exercise and a balanced diet are the keys to staying appropriate energy balance.2. The risk factors for PIH were increased pre-pregnancy BMI, increased passive smoking in first trimester and high FM level. The risk factors for GDM were increased pre-pregnancy BMI, high family income, increased number of childbirth, excessive protein intake and increased El from protein, high FM level. The risk factors for ICP were increased spontaneous abortion and high FM level.3. The high FMI was a representation status of EPB in long term during pregnancy. The significant association was detected between FMI and the incidence of PIH, GDM and ICP diseases. The adipose tissues play an important role to promote the incidence of PIH, GDM and ICP dieases.