Evaluation Of The Efficacy On Management Of Gestational Weight Gain

Objective:To discuss the appropriate mode of weight management during pregnancy by evaluating the efficacy of weight management on maternal and infant complications as well as pregnancy outcomes.Method:(1)Totally 580 healthy singletons primiparas who had made registration and antenatal examinantion as to delivered from July 2016 to January 2017 were selected and divided into four groups by pre-pregnancy body mass index(WHO criteria),namely the down weight group(BMI < 18.5kg/m2),normal group(BMI18.5~24.9kg/m2),overweight group(BMI25.0~29.9kg/m2),obese group(BMI≥30.0kg/m2).Then the pregnant women were divided into observation group(n=290)and control group(n=290).Women in the observation group received individualized nutritional guidance during pregnancy and control group not received it.According to a prospective design,continuous follow-up was performed and record the projects include height,age,pre-pregnancy and prenatal weight,pregnancy complications,the final delivery way,the neonatal birth weight,and Apgar score and other outcomes.Birth weight≥2500g~ < 4000 g was defined as normal weight,birth weight < 2500 g was defined as low birth weight,and birth weight≥4000g was defined as macrosomia.At last,the pregnant women were divided into the lower standard group,the standard group and the higher standard group according to whether the gestantional weight gain meeting the IOM recommendation.They were compared respectively the gestational weight gain and mode of delivery and incidence rate of complications during pregnancy to evaluate the impacts of GWG on the risk of pregnancy complications and efficacy of weight management on pregnancy outcomes.Results:1.There are 580 cases included in this study,19.0% underweight(110cases),73.4% normal(426 cases),6.0% overweight(35 cases)and 1.6% obese(9cases),among whom 70.3% met the IOM recommendation.the mean of maternal age was 24.3±3.0 years old;the average pre-pregnancy maternal body mass index was20.7±2.1kg/m2;the mean of gestational weight gain was 13.5±2.7kg;the average gestational age was 39.1±0.9 weeks;the mean of birth weight of the babies was3207.5±421.7g.The cesarean delivery rate was 13.3%.The rate of fetal macrosomia and low birth weight was 5.5% and 1.9%.The rate of preeclampsia and gestational diabetes mellitus is 6.0%,6.2%,respectively.2.Compare with the normal group(BMI between 18.5-24.9kg/m2),the RR ratio of underweight group which flow with preeclampsia are RR=0.351,95% CI[0.151~1.053],p<0.01,the RR ratio of the overweight group and the obese pregnant group which flow with preeclampsia are RR=3.175,4.827,95% CI[2.165~3.972],[2.147~6.134],p<0.01,respectively.There are significant difference in different group,especially before BMI≥25.0 is a risk factor for preeclampsia(RR>1).It shows that the higher BMI in prepregnancy period,the greater risk of the preeclampsia.3.Compare with the normal group,the RR ratio value of the underweight group concurrent gestational diabetes is RR=0.348,CI [0.169~1.263],the RR ratio value of the women in overweight group and obese pregnant group which concurrent with diabetes are RR=3.106,3.752,95%CI[2.011~3.371],[2.957~4.212],p<0.05,respectively.There are statistically significant difference in different groups,indicating that the higher BMI in prepregnancy period,the greater risk of the gestational diabetes mellitus.4.In these prepregnancy BMI normal groups,the proportion of cases with normal weight gain during pregnancy in the observation group was higher than that in the control group,and the two groups have statistically significant difference(χ2=6.21,p<0.05).Significant difference was observed in delivery mode(χ2=3.61,p<0.05),The incidence of preeclampsia,gestational diabetes mellitus,fetal macrosomia and low birth weight in the observation group was significantly lower than that in the control group(χ2=5.18,4.83,6.57 and 3.29,respectively,all p<0.05).Conclusion:1、The higher BMI in prepregnancy period,it seems like the greater risk of the gestational diabetes mellitus and preeclampsia.2 、 The normalization examination and the individualized nutritional guidance during pregnancy is helpful to control weight gain during pregnancy and to reduce the rate of cesarean delivery,it also has positive effect on reducing the occurrence of pregnancy complications.