很少孕妇的体重增加情况维持在建议范围内


  【24drs.com】根据发表于11月5日发病率和死亡率周报(Morbidity and Mortality Week Report)的一篇报告,2012和2013年在美国生产的孕妇中,只有32.1%孕妇的妊娠增加体重(GWG)介于美国医学研究院的建议范围内。
  
  不过,约有五分之一孕妇的体重增加不足,造成低出生体重婴儿,而约有近半数体重增加过多,这些都强调了产前介入的重要性。
  
  格鲁吉亚州亚特兰大国家慢性疾病预防与健康促进中心、疾病控制与预防中心生殖建康组研究员Nicholas P. Deputy等人写道,妊娠增加体重过多的高盛行率,在各州有所不同,与怀孕前的身体质量指数也有关,但是仍须加以考量,因为妊娠增加体重过多会增加巨婴、孕妇产后体重不降的风险,以及可能造成母亲与孩童肥胖。
  
  今年初,Deputy等研究人员报告指出,20.9%的美国孕妇体重增加情况低于建议量,32.0%符合建议量,47.2%超过建议量,但是该篇研究并未逐州检视盛行率。
  
  最近的报告中,他们检视各州妊娠增加体重低于、符合、高于医学研究院建议量(分别是不足、适当与超过)的盛行率,为此,他们分析了2013年足月生产(妊娠37 – 41周)单胞胎之美国孕妇的资料,共涵盖43个司法管辖区(41州、纽约市与哥伦比亚特区),这些地区都是使用2003年修订版出生证明,载有产妇的身高、孕前体重和生产时体重。
  
  此外,他们研究了5个州的2012年怀孕风险评估监督系统的资料,这5个州还没有采用2003年版出生证明。
  
  医学研究院提出的妊娠增加体重建议值为,体重过轻妇女是28-40磅(12.7-18.1公斤)、正常体重妇女是25-35磅(11.3-15.9公斤)、过重妇女是15-25磅(6.8-11.3公斤)、肥胖妇女则是11 -20磅(4.9-9.07公斤)。
  
  各州妊娠增加体重之盛行率的研究范围分成三类:12.6%-25.5%(不足)、26.2%-39.0%(适当)、38.2%-54.7%(过多);妊娠增加体重不足之盛行率,在20州与纽约市达到20%以上;妊娠增加体重过多的盛行率在17州达到50%以上。
  
  体重增加过多最多的州是阿拉斯加与爱荷华,约有55%的孕妇体重增加过多;阿肯色和纽泽西的妊娠增加体重适当比率最高,分别是38%和39%,而格鲁吉亚和华盛顿则是约有四分之一孕妇妊娠增加体重不足。
  
  如果依照怀孕前的身体质量指数分类,各州之间依旧有所差异,几乎每州过重妇女的妊娠增加体重过多盛行率都是最高的。
  
  研究作者呼吁,为了孕妇与孩童的健康,采取强化而全面的策略来提升达到妊娠增加体重适当的比率。
  
  他们指出,只有在第二和第三孕期的时候,大部份妇女会需要每天多摄取340-450大卡热量来支持她们的怀孕代谢需求。促进妊娠增加体重适当的策略,包括设定每日热量目标、每周150分钟中等强度运动,如快走。作者们建议,从怀孕初期就应定期自我检视体重增加情况,且每次产前检查也应测量体重,即早发现妊娠增加体重不足或过多,并采取适当矫正措施。
  
  资料来源:http://www.24drs.com/
  
  Native link:Few Pregnant Women Stay in Recommended Range for Weight Gain

Few Pregnant Women Stay in Recommended Range for Weight Gain

By Diana Swift
Medscape Medical News

Just 32.1% of pregnant women who delivered in the United States in 2012 and 2013 had a gestational weight gain (GWG) within the range recommended by the Institute of Medicine, according to a report published in the November 5 issue of the Morbidity and Mortality Week Report.

Although about one in five women gained inadequate weight, opening the door to low-birthweight babies, close to half gained too many pounds, highlighting the need for prenatal interventions.

"The high prevalence of excessive GWG, which varies by state and prepregnancy [body mass index], is of concern because excessive GWG increases the risk for macrosomia, postpartum weight retention, and obesity in mothers and possibly children," write Nicholas P. Deputy, MPH, a research fellow in the Centers for Disease Control and Prevention's Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, and colleagues.

Earlier this year, Deputy and fellow researchers reported that 20.9% of US pregnant women gained less than the recommended amount of weight, 32.0% the appropriate amount, and 47.2% more than the recommended amount, but that study did not examine prevalence by state.

In the current report, they estimate the state-specific prevalence of GWG below, within, and above Institute of Medicine recommendations (referred to as inadequate, appropriate, and excessive, respectively). To do this, they analyzed 2013 birth data for US resident women who delivered full-term (37 - 41 weeks' gestation) singleton infants from 43 jurisdictions (41 states, New York City, and the District of Columbia) that used the 2003 revised birth certificate, which collects maternal height, prepregnancy weight, and delivery weight.

In addition, they studied 2012 data from the Pregnancy Risk Assessment Monitoring System for five states that had not yet adopted the 2003 birth certificate.

The ranges for GWG recommended by the Institute of Medicine are 28 to 40 pounds for underweight women, 25 to 35 pounds for women of normal weight, 15 to 25 pounds for overweight women, and 11 to 20 pounds for obese women.

The prevalence of the three GWG categories across the states included in the study ranged from 12.6% to 25.5% inadequate, 26.2% to 39.0% appropriate, and 38.2% to 54.7% excessive. The prevalence of inadequate GWG was 20% or higher in 20 states and New York City; the prevalence of excessive GWG was 50% or higher in 17 states.

Topping the excessive list were Alaska and Iowa, with about 55% of mothers-to-be gaining too much weight. Arkansas and New Jersey had the highest proportions of appropriate GWG, at 38% and 39%, respectively, whereas in Georgia and Wisconsin, about a quarter of mothers had inadequate GWG.

In stratification by prepregnancy body mass index categories, the variations by state persisted, and overweight women had the highest prevalence of excessive GWG in nearly every state.

The study authors call for intensified, multifaceted strategies to increase the proportion of women who achieve appropriate GWG, in the interest of maternal and child health.

They point out that only during the second and third trimesters do most women need to consume an additional 340 to 450 calories per day to support the metabolic demands of pregnancy. Strategies to promote appropriate GWG might include setting daily calorie goals and doing 150 minutes per week of moderate-intensity physical activity such as brisk walking. Routine self-monitoring of weight gain should begin early in pregnancy and continue between prenatal care visits so that inadequate or excessive GWG can be identified when small, corrective steps can be taken, the authors advise.

Morb Mortal Wkly Rep. 2015;64:1215-1220.

    
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