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目的 探讨孕期体重变化率与足月产新生儿出生体重关联强度的剂量反应关系.方法 选取2006年1月至2013年12月江苏省昆山市围产保健监测系统18 868名孕产妇与足月产新生儿为研究对象.使用多因素logistic回归及限制性立方样条法分析产妇孕期体重变化率[即(末次产检体重一初次产检体重)/(末次产检孕周一初次产检孕周)]与足月产新生儿出生体重关联强度及其剂量反应关系.调整因素包括产妇年龄、教育程度、孕前BMI、户籍状态、经产妇、初次产检孕周与胎儿性别.结果 高水平的孕期体重变化率在孕前低BMI(OR=3.15,95％CI:1.40～7.07)、正常BMI(OR=3.64,95％CI:2.84～ 4.66)、超重(OR=2.37,95％CI:1.71～3.27)的产妇中与分娩足月巨大儿有统计学关联;孕前低BMI(OR=0.28,95％CI:0.13 ～0.61)及正常BMI(OR=0.37,95％CI:0.22～ 0.64)产妇与分娩足月低体重儿有统计学关联.孕期体重变化率与分娩足月巨大儿的关联强度呈现非线性“S”形剂量反应关系(非线性检验P＜0.000 1);与分娩足月低体重儿的关联强度呈“L”形非线性剂量反应关系(非线性检验P＜0.000 1).结论 孕期体重变化率与分娩足月低体重儿的关联强度呈现“L”形曲线,而与分娩足月巨大儿的关联强度呈现“S”形曲线.

Objective To examine the dose-response relationship between gestational weight gain rate and the neonate birth weight.Methods A total of 18 868 women with singleton gestations who delivered between January 2006 and December 2013 were included in this study.Maternal and neonate details of these women were drawn from the Perinatal Monitoring System database.Gestational weight gain rate was defined as the total weight gain during the last and first prenatal care visits divided by the interval weeks.Both Multiple logistic regression analysis and restricted cubic spline methods were performed.Confounding factors included maternal age,education,pre-pregnancy body mass index (BMI),state of residence,parity,gestational weeks of prenatal care entry,and sex of the neonate.Results The adjusted odds ratio for macrosomia was associated with gestational weight gain rate in lower pre-pregnancy BMI (OR=3.15,95％CI:1.40-7.07),normal (OR=3.64,95％CI:2.84-4.66) or overweight (OR=2.37,95％CI:1.71-3.27).The odds ratios of low birth weight appeared a decrease in those women with lower pre-pregnancy BMI (OR=0.28,95％CI:0.13-0.61) while the normal weight (OR=0.37,95％CI:0.22-0.64) group with gestational weight gain,the rate showed an increase.Association of gestational weight gain rate for macrosomia was found a S-curve in those term delivery women (non-linearity test P＜0.000 1).However,L-curve was observed for low birth weight and gestational weight gain rate in term births (non-linearity test P＜0.000 1).Conclusion A S-curve was seen between gestational weight gain rate and term delivered macrosomia while L-curve was observed among term delivered low birth weight neonates.