摘要目的:探讨妊娠各期血红蛋白浓度、血清铁蛋白浓度的变化与不良妊娠结局关系，指导孕期补铁。方法:前瞻性选取2016年8月至2018年5月在航天中心医院分娩的122例产妇，采集早、中、晚孕期、产后第一天血红蛋白浓度，以及早、中期铁蛋白浓度，记录妊娠期糖尿病、妊娠高血压疾病(妊娠期高血压与子痫前期、子痫)、早产、胎膜早破、产后出血、新生儿体重等分娩结局，分析妊娠各期血红蛋白浓度、血清铁蛋白浓度的变化与不良妊娠结局关系。结果:⑴122例产妇早、中、晚孕期以及产后第一天时的血红蛋白浓度组间比较差异有统计学意义( P<0.01)，四组间两两比较差异有统计学意义( P<0.05)；血清铁蛋白早、中孕期比较差异有统计学意义( P<0.01)。⑵妊娠期糖尿病组与非妊娠期糖尿病组中期血红蛋白比较差异有统计学意义( P<0.05)；妊娠高血压疾病组与非妊娠高血压组早期血红蛋白差异有统计学意义( P<0.05)，而早产患者与非早产患者晚期血红蛋白差异有统计学意义( P<0.05)。⑶孕中期无铁缺乏的患者(铁蛋白≥20 μg/L)较铁缺乏的患者更容易发生胎膜早破，孕晚期贫血患者更容易发生早产。⑷妊娠期糖尿病的风险因素为孕前高BMI( OR＝3.578，95% CI：1.604～7.985)及孕中期高血红蛋白浓度( OR＝1.425，95% CI：1.058～1.918)。妊娠高血压疾病的风险因素为孕前高BMI( OR＝5.313，95% CI：1.746～16.169)及孕早期高血红蛋白浓度( OR＝1.975，95% CI：1.048～3.720)。胎膜早破的独立风险因素为孕中期血清铁蛋白≥15 μg/L( OR＝2.836，95% CI：1.05～7.637)。早产的独立风险因素为妊娠晚期贫血( OR＝13.625，95% CI：2.470～75.161)。 结论:孕期补铁要掌握合适的时间，合理的剂量，个体化补铁是最适宜的办法，补铁过程中要严密监测，避免不良妊娠结局。

abstractsObjective:To study the relationship between the changes of hemoglobin concentration and serum ferritin concentration during pregnancy and the adverse pregnancy outcome, and to guide iron supplementation during pregnancy.Methods:122 parturient women who delivered in the Aerospace Center Hospital from August 2016 to may 2018 were prospectively selected. Data on hemoglobin concentration in each trimester and first day after delivery, ferritin concentration in first and second trimester, pregnancy outcomes of 122 parturient women was collected. Gestational diabetes mellitus, gestational hypertension (gestational hypertension and preeclampsia-eclampsia), preterm labor, premature rupture of membranes, postpartum hemorrhage, and neonatal weight were collected for statistical analysis.Results:⑴ There were significant differences in hemoglobin concentration among the early, middle, late pregnancy and the first day after delivery in 122 cases of parturient women ( P<0.01). There was significant difference in serum ferritin between early and middle pregnancy ( P<0.01). ⑵ There was a significant difference in hemoglobin between the gestational diabetes group and the non-gestational diabetes group ( P<0.05). Hemoglobin between pregnancy-induced hypertension (PIH) disease group and the normal hypertension group in early pregnancy have significant difference ( P<0.05), while hemoglobin between the preterm and term groups have significant difference ( P<0.05). ⑶ Patients with iron deficiency (ferritin ≥ 20 μg/L) were more likely to have premature rupture of membranes than those with iron deficiency, and those with anemia in late pregnancy were more likely to have premature delivery. ⑷ The risk factors of gestational diabetes mellitus were high body mass index (BMI) before pregnancy ( OR=3.578, 95% CI: 1.604-7.985) and high hemoglobin concentration during middle pregnancy ( OR=1.425, 95% CI: 1.058-1.918). High BMI before pregnancy ( OR=5.313, 95% CI: 1.746-16.169) and early high hemoglobin concentration ( OR=1.975, 95% CI: 1.048-3.720) were risk factors for PIH. The independent risk factor of PROM was serum ferritin ≥15 μg/L ( OR=2.836, 95% CI: 1.05-7.637). The independent risk factor of preterm birth was anemia in late pregnancy ( OR=13.625, 95% CI: 2.470-75.161). Conclusions:It is necessary to master the time and reasonable dose of iron supplement during pregnancy. Individualized iron supplement is the most appropriate method. Close monitoring should be carried out in the process of iron supplement to avoid adverse pregnancy outcomes.