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Article(id=1240413927218139798, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412112, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1733760000000, receivedDateStr=2024-12-10, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773667326025, onlineDateStr=2026-03-16, pubDate=1754755200000, pubDateStr=2025-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773667326025, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773667326025, creator=13701087609, updateTime=1773667326025, updator=13701087609, issue=Issue{id=1240413921266429979, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='15', pageStart='2689', pageEnd='2880', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773667324606, creator=13701087609, updateTime=1773667356299, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240414054267802325, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240414054267802326, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2761, endPage=2768, ext={EN=ArticleExt(id=1240413927448826526, articleId=1240413927218139798, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between gestational weight gain and neonatal birth weight in the Guangxi region, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To establish gestational age-specific weight gain trajectories associated with birth outcomes—small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA)—among females with different pre-pregnancy body mass index (preBMI) categories in Guangxi, China, and to compare these trajectories with the current national guidelines. The goal is to provide evidence for developing region-specific recommendations on gestational weight gain (GWG).

Methods

This study included 5 562 singleton pregnant females who delivered at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region between 2019 and 2021 and had complete clinical records. Gestational weight gain percentile curves were constructed for each birth weight category based on different preBMI strata and were compared with national guideline ranges. Logistic regression was used to assess associations between preBMI-specific GWG at different gestational stages and neonatal birth weight outcomes.

Results

For AGA outcomes, the recommended total GWG ranges were 12.81-16.50 kg for underweight females, 11.87-16.17 kg for normal-weight females, 10.46-15.41 kg for overweight females, and 7.51-13.29 kg for obese females. These ranges were all slightly higher than those suggested by the national guidelines,indicating potential regional differences in gestational weight gain. Total GWG was negatively associated with the risk of SGA and positively associated with the risk of LGA, with the impact on SGA gradually diminishing as preBMI increased. For SGA,weight gain during the first and second trimesters was negatively associated with the risk of SGA in females with underweight and normal pre-pregnancy BMI, while a similar trend was observed in overweight females during the second trimester. For LGA,weight gain in the first and second trimesters was positively associated with the risk of LGA in underweight and overweight females. In normal-weight females, a similar association was observed across all trimesters, whereas in obese females, positive associations were found in the first and third trimesters.

Conclusion

Gestational weight gain demonstrates significant regional characteristics. Developing region-specific and preBMI-based gestational age-specific GWG guidelines may be crucial for effectively reducing the incidence of both SGA and LGA.

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目的

绘制广西壮族自治区不同孕前体重指数（pre-pregnancy body mass index，preBMI）人群与小于胎龄儿（small for gestational age，SGA）、适于胎龄儿（appropriate for gestational age，AGA）及大于胎龄儿（large for gestational age，LGA）结局相关的孕周特异性体重增长轨迹，并比较其与现行国家指南的差异，旨在为制定地区性孕期体重增长建议提供依据。

方法

选取2019—2021年在广西壮族自治区妇幼保健院建档分娩、临床资料完整的单胎孕产妇，共纳入5 562例。根据不同preBMI分层，构建各类新生儿出生体重结局的孕期体重增长百分位数曲线，并与国家指南进行对比。同时，利用logistic回归分析不同preBMI及各孕期体重增长与新生儿出生体重结局的关联。

结果

孕前体重不足人群AGA的孕期总体重增长范围为12.81～16.50 kg，正常体重人群为11.87～16.17 kg，超重人群为10.46～15.41 kg，肥胖人群为7.51～13.29 kg，均略高于国家指南范围，体现了孕期体重增长的地域差异性。孕期总体重增长与SGA呈负相关，与LGA呈正相关，且随着preBMI的增加，对SGA的影响逐渐减弱。对于SGA，孕前体重不足和正常体重人群在孕早期、孕中期的体重增长与SGA风险呈负相关，超重人群则在孕中期显示类似趋势。对于LGA，孕前体重不足和超重人群在孕早期、孕中期的体重增长与LGA风险呈正相关，正常体重人群在各孕期显示类似趋势，而肥胖人群则在孕早期、孕晚期与LGA风险呈正相关。

结论

孕期体重增长具有明显的地域性特征，制定地区性和基于不同preBMI的孕周特异性体重增长计划，对有效降低SGA及LGA的发生率具有重要指导意义。

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覃洁，E-mail: ；
孔琳，E-mail: ；
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覃洁与孔琳为共同通信作者

袁培（1987—），男，硕士，工程师，研究方向:临床数据统计、挖掘

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Diabetes Therapy, 2023, 14(2): 363-375., articleTitle=Independent and joint associations of age, pre-pregnancy BMI, and gestational weight gain with adverse pregnancy outcomes in gestational diabetes mellitus, refAbstract=null), Reference(id=1240424362147378137, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, doi=null, pmid=null, pmcid=null, year=2024, volume=130, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[25], rfOrder=29, authorNames=Shekaili HAA, Hashmi IA, Omari OA, journalName=Midwifery, refType=null, unstructuredReference=Shekaili HAA, Hashmi IA, Omari OA. Gestational weight gain and its association with maternal and neonatal outcomes among pregnant women with normal pre-pregnancy body mass index from a Middle Eastern country[J]. Midwifery, 2024, 130: 103929., articleTitle=Gestational weight gain and its association with maternal and neonatal outcomes among pregnant women with normal pre-pregnancy body mass index from a Middle Eastern country, refAbstract=null), Reference(id=1240424362235458526, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, doi=null, pmid=null, pmcid=null, year=2023, volume=47, issue=12, pageStart=1269, pageEnd=1277, url=null, language=null, rfNumber=[26], rfOrder=30, authorNames=Guo YF, Souza SCS, Bruce L, journalName=International Journal of Obesity, refType=null, unstructuredReference=Guo YF, Souza SCS, Bruce L, et al. Gestational weight loss and fetal growth in uncomplicated pregnancies among women with obesity: a population-based retrospective cohort study[J].International Journal of Obesity, 2023, 47(12): 1269-1277., articleTitle=Gestational weight loss and fetal growth in uncomplicated pregnancies among women with obesity: a population-based retrospective cohort study, refAbstract=null)], funds=[Fund(id=1240424357571392319, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, awardId=2016YFC1000100, language=CN, fundingSource=国家“十三五”科技支撑重点专项课题“建立出生人口队列开展重大出生缺陷风险研究”(2016YFC1000100), fundOrder=null, country=null), Fund(id=1240424357655278405, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, awardId=2016YFC1000102, language=CN, fundingSource=“母亲围孕期药物暴露与子代出生缺陷关联的前瞻性研究”(2016YFC1000102), fundOrder=null, country=null), Fund(id=1240424357785301838, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, awardId=82060283; 82460312, language=CN, fundingSource=国家自然科学地区科学基金项目(82060283; 82460312), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240424348612358540, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, xref=1., ext=[AuthorCompanyExt(id=1240424348624941456, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, companyId=1240424348612358540, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Network Information Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530003, China), AuthorCompanyExt(id=1240424348822073752, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, companyId=1240424348612358540, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.广西壮族自治区妇幼保健院网络信息中心，广西 南宁 530003)]), AuthorCompany(id=1240424348943708578, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, xref=2., ext=[AuthorCompanyExt(id=1240424348947902883, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, companyId=1240424348943708578, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.广西壮族自治区妇幼保健院产科，广西 南宁 530003)]), AuthorCompany(id=1240424349056954796, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, xref=3., ext=[AuthorCompanyExt(id=1240424349065343403, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, companyId=1240424349056954796, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.广西壮族自治区妇幼保健院出生缺陷预防控制研究所，广西 南宁 530003)])], figs=[ArticleFig(id=1240424356019499744, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, language=EN, label=Figure 1, caption=

Note: the gray area representing the WS reference range, and the gray line on the x-axis (_._) marking the 14 and 28-week gestational age cutoff points.

, figureFileSmall=GAXf+mDI5Und1B9TvvZryA==, figureFileBig=X7vpYdz3X5YQ1cgQ7WIw8Q==, tableContent=null), ArticleFig(id=1240424356157911788, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, language=CN, label=图1, caption=不同preBMI分组及新生儿出生体重结局的GWG百分位数曲线

注：灰色区域为WS参考范围，x轴灰色线(_._)为14和28孕周截止线。

, figureFileSmall=GAXf+mDI5Und1B9TvvZryA==, figureFileBig=X7vpYdz3X5YQ1cgQ7WIw8Q==, tableContent=null), ArticleFig(id=1240424356329878262, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, language=EN, label=Figure 2, caption=

Note: The dark red dashed line on the Y-axis represents the WS reference lines for weight gain velocity in mid and late pregnancy (the same reference range applies to both, with the three lines representing the upper limit, median, and lower limit of the recommended range). The gray line on the x-axis (_._) marking the 14 and 28-week gestational age cutoff points.

, figureFileSmall=uPgiIl5L7cSwH6Slj96COA==, figureFileBig=T/GmZfj5B3wKC3CriPrRAA==, tableContent=null), ArticleFig(id=1240424356417958650, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, language=CN, label=图2, caption=不同preBMI分组及新生儿出生体重结局的每周体重增长值百分位数曲线

注：Y轴深红色线(_._)为WS孕中和孕晚期体重增速参考线(孕中和孕晚参考范围相同，三条线分别表示推荐值范围的上限、中位数和下限；x轴灰色线(_._)为14和28孕周截止线。

, figureFileSmall=uPgiIl5L7cSwH6Slj96COA==, figureFileBig=T/GmZfj5B3wKC3CriPrRAA==, tableContent=null), ArticleFig(id=1240424356527010560, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, language=EN, label=Figure 3, caption=Logistic regression analysis results of weight gain during different pregnancy periods and SGA, LGA outcomes, figureFileSmall=mkSqXF7GEjpJrZiz6/XJ/g==, figureFileBig=klYC8gO69WNu/6kO2b2nVA==, tableContent=null), ArticleFig(id=1240424356644451081, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, language=CN, label=图3, caption=妊娠期各时期增重与SGA、LGA结局的logistic回归分析结果

注：调整变量为年龄、民族、户籍、妊娠史和分娩史。

, figureFileSmall=mkSqXF7GEjpJrZiz6/XJ/g==, figureFileBig=klYC8gO69WNu/6kO2b2nVA==, tableContent=null), ArticleFig(id=1240424356795446036, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, language=EN, label=Table 1, caption=

Demographic and clinical characteristics of the study population stratified by pre-pregnancy BMI ［n（%）,（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总例数
(n=5 562)		体重不足组
(n=853)		正常体重组
(n=3 816)		超重组
(n=753)		肥胖组
(n=140)		χ2/F值P值
年龄（岁）199.351<0.001
<25543 (9.8)164 (19.2)331 (8.7)33 (4.4)15 (10.7)
25～291 910 (34.3)342 (40.1)1 295 (33.9)237 (31.5)36 (25.7)
30～342 215 (39.8)285 (33.4)1 564 (41.0)314 (41.7)52 (37.1)
≥35894 (16.1)62 (7.3)626 (16.4)169 (22.4)37 (26.4)
民族4.3340.632
汉族3 128 (56.2)490 (57.4)2 143 (56.2)418 (55.5)77 (55.0)
壮族2 188 (39.3)336 (39.4)1 499 (39.3)297 (39.4)56 (40.0)
其他民族246 (4.4)27 (3.2)174 (4.6)38 (5.0)7 (5.0)
户籍23.91<0.001
农村3 709 (66.7)629 (73.7)2 494 (65.4)500 (66.4)86 (61.4)
城市1 853 (33.3)224 (26.3)1 322 (34.6)253 (33.6)54 (38.6)
妊娠史（次）59.924<0.001
11 729 (31.1)340 (39.9)1 186 (31.1)169 (22.4)34 (24.3)
≥23 833 (68.9)513 (60.1)2 630 (68.9)584 (77.6)106 (75.7)
分娩史79.582<0.001
初产妇2 907 (52.3)539 (63.2)1 994 (52.3)313 (41.6)61 (43.6)
经产妇2 655 (47.7)314 (36.8)1 822 (47.7)440 (58.4)79 (56.4)
孕期总增重分组(WS标准)431.715<0.001
不足348 (6.3)130 (15.2)162 (4.2)43 (5.7)13 (9.3)
适宜2 595 (46.7)483 (56.6)1 901 (49.8)181 (24.0)30 (21.4)
过多2 619 (47.1)240 (28.1)1 753 (45.9)529 (70.3)97 (69.3)
分娩孕周(周)39.04±1.2839.00±1.1739.04±1.2739.03±1.4239.25±1.217.7070.052
新生儿性别4.0640.255
女2 562 (46.1)416 (48.8)1 740 (45.6)348 (46.2)58 (41.4)
男3 000 (53.9)437 (51.2)2 076 (54.4)405 (53.8)82 (58.6)
SGA30.806<0.001
否4 836 (86.9)704 (82.5)3 316 (86.9)685 (91.0)131 (93.6)
是726 (13.1)149 (17.5)500 (13.1)68 (9.0)9 (6.4)
AGA14.5940.002
否1 130 (20.3)179 (21.0)735 (19.3)174 (23.1)42 (30.0)
是4 432 (79.7)674 (79.0)3 081 (80.7)579 (76.9)98 (70.0)
LGA131.866<0.001
否5 158 (92.7)823 (96.5)3 581 (93.8)647 (85.9)107 (76.4)
是404 (7.3)30 (3.5)235 (6.2)106 (14.1)33 (23.6)
), ArticleFig(id=1240424356912886554, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, language=CN, label=表1, caption=

根据preBMI分层的研究人群人口学和临床特征［n（%）,（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总例数
(n=5 562)		体重不足组
(n=853)		正常体重组
(n=3 816)		超重组
(n=753)		肥胖组
(n=140)		χ2/F值P值
年龄（岁）199.351<0.001
<25543 (9.8)164 (19.2)331 (8.7)33 (4.4)15 (10.7)
25～291 910 (34.3)342 (40.1)1 295 (33.9)237 (31.5)36 (25.7)
30～342 215 (39.8)285 (33.4)1 564 (41.0)314 (41.7)52 (37.1)
≥35894 (16.1)62 (7.3)626 (16.4)169 (22.4)37 (26.4)
民族4.3340.632
汉族3 128 (56.2)490 (57.4)2 143 (56.2)418 (55.5)77 (55.0)
壮族2 188 (39.3)336 (39.4)1 499 (39.3)297 (39.4)56 (40.0)
其他民族246 (4.4)27 (3.2)174 (4.6)38 (5.0)7 (5.0)
户籍23.91<0.001
农村3 709 (66.7)629 (73.7)2 494 (65.4)500 (66.4)86 (61.4)
城市1 853 (33.3)224 (26.3)1 322 (34.6)253 (33.6)54 (38.6)
妊娠史（次）59.924<0.001
11 729 (31.1)340 (39.9)1 186 (31.1)169 (22.4)34 (24.3)
≥23 833 (68.9)513 (60.1)2 630 (68.9)584 (77.6)106 (75.7)
分娩史79.582<0.001
初产妇2 907 (52.3)539 (63.2)1 994 (52.3)313 (41.6)61 (43.6)
经产妇2 655 (47.7)314 (36.8)1 822 (47.7)440 (58.4)79 (56.4)
孕期总增重分组(WS标准)431.715<0.001
不足348 (6.3)130 (15.2)162 (4.2)43 (5.7)13 (9.3)
适宜2 595 (46.7)483 (56.6)1 901 (49.8)181 (24.0)30 (21.4)
过多2 619 (47.1)240 (28.1)1 753 (45.9)529 (70.3)97 (69.3)
分娩孕周(周)39.04±1.2839.00±1.1739.04±1.2739.03±1.4239.25±1.217.7070.052
新生儿性别4.0640.255
女2 562 (46.1)416 (48.8)1 740 (45.6)348 (46.2)58 (41.4)
男3 000 (53.9)437 (51.2)2 076 (54.4)405 (53.8)82 (58.6)
SGA30.806<0.001
否4 836 (86.9)704 (82.5)3 316 (86.9)685 (91.0)131 (93.6)
是726 (13.1)149 (17.5)500 (13.1)68 (9.0)9 (6.4)
AGA14.5940.002
否1 130 (20.3)179 (21.0)735 (19.3)174 (23.1)42 (30.0)
是4 432 (79.7)674 (79.0)3 081 (80.7)579 (76.9)98 (70.0)
LGA131.866<0.001
否5 158 (92.7)823 (96.5)3 581 (93.8)647 (85.9)107 (76.4)
是404 (7.3)30 (3.5)235 (6.2)106 (14.1)33 (23.6)
), ArticleFig(id=1240424357021938464, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, language=EN, label=Table 2, caption=

Comparison of the ranges of total gestational weight gain with the WS standards

, figureFileSmall=null, figureFileBig=null, tableContent=
preBMIGWG (kg)
WS标准本地区数值(P25～P75)
SGAAGALGA
体重不足11.0～16.012.14～16.2912.81～16.5015.00～17.74
正常体重8.0～14.011.10～15.2911.87～16.1713.05～17.03
超重7.0～11.09.92～14.8010.46～15.4111.68～16.19
肥胖5.0～9.08.95～11.997.51～13.299.57～14.86
), ArticleFig(id=1240424357151961896, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, language=CN, label=表2, caption=

孕期总增重区间与WS标准对比

, figureFileSmall=null, figureFileBig=null, tableContent=
preBMIGWG (kg)
WS标准本地区数值(P25～P75)
SGAAGALGA
体重不足11.0～16.012.14～16.2912.81～16.5015.00～17.74
正常体重8.0～14.011.10～15.2911.87～16.1713.05～17.03
超重7.0～11.09.92～14.8010.46～15.4111.68～16.19
肥胖5.0～9.08.95～11.997.51～13.299.57～14.86
), ArticleFig(id=1240424357248430893, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, language=EN, label=Table 3, caption=

Comparison of the ranges of weight gain in each stage of pregnancy with WS standards

, figureFileSmall=null, figureFileBig=null, tableContent=
preBMI孕早期(kg)孕中期(kg/week)孕晚期(kg/week)
WS标准本地数值(P25～P75)WS标准本地数值M(P25～P75)WS标准本地数值M(P25～P75)
SGAAGALGASGAAGALGASGAAGALGA
体重不足0～2.00.40～2.660.84～2.871.96～3.450.46(0.37～0.56)0.370.48(0.45～0.52)0.440.50(0.47～0.53)0.480.54(0.51～0.56)0.530.46(0.37～0.56)0.370.50(0.46～0.53)0.480.49(0.45～0.52)0.470.51(0.49～0.53)0.47
正常体重0～2.00.11～2.440.35～2.710.89～3.06(0.26～0.48)0.30(0.41～0.47)0.39(0.44～0.52)0.43(0.49～0.56)0.47(0.26～0.48）0.30(0.44～0.52)0.49(0.44～0.52)0.46(0.44～0.51)0.45
超重0～2.0-0.30～2.47-0.01～2.790.78～3.35(0.22～0.37)0.22(0.35～0.42)0.37(0.39～0.47)0.32(0.43～0.50)0.39(0.22～0.37)0.22(0.44～0.53)0.41(0.42～0.51)0.42(0.41～0.48)0.44
肥胖0～2.0-0.52～1.25-0.85～2.65-0.11～2.98(0.15～0.30)(0.35～0.39)(0.28～0.36)(0.35～0.43)(0.15～0.30)(0.38～0.43)(0.37～0.47)(0.40～0.49)
), ArticleFig(id=1240424357353288499, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413927218139798, language=CN, label=表3, caption=

妊娠期各时期增重区间与WS标准对比

, figureFileSmall=null, figureFileBig=null, tableContent=
preBMI孕早期(kg)孕中期(kg/week)孕晚期(kg/week)
WS标准本地数值(P25～P75)WS标准本地数值M(P25～P75)WS标准本地数值M(P25～P75)
SGAAGALGASGAAGALGASGAAGALGA
体重不足0～2.00.40～2.660.84～2.871.96～3.450.46(0.37～0.56)0.370.48(0.45～0.52)0.440.50(0.47～0.53)0.480.54(0.51～0.56)0.530.46(0.37～0.56)0.370.50(0.46～0.53)0.480.49(0.45～0.52)0.470.51(0.49～0.53)0.47
正常体重0～2.00.11～2.440.35～2.710.89～3.06(0.26～0.48)0.30(0.41～0.47)0.39(0.44～0.52)0.43(0.49～0.56)0.47(0.26～0.48）0.30(0.44～0.52)0.49(0.44～0.52)0.46(0.44～0.51)0.45
超重0～2.0-0.30～2.47-0.01～2.790.78～3.35(0.22～0.37)0.22(0.35～0.42)0.37(0.39～0.47)0.32(0.43～0.50)0.39(0.22～0.37)0.22(0.44～0.53)0.41(0.42～0.51)0.42(0.41～0.48)0.44
肥胖0～2.0-0.52～1.25-0.85～2.65-0.11～2.98(0.15～0.30)(0.35～0.39)(0.28～0.36)(0.35～0.43)(0.15～0.30)(0.38～0.43)(0.37～0.47)(0.40～0.49)
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广西地区孕期体重增长与新生儿出生体重的关联分析
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袁培 1 , 丘小霞 3 , 韦红卫 2 , 李佳霖 1 , 孔琳 2 , 覃洁 3
现代预防医学 | 儿少卫生与妇幼保健 2025,52(15): 2761-2768
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(15): 2761-2768
广西地区孕期体重增长与新生儿出生体重的关联分析
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袁培1, 丘小霞3, 韦红卫2, 李佳霖1, 孔琳2 , 覃洁3
作者信息
  • 1.广西壮族自治区妇幼保健院网络信息中心，广西 南宁 530003
  • 2.广西壮族自治区妇幼保健院产科，广西 南宁 530003
  • 3.广西壮族自治区妇幼保健院出生缺陷预防控制研究所，广西 南宁 530003

    • 袁培（1987—），男，硕士，工程师，研究方向:临床数据统计、挖掘

通讯作者:

覃洁，E-mail: ；
孔琳，E-mail: ；
Association between gestational weight gain and neonatal birth weight in the Guangxi region
Pei YUAN1, Xiao-xia QIU3, Hong-wei WEI2, Jia-lin LI1, Lin KONG2 , Jie QIN3
Affiliations
  • Network Information Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530003, China
出版时间: 2025-08-10 doi: 10.20043/j.cnki.MPM.202412112
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摘要
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目的

绘制广西壮族自治区不同孕前体重指数（pre-pregnancy body mass index，preBMI）人群与小于胎龄儿（small for gestational age，SGA）、适于胎龄儿（appropriate for gestational age，AGA）及大于胎龄儿（large for gestational age，LGA）结局相关的孕周特异性体重增长轨迹，并比较其与现行国家指南的差异，旨在为制定地区性孕期体重增长建议提供依据。

方法

选取2019—2021年在广西壮族自治区妇幼保健院建档分娩、临床资料完整的单胎孕产妇，共纳入5 562例。根据不同preBMI分层，构建各类新生儿出生体重结局的孕期体重增长百分位数曲线，并与国家指南进行对比。同时，利用logistic回归分析不同preBMI及各孕期体重增长与新生儿出生体重结局的关联。

结果

孕前体重不足人群AGA的孕期总体重增长范围为12.81～16.50 kg，正常体重人群为11.87～16.17 kg，超重人群为10.46～15.41 kg，肥胖人群为7.51～13.29 kg，均略高于国家指南范围，体现了孕期体重增长的地域差异性。孕期总体重增长与SGA呈负相关，与LGA呈正相关，且随着preBMI的增加，对SGA的影响逐渐减弱。对于SGA，孕前体重不足和正常体重人群在孕早期、孕中期的体重增长与SGA风险呈负相关，超重人群则在孕中期显示类似趋势。对于LGA，孕前体重不足和超重人群在孕早期、孕中期的体重增长与LGA风险呈正相关，正常体重人群在各孕期显示类似趋势，而肥胖人群则在孕早期、孕晚期与LGA风险呈正相关。

结论

孕期体重增长具有明显的地域性特征，制定地区性和基于不同preBMI的孕周特异性体重增长计划，对有效降低SGA及LGA的发生率具有重要指导意义。

孕前体重指数  /  孕期体重增长  /  小于胎龄儿  /  大于胎龄儿
Objective

To establish gestational age-specific weight gain trajectories associated with birth outcomes—small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA)—among females with different pre-pregnancy body mass index (preBMI) categories in Guangxi, China, and to compare these trajectories with the current national guidelines. The goal is to provide evidence for developing region-specific recommendations on gestational weight gain (GWG).

Methods

This study included 5 562 singleton pregnant females who delivered at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region between 2019 and 2021 and had complete clinical records. Gestational weight gain percentile curves were constructed for each birth weight category based on different preBMI strata and were compared with national guideline ranges. Logistic regression was used to assess associations between preBMI-specific GWG at different gestational stages and neonatal birth weight outcomes.

Results

For AGA outcomes, the recommended total GWG ranges were 12.81-16.50 kg for underweight females, 11.87-16.17 kg for normal-weight females, 10.46-15.41 kg for overweight females, and 7.51-13.29 kg for obese females. These ranges were all slightly higher than those suggested by the national guidelines,indicating potential regional differences in gestational weight gain. Total GWG was negatively associated with the risk of SGA and positively associated with the risk of LGA, with the impact on SGA gradually diminishing as preBMI increased. For SGA,weight gain during the first and second trimesters was negatively associated with the risk of SGA in females with underweight and normal pre-pregnancy BMI, while a similar trend was observed in overweight females during the second trimester. For LGA,weight gain in the first and second trimesters was positively associated with the risk of LGA in underweight and overweight females. In normal-weight females, a similar association was observed across all trimesters, whereas in obese females, positive associations were found in the first and third trimesters.

Conclusion

Gestational weight gain demonstrates significant regional characteristics. Developing region-specific and preBMI-based gestational age-specific GWG guidelines may be crucial for effectively reducing the incidence of both SGA and LGA.

Pre-pregnancy body mass index  /  Gestational weight gain  /  Small for gestational age  /  Large for gestational age
袁培, 丘小霞, 韦红卫, 李佳霖, 孔琳, 覃洁. 广西地区孕期体重增长与新生儿出生体重的关联分析. 现代预防医学, 2025 , 52 (15) : 2761 -2768 . DOI: 10.20043/j.cnki.MPM.202412112
Pei YUAN, Xiao-xia QIU, Hong-wei WEI, Jia-lin LI, Lin KONG, Jie QIN. Association between gestational weight gain and neonatal birth weight in the Guangxi region[J]. Modern Preventive Medicine, 2025 , 52 (15) : 2761 -2768 . DOI: 10.20043/j.cnki.MPM.202412112
正文
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孕期体重增长（gestational weight gain, GWG）是影响胎儿发育和母婴健康的关键因素。研究显示，GWG过低或过高均与母婴不良结局相关。GWG不足会增加小于胎龄儿（small for gestational age，SGA）、低出生体重和早产的风险。而GWG过高则会增加与妊娠期糖尿病、大于胎龄儿（large for gestational age，LGA）及剖腹产的风险[1-3]。孕前体重指数（pre-pregnancy body mass index, preBMI）作为反映孕妇妊娠前的健康状况的重要指标，是胎儿结局的重要影响因素[3]。由于地域和民族的差异，GWG的通用建议存在分歧。2009年，美国医学研究所根据世界卫生组织（WHO）的BMI分类制定了GWG指南[4]，然而多项亚洲国家的研究指出，该指南并不完全适用于亚洲人群[5-7]。自2022年10月起，我国正式发布了《妊娠期妇女体重增长推荐值标准：WS/T 801-2022》（简称WS标准）[8]。该标准基于中国的九个城市(北京、武汉、成都、深圳、东莞、哈尔滨、石家庄、青岛和丹阳)的医院数据制定，并发布了单胎妊娠妇女妊娠期体重增长图。
广西壮族自治区（简称广西）位于中国西南部，少数民族人口较多。目前针对广西GWG情况的研究较少。此外，不同孕期的GWG对围产期的结局的影响存在差异[9]。因此，本研究通过分析广西不同孕周孕产妇的GWG情况，并将其与现行国家指南进行对比，旨在为制定适合广西孕产妇人群的GWG建议提供科学依据。
1　对象与方法
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1.1　研究对象
选择2019年5月—2021年12月期间在广西壮族自治区妇幼保健院两院区建档分娩的孕妇作为研究对象。纳入标准：（1）单胎；（2）活产；（3）有完整的围产保健记录（14和28孕周的前后2周范围内分别至少有一次产前检查，且妊娠期间产检次数不少于6次）。排除标准：（1）多胎妊娠；（2）资料不完整；（3）母亲患妊娠并发症（如妊娠期糖尿病、子痫前期等）；（4）新生儿存在出生缺陷。最终符合要求的孕妇共计5 562例。所有招募病例自愿入组，并签署知情同意书。临床资料收集和研究方案遵循《赫尔辛基宣言》，并获得广西壮族自治区妇幼保健院伦理委员会批准（批准号：〔2017〕伦函审第〔4-2〕号）。
1.2　研究方法
孕妇的基本信息及临床信息从医院信息系统中提取。孕妇需脱鞋、着装轻便，使用京柏医疗数字仪器进行身高体重测量，体重精确到0.01 kg，身高精确到0.1 cm。总GWG的计算方法为入院分娩时测量的体重减去孕前体重的差值[8]，孕周由妊娠早期超声检查进行调整。
1.3　数据定义
按照BMI（kg/m2）的计算结果，将preBMI划分为体重不足（BMI<18.5 kg/m2）、正常体重（18.5 kg/m2≤BMI<24.0 kg/m2）、超重（24.0 kg/m2≤BMI<28.0 kg/m2）、肥胖（BMI≥28.0 kg/m2）。根据WS标准[8]，孕前体重不足孕妇推荐增重为11.0～16.0 kg，正常体重为8.0～14.0 kg，超重为7.0～11.0 kg，肥胖为5.0～9.0 kg。同时，参考中国广西本地的标准[10]，将新生儿出生体质量在同性别、同胎龄儿第90百分位数以上定义为LGA，第10百分位数以下为SGA，其他则为适于胎龄儿（appropriate for gestational age，AGA）。根据WS的标准[8]，孕早期增重为13+6周体重减去妊娠前体重，孕中期增重为13+6～27+6周体重变化值，孕晚期增重为分娩前体重减去27+6周的体重。每周增长速率的计算则采用相应孕期阶段的增重除以该阶段的周数。GWG中±3SD范围之外的数值视为异常值，并予以剔除。
1.4　统计学方法
根据preBMI和新生儿出生体重结局（SGA、AGA、LGA）进行分层，采用位置、尺度和形状的广义加性模型（GAMLSS）构建GWG（当前孕周总体重减去孕前体重）和每周体重增长值（当前孕周体重减去上一周体重）两类轨迹曲线[6,11-12]，分别获得百分位（第10、25、50、75和90）参考值。使用P25～P75作为适宜范围[4,13]，并与国家标准进行对比。最后，根据不同的preBMI，将孕早、中、晚三个时期的GWG作为连续变量，使用logistic回归模型，分析总GWG及不同孕期GWG与SGA和LGA风险的关联强度。所有分析均使用R软件（4.3.2版本）进行处理，双侧检验水准α=0.05。
2　结果
收起
2.1　研究数据基线分析
本研究共纳入5 562例分析对象。根据preBMI分层，孕前正常体重比例最高，占68.6%；孕前体重不足和超重组的比例相近，分别为15.3%和13.5%；孕前肥胖组比例最低，仅占2.5%。见表1。
2.2　GWG的百分位数曲线及其与国家指南的比较
根据preBMI分组和新生儿出生体重结局，构建了GWG（当前孕周总体重减去孕前体重）的平滑百分位数曲线。总体而言，随着孕周的增加，孕期增重逐步上升，GWG幅度大于WS标准。整个孕期，体重不足组的AGA第50百分位数处于WS标准范围内。孕晚期，正常体重、超重及肥胖组的AGA第50百分位数均高于WS标准的上限。此外，肥胖组孕妇在孕晚期，其AGA与SGA的第50百分位数几乎重合，孕晚期的体重增长对新生儿出生体重结局（主要为AGA及SGA）的影响有所减弱。见图1。
preBMI分组和新生儿出生体重结局的第25至75百分位数值与WS标准进行对比。结果显示，所有组别的AGA增重范围均高于WS标准的推荐值。随着preBMI的增加，三种体重结局的增重范围均呈下降趋势。见表2。
2.3　每周体重增长值的百分位数曲线及其与国家指南的比较
根据不同preBMI分组和新生儿出生体重结局，构建了每周体重增长值（当前孕周体重减去上一周体重）的百分位数曲线。体重不足和正常组，孕早期每周体重增长值最小，孕中期达到最大，孕晚期逐渐下降，提示当胎儿在孕晚期出现生长缓慢时，通过增加母体体重的方式可能难以改善胎儿体重不足的结局。超重组的AGA和LGA的最大每周体重增长值出现在孕中期，而SGA的最大每周体重增长值出现在孕晚期，孕晚期体重增加对改善SGA妊娠结局的效果有限。肥胖组的AGA和LGA的最大每周体重增长值出现在孕晚期，SGA则在孕中、孕晚期有两次波峰。见图2。
将本地区孕期增重和每周体重增长值与WS标准对比发现，孕早期增重和孕中、晚期的每周增长值均高于WS标准。对于体重不足和正常体重组，AGA结局在孕中期的每周增长值大于孕晚期；而对于超重和肥胖组，则是孕晚期高于孕中期。见表3。
2.4　基于logistic回归分析GWG与不同preBMI人群新生儿SGA及LGA结局的关联
整个妊娠期，除肥胖组外，其他组总GWG与SGA风险呈负相关，为保护性因素。而所有组总GWG与LGA风险呈正相关，为危险性因素。在孕早期，体重不足和正常体重组的增重与SGA发生风险呈负相关（OR=0.852, 95%CI:0.769～0.944；OR=0.939, 95%CI: 0.897～0.983）。体重不足组的早期增重对LGA风险的正向关联性最强（OR=1.425, 95%CI: 1.131～1.794），即孕早期每增加1 kg，孕妇体重不足组的新生儿出现LGA的风险上升42.5%。在妊娠中期，除肥胖组外，其他组的增重与SGA风险呈负相关，是保护因素；然而，这些组的体重增长与LGA风险呈正相关，是危险因素。正常体重组的孕中期增重对降低SGA风险的效果最显著（OR=0.792, 95%CI: 0.753～0.833）。在LGA方面，体重不足组的孕中期增重对LGA风险的正向关联性最强（OR=1.386, 95%CI: 1.119～1.718）。见图3。
3　讨论
收起
本研究首次基于preBMI和新生儿出生体重结局（SGA、AGA、LGA）对广西地区孕妇进行了分层分析，详细探讨了妊娠期不同阶段的体重增长轨迹。研究发现，广西地区孕妇的实际GWG普遍高于WS标准的推荐范围，且不同preBMI组在妊娠各阶段的增重模式存在显著差异。特别是，孕早和孕中期的增重对SGA和LGA的发生风险影响较大。此外，本研究观察到preBMI与新生儿出生体重结局之间存在复杂的关联，为制定精准的孕期体重管理策略提供了重要依据。
本研究显示，仅有46.7%的孕妇总GWG符合WS标准，而47.1%超过该标准，与相关研究结果相似[5,14]。Huang等[5]研究发现，孕前体重不足、正常体重、超重和肥胖孕妇的GWG中位数分别为15.0、14.4、13.5和12.1 kg。Zhang等[14]通过分析中国孕妇的不良妊娠结局，基于中国特定的BMI分类建立了最佳GWG范围。孕前体重不足、正常体重和超重孕妇最佳GWG范围分别为15.0(12.8～17.1)、14.2(12.1～16.4)和12.6(10.4～14.9) kg。这些研究结果略高于本研究的对应范围，但总体趋势一致。本研究观察到的与WS标准的差异性可能与广西地区的独特饮食文化和生活方式有关。广西作为少数民族聚居地，传统上偏好高碳水化合物和高油脂的饮食[15]。
本研究通过GAMLSS模型绘制了GWG和每周体重增长值百分位数曲线，揭示了不同preBMI组和新生儿出生体重结局的增重模式差异。LGA曲线轨迹相对较高，而SGA曲线轨迹则相对较低，且随着preBMI增加，轨迹的非线性波动变得愈发显著。Ranasinha等[16]也观察到了这一现象。这种非线性模式可能与胎儿脂肪组织形成过程密切相关，同时也反映了不同BMI组孕妇在妊娠各阶段的生理适应差异。此外，每周体重增长值曲线凸显了妊娠不同阶段的增重特点。在妊娠早期，由于孕妇体内激素水平的变化，可能导致进食减少、呕吐等症状，从而出现体重下降的现象。进入妊娠中期，母体血浆和脂肪沉积增加，脂肪细胞体积扩大，这有助于增强胎盘营养物质从母体到胎儿的转移，是孕妇体重增长及胎儿生长发育的关键时期[17-18]。到妊娠后期，体重增长主要来源于胎儿的发育和体液的变化[19]。
本研究发现，不同preBMI分组在妊娠期不同阶段的增重对SGA和LGA的影响存在显著差异。Zheng等[20]发现，孕早和孕中期体重增长较高的女性LGA风险增加，但未对preBMI进行分层分析。Wei等[17]也发现，孕早和孕中期的GWG速率增加与SGA风险降低相关,但孕晚期未观察到类似现象。这一结论与本研究结果相似，但其未探索与LGA的关联。本研究通过preBMI分层分析提供了更细致的见解，突显了制定平衡的GWG指导方针的重要性，可有效防止SGA和LGA的发生。
值得注意的是，孕前体重状态与新生儿出生体重结局之间的关系并非绝对。多项研究[19,11-22]发现，孕前超重或肥胖不仅会增加LGA婴儿的风险，同时孕期增重不足也与SGA风险增加相关，但未明确指出影响SGA、LGA的关键孕期。吕等[23]研究发现孕前体重不足的孕妇在孕早期存在新生儿LGA的风险（OR= 1.40, 95%CI:1.06～1.86）,但其未对SGA进行探索。本研究也观察到这种复杂关联，孕前体重不足的孕妇存在新生儿LGA的风险，而孕前超重的孕妇也存在SGA的风险。体重不足组孕早期增重对LGA的风险影响较大，孕早期每增重1 kg，LGA的风险上升42.5%；超重组在孕中期增重与SGA风险呈负相关（OR=0.864, 95%CI:0.769～0.970）。这种复杂的关联可能与多种因素有关[24-26]，如孕前体重不足的孕妇可能在孕早、孕中期过度补充营养，其身体会优先满足胎儿的营养需求，从而导致LGA结局的发生。而孕前超重的孕妇可能会伴随着代谢紊乱、胰岛素抵抗等生理变化，尤其是在孕中期这一胎儿体重增长的关键阶段，容易诱发多种妊娠并发症，这些因素都可能对胎儿的发育产生不利影响，从而增加SGA的风险。本研究仍存在一些局限性。一是，本研究仅纳入一家省级妇幼保健院的单中心数据，非多中心数据。二是，孕前体重数据为自我报告的，可能存在回忆偏差。此外，由于数据收集的限制，未纳入孕期体力活动、膳食结构等潜在混杂因素。
综上所述，本研究基于广西地区较大规模样本量的队列研究，对孕妇preBMI和新生儿出生体重结局进行了分层分析，揭示了不同preBMI组的不同孕期体重增长对新生儿出生体重结局的影响。这些结果为制定适应不同preBMI人群的孕期体重增长计划，预防SGA和LGA的发生提供了重要依据。
基金
收起
  • 国家“十三五”科技支撑重点专项课题“建立出生人口队列开展重大出生缺陷风险研究”(2016YFC1000100)
  • “母亲围孕期药物暴露与子代出生缺陷关联的前瞻性研究”(2016YFC1000102)
  • 国家自然科学地区科学基金项目(82060283; 82460312)
文献
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2025年第52卷第15期
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文章信息
doi: 10.20043/j.cnki.MPM.202412112
  • 接收时间：2024-12-10
  • 首发时间：2026-03-16
  • 出版时间：2025-08-10
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  • 收稿日期：2024-12-10
基金
国家“十三五”科技支撑重点专项课题“建立出生人口队列开展重大出生缺陷风险研究”(2016YFC1000100)
“母亲围孕期药物暴露与子代出生缺陷关联的前瞻性研究”(2016YFC1000102)
国家自然科学地区科学基金项目(82060283; 82460312)
作者信息
    1.广西壮族自治区妇幼保健院网络信息中心，广西 南宁 530003
    2.广西壮族自治区妇幼保健院产科，广西 南宁 530003
    3.广西壮族自治区妇幼保健院出生缺陷预防控制研究所，广西 南宁 530003

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