很少孕婦的體重增加情況維持在建議範圍內


  【24drs.com】根據發表於11月5日發病率和死亡率週報(Morbidity and Mortality Week Report)的一篇報告,2012和2013年在美國生產的孕婦中,只有32.1%孕婦的妊娠增加體重(GWG)介於美國醫學研究院的建議範圍內。
  
  不過,約有五分之一孕婦的體重增加不足,造成低出生體重嬰兒,而約有近半數體重增加過多,這些都強調了產前介入的重要性。
  
  喬治亞州亞特蘭大國家慢性疾病預防與健康促進中心、疾病控制與預防中心生殖建康組研究員Nicholas P. Deputy等人寫道,妊娠增加體重過多的高盛行率,在各州有所不同,與懷孕前的身體質量指數也有關,但是仍須加以考量,因為妊娠增加體重過多會增加巨嬰、孕婦產後體重不降的風險,以及可能造成母親與孩童肥胖。
  
  今年初,Deputy等研究人員報告指出,20.9%的美國孕婦體重增加情況低於建議量,32.0%符合建議量,47.2%超過建議量,但是該篇研究並未逐州檢視盛行率。
  
  最近的報告中,他們檢視各州妊娠增加體重低於、符合、高於醫學研究院建議量(分別是不足、適當與超過)的盛行率,為此,他們分析了2013年足月生產(妊娠37 – 41週)單胞胎之美國孕婦的資料,共涵蓋43個司法管轄區(41州、紐約市與哥倫比亞特區),這些地區都是使用2003年修訂版出生證明,載有產婦的身高、孕前體重和生產時體重。
  
  此外,他們研究了5個州的2012年懷孕風險評估監督系統的資料,這5個州還沒有採用2003年版出生證明。
  
  醫學研究院提出的妊娠增加體重建議值為,體重過輕婦女是28-40磅(12.7-18.1公斤)、正常體重婦女是25-35磅(11.3-15.9公斤)、過重婦女是15-25磅(6.8-11.3公斤)、肥胖婦女則是11 -20磅(4.9-9.07公斤)。
  
  各州妊娠增加體重之盛行率的研究範圍分成三類:12.6%-25.5%(不足)、26.2%-39.0%(適當)、38.2%-54.7%(過多);妊娠增加體重不足之盛行率,在20州與紐約市達到20%以上;妊娠增加體重過多的盛行率在17州達到50%以上。
  
  體重增加過多最多的州是阿拉斯加與愛荷華,約有55%的孕婦體重增加過多;阿肯色和紐澤西的妊娠增加體重適當比率最高,分別是38%和39%,而喬治亞和華盛頓則是約有四分之一孕婦妊娠增加體重不足。
  
  如果依照懷孕前的身體質量指數分類,各州之間依舊有所差異,幾乎每州過重婦女的妊娠增加體重過多盛行率都是最高的。
  
  研究作者呼籲,為了孕婦與孩童的健康,採取強化而全面的策略來提升達到妊娠增加體重適當的比率。
  
  他們指出,只有在第二和第三孕期的時候,大部份婦女會需要每天多攝取340-450大卡熱量來支持她們的懷孕代謝需求。促進妊娠增加體重適當的策略,包括設定每日熱量目標、每週150分鐘中等強度運動,如快走。作者們建議,從懷孕初期就應定期自我檢視體重增加情況,且每次產前檢查也應測量體重,即早發現妊娠增加體重不足或過多,並採取適當矯正措施。
  
  資料來源: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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