Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
권호 표지

The Relationship of Maternal Physical Characteristic Change and Neonatal Weights

산모의 신체적 특성변화와 신생아 체중의 상관관계: 1989년과 1999년의 비교

Yoon, Hea-Jin;Hoh, Jeong-Kyu;Cho, Soo-Hyun;Kim, Kyung-Tai;Moon, Hyung
윤혜진;호정규;조수현;김경태;문형

  • Published : 20040100
⟨ Previous Next ⟩

Abstract

Objective : This study was organized to find out whether there are differences between pregravid weight, body mass index, weight gain during pregnancy and birth weight in 1989 and 1999. Also it was designed to find out the factors which influenced the birth weight changes. Methods : A total of 725 (313 in 1989, 412 in 1999) pregnant women who had term delivery in the department of Obstetrics and Gynecology, Hanyang University Hospital were recruited for the study. Pregravid weight, body mass index, weight gain during pregnancy, body weight at the time of delivery and birth weight were examined through medical records retrospectively. Results : Pregnant women in 1999 were older (29.7$\pm$3.7 yr vs 28.3$\pm$3.2 yr, p=0.0001), pregravid weight (54.0$\pm$7.5 kg vs 50.7$\pm$5.5 kg, p=0.0001), height (159.6$\pm$4.8 cm vs 158.5$\pm$4.7 cm, p=0.002), body mass index (21.2$\pm$2.8 kg/m$^2$ vs 20.2$\pm$2.1 kg/m$^2$, p=0.0001), weight gain during pregnancy (13.6$\pm$4.8 kg vs 12.8$\pm$4.6 kg, p=0.016) and birth weight (3103$\pm$652 gm vs 2993$\pm$843 gm, p=0.025) compared with those in 1989. The frequency of overweight (BMI>26) in pregravid was significantly higher in 1999 (9.4%) than in 1989 (1.9%) (p=0.0001). Weight gain during pregnancy were lower in over-weight pregravid than in normal or under-weight pregravid in both year, but birth weight was not different according to pregravid weight in both years. Compared to the weight gain during pregnancy less than 16 kg, women who gained weight more than 16 kg during pregnancy were significantly taller and weighed more at the time of delivery, and showed increased birth weight than those who gained weight during pregnancy less than 16 kg in both years. Weight gain during pregnancy was higher in over-weight pregravid than normal or under-weight pregravid in 1999 (p-=0.012). The gain of body weight at the time of delivery in 1999 compared to those in 1989 is the most important factor for the birth weight change between two years. The increased pregravid weight, greater weight gain during pregnancy, and increased BMI also had an impact on the increasing birth weight in 1999. Conclusion : It is considered that physical characteristics of pregnant women in 1999 have been changed compared to those in 1989, and this change might be responsible for a birth weight increase.

목적 : 산모의 분만 전 체중, 신체질량지수 등의 비만도 및 임신 중 체중증가가 10년 전과 최근에 서로 차이가 있는지를 알아보고자 하였다. 또한 산모의 비만도 및 임신 중 체중증가가 태아의 체중에 미치는 영향을 알아보고자 하였다. 연구 방법 : 한양대학병원 산부인과에 입원하여 만삭 분만한 산모 725명 (1989년 1년 간 분만한 산모 중 313명, 1999년 1년 간 분만한 산모 중 412명)을 대상으로 하였다. 산모의 임신 전 평균체중, 임신 중 체중증가, 분만 시 체중 및 신생아 체중 등을 의무기록을 통하여 후향적으로 검토하였다. 결과 : 1999년에 분만한 산모는 1989년에 분만한 산모에 비하여 나이 (29.7$\pm$3.7세 vs 28.3$\pm$3.2t세, p=0.0001), 임신 전 체중 (54.0$\pm$7.5 kg vs 50.7$\pm$5.5 kg, p=0.0001), 신장 (159.6$\pm$4.8 cm vs 158.5$\pm$4.7 cm, p=0.002) 및 신체질량지수 (21.2$\pm$2.8 kg/m$^2$ vs 20.2$\pm$2.1 kg/m$^2$, p=0.0001)가 증가하였다. 임신 중 체중증가 (13.6$\pm$4.8 kg vs 12.8$\pm$4.6 kg, p=0.016) 및 신생아의 체중도 (3103$\pm$652 gm vs 2993$\pm$843 gm, p=0.025) 1999년에 1989년보다 증가하였다. 임신 전 신체질량지수 26 이상인 과체중 산모의 빈도도 1999년이 1989년보다 유의하게 높았다 (9.4% vs 1.9%, p=0.0001). 임신 전 신체질량지수가 26 이상으로 과체중인 여성은 정상 체중인 여성에 비하여 임신 중 체중증가가 1989년, 1999년 모두 낮았으며, 신생아의 체중은 서로 차이가 없었다. 1999년에 분만한 산모는 나이가 어리고 체중질량지수가 낮을수록 임신 중 체중증가가 많았다 (p=0.012). 한편 임신 중 체중증가가 16 kg 이상인 산모는 체중증가가 16 kg 미만인 산모에 비하여 분만시 체중 (p=0.0001, p=0.0001)과 신생아의 체중 (p=0.004, p=0.004)이 1999년, 1989년 모두에서 각각 높았다. 임신성 고혈압을 보인 산모의 빈도는 1989년에 비해 1999년에 감소하였다 (5.1% vs 1.4%, p=0.021). 그러나 1989년과 1999년 모두 신체질량지수 26 이상인 과체중 산모와 임신 중 체중증가 16 kg인 산모에서 임신성 고혈압의 빈도는 차이가 없었다 (p=0.259, p=0.705). 1989년에 비하여 1999년에 출생한 신생아의 체중이 증가하였으며 이에 영향을 미치는 요소들을 알아본 결과 분만 당시 산모의 체중증가가 가장 큰 영향을 미치며 그 외에도 신체질량지수의 증가, 임신 중 체중증가등이 작용하였다. 결론 : 1989년에 비하여 1999년에 분만한 산모의 신체적 특성이 변화하였으며 이로 인하여 신생아의 체중이 증가하였다고 사료된다.

Keywords

References

  1. Legato MJ. Gender-specific aspects of obesity. Int J Fertil Menopausal Stud 1997; 42: 184-97
  2. Anon. Women's Health. Australian Bureau of Statistics: Canbarra 1994
  3. Wilson BD, Wilson NC, Russell DG. Obesity and body fat distribution in the New Zealand population. N Z Med J 2001; 114: 127-30
  4. Bogain A, Isnard V, Gillet JY. Obesity in obstetrics and gynecology. Eur J Obstet Gynecol Reprod Biol 1998; 77: 217-28 https://doi.org/10.1016/S0301-2115(97)00247-9
  5. 문화관광부. 국민체력 실태조사 1998년 12월
  6. Durazo-Arvizu RA, Goldbourt U, McGee DL. Body-mass index and mortality. N Engl J Med. 2000; 342: 287-9
  7. Barker M, Robinson S, Osmond C, Barker DJ. Birth weight and body fat distribution in adolescent girls. Arch Dis Child 1997; 77: 381-3 https://doi.org/10.1136/adc.77.5.381
  8. Steinfeld JD, Valentine S, Lerer T, Ingardia CJ, Wax JR, Curry SL. Obesity-related complications of pregnancy vary by race. J Matern Fetal Med 2000; 9: 238-41 https://doi.org/10.1002/1520-6661(200007/08)9:4<238::AID-MFM10>3.0.CO;2-5
  9. Galtier-Dereure F, Boegner C, Bringer J. Obesity and pregnancy: complications and cost. Am J Clin Nutr 2000; 71: 1242-8
  10. American College of Obstetrics and Gynecologist: Nutrition during pregnancy. Technical Bullitin no. 1993a; 179
  11. Institute of Medicine. Subcommittee on nutritional status and weight gain during pregnancy. Nutrition during pregnancy. Washington. DC: National Academy Press, 1990
  12. Ananth CV, Wen SW. Trends in fetal growth among singleton gestations in the United States and Canada, 1985 through 1998. Semin Perinatol 2002; 26: 260-7 https://doi.org/10.1053/sper.2002.34772
  13. Kramer MS, Morin I, Yang H, Platt RW, Usher R, McNamara H, et al. Why are babies getting bigger? Temporal trends in fetal growth and its determinants. J Pediatr 2002; 141: 538-42 https://doi.org/10.1067/mpd.2002.128029
  14. Pritchard JA, MacDonald PC, Gant NF. Prenatal care, William Obstetrics, Seventeenth ed., Appleton-Century-Crofts 1985; 250
  15. Abrams B, Carmichael S, Selvin S. Factors associated with the pattern of maternal weight gain during pregnanacy. Obstet Gynecol 1995; 86: 170-6 https://doi.org/10.1016/0029-7844(95)00119-C
  16. Lenner A. Des Neugeborenen Kindes Beeinflussen(Abstract in Acta Obstet Gynecol Scand 1943-44 Suppl. I; 24: 1.)
  17. Simpson JW, Lawless RW, Mitchell AC. Responsibility of the obstetrician to the fetus. II. Influence of pregnancy weight and pregnancy weight gain on birth weight. Obstet Gynecol 1975; 45: 481-7
  18. Naeye RL. Maternal body weight and pregnancy outcome. Am J Clin Nutr 1990; 52: 273-9
  19. Catalano PM, Roman NM, Amini SB. Factors affecting fetal growth and body composition. Am J Obstet Gynecol 1995; 172: 1459-63 https://doi.org/10.1016/0002-9378(95)90478-6
  20. O' Sullivan. JB, Gellis SS. Aspects of birth weight and its influencing varibles Am J Obstet & Gynecol 1965; 92: 1023-9
  21. Fisch RO, Bilek MK, Ulstrom R. Obesity and leanness as birth andtheir relationship to body habitus in later childhood, Pediatrics 1975; 56: 521-8
  22. Harrison GG, Udall JN, Morrow G. Maternal obesity, weight gain in pregnancy, and infant birth weight. Am J Obstet Gynecol 1980; 136(3) 411-2
  23. Love EJ, Kinch RAH. Factors influencing the birth weight in normal pregnancy Am J Obstet & Gynecol 1965; 91: 342-9.
  24. Eastmann NJ, Jackson E. Weight relationships in pregnancy: The bearing of maternal weight gain and pre-pregnancy weight on birth weight in full term pregnancies. Obstet Gynecol Survey 1968; 23: 1003-25 https://doi.org/10.1097/00006254-196811000-00001
  25. 이명식, 한원보, 정종욱, 이승, 김재욱, 곽현모. 만기 산모의 체중증가와 신생아 체중에 관한 고찰. 대한산부회지 1984; 27: 337-43
  26. Brown JE, Murtaugh MA, Jacobs DR Jr, Margel I. Variation in newborn size according to pregnancy weight change by trimester. Am J Clin Nutr 2002; 76: 205-9
  27. Thorsdottir I, Torfadottir JE, Birgisdottir BE, Geirsson RT. Weight gain in women of normal weight before pregnancy: complications in pregnancy or delivery and birth outcome. Obstet Gynecol 2002; 99: 799-806 https://doi.org/10.1016/S0029-7844(02)01946-4
  28. Thorsdottir I, Torfadottir JE, Birgisdottir BE, Geirsson RT. Weight gain in women of normal weight before pregnancy: complications in pregnancy or delivery and birth outcome. Obstet Gynecol 2002; 99: 799-806 https://doi.org/10.1016/S0029-7844(02)01946-4
  29. Rooney BL, Schauberger CW. Excess pregnancy weight gain and longterm obesity: one decade later. Obstet Gynecol 2002; 100: 245-52 https://doi.org/10.1016/S0029-7844(02)02125-7
  30. Wong W, Tang NL, Lau TK, Wong TW. A new recommendation for maternal weight gain in Chinese women. J Am Diet Assoc 2000; 100: 791-6 https://doi.org/10.1016/S0002-8223(00)00230-3
  31. Lepercq J, Hauguel-De Mouzon S, Timsit J, Catalano PM. Fetal macrosomia and maternal weight gain during pregnancy. Diabetes Metab 2002; 28: 323-8
  32. Castro LC, Avina RL. Maternal obesity and pregnancy outcomes. Curr Opin Obstet Gynecol 2002; 14: 601-6 https://doi.org/10.1097/00001703-200212000-00005
  33. Giuliani A, Tamussino K, Basver A, Haas J, Petru E. The impact of body mass index and weight gain during pregnancy on puerperal complications after spontaneous vaginal delivery. Wien Klin Wochenschr 2002; 114: 383-6
  34. Dawson SI, Smith WC, Watson MS, Wilson BJ, Prescott GJ, Campbell D, et al. A cohort study of reproductive risk factors, weight and weight change and the development of diabetes mellitus. Diabetes Obes Metab 2003; 5: 244-50 https://doi.org/10.1046/j.1463-1326.2003.00269.x
  35. Linne Y, Rossner S. Interrelationships between weight development and weight retention in subsequent pregnancies: the SPAWN study. Acta Obstet Gynecol Scand 2003; 82: 318-25
  36. Watkins ML, Rasmussen SA, Honein MA, Botto LD, Moore CA. Maternal obesity and risk for birth defects. Pediatrics 2003; 111: 1152-8
  37. Neggers YH, Goldenberg RL, Ramey SL, Cliver SP Maternal prepregnancy body mass index and psychomotor development in children. Acta Obstet Gynecol Scand 2003; 82: 235-40