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备孕妇女膳食指南

2016-09-23 佚名 围产医学会

为保证成功妊娠、提高生育质量、预防不良妊娠结局,夫妻双方都应做好充分的孕前准备。 健康的身体状况、合理膳食、均衡营养是孕育新生命必需的物质基础。准备怀孕的妇女应接受健康体检及膳食和生活方式指导,使健康与营养状况尽可能达到最佳后再怀孕。健康体检要特别关注感染性疾病(如牙周病)以及血红蛋白、血浆叶酸、尿碘等反映营养状况的检测,目的是避免相关炎症及营养素缺乏对受孕成功和妊娠结局的不良影响。

为保证成功妊娠、提高生育质量、预防不良妊娠结局,夫妻双方都应做好充分的孕前准备。
 
健康的身体状况、合理膳食、均衡营养是孕育新生命必需的物质基础。准备怀孕的妇女应接受健康体检及膳食和生活方式指导,使健康与营养状况尽可能达到最佳后再怀孕。健康体检要特别关注感染性疾病(如牙周病)以及血红蛋白、血浆叶酸、尿碘等反映营养状况的检测,目的是避免相关炎症及营养素缺乏对受孕成功和妊娠结局的不良影响。备孕妇女膳食指南在一般人群膳食指南[2]基础上特别补充了以下3条内容:(1)调整孕前体重至适宜水平;(2)常吃含铁丰富的食物,选用碘盐,孕前3个月开始补充叶酸;(3)禁烟酒,保持健康生活方式。 

一、调整孕前体重至适宜水平 

(一)提要 

孕前体重与新生儿出生体重、婴儿死亡率以及孕期并发症等不良妊娠结局有密切关系。低体重或肥胖的育龄妇女是发生不良妊娠结局的高危人群,备孕妇女宜通过平衡膳食和适量运动来调整体重,尽量使体重指数(body mass index,BMI)达到18.5~23.9的理想范围。 

(二)关键推荐 

1.肥胖或低体重备孕妇女应调整体重,使BMI达到18.5~23.9。 
2.保证平衡膳食并维持适宜体重,以最佳的生理状态孕育新生命。
 
(三)实践应用 

备孕妇女应调整体重至适宜水平。 

1.低体重(BMI<18.5)者可通过适当增加食物量和规律运动来增加体重,每天可有1~2次的加餐,如每天增加牛奶200 ml或粮谷/畜肉类50 g或蛋类/鱼类75 g。 

2.肥胖(BMI≥28.0)者应改变不良饮食习惯,减慢进食速度,避免过量进食,减少高能量、高脂肪、高糖食物的摄入,多选择低生糖指数(glycemic index,GI)、富含膳食纤维、营养素密度高的食物。同时,应增加运动,推荐每天30~90 min中等强度的运动。 

(四)科学依据 

孕前适宜体重可降低发生不良妊娠结局的风险。孕前超重和肥胖会使妊娠期高血压疾病和糖尿病、巨大儿、剖宫产的风险增加,而且危险度随着肥胖程度增加而增加;孕前患糖尿病和肥胖不仅增加胎儿先天畸形的发生风险,还与子代成年后肥胖及代谢综合征的发生相关[3-6]。孕前消瘦增加低出生体重儿或早产儿的发生风险[7-9],而胎儿生长受限又与成年期的心血管疾病、糖尿病等慢性病有关。由于孕前体重与不良妊娠结局有密切关系,肥胖或低体重的备孕妇女均需调整体重至适宜水平,避免体重过高或过低对妊娠结局造成的不良影响。 

我国育龄妇女超重率和肥胖率已从1992年的16.8%和3.1%、2002年的23.3%和6.9%,分别上升到2010年的26.4% 和9.0%;另外,2002年我国育龄妇女中BMI<18.5者占8.0%,某些农村地区甚至高达9.7%[10]。 

二、常吃含铁丰富的食物,选用碘盐,孕前3个月开始补充叶酸 

(一)提要 

育龄妇女是铁缺乏和缺铁性贫血患病率较高的人群,怀孕前如果缺铁,可导致早产、胎儿生长受限、新生儿低出生体重以及妊娠期缺铁性贫血。因此,备孕妇女应经常摄入含铁丰富、利用率高的动物性食物,铁缺乏或缺铁性贫血者应纠正贫血后再怀孕。碘是合成甲状腺激素不可缺少的微量元素,为避免孕期碘缺乏对胎儿智力和体格发育产生的不良影响,备孕妇女除选用碘盐外,还应每周摄入1次富含碘的海产品。叶酸缺乏可影响胚胎细胞增殖、分化,增加神经管畸形及流产的风险,备孕妇女应从准备怀孕前3个月开始每天补充400 μg叶酸,并持续整个孕期。 

(二)关键推荐 

1. 多吃含铁丰富的食物,增加身体铁储备; 
2.选用碘盐,多吃含碘丰富的食物; 
3.至少孕前3个月开始补充叶酸。 

(三)实践应用 

1.吃含铁丰富的食物:动物血、肝脏及红肉中铁含量及铁的吸收率均较高,一日三餐中应该有瘦畜肉50~100 g,每周1次动物血或畜禽肝肾25~50 g。在摄入富含铁的畜肉或动物血和肝脏时,同时摄入含维生素C较多的蔬菜和水果,可提高膳食铁的吸收与利用率。 

2.选用碘盐,吃含碘丰富的食物:由于食物中普遍缺乏碘,选用加碘食盐可确保有规律的碘摄入[11]。我国现行食盐强化碘量为25 mg/kg,碘的烹调损失率为20%,按每日食盐摄入量6 g计算,可摄入碘约120 µg/d,达到成人推荐量。考虑到孕期对碘的需要增加、碘缺乏对胎儿的严重危害及早孕期妊娠反应会影响对食物和碘的摄入,建议备孕妇女除规律食用碘盐外,每周再摄入1次富含碘的食物,如海带、紫菜、贻贝(淡菜),以增加一定量的碘储备。 

3.孕前3个月开始补充叶酸:天然食物中的叶酸是结构复杂的多谷氨酸叶酸,进入体内后必须分解出小分子的单谷氨酸叶酸,才能被小肠吸收,生物利用率约为50%,而且由于对热、光和酸敏感,烹调加工的损失率可达50%~90%。人工合成的叶酸补充剂为叶酸单体,稳定性好,可被肠道直接吸收,空腹服用的生物利用率100%,与膳食混合后的生物利用率为85%,是天然食物叶酸的1.7倍。因此,备孕妇女应每天补充400 μg叶酸。 

(四)科学依据 

1.缺铁或贫血影响妊娠成功和母子健康:正常成年女性体内储存铁量约0.3~1.0 g,但育龄妇女因生育和月经失血,体内铁储备往往不足。孕前和孕早期缺铁或贫血,可影响妊娠结局和母子双方的健康,导致流产、胎儿生长受限以及新生儿低出生体重,还会使孕妇更易发生妊娠期缺铁性贫血[12-13]。孕妇贫血导致胎儿肝脏储存的铁量不足,不仅影响婴儿早期血红蛋白合成、引起贫血,而且影响含铁酶(血红素)的合成,并影响脑内多巴胺D2受体的产生,对胎儿及新生儿智力和行为发育产生不可逆的影响[14]。由于妊娠期对铁的需要量显著增加,而且良好的铁营养状况是成功妊娠的必要条件,故从计划怀孕开始,育龄妇女应尽可能多摄取含铁丰富的动物性食物,为妊娠储备足够的铁;准备怀孕但贫血或铁缺乏的女性应积极治疗,待贫血或铁缺乏纠正后再怀孕。 

2.碘营养状况与子代智力和体格发育有关:人体内的碘主要储存在甲状腺,约为8~15 mg,可维持机体2~3个月的需要。碘缺乏引起甲状腺激素合成减少,甲状腺功能减退,进而影响新陈代谢及蛋白质合成,并对儿童智力发育造成不可逆的损伤,世界卫生组织(World Health Organization,WHO)估计缺碘造成儿童智力损失5~20 个智商(intelligent quotient,IQ)评分,国内估计儿童智力损失10~15个百分点[15]。研究表明,妇女怀孕前和孕期碘摄入量低于25 μg/d时,新生儿可发生克汀病;孕期不及时补碘会增加胎儿神经系统发育迟缓的风险,碘缺乏患者在孕早期补碘对其胎儿的益处明显大于孕晚期补碘;孕前和孕期良好的碘营养状况可预防碘缺乏对胎儿神经系统和体格发育的不良影响[16]。
 
3.孕前3个月补充叶酸可降低子代神经管和多种畸形的风险:叶酸是一碳单位的主要供体之一,在同型半胱氨酸代谢、DNA合成、甲基化等方面发挥重要的作用,与正常发育、健康维持以及多种疾病的风险有关,是细胞增殖、组织生长与机体发育不可缺少的微量营养素。动物实验和人群流行病学研究表明,孕早期缺乏叶酸可引起死胎、流产、脑和神经管畸形,还可导致眼、口唇、腭、胃肠道、心血管、肾、骨骼等器官的畸形[17]。 

胚胎神经管分化发生在受精后2~4周,即4~6孕周,而妇女意识到自己怀孕通常在第5孕周以后或者更晚些时候,此时再补充叶酸预防胎儿神经管畸形,无疑为时已晚。研究表明,育龄妇女每天补充400 μg叶酸4周后,体内叶酸缺乏的状态得到一定改善,持续补充12~14周后血清或血浆叶酸浓度达到有效水平和稳定状态[18]。因此,必须从准备怀孕前3个月开始每天补充400 μg叶酸(补充剂),才能保证胚胎早期有较好的叶酸营养状态,满足其神经管分化对甲基的需要,降低子代神经管和多器官畸形发生的风险;对于曾有过神经管畸形儿生育史和怀疑有叶酸缺乏的妇女,应在医生指导下补充更大剂量的叶酸[19]。
 
我国育龄妇女体内叶酸水平较低,红细胞叶酸缺乏率北方妇女约54.9%、南方妇女约7.8%,在胎儿神经管畸形低发区的育龄妇女中,仍有相当一部分人缺乏叶酸;全国神经管畸形平均发病率2.74‰(北方约7‰、南方约1.5‰),北方地区高于南方地区,农村高于城市,每年约有8~10万名神经管畸形儿出生。国内外多项人体叶酸干预试验证实,胚胎神经管分化期补充叶酸可有效地降低胎儿神经管畸形的发生率,孕前期至孕早期服用叶酸补充剂可以预防80%的神经管畸形儿出生;给曾经生育过神经管畸形儿的母亲补充叶酸,能使其下次妊娠时神经管畸形率降低70%。我国一项大规模社区干预试验表明,妇女于妊娠前后每天口服叶酸400 μg,对神经管畸形高发地区和低发地区的预防率分别达到85%和41%。 

在我国,给计划怀孕的妇女和孕妇每天补充400 μg叶酸(补充剂),已成为重要的营养干预政策。 

三、禁烟酒,保持健康生活方式 

(一)提要 

良好的身体状况和营养贮备是成功孕育新生命最重要的条件,健康的生活方式、均衡的营养、有规律的运动和锻炼、充足的睡眠、愉悦的心情等,均有利于优孕优育[20-21],夫妻双方应共同为受孕进行充分的营养、身体和心理准备。应先纠正可能存在的营养缺乏和相关疾病,保持良好的卫生习惯和健康的生活方式。

(二)关键推荐 

1.禁烟酒,讲卫生,规律作息 
2.检查身体,纠正营养缺乏,治疗疾病 

(三)实践应用 

1.禁烟酒,讲卫生,规律作息:在准备怀孕前6个月夫妻双方均应停止吸烟、饮酒,并远离吸烟环境。还应注意保持良好的卫生习惯,避免感染、炎症及接触有毒有害物质。保持规律作息,避免熬夜和过度劳累,保证充足睡眠,保持愉悦心情,准备孕育新生命。 

2.检查身体,纠正营养缺乏,治疗疾病:计划怀孕前夫妻双方均应进行健康体检,及时发现可能存在的疾病或营养缺乏,遵循平衡膳食原则,纠正可能的营养缺乏,积极治疗相关疾病,避免带病怀孕。 

(四)科学依据 

1.吸烟和饮酒影响受孕与子代健康:夫妻一方或双方经常饮酒、酗酒,可影响受孕和下一代的健康。酒精可导致内分泌紊乱,影响精子或卵子发育,造成精子或卵子畸形,受孕时形成异常受精卵;影响受精卵顺利着床和胚胎发育,受酒精损害的生殖细胞形成的胚胎往往发育不正常而导致流产[22-23];男性长期或大量饮酒,引起慢性或急性酒精中毒,精子数量减少、活力降低,畸形精子、死亡精子的比例升高,进而影响受孕和胚胎发育[24];酒精可以通过胎盘进入胎儿血液,造成胎儿宫内发育不良、中枢神经系统发育异常、智力低下等。烟草中的有害成分通过血液循环进入生殖系统,会直接或间接地产生毒性作用,怀孕前夫妻双方或一方经常吸烟可增加下一代发生畸形的风险。每天吸烟10支以上者,其子女发生先天性畸形的风险增加2.1%;男性每天吸烟30支以上者,畸形精子的比例超过20%,且吸烟时间愈长,畸形精子愈多,停止吸烟半年后,精子方可恢复正常[25]。因此,计划怀孕前6个月夫妻双方均应戒烟、禁酒,计划怀孕的妇女还应远离吸烟环境。 

2.健康生活方式有利于提高生育质量:运动可以避免超重和肥胖,保持健康体重;增强心肺功能,改善血液循环与呼吸及消化系统的功能,提高抗病能力,增强机体的适应能力;调节人体紧张情绪,改善生理和心理状态,有助于睡眠。少动久坐的生活方式,可因能量消耗减少而使体内脂肪堆积,导致超重和肥胖,还可诱发颈椎病、腰椎病,也是心血管疾病、糖尿病等慢性病的危险因素。少动久坐的生活方式容易导致孕期增重过多,增加不良妊娠结局的风险。备孕妇女应坚持每天至少30 min中等强度的运动,改变少动久坐的不良习惯,为受孕和妊娠的成功奠定基础。孕前接受健康的生活方式指导和干预有助于获得良好妊娠结局,提高生育质量[26]。 

3. 孕前的疾病影响受孕和妊娠结局:母亲牙周炎是早产和低体重儿的独立危险因素;其发生机制可能与牙菌斑中的致病厌氧菌及其代谢产生的细胞因子侵入胎盘有关。孕期干预治疗研究表明,怀孕期间接受牙周炎治疗,改善牙周健康状况可降低早产和低出生体重率[27]。准备怀孕的育龄妇女应坚持每天早晚2次有效刷牙和餐后漱口,及时清除牙菌斑,并应定期检查与治疗牙周病,以预防早产低体重儿的发生。 


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  1. 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createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134258, encodeId=4314134258a5, content=总结的很好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134257, encodeId=211b13425e22, content=孕前体重与新生儿出生体重、婴儿死亡率以及孕期并发症等不良妊娠结局有密切关系!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:10:00 CST 2016, time=2016-09-24, status=1, ipAttribution=)]
    2017-02-17 wmu姿

    好好学习,学以致用,保持体重,健康生活

    0

  2. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1436708, encodeId=50941436e0811, content=<a href='/topic/show?id=9166424e48b' target=_blank style='color:#2F92EE;'>#备孕#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42474, encryptionId=9166424e48b, topicName=备孕)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sun Sep 25 04:47:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1350307, encodeId=e07e135030e98, content=<a href='/topic/show?id=224a85904ad' target=_blank style='color:#2F92EE;'>#膳食#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85904, encryptionId=224a85904ad, topicName=膳食)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Sep 25 04:47:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134670, encodeId=f62c1346e07c, content=有用的知识,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76f6105517, createdName=Jiangyh0406, createdTime=Sun Sep 25 04:37:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134559, encodeId=2c7a13455964, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb571956164, createdName=187清风, createdTime=Sat Sep 24 21:22:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134261, encodeId=ca92134261cb, content=总结的很全面!, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134259, encodeId=11af13425902, content=备孕妇女应调整体重至适宜水平!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134258, encodeId=4314134258a5, content=总结的很好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134257, encodeId=211b13425e22, content=孕前体重与新生儿出生体重、婴儿死亡率以及孕期并发症等不良妊娠结局有密切关系!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:10:00 CST 2016, time=2016-09-24, status=1, ipAttribution=)]
  3. 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createdName=187清风, createdTime=Sat Sep 24 21:22:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134261, encodeId=ca92134261cb, content=总结的很全面!, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134259, encodeId=11af13425902, content=备孕妇女应调整体重至适宜水平!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134258, encodeId=4314134258a5, content=总结的很好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134257, encodeId=211b13425e22, content=孕前体重与新生儿出生体重、婴儿死亡率以及孕期并发症等不良妊娠结局有密切关系!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:10:00 CST 2016, time=2016-09-24, status=1, ipAttribution=)]
    2016-09-25 zhouqu_8
  4. 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createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134258, encodeId=4314134258a5, content=总结的很好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134257, encodeId=211b13425e22, content=孕前体重与新生儿出生体重、婴儿死亡率以及孕期并发症等不良妊娠结局有密切关系!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:10:00 CST 2016, time=2016-09-24, status=1, ipAttribution=)]
    2016-09-25 zhaojie88
  5. 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createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134258, encodeId=4314134258a5, content=总结的很好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134257, encodeId=211b13425e22, content=孕前体重与新生儿出生体重、婴儿死亡率以及孕期并发症等不良妊娠结局有密切关系!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:10:00 CST 2016, time=2016-09-24, status=1, ipAttribution=)]
    2016-09-25 Jiangyh0406

    有用的知识,谢谢分享

    0

  6. 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createdName=187清风, createdTime=Sat Sep 24 21:22:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134261, encodeId=ca92134261cb, content=总结的很全面!, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134259, encodeId=11af13425902, content=备孕妇女应调整体重至适宜水平!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134258, encodeId=4314134258a5, content=总结的很好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134257, encodeId=211b13425e22, content=孕前体重与新生儿出生体重、婴儿死亡率以及孕期并发症等不良妊娠结局有密切关系!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:10:00 CST 2016, time=2016-09-24, status=1, ipAttribution=)]
    2016-09-24 187清风

    继续学习

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=176554, encodeId=41f11e655405, content=好好学习,学以致用,保持体重,健康生活, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=071c2012037, createdName=wmu姿, createdTime=Fri Feb 17 08:25:50 CST 2017, time=2017-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1454669, encodeId=f8e51454669da, content=<a href='/topic/show?id=4c5a8591220' target=_blank style='color:#2F92EE;'>#膳食指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85912, encryptionId=4c5a8591220, topicName=膳食指南)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=93855584330, createdName=hxj0119, createdTime=Sun Sep 25 04:47:00 CST 2016, time=2016-09-25, status=1, 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createdName=187清风, createdTime=Sat Sep 24 21:22:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134261, encodeId=ca92134261cb, content=总结的很全面!, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134259, encodeId=11af13425902, content=备孕妇女应调整体重至适宜水平!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134258, encodeId=4314134258a5, content=总结的很好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134257, encodeId=211b13425e22, content=孕前体重与新生儿出生体重、婴儿死亡率以及孕期并发症等不良妊娠结局有密切关系!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:10:00 CST 2016, time=2016-09-24, status=1, ipAttribution=)]
    2016-09-24 1e0d99ddm02(暂无匿称)

    总结的很全面!

    0

  8. 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createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:10:00 CST 2016, time=2016-09-24, status=1, ipAttribution=)]
    2016-09-24 1e0d99ddm02(暂无匿称)

    备孕妇女应调整体重至适宜水平!!!

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=176554, encodeId=41f11e655405, content=好好学习,学以致用,保持体重,健康生活, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=071c2012037, createdName=wmu姿, createdTime=Fri Feb 17 08:25:50 CST 2017, time=2017-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1454669, encodeId=f8e51454669da, content=<a href='/topic/show?id=4c5a8591220' target=_blank style='color:#2F92EE;'>#膳食指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85912, encryptionId=4c5a8591220, topicName=膳食指南)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=93855584330, createdName=hxj0119, createdTime=Sun Sep 25 04:47:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1436708, encodeId=50941436e0811, content=<a href='/topic/show?id=9166424e48b' target=_blank style='color:#2F92EE;'>#备孕#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42474, encryptionId=9166424e48b, topicName=备孕)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sun Sep 25 04:47:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1350307, encodeId=e07e135030e98, content=<a href='/topic/show?id=224a85904ad' target=_blank style='color:#2F92EE;'>#膳食#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85904, encryptionId=224a85904ad, topicName=膳食)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Sep 25 04:47:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134670, encodeId=f62c1346e07c, content=有用的知识,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76f6105517, createdName=Jiangyh0406, createdTime=Sun Sep 25 04:37:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134559, encodeId=2c7a13455964, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb571956164, createdName=187清风, createdTime=Sat Sep 24 21:22:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134261, encodeId=ca92134261cb, content=总结的很全面!, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134259, encodeId=11af13425902, content=备孕妇女应调整体重至适宜水平!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134258, encodeId=4314134258a5, content=总结的很好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134257, encodeId=211b13425e22, content=孕前体重与新生儿出生体重、婴儿死亡率以及孕期并发症等不良妊娠结局有密切关系!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:10:00 CST 2016, time=2016-09-24, status=1, ipAttribution=)]
    2016-09-24 1e0d99ddm02(暂无匿称)

    总结的很好!

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=176554, encodeId=41f11e655405, content=好好学习,学以致用,保持体重,健康生活, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=071c2012037, createdName=wmu姿, createdTime=Fri Feb 17 08:25:50 CST 2017, time=2017-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1454669, encodeId=f8e51454669da, content=<a href='/topic/show?id=4c5a8591220' target=_blank style='color:#2F92EE;'>#膳食指南#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85912, encryptionId=4c5a8591220, topicName=膳食指南)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=93855584330, createdName=hxj0119, createdTime=Sun Sep 25 04:47:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1436708, encodeId=50941436e0811, content=<a href='/topic/show?id=9166424e48b' target=_blank style='color:#2F92EE;'>#备孕#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42474, encryptionId=9166424e48b, topicName=备孕)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sun Sep 25 04:47:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1350307, encodeId=e07e135030e98, content=<a href='/topic/show?id=224a85904ad' target=_blank style='color:#2F92EE;'>#膳食#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85904, encryptionId=224a85904ad, topicName=膳食)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Sep 25 04:47:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134670, encodeId=f62c1346e07c, content=有用的知识,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76f6105517, createdName=Jiangyh0406, createdTime=Sun Sep 25 04:37:00 CST 2016, time=2016-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134559, encodeId=2c7a13455964, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cb571956164, createdName=187清风, createdTime=Sat Sep 24 21:22:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134261, encodeId=ca92134261cb, content=总结的很全面!, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134259, encodeId=11af13425902, content=备孕妇女应调整体重至适宜水平!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134258, encodeId=4314134258a5, content=总结的很好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:11:00 CST 2016, time=2016-09-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=134257, encodeId=211b13425e22, content=孕前体重与新生儿出生体重、婴儿死亡率以及孕期并发症等不良妊娠结局有密切关系!!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160817/IMG57B3C3F6DC2FD8753.jpg, createdBy=81321934679, createdName=1e0d99ddm02(暂无匿称), createdTime=Sat Sep 24 11:10:00 CST 2016, time=2016-09-24, status=1, ipAttribution=)]
    2016-09-24 1e0d99ddm02(暂无匿称)

    孕前体重与新生儿出生体重、婴儿死亡率以及孕期并发症等不良妊娠结局有密切关系!!!

    0

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