Lam P K, Torfs C P, Brand R J
California Birth Defects Monitoring Program, Emeryville 94608-1811, USA.
Epidemiology. 1999 Nov;10(6):717-21.
A mother's prepregnancy obesity has been suggested as a risk factor for having offspring with an abdominal wall defect. We evaluated this hypothesis among 104 cases of gastroschisis--a severe birth defect of the abdominal wall most prevalent in infants of young women--and 220 controls with no defect. Using Quetelet's index (QI = weight in kg/height in m2) as a measure of body mass, we found a higher risk of gastroschisis (odds ratio (OR) = 3.2; 95% confidence interval (CI) = 1.4-7.3) for underweight mothers (QI<18.1 kg/m2) and a lower risk (OR = 0.2; 0.05-0.9) for overweight mothers (QI>28.3 kg/m2) as compared with mothers of normal weight. As QI was correlated to height, with the correlation varying according to mother's ethnicity and age, we adjusted for these factors in the analysis; the adjusted values approximated the unadjusted values. Evaluation of QI as a continuous variable showed that, for every unit increase in QI, the risk for gastroschisis decreased by about 11%. Sociodemographic, pregnancy, and nutrient factors did not confound the association. These results suggest that low prepregnancy body mass rather than obesity is a risk factor for gastroschisis.
母亲孕前肥胖被认为是生出患有腹壁缺陷后代的一个风险因素。我们在104例腹裂患儿（一种严重的腹壁出生缺陷，在年轻女性所生婴儿中最为常见）和220例无缺陷的对照者中评估了这一假设。使用奎特列指数（QI = 体重（千克）/身高（米）的平方）作为衡量体重的指标，我们发现体重过轻的母亲（QI<18.1千克/平方米）生出腹裂患儿的风险更高（比值比（OR）= 3.2；95%置信区间（CI）= 1.4 - 7.3），而超重母亲（QI>28.3千克/平方米）生出腹裂患儿的风险较低（OR = 0.2；0.05 - 0.9），与体重正常的母亲相比。由于QI与身高相关，且相关性因母亲的种族和年龄而异，我们在分析中对这些因素进行了调整；调整后的值接近未调整的值。将QI作为连续变量进行评估表明，QI每增加一个单位，腹裂的风险就降低约11%。社会人口统计学、妊娠和营养因素并未混淆这种关联。这些结果表明，孕前体重过低而非肥胖是腹裂的一个风险因素。
