Lu G C, Rouse D J, DuBard M, Cliver S, Kimberlin D, Hauth J C
Center for Research in Women's Health, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, AL, USA.
Am J Obstet Gynecol. 2001 Oct;185(4):845-9. doi: 10.1067/mob.2001.117351.
In this study, we assessed the temporal trends and relative and attributable perinatal risks of maternal obesity over a 20-year period.
We conducted a retrospective cohort study between 1980 and 1999 by using a computerized perinatal database of all women who received prenatal care and delivered their infants within a regional health care system. The main outcome measures were as follows: (1) annual mean body weight and the percentage of women classified as obese at the first prenatal visit (primary definition > or = 200 lb; secondary definitions > or = 250 lb, > or = 300 lb, body mass index > 29 kg/m(2)); and (2) relative and attributable risks of obesity for selected maternal and perinatal morbidities in successive 5-year periods.
From 1980 to 1999, the mean maternal weight of women at the first prenatal visit increased 20% (144-172 lb), as did the percentage of women > or = 200 lb (7.3-24.4), the percentage > or = 250 lb (1.9-10.7), the percentage > or = 300 lb (0.5-4.9), and the percentage with a body mass index > 29 kg/m(2) (16.3-36.4), P < .01 for all. Controlling for maternal age, race, and smoking status, obese women were at increased risk at each period for cesarean delivery (range of adjusted relative risk, 1.5-1.8), gestational diabetes (range, 1.8-2.9), and large (> 90th percentile) for gestational age infants (range, 1.8-2.2). From the earliest 5-year period (1980-1984) to the most recent (1995-1999), the percentage of obesity-attributable cesarean deliveries more than tripled from 3.9 to 11.6. Similar percentage increases were observed for the obesity-attributable risks for gestational diabetes (12.8-29.6) and large for gestational age infants (6.5-19.1). Trends for secondary obesity definitions were similar, although the magnitude of the increased attributable risks was smaller.
Efforts to reduce the frequency of certain perinatal morbidities will be constrained unless effective measures to prevent, or limit the risks of, maternal obesity are developed and implemented.
在本研究中，我们评估了20年间孕产妇肥胖的时间趋势以及相对和可归因的围产期风险。
我们利用一个计算机化的围产期数据库，对1980年至1999年间在一个区域医疗系统中接受产前护理并分娩婴儿的所有女性进行了一项回顾性队列研究。主要结局指标如下：（1）首次产前检查时的年平均体重以及被归类为肥胖的女性百分比（主要定义为≥200磅；次要定义为≥250磅、≥300磅、体重指数>29kg/m²）；（2）连续5年期间选定的孕产妇和围产期疾病肥胖的相对风险和可归因风险。
从1980年到1999年，首次产前检查时女性的平均孕产妇体重增加了20%（从144磅增至172磅），体重≥200磅的女性百分比（从7.3%增至24.4%）、≥250磅的女性百分比（从1.9%增至10.7%）、≥300磅的女性百分比（从0.5%增至4.9%）以及体重指数>29kg/m²的女性百分比（从16.3%增至36.4%）也都有所增加，所有这些P值均<0.01。在控制了孕产妇年龄、种族和吸烟状况后，肥胖女性在每个时期剖宫产的风险增加（调整后的相对风险范围为1.5至1.8）。
