O'Brien Tara E, Ray Joel G, Chan Wee-Shian
Division of Obstetrical Medicine, Department of Medicine, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
Epidemiology. 2003 May;14(3):368-74. doi: 10.1097/00001648-200305000-00020.
Maternal obesity, both in itself and as part of the insulin resistance syndrome, is an important risk factor for the development of preeclampsia. Accurately quantifying the relation between prepregnancy maternal body mass index and the risk of preeclampsia may better identify those at highest risk. We performed a systematic overview of the literature to determine the association between prepregnancy body mass index and the risk of preeclampsia.
Two reviewers independently retrieved all relevant English language cohort studies through a systematic search of Medline and Embase between 1980 and June 2002. Study data were abstracted in a similar fashion. For each study, the risk ratio of preeclampsia was calculated by comparing the risk of preeclampsia among women with the highest body mass index with those with the lowest.
We identified thirteen cohort studies, comprising nearly 1.4 million women. The risk of preeclampsia typically doubled with each 5-7 kg/m2 increase in prepregnancy body mass index. This relation persisted in studies that excluded women with chronic hypertension, diabetes mellitus or multiple gestations, or after adjustment for other confounders.
Most observational studies demonstrate a consistently strong positive association between maternal prepregnancy body mass index and the risk of preeclampsia. Increasing obesity in developed countries is likely to increase the occurrence of preeclampsia. Consideration should be given to the potential benefits of prepregnancy weight reduction programs.
孕妇肥胖本身及其作为胰岛素抵抗综合征的一部分，是子痫前期发生的重要危险因素。准确量化孕前孕妇体重指数与子痫前期风险之间的关系，可能有助于更好地识别出风险最高的人群。我们对文献进行了系统综述，以确定孕前体重指数与子痫前期风险之间的关联。
两名研究者通过对1980年至2002年6月期间的Medline和Embase进行系统检索，独立检索了所有相关的英文队列研究。研究数据以类似方式提取。对于每项研究，通过比较体重指数最高的女性与最低的女性患子痫前期的风险，计算子痫前期的风险比。
我们确定了13项队列研究，涉及近140万女性。孕前体重指数每增加5 - 7kg/m²，子痫前期的风险通常会增加一倍。这种关系在排除患有慢性高血压、糖尿病或多胎妊娠的女性的研究中，或在对其他混杂因素进行调整后依然存在。
大多数观察性研究表明，孕妇孕前体重指数与子痫前期风险之间始终存在强烈的正相关。发达国家肥胖率的上升可能会增加子痫前期的发生率。应考虑孕前体重减轻计划的潜在益处。
