Perlow J H, Morgan M A, Montgomery D, Towers C V, Porto M
Department of Obstetrics and Gynecology, Long Beach Memorial Medical Center Women's Hospital, California.
Am J Obstet Gynecol. 1992 Oct;167(4 Pt 1):958-62. doi: 10.1016/s0002-9378(12)80019-6.
Our objective was to determine the impact of massive obesity during pregnancy, defined as maternal weight > 300 pounds, on perinatal outcome.
A case-controlled study was conducted. Between Jan. 1, 1986, and Dec. 31, 1990, 111 pregnant women weighing > 300 pounds who were delivered at Long Beach Memorial Women's Hospital were identified with a perinatal data base search. A control group matched for maternal age and parity was selected, and perinatal variables were compared between groups. To control for potential confounding medical complications, massively obese patients with diabetes and/or chronic hypertension antedating the index pregnancy were excluded from the obese group, and the data were reanalyzed. The Student t test chi 2, and Fisher's exact statistical analysis were used where appropriate.
Massively obese pregnant women are significantly more likely to have a multitude of adverse perinatal outcomes, including primary cesarean section (32.4% vs 14.3%, p = 0.002), macrosomia (30.2% vs 11.6%, p = 0.0001), intrauterine growth retardation (8.1% vs 0.9%, p = 0.03), and neonatal admission to the intensive care unit (15.6% vs 4.5%, p = 0.01). They also are significantly more likely to have chronic hypertension (27.0% vs 0.9%, p < 0.0001) and insulin-dependent diabetes mellitus (19.8% vs 2.7%, p = 0.0001). However, when those massively obese pregnant women with diabetes and/or hypertension antedating pregnancy are excluded from analysis, no statistically significant differences in perinatal outcome persisted.
Massively obese pregnant women are at high risk for adverse perinatal outcome; however, this risk appears to be related to medical complications of obesity.
我们的目的是确定孕期极度肥胖（定义为孕妇体重>300磅）对围产期结局的影响。
进行了一项病例对照研究。在1986年1月1日至1990年12月31日期间，通过围产期数据库搜索，确定了111名体重>300磅且在长滩纪念妇女医院分娩的孕妇。选择了一个在产妇年龄和产次方面相匹配的对照组，并对两组之间的围产期变量进行了比较。为了控制潜在的混杂医学并发症，将在本次妊娠前患有糖尿病和/或慢性高血压的极度肥胖患者排除在肥胖组之外，并对数据进行了重新分析。在适当的情况下使用了Student t检验、卡方检验和Fisher精确统计分析。
极度肥胖的孕妇出现多种不良围产期结局的可能性显著更高，包括初次剖宫产（32.4%对14.3%，p = 0.002）、巨大儿（30.2%对11.6%，p = 0.0001）、宫内生长受限（8.1%对0.9%，p = 0.03）以及新生儿入住重症监护病房（15.6%对4.5%，p = 0.01）。她们患慢性高血压（27.0%对0.9%，p < 0.0001）和胰岛素依赖型糖尿病（19.8%对2.7%，p = 0.0001）的可能性也显著更高。然而，当将妊娠前患有糖尿病和/或高血压的极度肥胖孕妇排除在分析之外时，围产期结局在统计学上没有持续存在显著差异。
极度肥胖的孕妇围产期不良结局风险很高；然而，这种风险似乎与肥胖的医学并发症有关。
