Ehrenberg Hugh M, Dierker LeRoy, Milluzzi Cynthia, Mercer Brian M
Department of Reproductive Biology, MetroHealth Medical Center, Case Western University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
Am J Obstet Gynecol. 2003 Dec;189(6):1726-30. doi: 10.1016/s0002-9378(03)00860-3.
The purpose of this study was to correlate low maternal pregravid weight, delivery weight, and poor gestational weight gain with perinatal outcomes.
Maternal and perinatal data from January 1997 to June 2001 were obtained from a perinatal database at MetroHealth Medical Center. Low maternal weight (LMW) was defined as pregravid or delivery weight <100 pounds or body mass index (BMI) < or =19.8 kg/m(2). Low maternal weight gain was defined as <0.27 kg per week. Perinatal complication rates in these subjects were compared with those with weights of 100 to 200 pounds, normal BMI (>19.8, <26 kg/m(2)), and normal gestational weight gain (0.27-0.52 kg/wk). Chi-square and t tests were used where appropriate. P<.05 was significant.
A percentage (2.6%) of 15,196 subjects began pregnancy weighing < or =100 pounds; 0.15% weighed <100 pounds at delivery and 13.2% had a pregravid BMI < or =19.8 kg/m(2). Pregravid LMW was highly correlated with ethnicity (Asians, 8.6%; Hispanics, 4.3%; Caucasians, 2.5%; African Americans, 1.9%; P<.001). Subjects with pregravid LMW were at increased risk for intrauterine growth restriction (IUGR) (relative risk [RR], 2.3, 95% CI, 1.3-4.05), and perineal tears (3rd-degree lacerations; RR, 1.8, 95% CI, 1.1-2.9), and low birth weight ([LBW] <2500 g; RR, 1.8, 95% CI, 1.1-2.9). They had a lower risk of cesarean section (RR, 0.72, 95% CI, 0.56-0.92) and preterm delivery (PTD) (RR, 1.1, 95% CI, 0.97-1.06). Pregravid BMI <19.8 kg/m(2) was associated with preterm labor (PTL) (RR, 1.22, 95% CI, 1.02-1.46), IUGR (RR, 1.67, 95% CI, 1.2-2.39), and LBW (<2500 g; RR, 1.13, 95% CI, 1.0-1.27) and was protective against cesarean delivery (RR, 0.8, 95% CI, 0.71-0.91). Delivery LMW was associated with LBW (<2500 g; RR, 2.81, 95% CI, 1.62-4.84), active-phase arrest (RR, 5.07, 95% CI, 1.85-13.9), PTL and PTD (RR, 2.5, 95% CI, 1.02-6.33, and RR, 2.45, 95% CI, 1.4-4.4, respectively), a lower gestational age at delivery (36.8 vs 38.3 wks, P<.05), and mediolateral episiotomy (RR, 9.6, 95% CI, 1.9-48.0). A percentage (0.8%) of subjects had BMI <19.8 kg/m(2) at delivery. Low delivery BMI was associated with birth weight <2500 g (RR, 1.74, 95% CI, 1.3-2.32), PTL (RR, 2.16, 95% CI, 1.45-3.19), and PTD (RR, 1.57, 95% CI, 1.18-2.11). Failure to thrive in pregnancy (weight gain <0.27 kg/wk) was associated with LBW (<1500 g; RR, 1.23, 95% CI, 1.03-1.45), <2500 g; RR, 1.22, 95% CI, 1.13-1.33), and PTL and PTD (RR, 1.2, 95% CI, 1.05-1.37, and RR, 1.11, 95% CI, 1.02-1.2, respectively).
Low weight and BMI at conception or delivery, as well as poor weight gain during pregnancy, are associated with LBW, prematurity, and maternal delivery complications.
本研究旨在探讨孕前体重低、分娩体重低及孕期体重增加不足与围产期结局之间的相关性。
1997年1月至2001年6月的孕产妇及围产期数据来自都市健康医疗中心的围产期数据库。低体重孕产妇（LMW）定义为孕前或分娩体重<100磅或体重指数（BMI）≤19.8kg/m²。孕期体重增加不足定义为每周增加<0.27kg。将这些研究对象的围产期并发症发生率与体重在100至200磅、BMI正常（>19.8，<26kg/m²）且孕期体重增加正常（0.27 - 0.52kg/周）的对象进行比较。在适当情况下使用卡方检验和t检验。P<0.05具有统计学意义。
在15196名研究对象中，2.6%的人怀孕时体重≤100磅；0.15%的人分娩时体重<100磅，13.2%的人孕前BMI≤19.8kg/m²。孕前低体重与种族高度相关（亚洲人，8.6%；西班牙裔，4.3%；白种人，2.5%；非裔美国人，1.9%；P<0.001）。孕前低体重的研究对象发生胎儿宫内生长受限（IUGR）的风险增加（相对风险[RR]，2.3，95%置信区间[CI]，1.3 - 4.05）、会阴撕裂（三度裂伤；RR，1.8，95%CI，1.1 - 2.9）以及低出生体重（[LBW]<2500g；RR，1.8，95%CI，1.1 - 2.9）的风险增加。他们剖宫产（RR，0.72，95%CI，0.56 - 0.92）和早产（PTD）（RR，1.1，95%CI，0.97 - 1.06）的风险较低。孕前BMI<19.8kg/m²与早产（PTL）（RR，1.22，95%CI，1.02 - 1.46）、IUGR（RR，1.67，95%CI，1.2 - 2.39）以及LBW（<2500g；RR，1.13，95%CI，1.0 - 1.27）相关，并且对剖宫产具有保护作用（RR，0.8，95%CI，0.71 - 0.91）。分娩时低体重与LBW（<2500g；RR，2.81，95%CI，1.62 - 4.84）、活跃期停滞（RR，5.07）相关，95%CI，1.85 - 13.9）、PTL和PTD（分别为RR，2.5，95%CI，1.02 - 6.33和RR，2.45，95%CI，1.4 - 4.4）、较低的分娩孕周（36.8周对38.3周，P<0.05）以及会阴侧切（RR，9.6，95%CI，1.9 - 48.0）相关。0.8%的研究对象分娩时BMI<19.8kg/m²。分娩时低BMI与出生体重<2500g（RR，1.74，95%CI，1.3 - 2.32）、PTL（RR，2.16，95%CI，1.45 - 3.19）和PTD（RR，1.57，95%CI，1.18 - 2.11）相关。孕期体重增长不良（体重增加<0.27kg/周）与LBW（<1500g；RR，1.23，95%CI，1.03 - 1.45）、<2500g；RR，1.22，95%CI，1.13 - 1.33）以及PTL和PTD（分别为RR，1.2，95%CI，1.05 - 1.37和RR，1.11，95%CI，1.02 - 1.2）相关。
受孕或分娩时体重和BMI低以及孕期体重增加不足与低出生体重、早产及孕产妇分娩并发症相关。
