肥胖合并妊娠的孕产妇结局

Maternal outcomes in pregnancies complicated by obesity.

作者信息

Robinson Heather E, O'Connell Colleen M, Joseph K S, McLeod N Lynne

机构信息

Department of Obstetrics and Gynaecology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.

出版信息

Obstet Gynecol. 2005 Dec;106(6):1357-64. doi: 10.1097/01.AOG.0000188387.88032.41.

DOI:10.1097/01.AOG.0000188387.88032.41

PMID:16319263

Abstract

OBJECTIVE

To investigate the relationship between prepregnancy obesity and maternal outcomes.

METHODS

A 15-year, population-based cohort study using the Nova Scotia Atlee Perinatal Database compared maternal outcomes in obese and nonobese women. Prepregnancy weight of 55-75 kg was considered nonobese, and weight greater than 90 kg was considered obese. Obese women were categorized into moderate obesity (90-120 kg) and severe obesity (> 120 kg) groups. Univariate and multivariable logistic regression analysis was performed, and odds ratios (ORs), adjusted ORs, and 95% confidence intervals (CIs) were calculated. P < .05 was considered statistically significant.

RESULTS

In 142,404 singleton pregnancies, 10,134 (7.2%) women were identified as obese (moderate obesity 92.3%, severe obesity 7.7%). The proportion of women in the obese categories increased from 3.2% in 1988 to 10.2% in 2002. Moderately obese women had an increased risk of pregnancy-induced hypertension (PIH) (adjusted OR 2.38, 95% CI 2.24-2.52), antepartum venous thromboembolism (adjusted OR 2.17, 95% CI 1.30-3.63), labor induction (adjusted OR 1.94, 95% CI 1.86-2.04), cesarean delivery (adjusted OR 1.60, 95% CI 1.53-1.67), and wound infection (adjusted OR 1.67, 95% CI 1.38-2.00). Severely obese women had an increased risk of PIH (adjusted OR 3.00, 95% CI 2.49-3.62), antepartum venous thromboembolism (adjusted OR 4.13, 95% CI 1.26-13.54), induction of labor (adjusted OR 2.77, 95% CI 2.39-3.21), cesarean delivery (adjusted OR 2.46, 95% CI 2.15-2.81), anesthesia complications (adjusted OR 2.01, 95% CI 1.33-3.06), and wound infection (adjusted OR 4.79, 95% CI 3.30-6.95). This implies that, relative to nonobese women, there was 1 excess case of PIH per 10 moderately obese women and 1 per 7 severely obese women. For antepartum venous thromboembolism, there was 1 excess case per 857 moderately obese women and 1 per 321 severely obese women.

CONCLUSION

Prepregnancy maternal obesity increases the risk of PIH, antepartum venous thromboembolism, labor induction, cesarean delivery, and wound infection.

摘要

目的

探讨孕前肥胖与孕产妇结局之间的关系。

方法

一项基于人群的15年队列研究，使用新斯科舍省阿特利围产期数据库比较肥胖和非肥胖女性的孕产妇结局。孕前体重55 - 75千克被视为非肥胖，体重超过90千克被视为肥胖。肥胖女性被分为中度肥胖（90 - 120千克）和重度肥胖（> 120千克）组。进行单因素和多因素逻辑回归分析，并计算比值比（OR）、调整后的OR和95%置信区间（CI）。P < 0.05被认为具有统计学意义。

结果

在142,404例单胎妊娠中，10,134例（7.2%）女性被确定为肥胖（中度肥胖92.3%，重度肥胖7.7%）。肥胖类别中的女性比例从1988年的3.2%增加到2002年的10.2%。中度肥胖女性发生妊娠期高血压（PIH）的风险增加（调整后的OR 2.38，95% CI 2.24 - 2.52）、产前静脉血栓栓塞（调整后的OR 2.17，95% CI 1.30 - 3.63）、引产（调整后的OR 1.94, 95% CI 1.86 - 2.04）、剖宫产（调整后的OR 1.60,95% CI 1.53 - 1.67）和伤口感染（调整后的OR 1.67, 95% CI 1.38 - 2.00）。重度肥胖女性发生PIH的风险增加（调整后的OR 3.00,95% CI 2.49 - 3.62）、产前静脉血栓栓塞（调整后的OR 4.13, 95% CI 1.26 - 13.54）、引产（调整后的OR 2.77, 95% CI 2.39 - 3.21）、剖宫产（调整后的OR 2.46, 95% CI 2.15 - 2.81）、麻醉并发症（调整后的OR 2.01, 95% CI 1.33 - 3.06）和伤口感染（调整后的OR 4.79, 95% CI 3.30 - 6.95）。这意味着，相对于非肥胖女性，每10例中度肥胖女性中PIH多1例，每7例重度肥胖女性中PIH多1例。对于产前静脉血栓栓塞，每857例中度肥胖女性中多1例，每321例重度肥胖女性中多1例。