Ducarme G, Rodrigues A, Aissaoui F, Davitian C, Pharisien I, Uzan M
Service de gynécologie-obstétrique, APHP, CHU Jean-Verdier, avenue du 14-Juillet, 93143 Bondy cedex, France.
Gynecol Obstet Fertil. 2007 Jan;35(1):19-24. doi: 10.1016/j.gyobfe.2006.10.029. Epub 2006 Dec 28.
To evaluate the deleterious effects of maternal obesity on obstetrical complications and neonatal outcomes.
Historical cohort study including all patients delivered in our maternity between 1st January 2002 and 31st December 2004. Intra uterine death and fetal loss before 22 weeks were excluded. Women were categorized by the Body Mass Index: less than 25, between 25 and 30, and more than 30. Maternal data, obstetrical complications, labor and its complications, and neonatal outcomes were studied.
During these 3 years, 23.5% (1336/5686) of patients were overweight and 7.5% (425/5686) were obese. Obstetrical pathologies (gestational diabetes mellitus, hypertension, preeclampsia and fetal macrosomia) and labour induction were more significantly frequent in obese patients (P < 0.01). We noted twice more caesarean sections during labour in obese patients. The rate of artificial placental delivery was significantly higher in obese patients (P < 0.01). Obese patients with prior caesarean sections had a rate of vaginal delivery significantly lower than non obese patients with prior C-sections (23.6 vs 43.8%; P < 0.01). Mean children birth weight was significantly higher in obese patients (3305 vs 3181 g; P < 0.01) with no impact on Apgar score.
Our study confirms that obesity is responsible for major obstetrical complications, for what should no doubt be considered as high risk pregnancies. Our practices must take these complications into account by ensuring an adapted and early management in order to improve maternal and neonatal issues.
评估母亲肥胖对产科并发症及新生儿结局的有害影响。
回顾性队列研究，纳入2002年1月1日至2004年12月31日在我院产科分娩的所有患者。排除22周前的宫内死亡和胎儿丢失情况。根据体重指数将女性分为：小于25、25至30、大于30。研究产妇数据、产科并发症、分娩及其并发症以及新生儿结局。
在这3年中，23.5%（1336/5686）的患者超重，7.5%（425/5686）的患者肥胖。肥胖患者中产科疾病（妊娠期糖尿病、高血压、先兆子痫和巨大儿）及引产更为常见（P<0.01）。我们注意到肥胖患者分娩时剖宫产次数增加了一倍。肥胖患者人工胎盘娩出率显著更高（P<0.01）。有剖宫产史的肥胖患者阴道分娩率显著低于有剖宫产史的非肥胖患者（23.6%对43.8%；P<0.01）。肥胖患者的新生儿平均出生体重显著更高（3305克对3181克；P<0.01），但对阿氏评分无影响。
我们的研究证实肥胖是主要产科并发症的原因，无疑应将其视为高危妊娠。我们的医疗实践必须考虑到这些并发症，通过确保适当的早期管理来改善母婴问题。
