Nohr Ellen Aagaard, Bech Bodil Hammer, Vaeth Michael, Rasmussen Kathleen M, Henriksen Tine Brink, Olsen Jorn
Danish Epidemiology Science Centre, Department of Epidemiology, Institute of Public Health, University of Aarhus, 8000 Aarhus C, Denmark.
Paediatr Perinat Epidemiol. 2007 Jan;21(1):5-14. doi: 10.1111/j.1365-3016.2007.00762.x.
The aim of the present study was to assess the impact of obesity and gestational weight gain on the risk of subtypes of preterm birth, because little is known about these associations. The study included 62 167 women within the Danish National Birth Cohort for whom self-reported information about prepregnancy body mass index (BMI) and gestational weight gain was available. Information about spontaneous preterm birth with or without preterm premature rupture of membranes (PPROM) and about induced preterm deliveries was obtained from national registers. Cox regression analyses were used to examine associations of prepregnancy BMI and gestational weight gain with subtypes of preterm birth. The crude risks of PPROM and of induced preterm deliveries were higher in obese women (BMI > or = 30) than in normal-weight women (18.5 < or = BMI < 25), especially before 34 completed weeks of gestation, when obese women faced twice the risk. In the adjusted analysis, the hazard ratios and 95% confidence intervals for PPROM and for induced preterm delivery in obese women were 1.5 [1.2, 1.9] and 1.2 [1.0, 1.6] respectively. When obesity-related diseases were accounted for, no excess risk of induced preterm deliveries was seen in obese women, but the increased risk of PPROM was unchanged. Low weight gain was associated with an increased risk of all subtypes of preterm birth compared with normal weight gain, especially in early spontaneous preterm births, where the risk was doubled. We concluded that prepregnancy obesity was associated with a higher risk of PPROM and early induced preterm deliveries.
本研究的目的是评估肥胖及孕期体重增加对早产各亚型风险的影响，因为目前对这些关联知之甚少。该研究纳入了丹麦国家出生队列中的62167名女性，她们提供了关于孕前体重指数（BMI）和孕期体重增加的自我报告信息。关于有无胎膜早破（PPROM）的自发性早产以及引产早产的信息来自国家登记处。采用Cox回归分析来研究孕前BMI和孕期体重增加与早产各亚型之间的关联。肥胖女性（BMI≥30）发生PPROM和引产早产的粗略风险高于正常体重女性（18.5≤BMI＜25），尤其是在妊娠满34周之前，肥胖女性面临的风险是正常体重女性的两倍。在调整分析中，肥胖女性发生PPROM和引产早产的风险比及95%置信区间分别为1.5[1.2, 1.9]和1.2[1.0, 1.6]。当考虑肥胖相关疾病时，肥胖女性未见引产早产的额外风险增加，但PPROM的风险增加未变。与正常体重增加相比，体重增加过少与所有早产亚型的风险增加相关，尤其是在早期自发性早产中，风险增加了一倍。我们得出结论，孕前肥胖与PPROM及早期引产早产的较高风险相关。
