Rudra Carole B, Frederick Ihunnaya O, Williams Michelle A
Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA.
Acta Obstet Gynecol Scand. 2008;87(5):510-7. doi: 10.1080/00016340801996838.
Associations between preterm delivery (PTD) and pre-pregnancy body mass index (BMI) and pregnancy weight gain may differ across outcome subtypes.
The authors analyzed data from 2,468 cohort participants in western Washington State, USA (1996-2005) and examined pre-pregnancy BMI and weight gain rate from pre-pregnancy to 18-22 weeks' gestation in relation to spontaneous PTD after preterm labor, spontaneous PTD after preterm premature rupture of membranes (PPROM), and indicated PTD.
Each 5 kg/m(2) BMI increase was associated with indicated PTD (adjusted odds ratio [OR] 1.71, 95% confidence interval [CI] 1.40-2.06). The association weakened somewhat after adjustment for hypertension and diabetes before and/or during pregnancy (5 kg/m(2) adjusted OR, 1.40; 95% CI, 1.12-1.75). Associations with spontaneous PTD and PPROM were weaker (5 kg/m(2) adjusted ORs, 0.90 and 1.14, respectively). Weight gain was associated with indicated delivery among women with normal BMI (0.1 kg/week adjusted OR, 1.22; 95% CI, 1.02-1.45) but not among overweight or obese women (adjusted OR, 1.02; 95% CI, 0.87-1.20). Weight gain was inversely associated with spontaneous PTD (0.1 kg/week adjusted OR, 0.87; 95% CI, 0.77-0.99) and not strongly associated with PPROM (adjusted OR, 1.03; 95% CI, 0.90-1.17).
Pre-pregnancy overweight increases indicated PTD risk independently of hypertension and diabetes. High early pregnancy weight gain increases indicated PTD risk in women with a normal BMI.
早产（PTD）与孕前体重指数（BMI）及孕期体重增加之间的关联可能因结局亚型而异。
作者分析了美国华盛顿州西部2468名队列参与者（1996 - 2005年）的数据，研究孕前BMI以及从孕前到妊娠18 - 22周的体重增加率与早产先兆后自发性早产、胎膜早破（PPROM）后自发性早产和医源性早产的关系。
BMI每增加5kg/m²与医源性早产相关（调整后的优势比[OR]为1.71，95%置信区间[CI]为1.40 - 2.06）。在对妊娠前和/或妊娠期间的高血压和糖尿病进行调整后，这种关联有所减弱（5kg/m²调整后的OR为1.40；95%CI为1.12 - 1.75）。与自发性早产和PPROM的关联较弱（5kg/m²调整后的OR分别为0.90和1.14）。体重增加与BMI正常的女性的医源性分娩相关（每周增加0.1kg调整后的OR为1.22；95%CI为1.02 - 1.45），但与超重或肥胖女性无关（调整后的OR为1.02；95%CI为0.87 - 1.20）。体重增加与自发性早产呈负相关（每周增加0.1kg调整后的OR为0.87；95%CI为0.77 - 0.99），与PPROM的关联不显著（调整后的OR为1.03；95%CI为0.90 - 1.17）。
孕前超重会独立于高血压和糖尿病增加医源性早产风险。孕早期体重增加过多会增加BMI正常女性的医源性早产风险。
