Heslehurst N, Simpson H, Ells L J, Rankin J, Wilkinson J, Lang R, Brown T J, Summerbell C D
The Centre for Food, Physical Activity, and Obesity Research, School of Health and Social Care, University of Teesside, Middlesbrough, UK.
Obes Rev. 2008 Nov;9(6):635-83. doi: 10.1111/j.1467-789X.2008.00511.x. Epub 2008 Jul 29.
Obesity is rising in the obstetric population, yet there is an absence of services and guidance for the management of maternal obesity. This systematic review aimed to investigate relationships between obesity and impact on obstetric care. Literature was systematically searched for cohort studies of pregnant women with anthropometric measurements recorded within 16-weeks gestation, followed up for the term of the pregnancy, with at least one obese and one comparison group. Two researchers independently data-extracted and quality-assessed each included study. Outcome measures were those that directly or indirectly impacted on maternity resources. Primary outcomes included instrumental delivery, caesarean delivery, duration of hospital stay, neonatal intensive care, neonatal trauma, haemorrhage, infection and 3rd/4th degree tears. Meta-analysis shows a significant relationship between obesity and increased odds of caesarean and instrumental deliveries, haemorrhage, infection, longer duration of hospital stay and increased neonatal intensive care requirement. Maternal obesity significantly contributes to a poorer prognosis for mother and baby during delivery and in the immediate post-partum period. National clinical guidelines for management of obese pregnant women, and public health interventions to help safeguard the health of mothers and their babies are urgently required.
肥胖在产科人群中呈上升趋势，但针对孕产妇肥胖管理的服务和指导却缺失。本系统评价旨在调查肥胖与产科护理影响之间的关系。系统检索文献，查找妊娠16周内记录了人体测量数据、随访至妊娠足月、至少有一个肥胖组和一个对照组的孕妇队列研究。两名研究人员独立对每项纳入研究进行数据提取和质量评估。结局指标为那些直接或间接影响产科资源的指标。主要结局包括器械助产、剖宫产、住院时间、新生儿重症监护、新生儿创伤、出血、感染以及会阴Ⅲ/Ⅳ度裂伤。荟萃分析显示，肥胖与剖宫产、器械助产、出血、感染、住院时间延长以及新生儿重症监护需求增加的几率之间存在显著关系。孕产妇肥胖在分娩期间及产后即刻会显著导致母婴预后更差。迫切需要制定肥胖孕妇管理的国家临床指南以及公共卫生干预措施，以保障母亲及其婴儿的健康。
