Aliyu Muktar H, Alio Amina P, Lynch O'Neil, Mbah Alfred, Salihu Hamisu M
Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota, USA.
J Matern Fetal Neonatal Med. 2009 Sep;22(9):745-50. doi: 10.3109/14767050902994523.
Placental abruption is a major cause of fetal and neonatal death and has been reported more frequently in twin pregnancies than among singleton gestations. The purpose of this article is to investigate the role of maternal pre-gravid body mass index (BMI) on the risk for placental abruption among twin pregnancies.
We used the Missouri maternally linked cohort files (years 1989-1997) consisting of twin live births (gestational age 20-44 weeks). Maternal pre-gravid weight was classified based on the following BMI-based categories: normal (18.5-24.9), underweight (<18.5), overweight (25-29.9), and obese (>30). We used logistic regression for generated adjusted odds ratios with correction for the presence of intra-cluster correlation using generalized estimating equations.
Overall, 261 cases of placental abruption were registered over the entire study period, yielding a placental abruption rate of 14.9/1000. The frequency of placental abruption correlated negatively with maternal BMI in a dose-effect pattern: underweight (19.3/1000); normal weight (16.1/1000); overweight (13.9/1000); and obese (9.5/1000) mothers (p for trend < 0.01). After adjusting for confounders, the likelihood of placental abruption was still lower in obese women (OR = 0.58; 95% CI = 0.38-0.87). By contrast, women who were underweight had a 20-30% greater likelihood for placental abruption when compared with normal weight mothers, although these findings were statistically not significant.
There is an inverse relationship between pre-gravid maternal BMI and placental abruption. The mechanism by which obesity impacts the likelihood of placental abruption in twin pregnancies requires further study.
胎盘早剥是胎儿和新生儿死亡的主要原因，据报道，双胎妊娠中胎盘早剥的发生率高于单胎妊娠。本文旨在研究孕前母体体重指数（BMI）在双胎妊娠胎盘早剥风险中的作用。
我们使用了密苏里州母婴关联队列文件（1989 - 1997年），其中包括双胎活产（孕龄20 - 44周）。孕前母体体重根据以下基于BMI的类别进行分类：正常（18.5 - 24.9）、体重过轻（<18.5）、超重（25 - 29.9）和肥胖（>30）。我们使用逻辑回归生成调整后的比值比，并使用广义估计方程对集群内相关性的存在进行校正。
总体而言，在整个研究期间共记录了261例胎盘早剥病例，胎盘早剥发生率为14.9/1000。胎盘早剥的频率与母体BMI呈剂量效应模式的负相关：体重过轻的母亲（19.3/1000）；正常体重的母亲（16.1/1000）；超重的母亲（13.9/1000）；肥胖的母亲（9.5/1000）（趋势p<0.01）。在调整混杂因素后，肥胖女性发生胎盘早剥的可能性仍然较低（OR = 0.58；95%CI = 0.38 - 0.87）。相比之下，体重过轻的女性与正常体重的母亲相比胎盘早剥的可能性高20 - 30%，尽管这些结果在统计学上不显著。
孕前母体BMI与胎盘早剥之间存在负相关关系。肥胖影响双胎妊娠胎盘早剥可能性的机制需要进一步研究。
