BJOG. 2010 Apr;117(5):575-84. doi: 10.1111/j.1471-0528.2009.02486.x. Epub 2010 Jan 20.
To determine whether higher maternal body mass index (BMI), independent of maternal glycaemia, is associated with adverse pregnancy outcomes.
Observational cohort study.
Fifteen centres in nine countries.
Eligible pregnant women.
A 75-g 2-hour oral glucose tolerance test (OGTT) was performed between 24 and 32 weeks of gestation in all participants. Maternal BMI was calculated from height and weight measured at the OGTT. Fetal adiposity was assessed using skinfold measurements and percentage of body fat was calculated. Associations between maternal BMI and pregnancy outcomes were assessed using multiple logistic regression analyses, with adjustment for potential confounders.
Predefined primary outcomes were birthweight >90th percentile, primary caesarean section, clinical neonatal hypoglycaemia and cord serum C-peptide >90th percentile. Secondary outcomes included pre-eclampsia, preterm delivery (before 37 weeks) and percentage of body fat >90th percentile.
Among 23 316 blinded participants, with control for maternal glycaemia and other potential confounders, higher maternal BMI was associated (odds ratio [95% confidence interval] for highest {> or =42.0 kg/m(2)} versus lowest {<22.6 kg/m(2)} BMI categories) with increased frequency of birthweight >90th percentile (3.52 [2.48-5.00]) and percentage of body fat >90th percentile (3.28 [2.28-4.71]), caesarean section (2.23 [1.66-2.99]), cord C-peptide >90th percentile (2.33 [1.58-3.43]) and pre-eclampsia (14.14 [9.44-21.17]). Preterm delivery was less frequent with higher BMI (0.48 [0.31-0.74]). Associations with fetal size tended to plateau in the highest maternal BMI categories.
Higher maternal BMI, independent of maternal glycaemia, is strongly associated with increased frequency of pregnancy complications, in particular those related to excess fetal growth and adiposity and to pre-eclampsia.
确定母体体重指数（BMI）是否与不良妊娠结局相关，而不受母体血糖水平的影响。
观察性队列研究。
九个国家的 15 个中心。
符合条件的孕妇。
所有参与者在妊娠 24-32 周时进行 75g 2 小时口服葡萄糖耐量试验（OGTT）。OGTT 时测量身高和体重，计算母体 BMI。使用皮褶测量法评估胎儿肥胖程度，并计算体脂百分比。采用多因素逻辑回归分析方法，调整潜在混杂因素后，评估母体 BMI 与妊娠结局的相关性。
预先定义的主要结局是出生体重>第 90 百分位数、初次剖宫产、新生儿临床低血糖和脐血 C 肽>第 90 百分位数。次要结局包括子痫前期、早产（<37 周）和体脂百分比>第 90 百分位数。
在 23316 名接受盲法评估的参与者中，控制了母体血糖和其他潜在混杂因素后，较高的母体 BMI 与出生体重>第 90 百分位数（3.52[2.48-5.00]）和体脂百分比>第 90 百分位数（3.28[2.28-4.71]）、剖宫产（2.23[1.66-2.99]）、脐血 C 肽>第 90 百分位数（2.33[1.58-3.43]）和子痫前期（14.14[9.44-21.17]）的发生频率增加相关。较高的 BMI 与早产的发生频率降低（0.48[0.31-0.74]）相关。与胎儿大小的相关性在母体 BMI 最高类别中趋于平稳。
母体 BMI 升高，与母体血糖水平无关，与妊娠并发症的发生频率增加密切相关，特别是与胎儿过度生长和肥胖以及子痫前期相关的并发症。
