From the University of Alabama at Birmingham Center for Women's Reproductive Health, Birmingham, Alabama.
Obstet Gynecol. 2010 Feb;115(2 Pt 1):290-296. doi: 10.1097/AOG.0b013e3181c9b8c3.
To examine temporal changes in maternal weight and the association with major structural anomalies and other factors, such as diabetes, in our primary obstetric population.
We conducted a serial, cross-sectional study using a perinatal database to identify all women with singletons who delivered in our system from 1991 to 2004. Three 5-year time epochs were defined to compare patient cohorts. Maternal weight, body mass index (BMI), diabetes status, incidence of major anomalies, and demographic data were compared. Multiple logistic regression was performed to estimate factors contributing to anomaly rates.
A total of 41,902 pregnancies were included. In each time epoch, there was an increase in the mean maternal weight, the mean BMI, the proportion of women weighing in excess of 200 lb, the proportion with a BMI higher than 29, the prevalence of pregestational diabetes, and the prevalence of major anomalies (all P<.001). There was no significant independent association between maternal obesity and the presence of a major anomaly. In a multivariable logistic model, the major factor contributing to the increasing rate of congenital anomalies was the prevalence of pregestational diabetes (odds ratio 3.8, 95% confidence interval 2.1-6.6). The population-attributable risk of anomalies related to obesity increased from essentially 0% in 1991-1994 to 6.1% in 2000-2004, whereas that related to diabetes increased from 3.3% to 9.2% during the same time periods.
Although the prevalence of maternal obesity and anomaly have increased, maternal weight alone was not associated with an increase in congenital anomalies. Instead, diabetes was significantly associated with the increase in the rate of anomalies seen in our population. Identification of maternal weight as a risk factor in epidemiologic studies may be a surrogate for pregestational diabetes.
II.
在我们的初级产科人群中，检查母体体重的时间变化及其与主要结构异常和其他因素（如糖尿病）的关系。
我们使用围产期数据库进行了一项连续的、横断面研究，以确定从 1991 年至 2004 年在我们系统中分娩的所有单胎女性的所有患者。定义了三个 5 年时间区间来比较患者队列。比较了母体体重、体重指数（BMI）、糖尿病状态、主要异常发生率和人口统计学数据。进行了多因素逻辑回归分析，以估计导致异常发生率的因素。
共纳入 41902 例妊娠。在每个时间区间，母体体重、BMI、体重超过 200 磅的女性比例、BMI 高于 29 的女性比例、孕前糖尿病的患病率以及主要异常的患病率均增加（均 P<.001）。母体肥胖与主要异常的存在之间没有显著的独立关联。在多变量逻辑模型中，导致先天性异常发生率增加的主要因素是孕前糖尿病的患病率（比值比 3.8，95%置信区间 2.1-6.6）。与肥胖相关的异常的人群归因风险从 1991-1994 年的基本上 0%增加到 2000-2004 年的 6.1%，而与糖尿病相关的风险从 3.3%增加到 9.2%同期。
尽管母体肥胖和异常的患病率有所增加，但母体体重本身与先天性异常的增加无关。相反，糖尿病与我们人群中异常发生率的增加显著相关。在流行病学研究中将母体体重确定为危险因素可能是孕前糖尿病的替代指标。
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