Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, USA.
Matern Child Health J. 2011 Apr;15(3):289-301. doi: 10.1007/s10995-010-0596-5.
We investigated the association between 2009 IOM recommendations and adverse infant outcomes by maternal prepregnancy body mass index (BMI). Birth outcomes for 570,672 women aged 18-40 years with a singleton full-term live-birth were assessed using 2004-2007 Florida live-birth certificates. Outcomes included large-for-gestational-age (LGA) and small-for-gestational-age (SGA). Associations between gestational weight change and outcomes were assessed for 10 BMI groups by calculating proportions, and logistic regression modeling was used to produce adjusted odds ratios (aORs) to account for the effect of confounders. We created comparison categories below and above recommendations using 2009 IOM recommendations as a reference. Of importance, 41.6% of women began pregnancy as overweight and obese and 51.2% gained weight excessively during pregnancy on the basis of 2009 IOM recommendations. Proportions of LGA were higher among obese women and increased with higher weight gain. Compared with recommended weight gain, aORs for LGA were lower with less than recommended gain (aOR range: 0.27-0.77) and higher with more than recommended gain (aOR range: 1.27-5.99). However, SGA was less prevalent among obese women, and the proportion of SGA by BMI was similar with higher weight gain. Gain less than recommended was associated with increased odds of SGA (aOR range: 1.11-2.97), and gain greater than recommended was associated with decreased odds of SGA (aOR range: 0.38-0.83). Gestational weight gain influenced the risk for LGA and SGA in opposite directions. Minimal weight gain or weight loss lowered risk for LGA among obese women. Compared with 1990 IOM recommendations, 2009 recommendations include weight gain ranges that are associated with lower risk of LGA and higher risk of SGA. Awareness of these tradeoffs may assist with clinical implementation of the 2009 IOM gestational weight gain recommendations. However, our results did not consider other maternal and infant outcomes related to gestational weight gain; therefore, the findings should be interpreted with caution.
我们研究了 2009 年 IOM 建议与产妇孕前体重指数（BMI）之间的关联，以了解不良婴儿结局。使用 2004-2007 年佛罗里达州活产出生证明，评估了 570672 名 18-40 岁单胎足月活产女性的分娩结局。结局包括巨大儿（LGA）和小于胎龄儿（SGA）。通过计算比例评估了 10 个 BMI 组中妊娠期体重变化与结局之间的关联，并使用逻辑回归模型产生校正优势比（aOR），以考虑混杂因素的影响。我们使用 2009 年 IOM 建议作为参考，创建了低于和高于建议值的比较类别。重要的是，根据 2009 年 IOM 建议，41.6%的女性在怀孕前超重和肥胖，51.2%的女性在怀孕期间体重增加过多。肥胖女性的 LGA 比例较高，且随着体重增加而增加。与推荐的体重增加相比，低于推荐值的体重增加（aOR 范围：0.27-0.77）与高于推荐值的体重增加（aOR 范围：1.27-5.99）的 LGA 的 aOR 较低。然而，肥胖女性的 SGA 发生率较低，且随着体重增加，BMI 与 SGA 的比例相似。低于推荐值的体重增加与 SGA 的发生几率增加相关（aOR 范围：1.11-2.97），而高于推荐值的体重增加与 SGA 的发生几率降低相关（aOR 范围：0.38-0.83）。妊娠期体重增加对 LGA 和 SGA 的风险有相反的影响。肥胖女性的最低体重增加或体重减轻会降低 LGA 的风险。与 1990 年 IOM 建议相比，2009 年建议的体重增加范围与 LGA 的风险降低和 SGA 的风险增加相关。对这些权衡的认识可能有助于临床实施 2009 年 IOM 妊娠期体重增加建议。然而，我们的结果没有考虑与妊娠期体重增加相关的其他母婴结局；因此，结果应谨慎解释。
