Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda MD 20892, USA.
Am J Clin Nutr. 2010 Jun;91(6):1543-9. doi: 10.3945/ajcn.2009.28865. Epub 2010 Apr 7.
Obesity affects almost one-third of pregnant women and causes many complications, including neural tube defects. It is not clear whether the risk of congenital heart defects, the most common malformations, is also increased.
This study was conducted to determine whether obesity is associated with an increased risk of congenital heart defects.
A population-based, nested, case-control study was conducted in infants born with congenital heart defects and unaffected controls from the cohort of all births (n = 1,536,828) between 1993 and 2003 in New York State, excluding New York City. The type of congenital heart defect, maternal body mass index (BMI; in kg/m(2)), and other risk factors were obtained from the Congenital Malformations Registry and vital records. Mothers of 7392 congenital heart defect cases and 56,304 unaffected controls were studied.
All obese women (BMI > or = 30) were significantly more likely than normal-weight women (BMI: 19-24.9) to have children with a congenital heart defect [odds ratio (OR): 1.15; 95% CI: 1.07, 1.23; P < 0.0001]. Overweight women were not at increased risk (OR: 1.00; 95% CI: 0.94, 1.06). The risk in morbidly obese women (BMI > or = 40) was higher (OR: 1.33; 95% CI: 1.15, 1.54; P = 0.0001) than that in obese women with a BMI of 30-39.9 (OR: 1.11; 95% CI: 1.04, 1.20; P = 0.004). There was a highly significant trend of increasing OR for congenital heart defects with increasing maternal obesity (P < 0.0001). The offspring of obese women had significantly higher ORs for atrial septal defects, hypoplastic left heart syndrome, aortic stenosis, pulmonic stenosis, and tetralogy of Fallot.
Obese, but not overweight, women are at significantly increased risk of bearing children with a range of congenital heart defects, and the risk increases with increasing BMI. Weight reduction as a way to reduce risk should be investigated.
肥胖影响了近三分之一的孕妇，并导致许多并发症，包括神经管缺陷。目前尚不清楚先天性心脏病（最常见的畸形之一）的风险是否也会增加。
本研究旨在确定肥胖是否与先天性心脏病风险增加有关。
在纽约州，1993 年至 2003 年期间进行了一项基于人群的、嵌套的病例对照研究，在所有出生儿队列中（n=1,536,828），排除了纽约市，对患有先天性心脏病和未受影响的对照组婴儿进行研究。先天性心脏病的类型、母亲的体重指数（BMI；kg/m²）和其他危险因素均从先天性畸形登记处和生命记录中获得。对 7392 例先天性心脏病病例和 56,304 例未受影响的对照组母亲进行了研究。
所有肥胖女性（BMI≥30）与正常体重女性（BMI：19-24.9）相比，其子女患有先天性心脏病的风险显著增加[比值比（OR）：1.15；95%置信区间（CI）：1.07，1.23；P<0.0001]。超重女性的风险没有增加（OR：1.00；95%CI：0.94，1.06）。病态肥胖女性（BMI≥40）的风险更高（OR：1.33；95%CI：1.15，1.54；P=0.0001），高于 BMI 为 30-39.9 的肥胖女性（OR：1.11；95%CI：1.04，1.20；P=0.004）。随着母亲肥胖程度的增加，先天性心脏病的 OR 呈显著上升趋势（P<0.0001）。肥胖女性的子女患有房间隔缺损、左心发育不全综合征、主动脉瓣狭窄、肺动脉瓣狭窄和法洛四联症的 OR 显著增加。
肥胖但不超重的女性生育患有一系列先天性心脏病的孩子的风险显著增加，且风险随 BMI 的增加而增加。应研究减肥作为降低风险的一种方法。
