孕前体重指数和孕期体重增加对韩国女性围产期结局的影响：一项回顾性队列研究。
The effects of pre-pregnancy body mass index and gestational weight gain on perinatal outcomes in Korean women: a retrospective cohort study.
机构信息
Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul, Korea.
出版信息
Reprod Biol Endocrinol. 2011 Jan 18;9:6. doi: 10.1186/1477-7827-9-6.
BACKGROUND
The purpose of the study was to evaluate the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain on perinatal outcomes in a population of Korean women.
METHODS
We retrospectively reviewed the medical records of 2,454 women who had received antenatal care at Seoul St. Mary's Hospital from January 2007 to December 2009. We used World Health Organization definitions for Asian populations of underweight (BMI < 18.5), normal (BMI equal or higher 18.5 and < 23), overweight (BMI equal or higher 23 and < 25), and obese (BMI equal or higher 25). We analyzed perinatal outcomes according to the pre-pregnancy BMI and weight gain during pregnancy, and calculated the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from multiple logistic regression models by considering maternal age, parity, number of fetuses, length of gestation, and medical history.
RESULTS
Among obese women, the adjusted ORs for gestational diabetes, hypertensive disorder, and incompetent internal os of cervix were 4.46, 2.53, and 3.70 (95% CI = 2.63-7.59, 1.26-5.07, and 1.50-9.12), respectively, and the adjusted ORs for neonatal complications such as macrosomia and low Apgar score were 2.08 and 1.98 (95% CI = 1.34-3.22 and 1.19-3.29), respectively, compared with normal weight women. However, there was no positive linear association between gestational weight gain and obstetric outcomes. In normal weight women, maternal and neonatal complications were significantly increased with inadequate weight gain during pregnancy (p < 0.0001 and = 0.0180, respectively), and we observed similar results in underweight women (p = 0.0136 and 0.0004, respectively).
CONCLUSIONS
This study shows that pre-pregnancy overweight and obesity are more closely related to the adverse obstetric outcomes than excess weight gain during pregnancy. In addition, inadequate weight gain during pregnancy can result in significant complications.
背景
本研究旨在评估韩国女性人群中，孕妇孕前体重指数（BMI）和孕期体重增加对围产期结局的影响。
方法
我们回顾性分析了 2007 年 1 月至 2009 年 12 月在首尔圣玛丽医院接受产前检查的 2454 名女性的病历。我们使用世界卫生组织（WHO）针对亚洲人群的定义来评估：体重不足（BMI<18.5）、正常（BMI 等于或高于 18.5 且<23）、超重（BMI 等于或高于 23 且<25）和肥胖（BMI 等于或高于 25）。我们根据孕妇孕前 BMI 和孕期体重增加情况分析围产期结局，并通过多因素逻辑回归模型，考虑母亲年龄、产次、胎儿数量、孕龄和病史等因素，计算调整后的比值比（OR）和 95%置信区间（CI）。
结果
在肥胖女性中，妊娠期糖尿病、高血压疾病和宫颈内口无力的调整 OR 分别为 4.46（95%CI=2.63-7.59）、2.53（95%CI=1.26-5.07）和 3.70（95%CI=1.50-9.12），巨大儿和低 Apgar 评分等新生儿并发症的调整 OR 分别为 2.08（95%CI=1.34-3.22）和 1.98（95%CI=1.19-3.29），与正常体重女性相比。然而，孕期体重增加与产科结局之间没有正线性关系。在正常体重女性中，孕期体重增加不足与母婴并发症显著增加（p<0.0001 和 p=0.0180），在体重不足的女性中也观察到类似的结果（p=0.0136 和 p=0.0004）。
结论
本研究表明，与孕期体重增加过多相比，孕前超重和肥胖与不良产科结局更为密切相关。此外，孕期体重增加不足可能导致显著的并发症。
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