足月分娩的初产妇体质量指数与第一产程和第二产程剖宫产风险的关系。
Risk of first-stage and second-stage cesarean delivery by maternal body mass index among nulliparous women in labor at term.
机构信息
From the Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; the Division of Women's Health, School of Biomedical and Health Sciences, Kings College, London, United Kingdom; and the Women and Children's Division, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia.
出版信息
Obstet Gynecol. 2011 Jun;117(6):1315-1322. doi: 10.1097/AOG.0b013e318217922a.
OBJECTIVE
To estimate in a cohort of nulliparous women in labor at term whether cesarean delivery rates are increased in first and second stages of labor in overweight and obese women and whether being overweight or obese is an independent risk factor for cesarean delivery.
METHODS
Nulliparous women recruited to the prospective Screening for Pregnancy Endpoints study who went into labor after 37 weeks of gestation were categorized according to ethnicity-specific body mass index (BMI) criteria as normal, overweight, or obese. Normal BMI was the referent. Multivariable analysis, adjusting for known confounders for obesity and cesarean delivery, was performed to estimate if being overweight or obese was associated with an increased risk of cesarean in labor (all cesarean deliveries and in first stage of labor).
RESULTS
Of 2,629 participants, 1,416 (54%) had normal BMIs, 773 (29%) were overweight, and 440 (17%) were obese. First-stage cesarean delivery was increased in overweight (n=149 [19%]) and obese (n=137 [31%]) women compared with normal-weight women (n=181 [13%; P<.001), whereas second-stage cesarean delivery was similar (normal BMI 76 [6.2%], overweight 45 [7.2%], obese 23 [7.6%], P=.87). Being overweight or obese was an independent risk factor for all cesarean deliveries in labor with adjusted odds ratio (OR) of 1.34 (95% confidence interval [CI] 1.07-1.67) and 2.51 (95% CI 1.94-3.25), respectively. Similarly, being overweight (adjusted OR 1.39; 95% CI 1.09-1.79) or obese (adjusted OR 2.89; 95% CI 2.19-3.80) was associated with increased cesarean delivery during the first stage. Risks of cesarean delivery were similar regardless of whether ethnicity-specific or World Health Organization (WHO) BMI criteria were used.
CONCLUSION
Among nulliparous women in labor at term, being overweight or obese by either WHO or ethnicity-specific BMI criteria is an independent risk factor for cesarean delivery in the first stage but not the second stage of labor.
CLINICAL TRIAL REGISTRATION
Australian New Zealand Clinical Trials Registry, www.anzctr.org.au, ACTRN12607000551493.
目的
在足月分娩的初产妇队列中评估，超重和肥胖妇女的第一产程和第二产程剖宫产率是否增加，以及超重或肥胖是否是剖宫产的独立危险因素。
方法
本前瞻性妊娠终点筛查研究招募了孕 37 周后进入产程的初产妇，根据特定种族的体重指数（BMI）标准将其分为正常、超重或肥胖。正常 BMI 为参照。采用多变量分析，调整肥胖和剖宫产的已知混杂因素，以评估超重或肥胖是否与剖宫产风险增加相关（所有剖宫产和第一产程）。
结果
在 2629 名参与者中，1416 名（54%）的 BMI 正常，773 名（29%）超重，440 名（17%）肥胖。与正常体重妇女相比，超重（n=149[19%]）和肥胖（n=137[31%]）妇女的第一产程剖宫产率增加（P<.001），而第二产程剖宫产率相似（正常 BMI 181[13%]，超重 76[6.2%]，肥胖 45[7.2%]，肥胖 23[7.6%]，P=.87）。超重或肥胖是剖宫产的独立危险因素，其校正比值比（OR）分别为 1.34（95%置信区间[CI]为 1.07-1.67）和 2.51（95% CI 1.94-3.25）。同样，超重（校正 OR 1.39；95% CI 1.09-1.79）或肥胖（校正 OR 2.89；95% CI 2.19-3.80）与第一产程剖宫产率增加相关。无论使用特定种族的 BMI 标准还是世界卫生组织（WHO）BMI 标准，剖宫产的风险相似。
结论
在足月分娩的初产妇中，无论采用 WHO 标准还是特定种族的 BMI 标准，超重或肥胖均是第一产程剖宫产的独立危险因素，但不是第二产程剖宫产的独立危险因素。
临床试验注册
澳大利亚和新西兰临床试验注册中心，www.anzctr.org.au，ACTRN12607000551493。
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