From the Department of Obstetrics and Gynecology, Section of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, New York.
Obstet Gynecol. 2011 Sep;118(3):569-575. doi: 10.1097/AOG.0b013e3182289f42.
To estimate the effect of second- and third-trimester rate of gestational weight gain on pregnancy outcomes using the revised Institute of Medicine guidelines.
This is a retrospective cohort study of singleton live births in upstate New York between January 2004 and December 2008. Women were grouped by prepregnancy body mass index (BMI) and rates of second- and third-trimester gestational weight gain were calculated. Women were then classified as having less than, within, or greater than recommended rates of gain. Maternal and neonatal outcomes were assessed based on rate of weight gain within each BMI class.
Of 73,977 women meeting inclusion criteria, 4% were underweight, 48% normal weight, 24% overweight, and 24% obese: 13% class I, 6% class II, and 5% class III, respectively. After controlling for potential confounding variables, less than recommended rates of second- and third-trimester weight gain were associated with increased odds of small-for-gestational-age neonates in all BMI groups except obese classes II and III. Greater than recommended rates of weight gain were associated with increased odds of large-for-gestational-age neonates in all BMI groups and increased odds of cesarean delivery in all BMI groups with the exception of underweight and obese class III women.
Suboptimal second- and third-trimester rates of gestational weight gain in the most obese women, even with net weight loss, do not increase the odds of small-for-gestational-age neonates. Excessive rates of gestational weight gain increase the odds of large-for-gestational-age neonates regardless of BMI.
II.
使用修订后的美国医学研究所指南，估计妊娠中期和晚期体重增加率对妊娠结局的影响。
这是一项在纽约州北部 2004 年 1 月至 2008 年 12 月期间进行的单胎活产的回顾性队列研究。根据孕前体重指数（BMI）将女性分组，并计算出妊娠中期和晚期的体重增加率。然后，根据每个 BMI 类别中的体重增加率将女性分为体重增加不足、在推荐范围内或超过推荐范围。根据体重增加率评估产妇和新生儿结局。
在符合纳入标准的 73977 名女性中，4%为体重不足，48%为正常体重，24%为超重，24%为肥胖：分别为 13%为 I 类，6%为 II 类，5%为 III 类。在控制了潜在的混杂变量后，在除肥胖 II 类和 III 类以外的所有 BMI 组中，低于推荐的妊娠中期和晚期体重增加率与较小的胎儿生长受限儿的几率增加相关。在所有 BMI 组中，高于推荐的体重增加率与较大的胎儿生长受限儿的几率增加相关，除了体重不足和肥胖 III 类女性外，在所有 BMI 组中与剖宫产的几率增加相关。
即使在肥胖程度最高的女性中，妊娠中期和晚期体重增加率不理想，也不会增加胎儿生长受限儿的几率。无论 BMI 如何，妊娠体重过度增加都会增加巨大儿的几率。
II 级。
