母亲孕前肥胖和孕期体重过度增加与不良妊娠结局及住院时间的关系。
Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay.
机构信息
School of Population Health, The University of Queensland, Brisbane, Australia.
出版信息
BMC Pregnancy Childbirth. 2011 Sep 6;11:62. doi: 10.1186/1471-2393-11-62.
BACKGROUND
It is relatively less known whether pre-pregnancy obesity and excess gestational weight gain (GWG) are associated with caesarean delivery, pregnancy complications, preterm birth, birth and placenta weights and increased length of postnatal hospital stay.
METHODS
We used a population-based cohort of 6632 women who gave birth in Brisbane, Australia, between 1981 and 1983. The independent associations of pre-pregnancy obesity, GWG and institute of medicine (IOM) categories of combined pre-pregnancy BMI and GWG with outcomes were examined using multivariable regression (for continuous outcomes) and multivariable multinomial regression (for categorical outcomes) models.
RESULTS
We found women who were obese prior to pregnancy and women who gained excess weight during pregnancy were at greater risk for a pregnancy complications (OR: 2.10; 1.74, 2.54; age adjusted model), caesarean section (OR 1.29; 1.09, 1.54), higher birth weight difference (206.45 gm; 178.82, 234.08) and greater placental weight difference (41.16 gm; 33.83, 48.49) and longer length of hospital stay. We also found that mothers who gained inadequate weight or were underweight before pregnancy were at greater risk of preterm birth (2.27; 1.71, 3.00), lower risk of pregnancy complications (0.58; 0.44, 0.77) and had lower birth (-190.63;-221.05,-160.20) and placental (-37.16; -45.23,-29.09) weights. Results indicate that all associations remain consistent after adjustment for a range of potential confounding factors with the exception of the association between pre-pregnancy obesity and hospital stay.
CONCLUSIONS
Pre-pregnancy obesity or excessive GWG are associated with greater risk of pregnancy complications, caesarean delivery and greater birth and placenta weight. Excess GWG is associated with a longer stay in hospital after delivery, independent of pre-pregnancy BMI, pregnancy complications and caesarean delivery. In addition to pre-pregnancy obesity, it is vital that clinical practice considers excess GWG as another indicator of adverse pregnancy outcomes.
背景
孕前肥胖和孕期体重过度增加（GWG）与剖宫产、妊娠并发症、早产、出生体重和胎盘重量以及产后住院时间延长的关系相对较少被人知晓。
方法
我们使用了一个基于人群的队列，该队列包括 1981 年至 1983 年期间在澳大利亚布里斯班分娩的 6632 名女性。使用多变量回归（用于连续结果）和多变量多项回归（用于分类结果）模型，检查孕前肥胖、GWG 和医学研究所（IOM）孕前 BMI 和 GWG 综合分类与结局的独立关联。
结果
我们发现，孕前肥胖的女性和孕期体重增加过多的女性更易发生妊娠并发症（OR：2.10；1.74，2.54；年龄调整模型）、剖宫产（OR 1.29；1.09，1.54）、出生体重差异更大（206.45 克；178.82，234.08）和胎盘重量差异更大（41.16 克；33.83，48.49），且住院时间更长。我们还发现，孕前体重不足或体重过轻的母亲早产风险更高（2.27；1.71，3.00），妊娠并发症风险更低（0.58；0.44，0.77），出生体重更低（-190.63；-221.05，-160.20）和胎盘重量更低（-37.16；-45.23，-29.09）。结果表明，除了孕前肥胖与住院时间的关联外，在调整了一系列潜在混杂因素后，所有关联仍然一致。
结论
孕前肥胖或 GWG 过度与妊娠并发症、剖宫产和更大的出生体重和胎盘重量风险增加相关。GWG 过度与产后住院时间延长相关，与孕前 BMI、妊娠并发症和剖宫产无关。除了孕前肥胖外，临床实践还必须将 GWG 过度视为不良妊娠结局的另一个指标。
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