McDonald Sarah D, Han Zhen, Mulla Sohail, Lutsiv Olha, Lee Tiffany, Beyene Joseph, Shah Prakesh, Ohlsson Arne, Shah Vibhuti, Murphy Kellie E, McDonald Sarah D, Hutton Eileen, Newburn-Cook Christine, Frick Corine, Scott Fran, Allen Victoria, Beyene Joseph, Cameron John D
Division of Maternal-Fetal Medicine, McMaster University, Hamilton, ON; Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON; Department of Radiology, McMaster University, Hamilton, ON; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON.
Department of Obstetrics and Gynecology, First Affiliated Hospital of Xi'an Jiao Tong University, Shaanxi Province, People's Republic of China.
J Obstet Gynaecol Can. 2011 Dec;33(12):1223-1233. doi: 10.1016/S1701-2163(16)35107-6.
Many women have high gestational weight gain (GWG), but potential neonatal consequences are not yet well quantified. We sought to determine the relationship between high GWG and preterm birth (PTB) and low birth weight (LBW) in singleton births.
We searched Medline and Embase and reference lists.
Two assessors independently performed all steps. We selected studies assessing high total or weekly GWG on PTB (< 37 weeks) and LBW (< 2500 grams).
Thirty-eight studies, 24 cohort and 14 case-control, were included involving 2 124 907 women. Most contained unadjusted data. Women with high total GWG had a decreased risk overall of PTB < 37 weeks (relative risk [RR] 0.75; 95% CI 0.60 to 0.96), PTB 32 to 36 weeks (RR 0.70; 95% CI 0.70 to 0.71), and < 32 weeks (RR 0.87; 95% CI 0.85 to 0.90). High GWG was associated with lower risk of LBW (RR 0.64; 95% CI 0.53 to 0.78). Women with the highest GWG had lower risks of LBW (RR 0.55; 95% CI 0.32 to 0.94) than women with moderately high GWG (RR 0.73; 95% CI 0.60 to 0.89). Women with the highest weekly GWG had greater risks of PTB (RR 1.51; 95% CI 1.47 to 1.55) than women with moderately high weekly GWG (RR 1.09; 95% CI 1.05 to 1.13). Women with high weekly GWG were at increased risk of PTB 32 to 36 weeks (RR 1.14; 95% CI 1.10 to 1.17 and < 32 weeks (RR 1.81; 95% CI 1.73 to 1.90).
Although women with high total GWG have lower unadjusted risks of PTB and LBW, high weekly GWG is associated with increased PTB, and more adjusted studies are needed, as are more studies in obese women. Potential benefits of high GWG for the infant must be balanced against maternal risks and other known infant risks such as high birth weight.
许多女性孕期体重增加过多（GWG），但其对新生儿的潜在影响尚未得到充分量化。我们旨在确定单胎妊娠中高GWG与早产（PTB）及低出生体重（LBW）之间的关系。
我们检索了Medline、Embase及参考文献列表。
两名评估者独立完成所有步骤。我们选择了评估总GWG或每周GWG过高对PTB（<37周）和LBW（<2500克）影响的研究。
纳入了38项研究，其中24项队列研究和14项病例对照研究，涉及2124907名女性。大多数研究包含未经调整的数据。总GWG过高的女性总体上发生<37周PTB的风险降低（相对风险[RR]0.75；95%可信区间[CI]0.60至0.96），32至36周PTB的风险降低（RR0.70；95%CI0.70至0.71），<32周PTB的风险降低（RR0.87；95%CI0.85至0.90）。高GWG与较低的LBW风险相关（RR0.64；95%CI0.53至0.78）。GWG最高的女性发生LBW的风险低于中度高GWG的女性（RR0.55；95%CI0.32至0.94）（中度高GWG女性的RR为0.73；95%CI0.60至0.89）。每周GWG最高的女性发生PTB的风险高于中度高每周GWG的女性（RR1.51；95%CI1.47至1.55）（中度高每周GWG女性的RR为1.09；95%CI1.05至1.13）。每周GWG过高的女性发生32至36周PTB的风险增加（RR1.14；95%CI1.10至1.17），<32周PTB的风险增加（RR1.81；95%CI1.73至1.90）。
尽管总GWG过高的女性未经调整的PTB和LBW风险较低，但每周GWG过高与PTB风险增加相关，需要更多的调整研究，也需要对肥胖女性进行更多研究。必须在高GWG对婴儿的潜在益处与母亲风险及其他已知的婴儿风险（如高出生体重）之间进行权衡。
