母亲肥胖对羊膜穿刺术和绒毛取样后胎儿丢失风险的影响。

Effect of maternal obesity on the risk of fetal loss after amniocentesis and chorionic villus sampling.

机构信息

Department of Obstetrics and Gynecology, Washington University, St. Louis, MO, USA.

出版信息

Obstet Gynecol. 2012 Apr;119(4):745-51. doi: 10.1097/AOG.0b013e318248f90f.

DOI:10.1097/AOG.0b013e318248f90f

PMID:22433338

Abstract

OBJECTIVE

To estimate the risk of fetal loss in obese women undergoing amniocentesis and chorionic villus sampling (CVS).

METHODS

This was a retrospective cohort study of all women undergoing amniocentesis or CVS. The primary outcome was any fetal loss before 24 weeks of gestation. A secondary analysis was performed examining pregnancy loss within 14 days of the procedure, excluding termination of pregnancy. Obese (body mass index [BMI] 30.0 or higher) and nonobese (BMI lower than 30.0) patients were compared, and the postprocedure loss rate was also estimated by BMI strata. Obese and nonobese patients were compared with univariable and bivariate statistics; multivariable logistic regression models were developed to estimate the effect of maternal obesity.

RESULTS

Between obese (n=2,742) and nonobese (n=8,037) women undergoing amniocentesis, no difference existed in the risk of fetal loss before 24 weeks of gestation (4.7% [combined background and procedure loss] compared with 4.2%, adjusted odds ratio [OR] 1.1, 95% confidence interval [CI] 0.8-1.5). For women undergoing CVS, no difference in the risk of pregnancy loss was seen between obese (n=855) and nonobese (n=4,125) women (6.4% compared with 6.3%, adjusted OR 1.0, 95% CI 0.7-1.3). Compared with women not undergoing a procedure, the attributable risk for obese women was 0.3% (95% CI -0.2 to 0.9) amniocentesis and 0.1% (95% CI -0.1 to 0.2) CVS. The difference in fetal loss between the BMI 40.0 or higher and BMI lower than 25.0 groups after amniocentesis was significant after adjusting for maternal age (adjusted OR 2.2, 95% CI 1.2-3.9). This study had greater than 90% power to detect a 50% increase in the risk of pregnancy loss after amniocentesis and CVS (with an α error of 0.05).

CONCLUSION

A BMI of 30.0-40.0 does not increase the risk for fetal loss after invasive prenatal diagnostic procedures. A higher loss rates with class III obesity (BMI 40.0 or higher) was observed for amniocentesis procedures.

LEVEL OF EVIDENCE

II.

摘要

目的

评估肥胖女性行羊膜穿刺术和绒毛膜取样（CVS）时胎儿丢失的风险。

方法

这是一项对所有行羊膜穿刺术或 CVS 的女性进行的回顾性队列研究。主要结局是 24 周前任何胎儿丢失。进行了二次分析，检查了手术 14 天内的妊娠丢失，不包括终止妊娠。比较肥胖（体重指数 [BMI]≥30.0）和非肥胖（BMI<30.0）患者，并按 BMI 分层估计术后丢失率。对肥胖和非肥胖患者进行单变量和双变量统计比较；建立多变量逻辑回归模型来估计母体肥胖的影响。

结果

在接受羊膜穿刺术的肥胖（n=2742）和非肥胖（n=8037）女性中，24 周前胎儿丢失的风险无差异（综合背景和手术丢失率为 4.7%，与 4.2%相比，调整后的优势比[OR]为 1.1，95%置信区间[CI]为 0.8-1.5）。对于接受 CVS 的女性，肥胖（n=855）和非肥胖（n=4125）女性的妊娠丢失风险无差异（6.4%与 6.3%相比，调整后的 OR 为 1.0，95% CI 为 0.7-1.3）。与未行手术的女性相比，肥胖女性的归因风险为 0.3%（95% CI 为-0.2%至 0.9%）行羊膜穿刺术和 0.1%（95% CI 为-0.1%至 0.2%）行 CVS。调整母亲年龄后，羊膜穿刺术后 BMI 为 40.0 或更高与 BMI 低于 25.0 组之间的胎儿丢失差异具有统计学意义（调整后的 OR 为 2.2，95% CI 为 1.2-3.9）。本研究有超过 90%的效能来检测羊膜穿刺术和 CVS 后妊娠丢失风险增加 50%（α误差为 0.05）。