Gilead Rami, Yaniv Salem Shimrit, Sergienko Ruslan, Sheiner Eyal
Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Faculty of Health Sciences, Beer-Sheva, Israel.
J Matern Fetal Neonatal Med. 2012 Dec;25(12):2579-82. doi: 10.3109/14767058.2012.716464. Epub 2012 Aug 28.
To investigate pregnancy outcomes, particularly cesarean delivery (CD), among women with "isolated" obesity (i.e. without additional comorbidities).
We conducted a retrospective population-based study between the years 1988-2010. The pregnancy outcomes of obese (prepregnancy BMI ≥30 kg/m(2)) and nonobese patients were compared. Patients with chronic hypertension, pregestational diabetes mellitus, other preexisting chronic morbidities, multiple gestations, age above 40 years, grand multiparity (above 5 deliveries), lack of prenatal care, and following fertility treatments were excluded from the analysis. Stratified analyses, using multiple logistic regression models, were performed to control for confounders.
During the study period, a total of 173,628 deliveries met the inclusion criteria; 1605 (0.9%) occurred in patients with "isolated" obesity. Higher rates of CD were found among patients with "isolated" obesity (30.7% vs. 12.3%; odds ration [OR] = 3.2; p < 0.001). When controlling for possible confounders, using a multivariable model with CD as the outcome variable, the association between "isolated" obesity and CD remained significant (adjusted OR = 2.6; p < 0.001). No significant differences were found in the risks of perinatal complications including perinatal mortality, shoulder dystocia, congenital malformations, and low 5-min Apgar score.
"Isolated" obesity, although not a risk factor for adverse perinatal outcomes, is an independent risk factor for CD.
研究“单纯性”肥胖（即无其他合并症）女性的妊娠结局，尤其是剖宫产情况。
我们在1988年至2010年间进行了一项基于人群的回顾性研究。比较了肥胖（孕前体重指数≥30 kg/m²）和非肥胖患者的妊娠结局。分析排除了患有慢性高血压、孕前糖尿病、其他已存在的慢性疾病、多胎妊娠、年龄超过40岁、多产（分娩5次以上）、缺乏产前检查以及接受过生育治疗的患者。采用多因素逻辑回归模型进行分层分析以控制混杂因素。
在研究期间，共有173,628例分娩符合纳入标准；其中1605例（0.9%）发生在“单纯性”肥胖患者中。“单纯性”肥胖患者的剖宫产率更高（30.7%对12.3%；优势比[OR]=3.2；p<0.001）。以剖宫产作为结局变量，使用多变量模型控制可能的混杂因素后，“单纯性”肥胖与剖宫产之间的关联仍然显著（校正OR=2.6；p<0.001）。在围产期并发症风险方面，包括围产期死亡率、肩难产、先天性畸形和5分钟阿氏评分低等，未发现显著差异。
“单纯性”肥胖虽然不是不良围产期结局的危险因素，但却是剖宫产的独立危险因素。
