Suresh Ashwin, Liu Anthony, Poulton Alison, Quinton Ann, Amer Zara, Mongelli Max, Martin Andrew, Benzie Ronald, Peek Michael, Nanan Ralph
Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
Aust N Z J Obstet Gynaecol. 2012 Oct;52(5):420-6. doi: 10.1111/j.1479-828X.2012.01471.x.
Obesity in pregnancy is associated with a number of adverse outcomes. The effects of central versus general obesity in pregnancy have not been well established.
To compare subcutaneous fat thickness (SFT) with body mass index (BMI) as a marker for pregnancy outcomes.
A stratified retrospective cohort study was performed on 1200 pregnancies, selected from a total of 4862 nulliparous, nonsmoking women between 2006 and 2010. SFT was measured on routine ultrasound at 18-22 weeks gestation. BMI and SFT measurements were compared for estimating risks for obesity-related pregnancy outcomes using logistic regression adjusted for maternal age.
The median SFT was 18.2 mm (range 6.3-50.9 mm), the median BMI was 23.8 kg/m(2) (range 15.2-52.5), and the correlation between SFT and BMI was 0.53. For every 5 mm increase in SFT and every 5 kg/m(2) increase in BMI, the odds ratios for developing gestational diabetes mellitus were 1.40 (CI 1.22-1.61, P < 0.001) and 1.16 (CI 0.95-1.40, P = 0.1), for caesarean section 1.28 (CI 1.16-1.40, P < 0.001) and 1.16 (CI 1.05-1.28, P = 0.003), large for gestational age 1.28 (CI 1.16-1.47, P = 0.001) and 1.10 (CI 0.95-1.28, P = 0.16) and cumulative adverse obesity-related pregnancy outcomes 1.16 (CI 1.10-1.28, P = 0.002) and 1.05 (CI 0.95-1.16, P = 0.45), respectively.
SFT at 18-22 weeks gestation is better than BMI as a marker for obesity-related pregnancy outcomes. As SFT is considered a surrogate measure for visceral fat, these results suggest that central obesity is a stronger risk factor than general adiposity in pregnancy.
孕期肥胖与多种不良结局相关。孕期中心性肥胖与全身性肥胖的影响尚未明确。
比较皮下脂肪厚度（SFT）与体重指数（BMI）作为妊娠结局标志物的情况。
对2006年至2010年间从4862名初产、非吸烟女性中选取的1200例妊娠进行分层回顾性队列研究。在妊娠18 - 22周时通过常规超声测量SFT。比较BMI和SFT测量值，使用经产妇年龄调整的逻辑回归来估计肥胖相关妊娠结局的风险。
SFT中位数为18.2毫米（范围6.3 - 50.9毫米），BMI中位数为23.8千克/平方米（范围15.2 - 52.5），SFT与BMI的相关性为0.53。SFT每增加5毫米以及BMI每增加5千克/平方米，发生妊娠期糖尿病的比值比分别为1.40（95%置信区间1.22 - 1.61，P < 0.001）和1.16（95%置信区间0.95 - 1.40，P = 0.1），剖宫产的比值比分别为1.28（95%置信区间1.16 - 1.40，P < 0.001）和1.16（95%置信区间1.05 - 1.28，P = 0.003），大于胎龄儿的比值比分别为1.28（95%置信区间1.16 - 1.47，P = 0.001）和1.10（95%置信区间0.95 - 1.28，P = 0.16），肥胖相关累积妊娠不良结局的比值比分别为1.16（95%置信区间1.10 - 1.28，P = 0.002）和1.05（95%置信区间0.95 - 1.16，P = 0.45）。
妊娠18 - 22周时的SFT作为肥胖相关妊娠结局的标志物优于BMI。由于SFT被认为是内脏脂肪的替代指标，这些结果表明孕期中心性肥胖是比全身性肥胖更强的危险因素。
