1] Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, Stockholm, Sweden [2] Centre for Longitudinal and Life Course Research, School of Population Health, University of Queensland, Brisbane, Queensland, Australia.
Centre for Longitudinal and Life Course Research, School of Population Health, University of Queensland, Brisbane, Queensland, Australia.
Int J Obes (Lond). 2014 Jan;38(1):91-6. doi: 10.1038/ijo.2013.62. Epub 2013 May 2.
Optimal gestational weight gain (GWG) leads to better outcomes for both the mother and child, whereas excessive gains can act as a key stage for obesity development. Little is known about social inequalities in GWG. This study investigates the influence of education level on pre-pregnancy body mass index (BMI) and GWG.
Register-based population study.
Sweden
Four thousand and eighty women born in Sweden who were a part of the third generation Uppsala Birth Cohort Study. Register data linkages were used to obtain information on social characteristics, BMI and GWG of women with singleton first births from 1982 to 2008.
Pre-pregnancy BMI and the Institute of Medicine's (IOM) categories of GWG for a given pre-pregnancy BMI. RESULTS were adjusted for calendar period, maternal age, living arrangements, smoking, history of chronic disease and pre-pregnancy BMI when appropriate.
Although most women (67%) were of healthy pre-pregnancy BMI, 20% were overweight and 8% were obese. Approximately half of all women in the sample had excessive GWG, with higher pre-pregnancy BMI associated with higher risk of excessive GWG, regardless of education level; this occurred for 76% of overweight and 75% of obese women. Lower educated women with a healthy pre-pregnancy BMI were at greater risk of excessive GWG-odds ratio 1.76 (95% confidence interval 1.28-2.43) for elementary and odds ratio 1.32 (1.06-1.64) for secondary compared with tertiary educated, adjusted for age and birth year period. Nearly half of women with an elementary or secondary education (48%) gained weight excessively.
Education did not provide a protective effect in avoiding excessive GWG among overweight and obese women, of whom ∼75% gained weight excessively. Lower educated women with a BMI within the healthy range, however, are at greater risk of excessive GWG. Health professionals need to tailor their pre-natal advice to different groups of women in order to achieve optimal pregnancy outcomes and avoid pregnancy acting as a stage in the development of obesity.
最佳的妊娠体重增加（GWG）对母婴双方都有更好的结果，而过度增加可能成为肥胖发展的关键阶段。关于 GWG 的社会不平等现象知之甚少。本研究调查了教育水平对孕前体重指数（BMI）和 GWG 的影响。
基于登记的人群研究。
瑞典
瑞典第三代乌普萨拉出生队列研究中的 4080 名出生妇女。利用登记数据链接，从 1982 年到 2008 年，获得了具有单胎首次分娩的妇女的社会特征、BMI 和 GWG 信息。
孕前 BMI 和医学研究所（IOM）的 GWG 类别，适当时调整了孕前 BMI 的日历期、母亲年龄、生活安排、吸烟、慢性疾病史和孕前 BMI。
尽管大多数女性（67%）的孕前 BMI 处于健康状态，但 20%超重，8%肥胖。在样本中，大约一半的女性 GWG 过多，较高的孕前 BMI 与 GWG 过多的风险增加相关，无论教育水平如何；超重和肥胖女性中分别有 76%和 75%发生这种情况。孕前 BMI 健康的低教育程度女性发生 GWG 过多的风险更大——与接受高等教育的女性相比，小学教育的比值比为 1.76（95%置信区间 1.28-2.43），中学教育的比值比为 1.32（1.06-1.64），调整年龄和出生年份。几乎一半的小学或中学教育程度的女性（48%）体重增加过多。
在超重和肥胖女性中，教育并不能提供避免 GWG 过多的保护作用，其中约 75%的女性体重增加过多。然而，BMI 在健康范围内的低教育程度女性发生 GWG 过多的风险更高。为了实现最佳妊娠结局并避免妊娠成为肥胖发展的一个阶段，健康专业人员需要根据不同的女性群体量身定制产前建议。
