Crane Joan M G, Murphy Phil, Burrage Lorraine, Hutchens Donna
Department of Obstetrics and Gynecology, Eastern Health, Memorial University, St. John's NL.
Newfoundland and Labrador Provincial Perinatal Program, Eastern Health, St. John's NL.
J Obstet Gynaecol Can. 2013 Jul;35(7):606-611. doi: 10.1016/S1701-2163(15)30879-3.
To evaluate the effects of extreme obesity (pre-pregnancy BMI ≥ 50.0 kg/m2) in pregnancy on maternal and perinatal outcomes.
We conducted a population-based cohort study using the Newfoundland and Labrador Perinatal Database to compare obstetric outcomes in women with extreme obesity and those with a normal BMI (pre-pregnancy BMI 18.50 to 24.99 kg/m2). We included women with singleton gestations who gave birth between January 1, 2002, and December 31, 2011. Maternal outcomes of interest included gestational hypertension, gestational diabetes, Caesarean section, shoulder dystocia, length of hospital stay, maternal ICU admission, postpartum hemorrhage, and death. Perinatal outcomes included birth weight, preterm birth, Apgar score, neonatal metabolic abnormality, NICU admission, stillbirth, and neonatal death. A composite morbidity outcome was developed including at least one of Caesarean section, gestational hypertension, birth weight ≥ 4000 g, birth weight < 2500 g, or NICU admission. Univariate analyses and multivariate logistic regression analyses (controlling for maternal age, parity, smoking, partner status, and gestational age) were performed, and adjusted odds ratios (aORs) and 95% confidence intervals were calculated.
A total of 5788 women were included in the study: 71 with extreme obesity and 5717 with a normal BMI. Extremely obese women were more likely to have gestational hypertension (19.7% vs. 4.8%) (aOR 1.56; 95% CI 1.33 to 1.82), gestational diabetes (21.1% vs. 1.5%) (aOR 2.04; 95% CI 1.74 to 2.38), shoulder dystocia (7.1% vs. 1.4%) (aOR 1.51; 95% CI 1.05 to 2.19), Caesarean section (60.6% vs. 25.0%) (aOR 1.46; 95% CI 1.29 to 1.65), length of hospital stay more than five days (excluding Caesarean section) (14.3% vs. 4.7%) (aOR 1.42; 95% CI 1.07 to 1.89), birth weight ≥ 4000 g (38.0% vs. 11.9%) (aOR 1.58; 95% CI 1.38 to 1.80), birth weight ≥ 4500 g (16.9% vs. 2.1%) (aOR 1.87; 95% CI 1.57 to 2.23), neonatal metabolic abnormality (8.5% vs. 2.0%) (aOR 1.50; 95% CI 1.20 to 1.86), NICU admission (16.9% vs. 7.8%) (aOR 1.28; 95% CI 1.07 to 1.52), stillbirth (1.4% vs. 0.2%) (aOR 1.68; 95% CI 1.00 to 2.82) and composite adverse outcome (81.7% vs. 41.5%) (aOR 1.57; 95% CI 1.35 to 1.83).
Women with extreme obesity have increased risks of a variety of adverse maternal and perinatal outcomes. As approximately 6 per 1000 women giving birth in our population have extreme obesity, it is important to address these risks pre-conceptually and encourage a healthier BMI before pregnancy.
评估孕期极度肥胖（孕前体重指数≥50.0 kg/m²）对孕产妇及围产期结局的影响。
我们利用纽芬兰和拉布拉多围产期数据库开展了一项基于人群的队列研究，以比较极度肥胖女性与体重指数正常（孕前体重指数18.50至24.99 kg/m²）女性的产科结局。纳入2002年1月1日至2011年12月31日期间分娩的单胎妊娠女性。感兴趣的孕产妇结局包括妊娠期高血压、妊娠期糖尿病、剖宫产、肩难产、住院时间、入住重症监护病房、产后出血及死亡。围产期结局包括出生体重、早产、阿氏评分、新生儿代谢异常、入住新生儿重症监护病房、死产及新生儿死亡。制定了一个综合发病结局，包括剖宫产、妊娠期高血压、出生体重≥4000 g、出生体重<2500 g或入住新生儿重症监护病房中的至少一项。进行了单因素分析和多因素逻辑回归分析（控制产妇年龄、产次、吸烟、伴侣状况及孕周），并计算了调整后的比值比（aOR）及95%置信区间。
共有5788名女性纳入研究：71名极度肥胖，5717名体重指数正常。极度肥胖女性更易发生妊娠期高血压（19.7%对4.8%）（aOR 1.56；95%置信区间1.33至1.82）、妊娠期糖尿病（21.1%对1.5%）（aOR 2.04；95%置信区间1.74至2.38）、肩难产（7.1%对1.4%）（aOR 1.51；95%置信区间1.05至2.19）、剖宫产（60.6%对25.0%）（aOR 1.46；95%置信区间1.29至1.65）、住院时间超过5天（不包括剖宫产）（14.3%对4.7%）（aOR 1.42；95%置信区间1.07至1.89）、出生体重≥4000 g（38.0%对1·9%）（aOR 1.58；95%置信区间1.38至1.80）、出生体重≥4500 g（16.9%对2.1%）（aOR 1.87；95%置信区间1.57至2.23）、新生儿代谢异常（8.5%对2.0%）（aOR 1.50；95%置信区间1.20至1.86）、入住新生儿重症监护病房（16.9%对7.8%）（aOR 1.28；95%置信区间1.07至1.52）、死产（1.4%对0.2%）（aOR 1.68；95%置信区间1.00至2.82）及综合不良结局（81.7%对41.5%）（aOR 1.57；95%置信区间1.35至1.83）。
极度肥胖女性发生各种不良孕产妇及围产期结局的风险增加。由于在我们的人群中每1000名分娩女性中约有6名极度肥胖，因此在孕前处理这些风险并鼓励孕前有更健康的体重指数非常重要。
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