National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Obesity (Silver Spring). 2013 Jun;21(6):1276-83. doi: 10.1002/oby.20156.
Approximately one-third of US reproductive-aged women are obese, and prepregnancy obesity is a strong risk factor for adverse fetal and infant outcomes. The annual number of preventable adverse fetal and infant outcomes associated with prepregnancy obesity in the U.S. was estimated.
Adverse fetal and infant outcomes for which statistically significant associations with prepregnancy obesity had been reported by peer-reviewed meta-analyses, which included fetal deaths and nine different major birth defects, were assessed. The true prevalence of prepregnancy obesity was estimated by multiplying self-reported prepregnancy obesity by a bias factor based on the difference between measured and self-reported obesity in U.S. adult women. A Monte Carlo simulation approach was used to model the attributable fraction and preventable number, accounting for uncertainty in the estimates for: strength of the association with obesity, obesity prevalence, and outcome prevalence.
Eliminating the impact of prepregnancy obesity would potentially prevent the highest numbers of four outcomes: fetal deaths (6,990; uncertainty interval [UI] 4,110-10,080), congenital heart defects (2,850; UI 1,035-5,065), hydrocephalus (490; UI 150-850), and spina bifida (405; UI 305-505). If 10% of women with prepregnancy obesity achieved a healthy weight before pregnancy or otherwise mitigated the impact of obesity, nearly 300 congenital heart defects and 700 fetal deaths per year could potentially be prevented.
This simulation suggests that effective prevention strategies to reduce prepregnancy obesity or the risk associated with obesity could have a measurable impact on infant health in the US.
大约三分之一的美国育龄妇女肥胖，孕前肥胖是不良胎儿和婴儿结局的一个重要危险因素。本研究估计了与美国孕前肥胖相关的可预防不良胎儿和婴儿结局的年发生数。
评估了经同行评审的荟萃分析报告的与孕前肥胖具有统计学显著相关性的不良胎儿和婴儿结局，包括胎儿死亡和 9 种不同的主要出生缺陷。通过将自我报告的孕前肥胖乘以基于美国成年女性测量体重和自我报告体重之间差异的偏倚因子，来估计真实的孕前肥胖流行率。采用蒙特卡罗模拟方法来对归因分数和可预防数量进行建模，该方法考虑了以下因素的不确定性：与肥胖相关的关联强度、肥胖流行率和结局流行率。
消除孕前肥胖的影响可能会预防最多的 4 种结局：胎儿死亡（6990；不确定区间[UI] 4110-10080）、先天性心脏缺陷（2850；UI 1035-5065）、脑积水（490；UI 150-850）和脊柱裂（405；UI 305-505）。如果 10%的孕前肥胖女性成功实现健康体重或采取其他措施减轻肥胖的影响，每年可能会预防近 300 例先天性心脏缺陷和 700 例胎儿死亡。
本模拟研究表明，有效的预防策略可降低孕前肥胖或肥胖相关风险，从而对美国婴儿健康产生可衡量的影响。
