Matern Child Health J. 2014 May;18(4):1038-47. doi: 10.1007/s10995-013-1356-0.
Small-for-gestational-age (SGA) and large-for gestational-age (LGA) infants are associated with increased adverse outcomes. While studies have estimated the association of gestational weight gain with birth weight in obese women, estimates are lacking by obesity class and diabetic status. A population-based historical cohort study of 66,010 obese pregnant women in Missouri delivering liveborn, singleton, term infants in 2002–2008 was conducted. Adjusted odds ratios for SGA and LGA infants were calculated for gestational weight gain categories with multiple logistic regression using the revised Institute of Medicine(IOM) recommended 11–20 pounds as the reference group. A weight gain of 3–10 pounds was not significantly associated with an increased risk of an SGA infant compared to 11–20 pounds in 5/6 obesity class/diabetic status combinations.The exception was Class I Obese non-diabetic women(adjusted odds ratio = 1.28, 95 % confidence interval 1.07, 1.52). When lower amounts of weight gain were considered, diabetic women who gained ≤2 pounds (including women who lost weight) did not have a significantly increased risk of an SGA infant compared to diabetic women who gained 11–20 pounds in any obesity class. Weight gains less than 11–20 pounds were significantly associated with a decreased risk of an LGA infant in 5/6 obesity class/diabetic status combinations. Weight gains lower than the IOM recommendation of 11–20 pounds during pregnancy for obese women generally were significantly associated with decreased risk of LGA infants without being significantly associated with increased risk of SGA infants and differed by obesity class and diabetic status.
小于胎龄儿（SGA）和大于胎龄儿（LGA）与不良结局的风险增加有关。虽然研究已经估计了肥胖女性的妊娠体重增加与出生体重的关系，但缺乏按肥胖程度和糖尿病状态分类的估计值。在 2002 年至 2008 年间，密苏里州进行了一项基于人群的历史队列研究，共纳入 66010 名肥胖孕妇，这些孕妇分娩的是活产、单胎、足月婴儿。采用多因素逻辑回归分析，以修订后的美国医学研究所（IOM）推荐的 11-20 磅为参考组，对妊娠期体重增加类别进行调整，计算 SGA 和 LGA 婴儿的比值比。与 11-20 磅相比，5/6 肥胖程度/糖尿病状态组合中，增重 3-10 磅与 SGA 婴儿风险增加无显著相关性。除了 I 型肥胖非糖尿病妇女（调整比值比为 1.28，95%置信区间 1.07-1.52）。当考虑到较低的体重增加量时，增重≤2 磅（包括体重减轻的妇女）的糖尿病妇女与任何肥胖程度下增重 11-20 磅的糖尿病妇女相比，SGA 婴儿的风险没有显著增加。在 5/6 肥胖程度/糖尿病状态组合中，体重增加低于 11-20 磅与 LGA 婴儿的风险降低显著相关。与 IOM 建议的 11-20 磅相比，肥胖妇女孕期体重增加低于 11-20 磅通常与 LGA 婴儿的风险降低显著相关，而与 SGA 婴儿的风险增加无关，且肥胖程度和糖尿病状态不同。
