Kyvernitakis Ioannis, Köhler Christine, Schmidt Stephan, Misselwitz Björn, Großmann Jasmin, Hadji Peyman, Kalder Matthias
J Perinat Med. 2015 Jul;43(4):449-54. doi: 10.1515/jpm-2014-0126.
Maternal obesity is a risk factor for cesarean delivery (CD). The aim of this analysis was to determine the association between early-pregnancy body mass index (BMI) and the rate of CD over the past two decades.
We retrospectively analyzed data from the perinatal quality registry of singleton deliveries in the state of Hesse in Germany from 1990 to 2012. We divided the patients into groups according to the WHO criteria for BMI: underweight (<18.5), normal weight (18.5-<25), overweight (25-<30), obese class I (30-<35), obese class II (35-<40), and obese class III (≥40).
The analysis included 1,092,311 patients with available data regarding maternal BMI and mode of delivery. The CD rates for underweight (<18.5), normal weight (18.5-<25), overweight (25-<30), obese class I (30-<35), obese class II (35-<40), and obese class III (≥40) women increased from 14.4%, 16.1%, 19.5%, 22.3%, 25%, and 26.9% in the year 1990 to 27.9%, 31.4%, 38.8%, 45.1%, 50.2%, and 55.2% in the year 2012, respectively (P<0.001).
Maternal BMI in early pregnancy is linearly associated with the incidence of CD. We found a disproportionate increase of CD in morbidly obese women compared with the CD incidence in the reference BMI population over the past two decades.
孕妇肥胖是剖宫产（CD）的一个危险因素。本分析的目的是确定孕早期体重指数（BMI）与过去二十年剖宫产率之间的关联。
我们回顾性分析了1990年至2012年德国黑森州单胎分娩围产期质量登记处的数据。我们根据世界卫生组织的BMI标准将患者分为以下几组：体重过轻（<18.5）、正常体重（18.5 - <25）、超重（25 - <30）、肥胖I级（30 - <35）、肥胖II级（35 - <40）和肥胖III级（≥40）。
该分析纳入了1,092,311例有产妇BMI和分娩方式相关可用数据的患者。体重过轻（<18.5）、正常体重（18.5 - <25）、超重（25 - <30）、肥胖I级（30 - <35）、肥胖II级（35 - <40）和肥胖III级（≥40）女性的剖宫产率分别从1990年的14.4%、16.1%、19.5%、22.3%、25%和26.9%上升至2012年的27.9%、31.4%、38.8%、45.1%、50.2%和55.2%（P<0.001）。
孕早期产妇BMI与剖宫产发生率呈线性相关。我们发现，在过去二十年中，与参考BMI人群的剖宫产发生率相比，病态肥胖女性的剖宫产率增加幅度不成比例。
