Barton John R, Joy Saju D, Rhea Debbie J, Sibai Amanda J, Sibai Baha M
Perinatal Diagnostic Center, Baptist Health Lexington, Lexington, Kentucky.
Department of Maternal-Fetal Medicine, Carolinas Medical Center, Charlotte, North Carolina.
Am J Perinatol. 2015 Jun;32(7):615-20. doi: 10.1055/s-0034-1386634. Epub 2014 Dec 8.
The objective of this study was to examine the influence of gestational weight gain on the development of gestational hypertension/preeclampsia (GHTN/PE) in women with an obese prepregnancy body mass index (BMI).
Obese women with a singleton pregnancy enrolled at < 20 weeks were studied. Data were classified according to reported gestational weight gain (losing weight, under-gaining, within target, and over-gaining) from the recommended range of 11 to 9.7 kg and by obesity class (class 1 = BMI 30-34.9 kg/m(2), class 2 = 35-39.9 kg/m(2), class 3 = 40-49.9 kg/m(2), and class 4 ≥ 50 kg/m(2)). Rates of GHTN/PE were compared by weight gain group overall and within obesity class using Pearson chi-square statistics.
For the 27,898 obese women studied, rates of GHTN/PE increased with increasing class of obesity (15.2% for class 1 and 32.0% for class 4). The incidence of GHTN/PE in obese women was not modified with weight loss or weight gain below recommended levels. Overall for obese women, over-gaining weight was associated with higher rates of GHTN/PE compared with those with a target rate for obesity classes 1 to 3 (each p < 0.001).
Below recommended gestational weight gain did not reduce the risk for GHTN/PE in women with an obese prepregnancy BMI. These data support a gestational weight gain goal ≤ 9.7 kg in obese gravidas.
本研究的目的是探讨孕前体重指数（BMI）肥胖的女性孕期体重增加对妊娠期高血压/子痫前期（GHTN/PE）发生发展的影响。
对孕20周前登记入组的单胎妊娠肥胖女性进行研究。根据报告的孕期体重增加情况（体重减轻、体重增加不足、体重增加在目标范围内、体重增加过多）将数据分类，体重增加情况依据11至9.7 kg的推荐范围划分，同时按照肥胖等级分类（1级=BMI 30 - 34.9 kg/m²，2级=35 - 39.9 kg/m²，3级=40 - 49.9 kg/m²，4级≥50 kg/m²）。使用Pearson卡方统计量比较总体体重增加组以及肥胖等级内GHTN/PE的发生率。
在研究的27898名肥胖女性中，GHTN/PE的发生率随肥胖等级的增加而升高（1级为15.2%，4级为32.0%）。肥胖女性中，体重减轻或体重增加低于推荐水平时，GHTN/PE的发生率并未改变。总体而言，与肥胖等级1至3中体重增加达到目标值的女性相比，肥胖女性体重增加过多与更高的GHTN/PE发生率相关（各p<0.001）。
孕期体重增加低于推荐水平并未降低孕前BMI肥胖女性发生GHTN/PE的风险。这些数据支持肥胖孕妇的孕期体重增加目标≤9.7 kg。
