Hawley Nicola L, Johnson William, Hart Chantelle N, Triche Elizabeth W, Ah Ching John, Muasau-Howard Bethel, McGarvey Stephen T
Department of Chronic Disease Epidemiology, School of Public Health, Yale University, P.O. Box 208034, New Haven, CT, 06520-8034, USA.
MRC Human Nutrition Research Unit, Cambridge, UK.
BMC Pregnancy Childbirth. 2015 Feb 3;15:10. doi: 10.1186/s12884-015-0451-1.
As obesity has increased worldwide, so have levels of obesity during pregnancy and excess gestational weight gain (GWG). The aim of this paper was to describe GWG among American Samoan women and examine the association between GWG and four adverse pregnancy and infant outcomes: cesarean delivery, small- and large-for-gestational age (SGA/LGA), and infant overweight/obesity.
Data were extracted from prenatal care records of 632 Samoan women. Mixed-effects growth models were used to produce individual weight-for-gestational week curves from which second and third trimester weight gain was estimated. Binary logistic regression was used to examine associations between GWG and the outcomes of interest.
Most women were overweight/obese in early pregnancy (86%) and 78% exceeded the Institute of Medicine GWG guidelines. Greater GWG in the second trimester and early pregnancy weight were independently associated with increased odds of a c-section (OR 1.40 [95% CI: 1.08, 1.83]) and OR 1.51 [95% CI: 1.17, 1.95], respectively). Risk of delivering a LGA infant increased with greater third trimester weight gain and higher early pregnancy weight, while second trimester weight gain was negatively associated with SGA. Risk of infant overweight/obesity at 12 months increased with early pregnancy weight (OR: 1.23 [95% CI: 1.01, 1.51]) and infant birthweight.
The high levels of pregnancy obesity and excessive GWG in American Samoa suggest that it is important for physicians to encourage women into prenatal care early and begin education about appropriate GWG and the potential risks of excess weight gain for both the mother and baby.
随着全球肥胖率的上升，孕期肥胖水平和孕期体重过度增加（GWG）也随之增加。本文旨在描述美属萨摩亚妇女的孕期体重增加情况，并研究孕期体重增加与四种不良妊娠和婴儿结局之间的关联：剖宫产、小于胎龄儿和大于胎龄儿（SGA/LGA）以及婴儿超重/肥胖。
从632名萨摩亚妇女的产前护理记录中提取数据。使用混合效应生长模型生成个体孕周体重曲线，据此估算孕中期和孕晚期的体重增加情况。采用二元逻辑回归分析孕期体重增加与感兴趣结局之间的关联。
大多数妇女在孕早期超重/肥胖（86%），78%的人超过了医学研究所的孕期体重增加指南。孕中期体重增加较多和孕早期体重与剖宫产几率增加独立相关（OR分别为1.40 [95% CI：1.08, 1.83]）和1.51 [95% CI：1.17, 1.95]）。孕晚期体重增加较多和孕早期体重较高会增加分娩大于胎龄儿的风险，而孕中期体重增加与小于胎龄儿呈负相关。婴儿12个月时超重/肥胖的风险随着孕早期体重（OR：1.23 [95% CI：1.01, 1.51]）和婴儿出生体重的增加而增加。
美属萨摩亚孕期肥胖和孕期体重过度增加的高水平表明，医生尽早鼓励妇女进行产前护理，并开始对适当的孕期体重增加以及母亲和婴儿体重过度增加的潜在风险进行教育非常重要。
