Dzakpasu Susie, Fahey John, Kirby Russell S, Tough Suzanne C, Chalmers Beverley, Heaman Maureen I, Bartholomew Sharon, Biringer Anne, Darling Elizabeth K, Lee Lily S, McDonald Sarah D
Maternal and Infant Health Section, Health Surveillance and Epidemiology Division, Public Health Agency of Canada, 785 Carling Avenue, 6804A 4th Floor, Ottawa, Ontario, K1A 0 K9, Canada.
Reproductive Care Program of Nova Scotia, Halifax, Nova Scotia, Canada.
BMC Pregnancy Childbirth. 2015 Feb 5;15:21. doi: 10.1186/s12884-015-0452-0.
Low or high prepregnancy body mass index (BMI) and inadequate or excess gestational weight gain (GWG) are associated with adverse neonatal outcomes. This study estimates the contribution of these risk factors to preterm births (PTBs), small-for-gestational age (SGA) and large-for-gestational age (LGA) births in Canada compared to the contribution of prenatal smoking, a recognized perinatal risk factor.
We analyzed data from the Canadian Maternity Experiences Survey. A sample of 5,930 women who had a singleton live birth in 2005-2006 was weighted to a nationally representative population of 71,200 women. From adjusted odds ratios, we calculated population attributable fractions to estimate the contribution of BMI, GWG and prenatal smoking to PTB, SGA and LGA infants overall and across four obstetric groups.
Overall, 6% of women were underweight (<18.5 kg/m(2)) and 34.4% were overweight or obese (≥25.0 kg/m(2)). More than half (59.4%) gained above the recommended weight for their BMI, 18.6% gained less than the recommended weight and 10.4% smoked prenatally. Excess GWG contributed more to adverse outcomes than BMI, contributing to 18.2% of PTB and 15.9% of LGA. Although the distribution of BMI and GWG was similar across obstetric groups, their impact was greater among primigravid women and multigravid women without a previous PTB or pregnancy loss. The contributions of BMI and GWG to PTB and SGA exceeded that of prenatal smoking.
Maternal weight, and GWG in particular, contributes significantly to the occurrence of adverse neonatal outcomes in Canada. Indeed, this contribution exceeds that of prenatal smoking for PTB and SGA, highlighting its public health importance.
孕前体重指数（BMI）过低或过高以及孕期体重增加（GWG）不足或过多均与不良新生儿结局相关。本研究评估了这些风险因素对加拿大早产（PTB）、小于胎龄儿（SGA）和大于胎龄儿（LGA）出生的影响，并与已确认的围产期风险因素——产前吸烟的影响进行比较。
我们分析了加拿大孕产妇经历调查的数据。对2005 - 2006年单胎活产的5930名女性样本进行加权处理，使其代表全国71200名女性的总体情况。根据调整后的比值比，我们计算了人群归因分数，以评估BMI、GWG和产前吸烟对总体以及四个产科组中PTB、SGA和LGA婴儿的影响。
总体而言，6%的女性体重过轻（<18.5 kg/m²），34.4%的女性超重或肥胖（≥25.0 kg/m²）。超过一半（59.4%）的女性孕期体重增加超过其BMI对应的推荐体重，18.6%的女性体重增加少于推荐体重，10.4%的女性产前吸烟。与BMI相比，GWG过多对不良结局的影响更大，导致18.2%的PTB和15.9%的LGA。尽管不同产科组中BMI和GWG的分布相似，但它们对初产妇和既往无PTB或流产史的经产妇的影响更大。BMI和GWG对PTB和SGA的影响超过产前吸烟。
母亲体重，尤其是GWG，对加拿大不良新生儿结局的发生有显著影响。事实上，对于PTB和SGA，这种影响超过了产前吸烟，凸显了其在公共卫生方面的重要性。
