健康体检者研究（HEXA）中18 - 20岁时的体重指数与后期自然流产风险
Body mass index at age 18-20 and later risk of spontaneous abortion in the Health Examinees Study (HEXA).
作者信息
Jung Sun Jae, Park Sue Kyung, Shin Aesun, Lee Sang-Ah, Choi Ji-Yeob, Hong Yun-Chul, Yoo Keun-Young, Lee Jong-Koo, Kang Daehee
机构信息
Department of Biomedical Science, Seoul National University College of Medicine, Seoul, South Korea.
Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.
出版信息
BMC Pregnancy Childbirth. 2015 Sep 24;15:228. doi: 10.1186/s12884-015-0665-2.
BACKGROUND
Spontaneous abortion (SA) affects 11.2% of recognized pregnancies in Korea. Many studies have focused on the increased risk of SA in obese populations, but there are few studies that have focused on underweight (Body mass index (BMI) <18.5 kg/m2) women, especially in relation to pre-pregnancy BMI. The aim of this study was to examine the role of pre-pregnancy BMI at age 18-20 in later SA.
METHODS
Among the women who were ever pregnant in the Health Examinees Study (HEXA), which was one of the cohorts studied in the KoGES (Korean Genome and Epidemiology Study) from 2004 to 2012 (N = 80,447), the likelihood of SA based on pre-pregnancy BMI, classified by the criteria for Asians (Underweight: <18.5 kg/m2; Normal range: 18.5-22.9 kg/m2; Overweight at risk: 23-24.9 kg/m2; Obese I: 25-29.9 kg/m2; Obese II: ≥30 kg/m2), was presented as odds ratios (ORs) and 95% confidence intervals (95% CIs) using logistic regression models.
RESULTS
Being underweight or obese relative to the normal weight range was associated with a higher likelihood of SA (OR = 1.10 [95% CI = 1.05-1.15] in underweight women and OR = 1.06 [95% CI = 0.96-1.16] in obese women), and this effect was much greater in women who experienced recurrent SAs (for three or more SAs: OR = 1.29 [95% CI 1.14-1.46] in underweight women and OR = 1.39 [95% CI 1.09-1.78] in obese women). Obesity was associated with an increased likelihood of SA at a younger age (≤25 years), whereas underweight was associated with an increased OR of SA at an older age (≥26 years).
DISCUSSION
As this study was conducted with baseline data of original cohort which focused on other chronic diseases, recall for previous pregnancy-related information might be less accurate. However, this study shows strength in its large size and prospective potential.
CONCLUSIONS
Pre-pregnancy BMI at ages 18-20 years revealed a U-shaped association with SA, and underweight and obese women showed increased likelihood for SA during different age periods.
背景
在韩国，自然流产（SA）影响着11.2%已确认的妊娠。许多研究聚焦于肥胖人群中自然流产风险的增加，但很少有研究关注体重过轻（体重指数（BMI）<18.5 kg/m²）的女性，尤其是与孕前BMI相关的情况。本研究的目的是探讨18 - 20岁时的孕前BMI在后期自然流产中的作用。
方法
在2004年至2012年韩国基因组与流行病学研究（KoGES）中所研究的队列之一健康体检者研究（HEXA）中曾怀孕的女性中（N = 80,447），根据亚洲人的标准对孕前BMI进行分类（体重过轻：<18.5 kg/m²；正常范围：18.5 - 22.9 kg/m²；有超重风险：23 - 24.9 kg/m²；肥胖I级：25 - 29.9 kg/m²；肥胖II级：≥30 kg/m²），使用逻辑回归模型将自然流产的可能性表示为比值比（OR）和95%置信区间（95% CI）。
结果
相对于正常体重范围，体重过轻或肥胖与自然流产的可能性较高相关（体重过轻女性的OR = 1.10 [95% CI = 1.05 - 1.15]，肥胖女性为OR = 1.06 [95% CI = 0.96 - 1.16]），并且这种影响在经历复发性自然流产的女性中更大（三次或更多次自然流产：体重过轻女性的OR = 1.29 [95% CI 1.14 - 1.46]，肥胖女性为OR = 1.39 [95% CI 1.09 - 1.78]）。肥胖与较年轻年龄（≤25岁）时自然流产的可能性增加相关，而体重过轻与较年长年龄（≥26岁）时自然流产的OR增加相关。
讨论
由于本研究是基于关注其他慢性疾病的原始队列的基线数据进行的，对既往妊娠相关信息的回忆可能不太准确。然而，本研究在样本量大和具有前瞻性潜力方面具有优势。
结论
18 - 20岁时的孕前BMI与自然流产呈U形关联，体重过轻和肥胖女性在不同年龄阶段自然流产的可能性增加。
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