Feresu Shingairai A, Wang Yi, Dickinson Stephanie
Epidemiology and Biostatistics Track, School of Health Systems and Public Health, University of Pretoria, 5-10 H.W. Snyman Building, 31 Bophelo Road, Gezina, 0031, Pretoria, South Africa.
School of Health Sciences, College of Health Sciences, Walden University, 155 Fifth Ave. South, Suite 100, Minneapolis, MN, 55401, USA.
BMC Pregnancy Childbirth. 2015 Oct 16;15:266. doi: 10.1186/s12884-015-0696-8.
Obesity is a serious medical condition affecting more than 30% of Indiana, and 25% of Unites States pregnant women. Obesity is related to maternal complications, and significantly impacts the health of pregnant women. The objective of this study was to describe the relationship between maternal complications and pre-pregnancy maternal weight.
Using logistic regression models, we analyzed 2008 to 2010 birth certificate data, for 255,773 live births abstracted from the Indiana Vital Statistics registry. We examined the risk of reproductive factors, obstetrical complications and perinatal (intrapartum) complications for underweight, healthy weight, overweight and obese women for this population.
Women who received prenatal care were more likely to be obese [adjusted odds ratio (AOR) = 1.82 (1.56-2.13)]. While women with parity of zero (0) were less likely to be obese [AOR = 0.89, 95% CI (0.86-0.91)]. Women giving birth to twins [AOR = 1.25, 95% CI (1.17- 1.33)], women delivering by Caesarian section [AOR = 2.31, 95% CI ( 2.26-2.37)], and women who previously had a Caesarian section [AOR = 1.95, 95% CI (1.88-2.02)] were more likely to be obese. There was evidence of metabolic like complication in this population, due to obesity. Obesity was significantly associated with obstetrical conditions of the metabolic syndrome, including pre-pregnancy diabetes, gestational diabetes, pre-pregnancy hypertension, pregnancy-induced hypertension and eclampsia [AOR = 5.12, 95% CI (4.47-5.85); AOR = 3.87, 95% CI (3.68-4.08); AOR = 7.66, 95% CI (6.77-8.65); AOR = 3.23, 95% CI (3.07-3.39); and AOR = 1.77, 95% CI (1.31-2.40), respectively. Maternal obesity modestly increased the risk of induction, epidural, post-delivery bleeding, and prolonged labor [AOR = 1.26, 95% CI (1.23-1.29); AOR = 1.15, 95% CI (1.13-1.18); AOR = 1.20, 95% CI (1.12-1.28); and AOR = 1.44, 95% CI (1.30-1.61)], respectively. Obese women were less likely to have blood transfusions [AOR = .74, 95% CI (0.58-96)], vaginal tears [AOR = 0.51, 95% CI (0.44-0.59)], or infections [AOR = 86, 95% CI (0.80-0.93)].
Our results suggest that maternal obesity in Indiana, like other populations in the USA, is associated with high risks of maternal complications for pregnant women. Pre-pregnancy obesity prevention efforts should focus on targeting children, adolescent and young women, if the goal to reduce the risk of maternal complications related to obesity, is to be reached.
肥胖是一种严重的医学状况，影响着超过30%的印第安纳州人以及25%的美国孕妇。肥胖与孕产妇并发症相关，并对孕妇的健康产生重大影响。本研究的目的是描述孕产妇并发症与孕前体重之间的关系。
我们使用逻辑回归模型，分析了从印第安纳州生命统计登记处提取的2008年至2010年的255,773例活产出生证明数据。我们研究了该人群中体重过轻、健康体重、超重和肥胖女性的生殖因素、产科并发症和围产期（分娩期）并发症的风险。
接受产前护理的女性更有可能肥胖[调整后的优势比（AOR）= 1.82（1.56 - 2.13）]。而未生育过（0胎次）的女性肥胖的可能性较小[AOR = 0.89，95%置信区间（0.86 - 0.91）]。生育双胞胎的女性[AOR = 1.25，95%置信区间（1.17 - 1.33）]、剖宫产分娩的女性[AOR = 2.31，95%置信区间（2.26 - 2.37）]以及既往有剖宫产史的女性[AOR = 1.95，95%置信区间（1.88 - 2.02）]更有可能肥胖。有证据表明该人群中存在因肥胖导致的类似代谢性的并发症。肥胖与代谢综合征的产科情况显著相关，包括孕前糖尿病、妊娠期糖尿病、孕前高血压、妊娠高血压和子痫[AOR分别为5.12，95%置信区间（4.47 - 5.85）；AOR为3.87，95%置信区间（3.68 - 4.08）；AOR为7.66，95%置信区间（6.77 - 8.65）；AOR为3.23，95%置信区间（3.07 - 3.39）；以及AOR为1.77，95%置信区间（1.31 - 2.40）]。孕产妇肥胖适度增加了引产、硬膜外麻醉、产后出血和产程延长的风险[AOR分别为1.26，95%置信区间（1.23 - 1.29）；AOR为1.15，95%置信区间（1.13 - 1.18）；AOR为1.20，95%置信区间（1.12 - 1.28）；以及AOR为1.44，95%置信区间（1.30 - 1.61）]。肥胖女性输血[AOR = 0.74，95%置信区间（0.58 - 0.96）]、发生阴道撕裂[AOR = 0.51，95%置信区间（0.44 - 0.59）]或感染[AOR = 0.86，95%置信区间（0.80 - 0.93）]的可能性较小。
我们的结果表明，印第安纳州的孕产妇肥胖与美国其他人群一样，与孕妇发生孕产妇并发症的高风险相关。如果要实现降低与肥胖相关的孕产妇并发症风险的目标，孕前肥胖预防工作应侧重于针对儿童、青少年和年轻女性。
