Maier Josefine Theresia, Schalinski Elisabeth, Gauger Ulrich, Hellmeyer Lars
J Perinat Med. 2016 May 1;44(4):397-404. doi: 10.1515/jpm-2015-0172.
Overweight and obesity is a serious health risk in both developed and developing nations. It is a common finding among women in their reproductive age. Half of patients entering their pregnancy in the US have a BMI >25.0 and therefore qualify as overweight or obese. Moreover, there is a tendency towards increased weight gain during pregnancy. Studies have shown that gestational overweight is associated with complications in pregnancy and birthing as well as short-term and long-term impacts on neonatal outcome in childhood and adulthood.
Five hundred and ninety-one women visiting our tertiary perinatal center in 2014 were analyzed for antenatal BMI, gestational weight gain, as well as pregnancy outcome and complication together with neonatal weight and outcome. Pregnancy weight gain was assessed based on the IOM guidelines (Institute of Medicine) issued in 2009.
Twenty-nine percent of our population was overweight with a BMI of more than 25.0. The general weight gain was in every BMI group similar (median ranging from 12.0 to 14.0 kg). Approximately one third gained more than the appropriate amount (37%, P<0.001). Women with more gestational weight were at risk of labor induction (55.0% vs. 45.7% labor induction in total, P=0.007). Strikingly, those patients were found to have significantly higher rates of secondary cesarean section (22.4% vs. 15.4%) and decreased chances of spontaneous vaginal birth (57.5% vs. 61.4%) (P=0.008). Furthermore women with a pregnancy weight gain in excess of the guidelines gave birth to neonates with a higher birth weight (>75.centile, 28.3% vs. 21.3%, P<0.001).
Altogether, one third of the analyzed population is already overweight or obese when entering pregnancy. A higher gestational weight gain than the recommended amount was found in 37% of cases. We found an association with pregnancy and birthing complications as well as higher infant weight. This highlights the importance of preconceptive and prenatal advice, and if necessary, intervention on BMI and weight gain.
超重和肥胖在发达国家和发展中国家都是严重的健康风险。这在育龄女性中很常见。在美国，一半怀孕的女性BMI>25.0，因此属于超重或肥胖。此外，孕期体重有增加的趋势。研究表明，孕期超重与妊娠和分娩并发症以及对儿童期和成年期新生儿结局的短期和长期影响有关。
对2014年访问我们三级围产期中心的591名女性进行分析，包括产前BMI、孕期体重增加、妊娠结局和并发症以及新生儿体重和结局。根据2009年发布的美国医学研究所（IOM）指南评估孕期体重增加情况。
我们研究人群中有29%超重，BMI超过25.0。每个BMI组的总体体重增加相似（中位数在12.0至14.0千克之间）。约三分之一的人体重增加超过适当量（37%，P<0.001）。孕期体重增加较多的女性有引产风险（引产率分别为55.0%和45.7%，P=0.007）。引人注目的是，这些患者的二次剖宫产率显著更高（分别为22.4%和15.4%），自然阴道分娩的几率降低（分别为57.5%和61.4%）（P=0.008）。此外，孕期体重增加超过指南的女性所生新生儿出生体重较高（>第75百分位数，分别为28.3%和21.3%，P<0.001）。
总体而言，三分之一的分析人群在怀孕时就已经超重或肥胖。37%的病例中孕期体重增加高于推荐量。我们发现其与妊娠和分娩并发症以及较高的婴儿体重有关。这凸显了孕前和产前咨询的重要性，以及必要时对BMI和体重增加进行干预的重要性。
