Edelson P Kaitlyn, Bastek Jamie A, Levine Lisa D
Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Am J Perinatol. 2016 Jul;33(9):839-43. doi: 10.1055/s-0036-1572541. Epub 2016 Mar 9.
Objectives Despite limited data, antenatal testing has been initiated in many institutions for women with morbid obesity given their increased risk of stillbirth. Therefore, our objective was to evaluate the obstetrical implications of antenatal testing in the morbidly obese population. Study Design We performed a retrospective cohort study of women undergoing antenatal testing from January 2011 through December 2012 who delivered at our institution. The exposed group was women undergoing antenatal testing with morbid obesity (body mass index [BMI] ≥ 40 kg/m(2)). This group was subdivided into two groups: group 1, which included women undergoing testing for morbid obesity alone, and group 2, which included women undergoing testing for morbid obesity with an additional medical comorbidity. The unexposed group (group 3) comprised nonmorbidly obese women (BMI < 35 kg/m(2)) undergoing antenatal testing for similar medical comorbidities. Our primary outcomes were induction of labor and gestational age at delivery. Results A total of 512 women met inclusion criteria. Group 1 had a lower induction rate as compared with groups 2 and 3 (22.2, 32.5, and 37.6%, respectively; p = 0.003). Additionally, women delivered at a later gestational age in group 1 (39.3 weeks [38.4-40.2]) compared with groups 2 (38.5 weeks [36.1-40.3]) or 3 (37.1 weeks [37.0-38.2]), p = 0.04. There were no significant differences in our secondary outcomes including rate of cesarean delivery (p = 0.11) or rate of nonreactive nonstress test (p = 0.4). Conclusions While it remains unknown whether antenatal testing decreases the stillbirth risk in morbidly obese women, this population does not appear to be at increased risk of induction of labor or delivery prior to 39 weeks secondary to testing. Future studies should evaluate neonatal implications and cost-effectiveness of antenatal testing in this group.
尽管数据有限，但鉴于死产风险增加，许多机构已开始对病态肥胖女性进行产前检查。因此，我们的目的是评估产前检查对病态肥胖人群的产科影响。研究设计：我们对2011年1月至2012年12月在本院分娩且接受产前检查的女性进行了一项回顾性队列研究。暴露组为患有病态肥胖（体重指数[BMI]≥40kg/m²）且接受产前检查的女性。该组又分为两组：第1组，仅包括因病态肥胖接受检查的女性；第2组，包括因病态肥胖且伴有其他内科合并症而接受检查的女性。未暴露组（第3组）包括因类似内科合并症接受产前检查的非病态肥胖女性（BMI＜35kg/m²）。我们的主要结局是引产和分娩时的孕周。结果：共有512名女性符合纳入标准。与第2组和第3组相比，第1组的引产率较低（分别为22.2%、32.5%和37.6%；p = 0.003）。此外，与第2组（38.5周[36.1 - 40.3]）或第3组（37.1周[37.0 - 38.2]）相比，第1组女性的分娩孕周较晚（39.3周[38.4 - 40.2]），p = 0.04。我们的次要结局包括剖宫产率（p = 0.11）或无反应型无应激试验率（p = 0.4），均无显著差异。结论：虽然产前检查是否能降低病态肥胖女性的死产风险尚不清楚，但该人群似乎不会因检查而增加引产或在39周前分娩的风险。未来的研究应评估该组产前检查对新生儿的影响及成本效益。
