McBain Rosemary D, Dekker Gustaaf A, Clifton Vicki L, Mol Ben W, Grzeskowiak Luke E
Lyell McEwin Hospital, Elizabeth Vale, SA, Australia; School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.
Lyell McEwin Hospital, Elizabeth Vale, SA, Australia; School of Paediatrics and Reproductive Health, The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.
Eur J Obstet Gynecol Reprod Biol. 2016 Oct;205:98-104. doi: 10.1016/j.ejogrb.2016.07.487. Epub 2016 Aug 3.
To examine the patterns and predictors of inter-pregnancy body mass index (BMI) change and its impact on perinatal outcomes in the second pregnancy.
Retrospective cohort study.
Tertiary teaching hospital in Adelaide, Australia.
Women with their first and second consecutive, singleton deliveries occurring between 2000 and 2012 (N=5371).
Inter-pregnancy weight change calculated based on difference between BMI at respective antenatal booking visits. Association between inter-pregnancy weight change and perinatal outcomes investigated using multivariate generalised linear models, with stratification according to initial maternal BMI category in first pregnancy.
Gestational diabetes (GDM); pregnancy induced hypertensive disorders; small-for-gestational age (SGA); preterm birth; large-for-gestational age (LGA) and macrosomia (>4500g).
On average, women with a normal BMI gained 1kg/m(2) between first and second pregnancies, while women who were overweight or obese gained 1.37kg/m(2). Among women with a normal BMI in their first pregnancy, a BMI increase of ≥4kg/m(2) was associated with increased risk of developing GDM (aRR 1.97; 95% CI 1.22-3.19), a macrosomic (aRR 4.06; 95% CI 2.25-7.34) or LGA infant (aRR 1.31 0.96-1.78) in the second pregnancy, while a reduction in BMI (≤-2kg/m(2)) was associated with an increased risk of SGA (aRR 1.94; 1.19-3.16). Among women who were overweight or obese in their first pregnancy, a BMI increase of ≥2-4 and ≥4kg/m(2) was associated with increased risks of developing GDM in the second pregnancy (aRR 1.39; 95% CI 1.01-1.91 and aRR 1.64 95% CI 1.16-2.31; ptrend<0.001), while no associations were observed for a BMI increase and risk of a macrosomic, SGA, or LGA infant. In contrast, reduction in BMI (≤-2kg/m(2)) was associated with a reduced risk of GDM (aRR 0.58 95% CI 0.37-0.90) and SGA (aRR 0.47; 95% CI 0.25-0.87).
Increases in BMI between pregnancies is associated with an increased risk for perinatal complications, even in normal-weight women, while a reduction in BMI is associated with improved perinatal outcomes among women who are overweight/obese. Inter-pregnancy weight control is an important target to reduce the risk of an adverse perinatal outcome in a subsequent pregnancy.
研究两次妊娠期间体重指数（BMI）变化的模式和预测因素及其对第二次妊娠围产期结局的影响。
回顾性队列研究。
澳大利亚阿德莱德的三级教学医院。
2000年至2012年间连续进行首次和第二次单胎分娩的妇女（N = 5371）。
根据各次产前检查时的BMI差异计算两次妊娠期间的体重变化。使用多变量广义线性模型研究两次妊娠期间体重变化与围产期结局之间的关联，并根据首次妊娠时母亲的初始BMI类别进行分层。
妊娠期糖尿病（GDM）；妊娠高血压疾病；小于胎龄儿（SGA）；早产；大于胎龄儿（LGA）和巨大儿（>4500g）。
平均而言，BMI正常的妇女在第一次和第二次妊娠之间体重增加了1kg/m²，而超重或肥胖的妇女体重增加了1.37kg/m²。在首次妊娠BMI正常的妇女中，BMI增加≥4kg/m²与第二次妊娠发生GDM的风险增加相关（调整后相对危险度[aRR] 1.97；95%可信区间[CI] 1.22 - 3.19），与巨大儿（aRR 4.06；95% CI 2.25 - 7.34）或LGA婴儿（aRR 1.31，95% CI 0.96 - 1.78）的风险增加相关，而BMI降低（≤ - 2kg/m²）与SGA风险增加相关（aRR 1.94；95% CI 1.19 - 3.16）。在首次妊娠超重或肥胖的妇女中，BMI增加≥2 - 4kg/m²和≥4kg/m²与第二次妊娠发生GDM的风险增加相关（aRR 1.39；95% CI 1.01 - 1.91和aRR 1.64，95% CI 1.16 - 2.31；趋势P<0.001），而未观察到BMI增加与巨大儿、SGA或LGA婴儿风险之间的关联。相比之下，BMI降低（≤ - 2kg/m²）与GDM风险降低（aRR 0.58，95% CI 0.37 - 0.90）和SGA风险降低（aRR 0.47；95% CI 0.25 - 0.87）相关。
即使是体重正常的妇女，两次妊娠期间BMI增加也与围产期并发症风险增加相关，而BMI降低与超重/肥胖妇女围产期结局改善相关。两次妊娠期间的体重控制是降低后续妊娠不良围产期结局风险的重要目标。
