Heslehurst N, Vieira R, Hayes L, Crowe L, Jones D, Robalino S, Slack E, Rankin J
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
Obes Rev. 2017 Mar;18(3):293-308. doi: 10.1111/obr.12489. Epub 2017 Jan 13.
Post-term birth is a preventable cause of perinatal mortality and severe morbidity. This review examined the association between maternal body mass index (BMI) and post-term birth at ≥42 and ≥41 weeks' gestation. Five databases, reference lists and citations were searched from May to November 2015. Observational studies published in English since 1990 were included. Linear and nonlinear dose-response meta-analyses were conducted by using random effects models. Sensitivity analyses assessed robustness of the results. Meta-regression and sub-group meta-analyses explored heterogeneity. Obesity classes were defined as I (30.0-34.9 kg m ), II (35.0-39.9 kg m ) and III (≥40 kg m ; IIIa 40.0-44.9 kg m , IIIb ≥ 45.0 kg m ). Searches identified 16,375 results, and 39 studies met the inclusion criteria (n = 4,143,700 births). A nonlinear association between maternal BMI and births ≥42 weeks was identified; odds ratios and 95% confidence intervals for obesity classes I-IIIb were 1.42 (1.27-1.58), 1.55 (1.37-1.75), 1.65 (1.44-1.87) and 1.75 (1.50-2.04) respectively. BMI was linearly associated with births ≥41 weeks: odds ratio is 1.13 (95% confidence interval 1.05-1.21) for each 5-unit increase in BMI. The strength of the association between BMI and post-term birth increases with increasing BMI. Odds are greatest for births ≥42 weeks among class III obesity. Targeted interventions to prevent the adverse outcomes associated with post-term birth should consider the difference in risk between obesity classes.
过期产是围产期死亡率和严重发病率的一个可预防原因。本综述研究了孕妇体重指数（BMI）与妊娠≥42周和≥41周时过期产之间的关联。2015年5月至11月检索了五个数据库、参考文献列表和引文。纳入自1990年以来以英文发表的观察性研究。使用随机效应模型进行线性和非线性剂量反应荟萃分析。敏感性分析评估结果的稳健性。荟萃回归和亚组荟萃分析探讨异质性。肥胖类别定义为I（30.0 - 34.9kg/m²）、II（35.0 - 39.9kg/m²）和III（≥40kg/m²；IIIa 40.0 - 44.9kg/m²，IIIb≥45.0kg/m²）。检索到16375条结果，39项研究符合纳入标准（n = 4143700例分娩）。确定孕妇BMI与≥42周分娩之间存在非线性关联；肥胖类别I - IIIb的比值比和95%置信区间分别为1.42（1.27 - 1.58）、1.55（1.37 - 1.75）、1.65（1.44 - 1.87）和1.75（1.50 - 2.04）。BMI与≥41周分娩呈线性关联：BMI每增加5个单位，比值比为1.13（95%置信区间1.05 - 1.21）。BMI与过期产之间关联的强度随BMI增加而增加。III级肥胖中≥42周分娩的几率最高。预防与过期产相关不良结局的针对性干预措施应考虑肥胖类别之间的风险差异。
