Wallace Jacqueline M, Bhattacharya Sohinee, Horgan Graham W
Rowett Institute, University of Aberdeen, Aberdeen, Scotland, United Kingdom.
Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom.
PLoS One. 2017 Jun 19;12(6):e0179589. doi: 10.1371/journal.pone.0179589. eCollection 2017.
Weight-change across parities and/or current BMI may influence maternal and fetal morbidity and requires to be differentiated to better inform weight-management guidance.
Direction, pattern and magnitude of weight-change across three consecutive parities and thereby two inter-pregnancy periods was described in 5079 women. The association between inter-pregnancy weight-change versus current BMI and adverse maternal events, SGA-birth and preterm delivery at second and third pregnancy were investigated by logistic regression.
More women gained weight across the defined childbearing period than lost it, with ~35% of normal and overweight women gaining sufficient weight to move up a BMI-category. Nine patterns of weight-change were defined across two inter-pregnancy periods and 50% of women remained weight-stable throughout (within 2BMI units/period). Women who were overweight/obese at first pregnancy had higher risk of substantial weight-gain and loss (>10kg) during each of two inter-pregnancy periods. Inter-pregnancy weight-gain (> 2BMI units) between first and second pregnancy increased the risk of maternal morbidity (1or more event of hypertensive disease, caesarean-section, thromboembolism) at second pregnancy, while weight-loss (>2BMI units) increased the risk of SGA-birth. Similarly, increased risk of maternal morbidity at the third pregnancy was influenced by weight-gain during both inter-pregnancy periods but not by current BMI-category. Both weight-gain between first and second pregnancy, and being overweight/obese by third pregnancy protected the fetus against SGA-birth whereas weight-loss between second and third pregnancy doubled the SGA risk.
Half the women studied exhibited significant weight-fluctuations. This influenced their risk of maternal morbidity and SGA-birth at second and third pregnancy.
不同胎次间的体重变化和/或当前体重指数（BMI）可能会影响孕产妇和胎儿的发病率，需要进行区分以更好地为体重管理指导提供信息。
描述了5079名女性在连续三个胎次间的体重变化方向、模式和幅度，从而涉及两个孕期之间的情况。通过逻辑回归研究孕期体重变化与当前BMI和不良孕产妇事件、小于胎龄儿出生以及第二和第三次怀孕时早产之间的关联。
在规定的生育期内体重增加的女性多于体重减轻的女性，约35%的正常体重和超重女性体重增加足以使BMI类别上升。在两个孕期之间定义了九种体重变化模式，50%的女性在整个过程中体重保持稳定（每阶段BMI变化在2个单位以内）。首次怀孕时超重/肥胖的女性在两个孕期中的每一个期间体重大幅增加和减少（>10kg）的风险更高。第一次和第二次怀孕之间的孕期体重增加（>2个BMI单位）会增加第二次怀孕时孕产妇发病的风险（1次或更多次高血压疾病、剖宫产、血栓栓塞事件），而体重减轻（>2个BMI单位）会增加小于胎龄儿出生的风险。同样，第三次怀孕时孕产妇发病风险的增加受两个孕期体重增加的影响，但不受当前BMI类别的影响。第一次和第二次怀孕之间的体重增加以及第三次怀孕时超重/肥胖都能保护胎儿免于小于胎龄儿出生，而第二次和第三次怀孕之间的体重减轻会使小于胎龄儿风险加倍。
所研究的女性中有一半表现出显著的体重波动。这影响了她们在第二次和第三次怀孕时孕产妇发病和小于胎龄儿出生的风险。
