Denison Fiona C, MacGregor Heather, Stirrat Laura I, Stevenson Kerrie, Norman Jane E, Reynolds Rebecca M
Tommy's Centre for Maternal and Fetal Health, MRC, University of Edinburgh Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.
British Heart Foundation Centre for Cardiovascular Research, University of Edinburgh, Edinburgh, UK.
BMJ Open. 2017 Jun 21;7(5):e015218. doi: 10.1136/bmjopen-2016-015218.
To determine whether attendance at a specialised multidisciplinary antenatal clinic for women with class III obesity (BMI >40 kg/m) is associated with improved clinical outcomes compared with standard antenatal care.
Retrospective cohort study using routinely collected data from electronic patient record.
Community and hospital based antenatal care.
Women with a singleton pregnancy with class III obesity booked for antenatal care and delivered in one of two hospitals in NHS Lothian, Scotland, UK between 2008 and 2014. Maternal and offspring outcomes were compared in women who attended a specialised obesity clinic (n=511) compared with standard antenatal care (n=502).
Included stillbirth, low birth weight, gestational diabetes, induction of labour and caesarean section.
Compared with standard care, women receiving specialist care were less likely to have a stillbirth (OR 0.12, 95% CI 0.06 to 0.97) and a low birthweight baby (OR 0.57, 95% CI 0.33 to 0.99) and more likely to be screened for (100% vs 73.6%; p<0.001) and diagnosed with (26.0% vs 12.5%; p<0.001) gestational diabetes, to require induction of labour (38.4% vs 29.9%; p=0.009), an elective (20.3% vs 17.7%; p<0.001) and emergency (23.9% vs 20.3%; p<0.001) caesarean section and attend antenatal triage one or more times during pregnancy (77.7% vs 53.1%; p<0.001). Women attending the specialist clinic had a higher BMI (44.5 kg/m (4.3) vs 43.2 kg/m (3.1); p<0.001) and were more likely to be nulliparous (46.0% vs 24.9%; p<0.001). There were no other differences in maternal demographic or maternal and offspring outcomes between groups.
Attendance at a specialised antenatal clinic for obesity is associated with reduced rates of stillbirth and low birth weight and improved detection of gestational diabetes. The improvement in clinical outcomes is associated with an increase in healthcare attendance to obstetric triage and clinical interventions including induction of labour and caesarean section.
确定与标准产前护理相比，III级肥胖（BMI>40kg/m²）女性前往专门的多学科产前诊所就诊是否与更好的临床结局相关。
使用从电子病历中常规收集的数据进行回顾性队列研究。
基于社区和医院的产前护理。
2008年至2014年期间在英国苏格兰洛锡安国民保健服务体系的两家医院之一预约产前护理并分娩的单胎妊娠III级肥胖女性。将前往专门肥胖诊所就诊的女性（n = 511）与接受标准产前护理的女性（n = 502）的母婴结局进行比较。
包括死产、低出生体重、妊娠期糖尿病、引产和剖宫产。
与标准护理相比，接受专科护理的女性死产（比值比0.12，95%可信区间0.06至0.97）和低出生体重儿（比值比0.57，95%可信区间0.33至0.99）的可能性较小，接受妊娠期糖尿病筛查（100%对73.6%；p<0.001）和诊断为妊娠期糖尿病（26.0%对12.5%；p<0.001）的可能性较大，需要引产（38.4%对29.9%；p = 0.009）、择期剖宫产（20.3%对17.7%；p<0.001）和急诊剖宫产（23.9%对20.3%；p<0.001）以及在孕期前往产前分诊一次或多次（77.7%对53.1%；p<0.001）的可能性也较大。前往专科诊所就诊的女性BMI更高（44.5kg/m²（4.3）对43.2kg/m²（3.1）；p<0.001），且更可能为初产妇（46.0%对24.9%；p<0.001）。两组之间在产妇人口统计学特征或母婴结局方面没有其他差异。
前往专门的肥胖产前诊所就诊与死产率和低出生体重率降低以及妊娠期糖尿病检测改善相关。临床结局的改善与产科分诊医疗就诊次数增加以及包括引产和剖宫产在内的临床干预措施增加有关。
