Siegel Anne M, Tita Alan T, Machemehl Hannah, Biggio Joseph R, Harper Lorie M
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama.
AJP Rep. 2017 Jul;7(3):e145-e150. doi: 10.1055/s-0037-1604076. Epub 2017 Jul 12.
To assess the impact of gestational weight gain (GWG) outside the Institute of Medicine (IOM) recommendations on perinatal outcomes in pregnancies complicated by chronic hypertension (HTN). The study consisted of a retrospective cohort of all singletons with HTN from 2000 to 2014. Maternal outcomes examined were superimposed preeclampsia and cesarean delivery. Neonatal outcomes were small for gestational age (SGA), large for gestational age (LGA), and preterm birth (PTB). Groups were compared using analysis of variance and chi-squared test for trend. Backward stepwise logistic regression was adjusted for confounding factors. Of 702 subjects, 106 (15.1%) gained within, 176 (25.0%) gained less, and 420 (59.8%) gained more weight than the IOM recommendations. After adjusting for confounders, GWG above IOM recommendations remained associated with LGA (adjusted odds ratio [AOR]: 2.53, confidence interval [CI] 95%:1.29-4.95). Weight gain less than recommended was associated with a decreased risk of superimposed preeclampsia (AOR: 0.49, CI 95%: 0.26-0.93) without increasing the risk of SGA (AOR: 1.03, CI 95%: 0.57-1.86). Women with pregnancies complicated by chronic HTN should be counseled regarding the association of LGA with excessive GWG. Additionally, they should be counseled that weight gain below recommendations may be associated with a decreased risk of superimposed preeclampsia; however, this association deserves further investigation.
评估妊娠体重增加（GWG）超出美国医学研究所（IOM）推荐范围对合并慢性高血压（HTN）妊娠的围产期结局的影响。 该研究为一项回顾性队列研究，纳入了2000年至2014年所有患有HTN的单胎妊娠。所检查的孕产妇结局为并发子痫前期和剖宫产。新生儿结局为小于胎龄儿（SGA）、大于胎龄儿（LGA）和早产（PTB）。采用方差分析和趋势卡方检验对各组进行比较。对混杂因素进行了向后逐步逻辑回归调整。 在702名受试者中，106名（15.1%）的体重增加在IOM推荐范围内，176名（25.0%）体重增加不足，420名（59.8%）体重增加超过IOM推荐范围。在对混杂因素进行调整后，超出IOM推荐范围的GWG仍与LGA相关（调整后的优势比[AOR]：2.53，95%置信区间[CI]：1.29 - 4.95）。体重增加低于推荐范围与并发子痫前期风险降低相关（AOR：0.49，95%CI：0.26 - 0.93），且未增加SGA风险（AOR：1.03，95%CI：0.57 - 1.86）。 对于合并慢性HTN妊娠的女性，应就LGA与过度GWG的关联给予咨询。此外，应告知她们体重增加低于推荐范围可能与并发子痫前期风险降低相关；然而，这种关联值得进一步研究。
