Khanolkar Amal R, Hanley Gillian E, Koupil Ilona, Janssen Patricia A
Centre for Health Equity Studies (CHESS), Stockholm University, Stockholm, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Ethn Health. 2020 Jan;25(1):110-125. doi: 10.1080/13557858.2017.1398312. Epub 2017 Nov 13.
To determine whether the Institute Of Medicine's (IOM) 2009 guidelines for weight-gain during pregnancy are predictive of maternal and infant outcomes in ethnic minority populations. We designed a population-based study using administrative data on 181,948 women who delivered live singleton births in Washington State between 2006-2008. We examined risks of gestational hypertension, preeclampsia/eclampsia, cesarean delivery, and extended hospital stay in White, Black, Native-American, East-Asian, Hispanic, South-Asian and Hawaiian/Pacific islander women according to whether they gained more or less weight during pregnancy than recommended by IOM guidelines. We also examined risks of neonatal outcomes including Apgar score <7 at 5 min, admission to NICU, requirement for ventilation, and a diagnosis of small or large for gestational age at birth. Gaining too much weight was associated with increased odds for gestational hypertension (adjusted OR (aOR) ranged between 1.53-2.22), preeclampsia/eclampsia (aOR 1.44-1.81), cesarean delivery (aOR 1.07-1.38) and extended hospital stay (aOR 1.06-1.28) in all ethnic groups. Gaining too little weight was associated with decreased odds for gestational hypertension and delivery by cesarean section in Whites, Blacks and Hispanics. Gaining less weight or more weight than recommended was associated with increased odds for small for gestational age and large for gestational age infants respectively, in all ethnic groups. Adherence to the 2009 IOM guidelines for weight gain during pregnancy reduces risk for various adverse maternal outcomes in all ethnic groups studied. However, the guidelines were less predictive of infant outcomes with the exception of small and large for gestational age. GWG: Gestational weight gain; IOM/NRC; Institute of Medicine and National Research Council; NICU: Neonatal intensive care need for ventilation; SGA: Small for gestational age; LGA: Large for gestational age; BERD: Birth Events Records Database; CHARS: Comprehensive Hospital Discharge Abstract Reporting System; ICD: International Classification of Disease; LMP: Last menstrual period; OR: Odds ratio.
为确定美国医学研究所（IOM）2009年关于孕期体重增加的指南是否能预测少数族裔人群的母婴结局。我们设计了一项基于人群的研究，使用了2006 - 2008年期间在华盛顿州分娩单胎活产的181,948名妇女的管理数据。我们根据白人、黑人、美洲原住民、东亚人、西班牙裔、南亚人和夏威夷/太平洋岛民妇女孕期体重增加是否多于或少于IOM指南推荐量，研究了她们患妊娠期高血压、先兆子痫/子痫、剖宫产以及延长住院时间的风险。我们还研究了新生儿结局的风险，包括出生后5分钟阿氏评分<7、入住新生儿重症监护病房、需要通气以及出生时诊断为小于胎龄儿或大于胎龄儿。体重增加过多与所有种族中妊娠期高血压（调整后的比值比（aOR）在1.53 - 2.22之间）、先兆子痫/子痫（aOR为1.44 - 1.81）、剖宫产（aOR为1.07 - 1.38）和延长住院时间（aOR为1.06 - 1.28）的几率增加相关。体重增加过少与白人、黑人和西班牙裔中妊娠期高血压和剖宫产的几率降低相关。在所有种族中，体重增加少于或多于推荐量分别与小于胎龄儿和大于胎龄儿的几率增加相关。遵循2009年IOM关于孕期体重增加的指南可降低所有研究种族中各种不良母体结局的风险。然而，除了小于胎龄儿和大于胎龄儿外，该指南对婴儿结局的预测性较差。GWG：孕期体重增加；IOM/NRC：美国医学研究所和国家研究委员会；NICU：新生儿重症监护，需要通气；SGA：小于胎龄儿；LGA：大于胎龄儿；BERD：出生事件记录数据库；CHARS：综合医院出院摘要报告系统；ICD：国际疾病分类；LMP：末次月经；OR：比值比。
