Tanaka Kei, Matsushima Miho, Izawa Tomoko, Furukawa Seishi, Kobayashi Yoichi, Iwashita Mitsutoshi
Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan.
J Obstet Gynaecol Res. 2018 Apr;44(4):691-696. doi: 10.1111/jog.13575. Epub 2018 Jan 18.
We aimed to examine the influence of maternal obesity on fetal growth in utero at different periods of pregnancies with normal glucose tolerance.
A retrospective cohort study on 356 pregnant women with normal glucose tolerance was conducted. The women were categorized by pre-pregnancy body mass index (BMI) as obese (OB; BMI ≥ 25.0 kg/m ) or non-obese (n-OB). Z-scores of the fetal abdominal circumference (AC) and the rate of fetal macrosomia (AC ≥ 90th percentile) at 19, 30, and 36 gestational weeks (GW) were compared between the two groups. Maternal demographics (age, parity, height, pre-pregnancy BMI, history of prior large-for-gestational-age delivery) were compared between the pregnancies with and without fetal macrosomia at each gestational age. Multiple logistic regression analysis was performed to determine the independent risk factors for fetal macrosomia.
Birthweights of the neonates were significantly higher in the OB group. Z-scores of the fetal AC were significantly higher in the OB group at 30 and 36 GW, while no significant difference was found at 19 GW. The rates of fetal macrosomia in the OB group were also higher at 30 and 36 GW, while maternal obesity was not associated with fetal macrosomia at 19 GW. Pre-pregnancy BMI was detected as the independent predictor of fetal macrosomia at 30 GW (odds ratio, 1.19 [95% CI]) and 36 GW (odds ratio, 1.13 [95% CI]).
Maternal pre-pregnancy obesity has a promoting effect on fetal growth from the third trimester through birth.
我们旨在研究孕期糖耐量正常情况下，母亲肥胖对不同孕期胎儿宫内生长的影响。
对356例糖耐量正常的孕妇进行回顾性队列研究。根据孕前体重指数（BMI）将这些女性分为肥胖组（OB；BMI≥25.0kg/m²）和非肥胖组（n-OB）。比较两组在孕19周、30周和36周时胎儿腹围（AC）的Z评分及巨大儿发生率（AC≥第90百分位数）。比较各孕周有和没有巨大儿的孕妇的母亲人口统计学特征（年龄、产次、身高、孕前BMI、既往大于胎龄儿分娩史）。进行多因素logistic回归分析以确定巨大儿的独立危险因素。
OB组新生儿出生体重显著更高。OB组在孕30周和36周时胎儿AC的Z评分显著更高，而在孕19周时未发现显著差异。OB组在孕30周和36周时巨大儿发生率也更高，而母亲肥胖与孕19周时的巨大儿无关。孕前BMI被检测为孕30周（比值比，1.19[95%CI]）和孕36周（比值比，1.13[95%CI]）时巨大儿的独立预测因素。
母亲孕前肥胖对胎儿从孕晚期到出生的生长有促进作用。
