Royal Prince Alfred Hospital, Sydney, NSW
Sydney School of Public Health, University of Sydney, Sydney, NSW.
Med J Aust. 2018 Feb 19;208(3):119-125. doi: 10.5694/mja17.00344.
To examine the prevalence across 25 years of overweight and obesity among nulliparous Australian women during early pregnancy; to estimate the proportions of adverse perinatal outcomes attributable to overweight and obesity in this population.
Cohort study; retrospective analysis of electronic maternity data. Setting, participants: 42 582 nulliparous women with singleton pregnancies giving birth at the Royal Prince Alfred Hospital, an urban teaching hospital in Sydney, January 1990 - December 2014.
Maternal body mass index (BMI), socio-demographic characteristics, and selected maternal, birth and neonatal outcomes; the proportion of adverse perinatal outcomes that could be averted by reducing the prevalence of overweight and obesity in women prior to first pregnancies (population attributable fraction, PAF).
The prevalence of overweight among nulliparous pregnant women increased from 12.7% (1990-1994) to 16.4% (2010-2014); the prevalence of obesity rose from 4.8% to 7.3% in the same period, while the proportion with normal range BMIs fell from 73.5% to 68.2%. The PAFs for key adverse maternal and neonatal outcomes increased across the study period; during 2010-2014, 23.8% of pre-eclampsia, 23.4% of fetal macrosomia, and 17.0% of gestational diabetes were attributable to overweight and obesity. Were overweight and obese women to have moved down one BMI category during 2010-2014, 19% of pre-eclampsia, 15.9% of macrosomia, 14.2% of gestational diabetes, 8.5% of caesarean deliveries, 7.1% of low for gestational age birthweight, 6.8% of post partum haemorrhage, 6.5% of admissions to special care nursery, 5.8% of prematurity, and 3.8% of fetal abnormality could have been averted.
Over the past 25 years, the proportions of adverse perinatal outcomes attributable to overweight and obesity have risen with the increasing prevalence of maternal overweight and obesity. A substantial proportion of these outcomes might be averted with obesity prevention strategies that reduce pre-pregnancy maternal weight.
调查 25 年来澳大利亚初产妇孕期超重和肥胖的流行情况；估计该人群中超重和肥胖导致的不良围产期结局的比例。
队列研究；对电子产妇数据的回顾性分析。地点、参与者：1990 年 1 月至 2014 年 12 月在悉尼城市教学医院皇家阿尔弗雷德王子医院分娩的 42582 名初产妇单胎妊娠。
母体体重指数（BMI）、社会人口学特征以及选定的产妇、分娩和新生儿结局；通过降低初产妇前超重和肥胖的流行率，可避免的不良围产期结局的比例（人群归因分数，PAF）。
初产妇超重的患病率从 1990-1994 年的 12.7%上升至 2010-2014 年的 16.4%；肥胖的患病率同期从 4.8%上升至 7.3%，而正常 BMI 的比例从 73.5%下降至 68.2%。研究期间，关键不良产妇和新生儿结局的 PAF 呈上升趋势；2010-2014 年，子痫前期的 23.8%、胎儿巨大儿的 23.4%和妊娠期糖尿病的 17.0%归因于超重和肥胖。如果 2010-2014 年超重和肥胖的妇女体重指数下降一个等级，那么 19%的子痫前期、15.9%的巨大儿、14.2%的妊娠期糖尿病、8.5%的剖宫产、7.1%的出生体重小于胎龄、6.8%的产后出血、6.5%的新生儿重症监护病房入院、5.8%的早产和 3.8%的胎儿异常可以避免。
在过去的 25 年中，由于超重和肥胖产妇的比例增加，与超重和肥胖相关的不良围产期结局的比例也有所上升。通过减少产妇孕前体重的肥胖预防策略，可以避免相当一部分的这些结局。
