Nucci D, Chiavarini M, Duca E, Pieroni L, Salmasi L, Minelli L
Unit of Public Health, Department of Experimental Medicine, University of Perugia, Perugia, Italy - Digestive Endoscopy Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
Unit of Public Health, Department of Experimental Medicine, University of Perugia, Perugia, Italy.
Ann Ig. 2018 Mar-Apr;30(2):140-152. doi: 10.7416/ai.2018.2205.
Overweight and obese women present an increased risk of poor maternal and child health outcomes. The aim of this paper is to analyze the joint effects of pre-pregnancy body mass index and inadequate gestational weight gain on birth weight and gestational age in an Italian sample of pregnant women.
Data were obtained from a sample of about 2,000 pregnant women at the University Teaching Hospital of Perugia University (Italy) in 2013. We used the revised classification proposed by Institute of Medicine to identify gestational weight gains considered as appropriate. Logistic regression models were used to estimate the adjusted odds-ratios of women belonging to any BMI class different from normal (used as the reference category) and of women who increased their weight by an amount smaller or greater than normal, controlling for a large set of observable confounders.
Higher probability of low birth weight was associated with both obesity (OR = 1.9124, s.e. = 0.526) and less than normal weight gains (OR = 2.3614, s.e. = 0.388). The probability of fetal macrosomia was found to be positively associated with more than normal weight increases (OR = 2.6232, s.e. = 0.465). Pre-term deliveries were associated with less than normal gestational weight gains (OR 1.7338, s.e. = 0.320).
Overweight and obesity represent a big issue for public health. In particular, weight management during pregnancy and pre-pregnancy could determine negative health outcomes in newborns. In our study we found that inadequate weight variations during pregnancy, according to the Classification of the Institute of Medicine, negatively influence health conditions at birth. Stronger initiatives, especially in terms of midwifery, nurse training and informative policies should be adopted by policy makers.
超重和肥胖女性出现母婴健康不良结局的风险增加。本文旨在分析意大利孕妇样本中孕前体重指数和孕期体重增加不足对出生体重和孕周的联合影响。
数据来源于2013年意大利佩鲁贾大学教学医院约2000名孕妇的样本。我们采用医学研究所提出的修订分类来确定被认为合适的孕期体重增加。使用逻辑回归模型来估计属于不同于正常体重指数类别（用作参考类别）的女性以及体重增加量小于或大于正常量的女性的调整后比值比，并控制大量可观察到的混杂因素。
低出生体重的较高概率与肥胖（比值比 = 1.9124，标准误 = 0.526）和体重增加低于正常水平（比值比 = 2.3614，标准误 = 0.388）均相关。巨大儿的概率与体重增加超过正常水平呈正相关（比值比 = 2.6232，标准误 = 0.465）。早产与孕期体重增加低于正常水平相关（比值比1.7338，标准误 = 0.320）。
超重和肥胖是公共卫生的一个重大问题。特别是，孕期和孕前的体重管理可能会决定新生儿的负面健康结局。在我们的研究中，我们发现根据医学研究所的分类，孕期体重变化不足会对出生时的健康状况产生负面影响。政策制定者应采取更强有力的举措，特别是在助产、护士培训和宣传政策方面。
