1 Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.
2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
J Womens Health (Larchmt). 2019 Mar;28(3):375-383. doi: 10.1089/jwh.2017.6574. Epub 2018 Jun 19.
Evidence used to guide the current Institute of Medicine (IOM) gestational weight gain (GWG) recommendations is largely derived from studies of European descent, and as such the guidelines are the same for all races and ethnicities. The guidelines are also the same for prepregnancy obesity classes I through III.
Considering these literature gaps, we aim to (1) determine the association between the IOM GWG guidelines and three common pregnancy complications: preeclampsia, gestational diabetes mellitus, and cesarean delivery in a racially and ethnically diverse population; and (2) assess whether the association between GWG and pregnancy complications differs by race/ethnicity or prepregnancy body mass index (BMI) categories, particularly obesity classes I through III.
To address these aims, we analyzed data from the Boston Birth Cohort. We calculated GWG using data from electronic medical records or, when missing, from a postdelivery questionnaire. We examined GWG continuously and categorically using the IOM formula.
Of the 5,568 women included, 54.5% met the IOM criterion for excessive GWG. Compared to women who had adequate GWG, women who gained excessive weight had 1.65 (95% confidence interval [CI] 1.27-2.14) times greater odds of preeclampsia; 1.68 (95% CI 1.15-2.46) times greater odds of gestational diabetes; and no significant change in odds of cesarean delivery (odds ratio [OR] = 1.14, 95% CI 0.99-1.31). Associations did not differ by race, ethnicity, or prepregnancy BMI categories including comparisons of obesity class I versus II or III (all p-values for interaction >0.05).
In this racially and ethnically diverse population, excessive GWG was associated with higher odds of preeclampsia, gestational diabetes, and nonsignificantly, with cesarean delivery. Associations did not differ appreciably by race, ethnicity, or prepregnancy BMI categories. Our results support the relevance of the IOM GWG recommendations in racially and ethnically diverse populations, and in women in the higher prepregnancy obesity classes.
目前，指导研究所医学研究所（IOM）妊娠体重增加（GWG）建议的证据主要来自欧洲血统的研究，因此，这些指南适用于所有种族和族裔。该指南也适用于孕前肥胖 I 至 III 类。
鉴于这些文献差距，我们旨在（1）确定 IOM GWG 指南与三种常见妊娠并发症之间的关联：在种族和族裔多样化的人群中，子痫前期、妊娠糖尿病和剖宫产；（2）评估 GWG 与妊娠并发症之间的关联是否因种族/族裔或孕前体重指数（BMI）类别而有所不同，特别是肥胖 I 至 III 类。
为了达到这些目的，我们分析了波士顿出生队列的数据。我们使用电子病历中的数据或产后问卷调查中缺失的数据来计算 GWG。我们使用 IOM 公式连续和分类地检查 GWG。
在纳入的 5568 名女性中，54.5%符合 IOM 过量 GWG 的标准。与 GWG 充足的女性相比，体重增加过多的女性患子痫前期的几率增加了 1.65 倍（95%置信区间[CI] 1.27-2.14）；患妊娠糖尿病的几率增加了 1.68 倍（95%CI 1.15-2.46）；剖宫产的几率没有显著变化（比值比[OR] = 1.14，95%CI 0.99-1.31）。关联不因种族、族裔或孕前 BMI 类别而有差异，包括肥胖 I 类与 II 类或 III 类的比较（所有交互作用的 p 值均>0.05）。
在这个种族和族裔多样化的人群中，GWG 过多与子痫前期、妊娠糖尿病的几率增加有关，而与剖宫产的几率增加无显著相关性。关联在种族、族裔或孕前 BMI 类别方面没有明显差异。我们的结果支持 IOM GWG 建议在种族和族裔多样化人群以及孕前肥胖较高的女性中的相关性。
