Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510000, P. R. China.
Reprod Biol Endocrinol. 2018 Aug 10;16(1):77. doi: 10.1186/s12958-018-0397-z.
Appropriate classification of obesity is vital for risk assessment and complication prevention during pregnancy. We aimed to explore which pre-pregnancy BMI cut-offs of obesity, either BMI ≥ 25 kg/m as recommended by the WHO for Asians or BMI ≥ 28 kg/m as suggested by the Working Group on Obesity in China (WGOC), best predicts the risk of adverse maternal and perinatal outcomes.
We retrospectively reviewed 11,494 medical records for live singleton deliveries in a tertiary center in Guangzhou, China, between January 2013 and December 2016. The primary outcomes included maternal obesity prevalence, adverse maternal and perinatal outcomes. Data were analyzed using the Chi-square test, logistic regression, and diagnostics tests.
Among the study population, 824 (7.2%) were obese according to the WHO criteria for Asian populations, and this would be reduced to 198 (1.7%) based on the criteria of WGOC. Obesity-related adverse maternal and perinatal outcomes were gestational diabetes mellitus, preeclampsia, cesarean section, and large for gestational age (P < 0.05). Compared to the WGOC criterion, the WHO for Asians criterion had a higher Youden index in our assessment of its predictive value in identifying risk of obesity-related adverse outcomes for Chinese pregnant women. Women in the BMI range of 25 to 28 kg/m are at high risks for adverse maternal and perinatal outcomes, which were similar to women with BMI ≥ 28 kg/m.
A lower pre-pregnancy BMI cutoff at 25 kg/m for defining obesity may be appropriate for pregnant women in South China. If WGOC standards are applied to pregnant Chinese populations, a significant proportion of at-risk patients may be missed.
适当的肥胖分类对于妊娠期间的风险评估和并发症预防至关重要。我们旨在探讨亚洲人世界卫生组织（WHO）推荐的孕前 BMI 肥胖切点（BMI≥25kg/m2）或中国人肥胖工作组（WGOC）建议的 BMI≥28kg/m2，哪一个能更好地预测不良母婴围产结局的风险。
我们回顾性分析了 2013 年 1 月至 2016 年 12 月在中国广州一家三级医院的 11494 例活产单胎分娩的病历。主要结局包括产妇肥胖患病率、不良母婴围产结局。采用卡方检验、logistic 回归和诊断试验进行数据分析。
在研究人群中，根据亚洲人群的 WHO 标准，有 824 例（7.2%）肥胖，而根据 WGOC 的标准，这一比例将降至 198 例（1.7%）。肥胖相关的不良母婴围产结局包括妊娠期糖尿病、子痫前期、剖宫产和巨大儿（P<0.05）。与 WGOC 标准相比，WHO 亚洲标准在评估其识别中国孕妇肥胖相关不良结局风险的预测价值方面具有更高的 Youden 指数。BMI 范围在 25 至 28kg/m2的女性发生不良母婴围产结局的风险较高，与 BMI≥28kg/m2的女性相似。
将孕前 BMI 切点定义为 25kg/m2 可能更适合华南地区的孕妇。如果将 WGOC 标准应用于中国孕妇人群，可能会遗漏很大一部分高危患者。
