Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Obstet Gynecol. 2018 Oct;132(4):835-841. doi: 10.1097/AOG.0000000000002775.
To compare the independent risk of neonatal morbidity between the offspring of obese and nonobese women without hypertension or diabetes.
This is a secondary analysis of a prospective single-center cohort study of singleton deliveries at or beyond 37 weeks of gestation from 2010 to 2014. Women with diabetes (pregestational or gestational) and hypertensive disorders were excluded. The primary outcomes were 1) a composite neonatal morbidity including death, mechanical ventilation, respiratory distress, meconium aspiration, suspected sepsis, confirmed sepsis, hypoxic-ischemic encephalopathy, therapeutic hypothermia, or seizures; and 2) a composite of neonatal neurologic morbidity including hypoxic-ischemic encephalopathy, therapeutic hypothermia, or seizures. The primary outcomes were compared between the offspring of obese (body mass index 30 or greater) and nonobese women. Adjusted odds ratios (ORs) were estimated using multivariable logistic regression.
Of 6,458 women without diabetes or hypertensive disorders, 3,311 (51%) were obese. After adjusting for race, neonates of obese patients were at significantly increased risk for the composite neonatal morbidity (9.2% vs 7.2%, adjusted OR 1.39, 95% CI 1.15-1.67) and neurologic neonatal morbidity (0.7% vs 0.3%, adjusted OR 2.84, 95% CI 1.22-6.65). Specifically, neonates of obese patients were more likely to have hypoxic-ischemic encephalopathy (0.5% vs 0.2%, adjusted OR 2.80, 95% CI 1.02-7.68), hypothermia treatment (0.6% vs 0.2%, adjusted OR 2.92 95% CI 1.17-7.30), and suspected sepsis (7.6% vs 5.8%, adjusted OR 1.45, 95% CI 1.18-1.79).
In patients who labor, maternal obesity is an independent risk factor for significant neonatal morbidity, even in the absence of hypertensive disorders or diabetes.
比较无高血压或糖尿病的肥胖和非肥胖女性所生后代新生儿发病率的独立风险。
这是对 2010 年至 2014 年间单胎足月（≥37 周）分娩的前瞻性单中心队列研究的二次分析。排除患有糖尿病（孕前或孕期）和高血压疾病的患者。主要结局包括 1）包括死亡、机械通气、呼吸窘迫、胎粪吸入、疑似败血症、确诊败血症、缺氧缺血性脑病、治疗性低温或癫痫发作的复合新生儿发病率；2）包括缺氧缺血性脑病、治疗性低温或癫痫发作的复合新生儿神经发病率。比较肥胖（体重指数≥30）和非肥胖女性所生后代的主要结局。使用多变量逻辑回归估计调整后的优势比（OR）。
在 6458 名无糖尿病或高血压疾病的女性中，3311 名（51%）肥胖。调整种族因素后，肥胖患者的新生儿发生复合新生儿发病率的风险显著增加（9.2%比 7.2%，调整 OR 1.39，95%CI 1.15-1.67）和神经新生儿发病率（0.7%比 0.3%，调整 OR 2.84，95%CI 1.22-6.65）。具体而言，肥胖患者的新生儿更有可能发生缺氧缺血性脑病（0.5%比 0.2%，调整 OR 2.80，95%CI 1.02-7.68）、低温治疗（0.6%比 0.2%，调整 OR 2.92 95%CI 1.17-7.30）和疑似败血症（7.6%比 5.8%，调整 OR 1.45，95%CI 1.18-1.79）。
在分娩的患者中，即使没有高血压或糖尿病，母体肥胖也是新生儿发病率显著增加的独立危险因素。
