省际间孕前体重指数和孕期体重增加的差异及其对小于胎龄儿和大于胎龄儿新生儿出生体重的影响。

Interprovincial variation in pre-pregnancy body mass index and gestational weight gain and their impact on neonatal birth weight with respect to small and large for gestational age.

机构信息

Department of Obstetrics & Gynecology, Department of Health Research Methods, Evidence, and Impact, Department of Radiology, McMaster University, 1280 Main Street West, Room 3N52B, Hamilton, ON, L8S 4K1, Canada.

Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University, Halifax, NS, Canada.

出版信息

Can J Public Health. 2018 Aug;109(4):527-538. doi: 10.17269/s41997-018-0086-x. Epub 2018 Sep 6.

DOI:10.17269/s41997-018-0086-x

PMID:30191462

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6964407/

Abstract

OBJECTIVES

To explore provincial variation in both excess and inadequate pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) and their impact on small- and large-for-gestational-age (SGA, LGA) infants.

METHODS

Four provinces with a perinatal database capturing the required exposures participated: British Columbia (BC), Ontario (ON), Nova Scotia (NS), and Newfoundland and Labrador (NL). In multiple, concurrent retrospective studies, we included women ≥ 19 years, who gave birth from 22 to 42 weeks' gestation, to a live singleton from April 2013-March 2014. From adjusted odds ratios, we calculated population attributable fractions (PAF) of SGA and LGA for BMI and GWG.

RESULTS

The proportion of overweight and obese women increased from western to eastern Canada. In BC, ON, NS, and NL, the proportions of women who were overweight were 21.1%, 24.0%, 23.7%, and 25.4%, while obesity proportions were 14.2%, 18.1%, 24.2%, and 29.8%, respectively. Excess GWG affected 53.9%, 49.9%, 57.6%, and 65.6% of women, respectively. Excess GWG contributed to 29.5-42.5% of LGA, compared with the PAFs for overweight (6.8-12.0%) and obesity (13.2-20.6%). Inadequate GWG's contribution to SGA (4.8-12.3%) was higher than underweight BMI's (2.9-6.2%).

CONCLUSION

In this interprovincial study, high and increasing proportions of women from west to east had excess pre-pregnancy BMI, and between half to two thirds had excess GWG. The contributions of GWG outside of recommendations to SGA and LGA were greater than that of low or high BMI. GWG is a potentially modifiable determinant of SGA and LGA across Canada.

摘要

目的

探讨超重和体重不足的孕前体质量指数（BMI）和妊娠增重（GWG）的省级差异，及其对小于胎龄儿（SGA）和大于胎龄儿（LGA）的影响。

方法

有围产期数据库且符合研究要求的四个省份参与了此次研究：不列颠哥伦比亚省（BC）、安大略省（ON）、新斯科舍省（NS）和纽芬兰和拉布拉多省（NL）。在多个并行的回顾性研究中，我们纳入了 2013 年 4 月至 2014 年 3 月期间 19 岁及以上、单胎妊娠 22-42 周分娩的女性。我们从调整后的比值比中计算了 BMI 和 GWG 导致 SGA 和 LGA 的人群归因分数（PAF）。

结果

超重和肥胖女性的比例从加拿大西部到东部逐渐增加。在 BC、ON、NS 和 NL，超重女性的比例分别为 21.1%、24.0%、23.7%和 25.4%，肥胖女性的比例分别为 14.2%、18.1%、24.2%和 29.8%。分别有 53.9%、49.9%、57.6%和 65.6%的女性存在 GWG 过量。与超重（6.8-12.0%）和肥胖（13.2-20.6%）的 PAF 相比，GWG 过量导致 LGA 的比例为 29.5-42.5%。GWG 不足导致 SGA 的比例（4.8-12.3%）高于低体重 BMI（2.9-6.2%）。