Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, University of Texas Medical Branch, Galveston, Texas, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio, Columbia University, New York, New York, University of Utah Health Sciences Center, Salt Lake City, Utah, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, University of Pittsburgh, Pittsburgh, Pennsylvania, The Ohio State University, Columbus, Ohio, University of Alabama at Birmingham, Birmingham, Alabama, Wayne State University, Detroit, Michigan, Brown University, Providence, Rhode Island, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas, and Oregon Health & Science University, Portland, Oregon; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Obstet Gynecol. 2018 Oct;132(4):875-881. doi: 10.1097/AOG.0000000000002854.
To evaluate the association between gestational weight gain and maternal and neonatal outcomes in a large, geographically diverse cohort.
Trained chart abstractors at 25 hospitals obtained maternal and neonatal data for all deliveries on randomly selected days over 3 years (2008-2011). Gestational weight gain was derived using weight at delivery minus prepregnancy or first-trimester weight and categorized as below, within, or above the Institute of Medicine (IOM) guidelines in this retrospective cohort study. Maternal (primary or repeat cesarean delivery, third- or fourth-degree lacerations, severe postpartum hemorrhage, hypertensive disease of pregnancy) and neonatal (preterm birth, shoulder dystocia, macrosomia, hypoglycemia) outcomes were compared among women in the gestational weight gain categories in unadjusted and adjusted analyses with odds ratios (ORs) and 95% CI reported. Covariates included age, race-ethnicity, tobacco use, insurance type, parity, prior cesarean delivery, pregestational diabetes, hypertension, and hospital type.
Of the 29,861 women included, 51% and 21% had gestational weight gain above and below the guidelines, respectively. There was an association between gestational weight gain above the IOM guidelines and cesarean delivery in both nulliparous women (adjusted OR 1.44, 95% CI 1.31-1.59) and multiparous women (adjusted OR 1.26, 95% CI 1.13-1.41) and hypertensive diseases of pregnancy in nulliparous and multiparous women combined (adjusted OR 1.84, 95% CI 1.66-2.04). For the neonatal outcomes, gestational weight gain above the IOM guidelines was associated with shoulder dystocia (adjusted OR 1.74, 95% CI 1.41-2.14), macrosomia (adjusted OR 2.66, 95% CI 2.03-3.48), and neonatal hypoglycemia (adjusted OR 1.60, 95% CI 1.16-2.22). Gestational weight gain below the guidelines was associated with spontaneous (adjusted OR 1.50, 95% CI 1.31-1.73) and indicated (adjusted OR 1.34, 95% CI 1.12-1.60) preterm birth.
In a large, diverse cohort with prospectively collected data, gestational weight gain below or above guidelines is associated with a variety of adverse pregnancy outcomes.
在一个大型、地理分布广泛的队列中，评估妊娠体重增加与母婴结局的关系。
在 25 家医院中，经过培训的图表记录员在 3 年期间（2008-2011 年）随机选择几天，获取所有分娩的母婴数据。妊娠体重增加是通过分娩时的体重减去孕前或孕早期的体重来计算的，并根据美国医学研究所（IOM）指南分为低于、等于和高于指南的类别。在未调整和调整分析中，使用比值比（OR）和 95%置信区间（CI）比较了体重增加类别中的产妇（原发性或重复剖宫产、三度或四度裂伤、严重产后出血、妊娠高血压疾病）和新生儿（早产、肩难产、巨大儿、低血糖）结局。
在纳入的 29861 名女性中，分别有 51%和 21%的女性体重增加低于和高于指南。在未产妇女（调整后的 OR 1.44，95%CI 1.31-1.59）和经产妇（调整后的 OR 1.26，95%CI 1.13-1.41）中，妊娠体重增加高于 IOM 指南与剖宫产有关，在未产和经产妇中，妊娠高血压疾病的综合风险增加（调整后的 OR 1.84，95%CI 1.66-2.04）。对于新生儿结局，妊娠体重增加高于 IOM 指南与肩难产（调整后的 OR 1.74，95%CI 1.41-2.14）、巨大儿（调整后的 OR 2.66，95%CI 2.03-3.48）和新生儿低血糖（调整后的 OR 1.60，95%CI 1.16-2.22）有关。低于指南的妊娠体重增加与自发性（调整后的 OR 1.50，95%CI 1.31-1.73）和指征性（调整后的 OR 1.34，95%CI 1.12-1.60）早产有关。
在一个具有前瞻性数据收集的大型、多样化队列中，低于或高于指南的妊娠体重增加与多种不良妊娠结局有关。
