孕产妇肥胖与严重孕产妇发病之间的关联：来自法国基于人群的EPIMOMS研究的结果。
Associations between maternal obesity and severe maternal morbidity: Findings from the French EPIMOMS population-based study.
作者信息
Siddiqui Ayesha, Azria Elie, Howell Elizabeth A, Deneux-Tharaux Catherine
机构信息
National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.
出版信息
Paediatr Perinat Epidemiol. 2019 Jan;33(1):7-16. doi: 10.1111/ppe.12522. Epub 2018 Oct 17.
BACKGROUND
Maternal obesity is increasing. There is growing evidence of its effect on severe maternal morbidity. We assessed prepregnancy obesity as an independent risk factor for severe maternal morbidity by timing and cause.
METHODS
We designed a case-control analysis within the EPIMOMS prospective population-based study conducted in six French regions in 2012-2013 (182 309 women who delivered at ≥22 weeks). Cases were all women who experienced severe maternal morbidity during pregnancy to 42 days postpartum as per a multicriteria definition derived by national expert consensus (n = 2540, severe maternal morbidity prevalence 1.4%). Controls were randomly selected from the same health centres (n = 3651). The association between obesity and severe maternal morbidity was assessed from fitting multivariable logistic regression models: overall, by timing (antepartum and intrapartum/ postpartum), and by cause.
RESULTS
Prepregnancy obesity was associated with overall severe maternal morbidity (adjusted odds ratio [OR] 1.34, 95% confidence interval [CI] 1.14, 1.59) and antepartum severe maternal morbidity (OR 2.07, 95% CI 1.61, 2.65), but not with intra/postpartum severe maternal morbidity (OR 1.15, 95% CI 0.96, 1.38). Among antepartum severe maternal morbidity, severe hypertensive disorders were most strongly associated with obesity (OR 2.50, 95% CI 1.85, 3.40) but the risk of antepartum severe maternal morbidity due to other causes was also increased among obese women (OR 1.64, 95% CI 1.13, 2.37). Obesity was not associated with severe postpartum haemorrhage (OR 1.12, 95% CI 0.92, 1.37).
CONCLUSION
Obesity is associated with an increased risk of antepartum, but not intra/ postpartum, severe maternal morbidity.
背景
孕产妇肥胖现象日益增多。越来越多的证据表明其对严重孕产妇发病有影响。我们通过发病时间和病因评估孕前肥胖作为严重孕产妇发病的独立危险因素。
方法
我们在2012 - 2013年于法国六个地区开展的EPIMOMS前瞻性人群研究中设计了一项病例对照分析（182309名孕周≥22周的分娩女性）。病例为所有根据国家专家共识得出的多标准定义，在孕期至产后42天期间发生严重孕产妇发病的女性（n = 2540，严重孕产妇发病患病率1.4%）。对照从相同的健康中心随机选取（n = 3651）。通过拟合多变量逻辑回归模型评估肥胖与严重孕产妇发病之间的关联：总体而言，按发病时间（产前和产时/产后）以及按病因进行评估。
结果
孕前肥胖与总体严重孕产妇发病相关（调整后的优势比[OR]为1.34，95%置信区间[CI]为1.14，1.59）以及产前严重孕产妇发病相关（OR为2.07，95% CI为1.61，2.65），但与产时/产后严重孕产妇发病无关（OR为1.15，95% CI为0.96，1.38）。在产前严重孕产妇发病中，重度高血压疾病与肥胖关联最为密切（OR为2.50，95% CI为1.85，3.40），但肥胖女性中因其他原因导致的产前严重孕产妇发病风险也有所增加（OR为1.64，95% CI为1.13，2.37）。肥胖与严重产后出血无关（OR为1.12，95% CI为0.92，1.37）。
结论
肥胖与产前严重孕产妇发病风险增加相关，但与产时/产后严重孕产妇发病风险无关。
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