School of Medicine, University of Texas, Rio Grande Valley, 1201 West University Drive, Edinburg, TX, 78539, USA.
College of Veterinary Medicine and Biomedical Science, Texas A&M University, College Station, TX, 77843-4475, USA.
BMC Pregnancy Childbirth. 2019 Apr 11;19(1):126. doi: 10.1186/s12884-019-2273-z.
Maternal obesity has a wide range of health effects on both the pregnant woman and developing fetus. The clinical significance of these disorders, combined with a dramatically increasing prevalence of obesity among pregnant women has precipitated a major health crisis in the United States. The most commonly used recommendations for gestational weight gain were established by the Institute of Medicine (IOM) in 2009 and have become well known and often adopted. The authors of the IOM report acknowledged that the recommended gestational weight gain of 5 to 9 kg for obese women whose body mass index was greater than 30 kg/m was based on very little empirical evidence. The objective of this study was to evaluate whether a 5 to 9 kg weight gain, for obese women, optimized a set of maternal and neonatal health outcomes.
Data containing approximately 12,000,000 birth records were obtained from the United States Natality database for the years 2014 to 2016. A Bayesian modeling approach was used to estimate the controlled direct effects of pre-pregnancy body mass index and gestational weight gain.
Obese women gaining less than 5 kg during pregnancy had reduced maternal risks for gestational hypertension, eclampsia, induction of labor and Caesarian section. In contrast, maternal gestational weight gain of less than 5 kg was associated with increased risks for multiple adverse neonatal outcomes with macrosomia the exception. Obese women who gained more than 9 kg during pregnancy had increased risk for multiple maternal and neonatal adverse outcomes.
Obese women who were observed to gain less than 5 kg during gestation had reduced odds of several peripartum disorders. However, this lower gestational weight gain was associated with an increase in multiple risks for the neonate.
母体肥胖对孕妇和胎儿发育都有广泛的健康影响。这些疾病的临床意义，加上孕妇肥胖率的急剧上升，在美国引发了一场重大的健康危机。最常用于指导孕妇体重增长的建议是由美国医学研究所（IOM）于 2009 年制定的，这些建议已经广为人知并经常被采用。IOM 报告的作者承认，对于 BMI 大于 30kg/m2 的肥胖女性，建议的妊娠增重 5 到 9kg 是基于很少的经验证据。本研究的目的是评估肥胖女性增重 5 到 9kg 是否能优化一系列母婴健康结局。
从美国出生率数据库中获取了 2014 年至 2016 年大约 1200 万份分娩记录的数据。采用贝叶斯建模方法估计孕前 BMI 和妊娠期体重增加的控制直接效应。
怀孕期间体重增加不足 5kg 的肥胖女性发生妊娠高血压、子痫前期、引产和剖宫产的风险降低。相比之下，体重增加不足 5kg 与多种不良新生儿结局的风险增加有关，除了巨大儿。怀孕期间体重增加超过 9kg 的肥胖女性有多种母婴不良结局的风险增加。
在妊娠期间体重增加不足 5kg 的肥胖女性发生围产期多种疾病的几率降低。然而，这种较低的妊娠体重增加与新生儿多种风险的增加有关。
