Naiqiso Silipa Lock Sam, Christensen Pernille Meliá, Okesene-Gafa Karaponi, McCowan Lesley Me
Obstetrics and Gynaecology Registrar, Counties Manukau Health, Middlemore Hospital, Auckland.
Research and Evaluation Office, Ko Awatea, Counties Manukau Health, Middlemore Hospital, Auckland.
N Z Med J. 2019 Jun 21;132(1497):37-45.
High and low gestational weight gain (GWG) adversely affects perinatal outcomes, and impacts long-term maternal and child health. Our aim is to report i) GWG categories by 2009 Institute of Medicine guidelines in the multi-ethnic population in Counties Manukau Health, ii) demographic factors and iii) adverse perinatal outcomes associated with high and low GWG.
Women with singleton pregnancy and weight recorded at ≤20 weeks and again in the third trimester comprised the study population. GWG categories (weight gain per week) were defined as low, normal or high. Maternal characteristics and pregnancy outcomes were compared between GWG categories.
Study population comprised 604 women: 39.7% Pacific, 19.9% Māori, 21.5% European. 70.5% were overweight or obese, and 65.1% lived in the highest deprivation decile areas. 70.7% had high, 16.1% had normal and 13.2% had low GWG. Pacific [OR 3.58 (95% CI 1.82, 7.03)] had increased odds of high GWG and Para 2/3+ had reduced odds of high GWG [OR 0.50 (95% CI 0.26, 0.99), OR 0.36 (95% CI 0.17, 0.74) respectively]. Low GWG was associated with increased SGA [ OR 2.48 (95% CI 1.11, 6.44)] and with GDM [OR 2.74 (95%CI 1.06, 8.79)]. We demonstrated a linear association between GWG and birthweight with 126g (95% CI: 90g, 162g) increase per 250g increase in weekly GWG.
The majority of participants had high GWG, which is clinically relevant as this was associated with increased infant weight, with potential to perpetuate intergenerational obesity. The association between low GWG and GDM may reflect care in the GDM clinic.
孕期体重增加（GWG）过高或过低都会对围产期结局产生不利影响，并影响母婴长期健康。我们的目的是报告：i）根据2009年美国医学研究所指南，马努考郡健康服务中心多民族人群中的GWG类别；ii）人口统计学因素；iii）与GWG过高和过低相关的不良围产期结局。
研究人群包括单胎妊娠且在孕20周及之前和孕晚期均记录了体重的女性。GWG类别（每周体重增加量）分为低、正常或高。比较不同GWG类别之间的产妇特征和妊娠结局。
研究人群包括604名女性：39.7%为太平洋岛民，19.9%为毛利人，21.5%为欧洲人。70.5%超重或肥胖，65.1%生活在最贫困的十分位地区。70.7%的GWG高，16.1%正常，13.2%低。太平洋岛民[比值比（OR）3.58（95%置信区间1.82, 7.03）]GWG高的几率增加，经产妇2/3及以上GWG高的几率降低[分别为OR 0.50（95%置信区间0.26, 0.99），OR 0.36（95%置信区间0.17, 0.74）]。GWG低与小于胎龄儿增加[OR 2.48（95%置信区间1.11, 6.44）]和妊娠期糖尿病（GDM）[OR 2.74（95%置信区间1.06, 8.79）]相关。我们证明了GWG与出生体重之间存在线性关联，每周GWG每增加250g，出生体重增加126g（95%置信区间：90g，162g）。
大多数参与者的GWG高，这在临床上具有相关性，因为这与婴儿体重增加有关，有可能使代际肥胖持续存在。GWG低与GDM之间的关联可能反映了GDM诊所的护理情况。
