Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of North Carolina, Chapel Hill, North Carolina.
Birth Defects Res. 2019 Oct 1;111(16):1205-1216. doi: 10.1002/bdr2.1552. Epub 2019 Jul 19.
To investigate first-year survival of infants born with spina bifida, and examine the association of maternal prepregnancy body mass index (BMI) with infant mortality.
This is a retrospective cohort study of 1,533 liveborn infants with nonsyndromic spina bifida with estimated dates of delivery from 1998 to 2011 whose mothers were eligible for the National Birth Defects Prevention Study (NBDPS). NBDPS data were linked to death records to conduct survival analyses. Kaplan-Meier survival functions estimated mortality risk over the first year of life. Cox proportional hazards models estimated hazard ratios (HRs) for maternal prepregnancy BMI categorized as underweight (<18.5), normal (18.5-24.9), overweight (25-29.9), and obese (≥30).
Infant mortality risk among infants with spina bifida was (4.4% [3.52, 5.60%]). Infants with multiple co-occurring defects, very preterm delivery, multiple gestation, high-level spina bifida lesions, or non-Hispanic Black mothers had an elevated risk of infant mortality. Maternal prepregnancy underweight and obesity were associated with higher infant mortality (15.7% [7.20, 32.30%] and 5.82% [3.60, 9.35%], respectively). Adjusted HR estimates showed underweight and obese mothers had greater hazard of infant mortality compared to normal weight mothers (HR: 4.5 [1.08, 16.72] and 2.6 [1.36, 8.02], respectively).
The overall risk of infant mortality for infants born with spina bifida was lower than most previously reported estimates. Infants born with spina bifida to mothers who were underweight or obese prepregnancy were at higher risk of infant mortality. This study provides additional evidence of the importance of healthy maternal weight prior to pregnancy.
研究无脑畸形婴儿的第一年存活率，并探讨产妇孕前体重指数（BMI）与婴儿死亡率的关系。
这是一项对 1998 年至 2011 年期间出生的 1533 名无脑畸形活产婴儿进行的回顾性队列研究，这些婴儿的估计预产期符合国家出生缺陷预防研究（NBDPS）的条件。NBDPS 数据与死亡记录相链接，以进行生存分析。Kaplan-Meier 生存函数估计了婴儿在生命的第一年的死亡风险。Cox 比例风险模型估计了孕前 BMI 分类（体重不足<18.5、正常 18.5-24.9、超重 25-29.9 和肥胖≥30）的产妇的危险比（HR）。
无脑畸形婴儿的死亡率为 4.4%（3.52%-5.60%）。存在多种合并缺陷、极早产、多胎妊娠、高位脊柱裂病变或非西班牙裔黑人母亲的婴儿死亡率较高。产妇孕前体重不足和肥胖与较高的婴儿死亡率相关（分别为 15.7%（7.20%-32.30%）和 5.82%（3.60%-9.35%））。调整后的 HR 估计表明，与正常体重母亲相比，体重不足和肥胖母亲的婴儿死亡率更高（HR：4.5[1.08-16.72]和 2.6[1.36-8.02]）。
无脑畸形婴儿的整体婴儿死亡率风险低于大多数先前报道的估计值。无脑畸形婴儿的母亲在孕前体重不足或肥胖时，婴儿死亡率的风险更高。这项研究提供了额外的证据，表明在怀孕前保持健康的母亲体重很重要。
