Lucas A, Morley R, Cole T J, Bamford M F, Boon A, Crowle P, Dossetor J F, Pearse R
MRC Dunn Nutrition Unit, Cambridge.
Br Med J (Clin Res Ed). 1988 May 28;296(6635):1495-7. doi: 10.1136/bmj.296.6635.1495.
To investigate the effect of maternal fatness on the mortality of infants born preterm up to the corrected age of 18 months 795 mother-infant pairs were studied. Maternal fatness was defined by Quetelet's index (weight/(height] and all infants weighed less than 1850 g at birth. In 771 mother-infant pairs maternal age, complications of pregnancy, mode of delivery, parity, social class, and the baby's sex and gestation were analysed by a logistic regression model for associations with infant mortality (but deaths from severe congenital abnormalities and those occurring during the first 48 hours after birth were excluded). In a subgroup of 284 mother-infant pairs all infant deaths except those from severe congenital abnormalities were analysed in association with the infant's birth weight and gestation and the mother's height and weight; this second analysis included another 24 infants who had died within 48 hours after birth. In the first analysis mortality overall was 7% (55/771), rising from 4% (71/173) in thin mothers (Quetelet's index less than 20) to 15% (6/40) in mothers with grades II and III obesity (Quetelet's index greater than 30). After adjusting for major demographic and antenatal factors, including serious complications of pregnancy, maternal fatness was second in importance only to length of gestation in predicting death of infants born preterm. In the second analysis mortality overall was 15% (44/284), rising from 9% (5/53) in thin mothers to 47% (8/17) in mothers with grades II and III obesity. In both analyses the relative risk of death by 18 months post-term was nearly four times greater in infants born to obese mothers than in those born to thin mothers. In addition, maternal fatness was associated with reduced birth weight, whereas it is associated with macrosomia in term infants. These data differ fundamentally from those reported in full term babies of obese mothers. It is speculated that the altered metabolic milieu in obesity may reduce the ability of the fetus to adapt to extrauterine life if it is born preterm.
为了研究母亲肥胖对早产婴儿至校正年龄18个月时死亡率的影响，对795对母婴进行了研究。母亲肥胖程度由奎特利指数（体重/身高²）定义，所有婴儿出生时体重均小于1850克。在771对母婴中，通过逻辑回归模型分析母亲年龄、妊娠并发症、分娩方式、产次、社会阶层以及婴儿的性别和孕周与婴儿死亡率的关联（但严重先天性异常导致的死亡以及出生后48小时内发生的死亡被排除）。在284对母婴的亚组中，分析了除严重先天性异常导致的死亡之外的所有婴儿死亡情况，并将其与婴儿的出生体重、孕周以及母亲的身高和体重相关联；第二次分析纳入了另外24名出生后48小时内死亡的婴儿。在第一次分析中，总体死亡率为7%（55/771），瘦母亲（奎特利指数小于20）中的死亡率为4%（71/173），而II级和III级肥胖母亲（奎特利指数大于30）中的死亡率为15%（6/40）。在对包括妊娠严重并发症在内的主要人口统计学和产前因素进行调整后，母亲肥胖在预测早产婴儿死亡方面的重要性仅次于孕周。在第二次分析中，总体死亡率为15%（44/284），瘦母亲中的死亡率为9%（5/53），II级和III级肥胖母亲中的死亡率为47%（8/17）。在两项分析中，足月后18个月时肥胖母亲所生婴儿的死亡相对风险几乎是瘦母亲所生婴儿的四倍。此外，母亲肥胖与出生体重降低有关，而在足月儿中则与巨大儿有关。这些数据与肥胖母亲所生足月儿的报道数据有根本差异。据推测，如果早产，肥胖状态下改变的代谢环境可能会降低胎儿适应宫外生活的能力。
