Department of Pediatrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, The Netherlands.
Obes Rev. 2020 Mar;21(3):e12974. doi: 10.1111/obr.12974. Epub 2019 Nov 21.
Prepregnancy overweight and obesity are associated with higher risk of perinatal complications. However, the effect of weight change prior to pregnancy on perinatal outcome is largely unknown. Therefore, it is aimed to examine the impact on perinatal outcomes of interpregnancy BMI change in women of different BMI categories. The MEDLINE, EMBASE, LILACS, and CINAHL databases were searched (1990-August 2019). Observational studies on interpregnancy BMI change were selected. Outcomes evaluated were gestational diabetes mellitus (GDM), preeclampsia, gestational hypertension (GH), cesarean section, preterm birth, and newborns being large (LGA) or small (SGA) for gestational age. Meta-analyses and meta-regression analyses were executed. Thirty studies were included (n > 1 million). Interpregnancy BMI gain was associated with a higher risk of GDM (for BMI gain ≥3 kg/m : OR 2.21; [95%CI 1.53-3.19]), preeclampsia (1.77 [1.53-2.04]), GH (1.78 [1.61-1.97]), cesarean section (1.32 [1.24-1.39]), and LGA (1.54 [1.28-1.86]). The effects of BMI gain were most pronounced in women with BMI <25 kg/m before the first pregnancy regarding GDM, GH, and cesarean section. Except for LGA, interpregnancy BMI loss did not result in a decreased risk of perinatal complications. In this study, women of normal weight who gain weight before pregnancy were identified as a high-risk population for perinatal complications. This emphasizes that weight management is important for women of all BMI categories and a pregnancy wish.
孕前超重和肥胖与围产期并发症的风险增加有关。然而，孕前体重变化对围产期结局的影响在很大程度上尚不清楚。因此，本研究旨在探讨不同 BMI 类别孕妇孕期体重指数变化对围产期结局的影响。检索了 MEDLINE、EMBASE、LILACS 和 CINAHL 数据库（1990 年 8 月至 2019 年 8 月）。选择了关于孕期体重指数变化的观察性研究。评估的结局为妊娠期糖尿病（GDM）、子痫前期、妊娠期高血压（GH）、剖宫产、早产和新生儿出生时为（AGA）巨大儿（LGA）或小于胎龄儿（SGA）。进行了荟萃分析和荟萃回归分析。共纳入 30 项研究（n＞100 万）。孕期体重指数增加与 GDM（体重指数增加≥3kg/m2：OR 2.21；95%CI 1.53-3.19）、子痫前期（1.77；1.53-2.04）、GH（1.78；1.61-1.97）、剖宫产（1.32；1.24-1.39）和 LGA（1.54；1.28-1.86）的风险增加相关。在首次妊娠前 BMI＜25kg/m2的女性中，BMI 增加对 GDM、GH 和剖宫产的影响最为显著。除 LGA 外，孕期体重减轻并不会降低围产期并发症的风险。在这项研究中，孕前体重增加的正常体重女性被确定为围产期并发症的高危人群。这强调了体重管理对所有 BMI 类别的女性和有妊娠意愿的女性都很重要。
