Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Department of Medical Science, Uppsala University, Uppsala, Sweden.
Acta Obstet Gynecol Scand. 2020 Dec;99(12):1640-1648. doi: 10.1111/aogs.13929. Epub 2020 Jul 6.
Obesity-associated adverse obstetric outcomes are well-known but still relatively rare and difficult to predict. Not all obese individuals are unhealthy; some have metabolically healthy obesity (MHO) and others have metabolic unhealthy obesity (MUO). Our aim was to investigate whether the MHO and MUO classification could be used for prediction of obesity-associated complications in pregnancy.
We included 547 pregnant women with obesity, 2302 pregnant women with overweight and 5852 normal weight pregnant women. The women with obesity were classified as MUO (n = 181, 33.1%) or MHO (n = 366, 66.9%) based on first trimester blood pressure, lipoprotein levels and nonfasting glucose levels. The risk of obstetric outcomes was evaluated by multivariable logistic regression. We compared cardiovascular risk markers in blood between obese pregnant women with MUO and MHO.
Overall, 45.9% of women with MUO developed at least one adverse obesity-associated obstetric outcome, whereas corresponding proportions in women with MHO, overweight and normal weight were 35.0%, 27.6% and 21.2%, respectively. Following adjustment, the overall risk of at least one obesity-associated obstetric or perinatal complication in women with MUO, vs women with MHO, was increased (adjusted odds ratio 1.49, 95% confidence interval 1.03-2.15), but the predictive value of the model was low. Women with MUO had altered levels of cardiovascular risk markers such as cathepsin S, adiponectin, and cystatin C in comparison with women with MHO.
Women with MUO had an overall increased risk of adverse obstetric outcomes in comparison to women with MHO, but the classification had little relevance for risk prediction beyond that of body mass index.
肥胖相关的不良产科结局是众所周知的，但仍然相对罕见且难以预测。并非所有肥胖者都不健康；有些是代谢健康型肥胖（MHO），有些是代谢不健康型肥胖（MUO）。我们的目的是探讨 MUO 和 MUO 分类是否可用于预测妊娠期间与肥胖相关的并发症。
我们纳入了 547 名肥胖孕妇、2302 名超重孕妇和 5852 名正常体重孕妇。根据孕早期血压、脂蛋白水平和非空腹血糖水平，将肥胖孕妇分为 MUO（n=181，33.1%）或 MHO（n=366，66.9%）。通过多变量逻辑回归评估产科结局的风险。我们比较了 MUO 和 MHO 肥胖孕妇之间血液中的心血管风险标志物。
总体而言，45.9%的 MUO 孕妇至少发生了一种不良的肥胖相关产科结局，而 MHO、超重和正常体重孕妇的相应比例分别为 35.0%、27.6%和 21.2%。调整后，MUO 孕妇与 MHO 孕妇相比，至少有一种肥胖相关产科或围产并发症的总体风险增加（调整后的优势比 1.49，95%置信区间 1.03-2.15），但模型的预测价值较低。与 MHO 孕妇相比，MUO 孕妇的心血管风险标志物水平如组织蛋白酶 S、脂联素和胱抑素 C 发生改变。
与 MHO 孕妇相比，MUO 孕妇的不良产科结局风险总体增加，但该分类对 BMI 以外的风险预测相关性不大。
