Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.
Obstet Gynecol. 2020 Jul;136(1):118-127. doi: 10.1097/AOG.0000000000003901.
To evaluate the relationship between maternal body mass index (BMI) at delivery and rates of early-onset and late-onset hypertensive disorders of pregnancy.
We performed a population-based, retrospective cohort study using U.S. Vital Statistics period-linked birth and infant death certificates from 2014 to 2017. Women who delivered a nonanomalous singleton live neonate from 24 to 41 completed weeks of gestation were included. We excluded women with chronic hypertension and those with BMIs less than 18.5. The primary exposure was maternal BMI, defined as nonobese (BMI 18.5-29.9; referent group), class 1 obesity (BMI 30.0-34.9), class 2 obesity (BMI 35.0-39.9), and class 3 obesity (BMI 40.0 or greater). The primary outcome was delivery with hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, or eclampsia) at less than 34 weeks of gestation or at 34 weeks or more. Multivariable Poisson regression was used to estimate relate risk and adjust for confounding variables. Results are presented as adjusted relative risk (aRR) and 95% CIs.
Of the 15.8 million women with live births during the study period, 14.0 million (88.6%) met inclusion criteria, and 825,722 (5.9%) had hypertensive disorders of pregnancy. The risk of early-onset hypertensive disorders of pregnancy was significantly higher in women with class 1 obesity (aRR 1.13; 95% CI 1.10-1.16), class 2 obesity (aRR 1.57; 95% CI 1.53-1.62), and class 3 obesity (aRR 2.18; 95% CI 2.12-2.24), compared with nonobese women. The risk of late-onset hypertensive disorders of pregnancy was also significantly increased in women with class 1 obesity (aRR 1.71; 95% CI 1.70-1.73), class 2 obesity (aRR 2.60; 95% CI 2.58-2.62), and class 3 obesity (aRR 3.93; 95% CI 3.91-3.96) compared with nonobese women.
Compared with nonobese women, the risk of early-onset and late-onset hypertensive disorders of pregnancy is significantly and progressively increased among women with increased class of obesity.
评估产妇分娩时的体重指数（BMI）与早发性和晚发性妊娠高血压疾病发生率之间的关系。
我们使用美国生命统计期链接的 2014 年至 2017 年出生和婴儿死亡证书进行了一项基于人群的回顾性队列研究。纳入了分娩 24 至 41 周完整周非畸形单胎活新生儿的妇女。我们排除了患有慢性高血压和 BMI 低于 18.5 的妇女。主要暴露因素是产妇 BMI，定义为非肥胖（BMI 18.5-29.9；参照组）、1 级肥胖（BMI 30.0-34.9）、2 级肥胖（BMI 35.0-39.9）和 3 级肥胖（BMI 40.0 或更高）。主要结局是在 34 周或更晚分娩时或在 34 周前发生妊娠高血压疾病（妊娠期高血压、子痫前期或子痫）。多变量泊松回归用于估计相对风险并调整混杂变量。结果以调整后的相对风险（aRR）和 95%CI 表示。
在研究期间，有 1580 万活产妇女，其中 1400 万（88.6%）符合纳入标准，825722 名（5.9%）患有妊娠高血压疾病。与非肥胖妇女相比，1 级肥胖（aRR 1.13；95%CI 1.10-1.16）、2 级肥胖（aRR 1.57；95%CI 1.53-1.62）和 3 级肥胖（aRR 2.18；95%CI 2.12-2.24）的妇女发生早发性妊娠高血压疾病的风险显著更高。与非肥胖妇女相比，1 级肥胖（aRR 1.71；95%CI 1.70-1.73）、2 级肥胖（aRR 2.60；95%CI 2.58-2.62）和 3 级肥胖（aRR 3.93；95%CI 3.91-3.96）的妇女发生晚发性妊娠高血压疾病的风险也显著增加。
与非肥胖妇女相比，肥胖程度增加的妇女发生早发性和晚发性妊娠高血压疾病的风险显著且逐渐增加。
