Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, TX, USA.
Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston, TX, USA; Office of the Provost, Baylor College of Medicine, Houston, TX, USA.
Eur J Obstet Gynecol Reprod Biol. 2020 Sep;252:1-6. doi: 10.1016/j.ejogrb.2020.06.004. Epub 2020 Jun 9.
An examination of the synergistic effects of maternal obesity and macrosomia on the risk of stillbirth is lacking. The purpose of this study was to determine the association between fetal macrosomia, maternal obesity, and the risk of stillbirth.
This retrospective cross-sectional study used the CDC's Birth Data and Fetal Death Data files for 2014-2017 [n = 10,043,398 total births; including 48,799 stillbirths]. The exposure was fetal macrosomia stratified by obesity subtypes (I-III). The outcome was the risk of stillbirth. We also controlled for potential and known confounding factors in adjusted models. Adjusted Relative Risks (ARR) were estimated with log-binomial regression models.
The rate of stillbirth was higher among macrosomic infants born to mothers with obesity compared to those without (6.55 vs. 0.54 per 1000 total births). After controlling for confounding, women with obesity types II and III were at increased risk for stillbirth [Obesity II ARR = 2.37 (2.07-2.72); Obesity III ARR = 9.06 (7.61-10.78)].
Obesity-related fetal overgrowth is a significant risk factor for stillbirth, especially among women with type II and type III obesity. This finding highlights the need for more effective clinical and public health strategies to address pre-pregnancy obesity and to optimize gestational weight gain.
缺乏母体肥胖和巨大儿对死胎风险的协同作用的研究。本研究旨在确定胎儿巨大儿、母体肥胖与死胎风险之间的关联。
本回顾性横断面研究使用了 2014 年至 2017 年美国疾病控制与预防中心（CDC）的出生数据和胎儿死亡数据文件[总出生人数为 10043398 人，包括 48799 例死胎]。暴露因素为肥胖亚组（I-III 型）分层的胎儿巨大儿。结局为死胎风险。我们还在调整模型中控制了潜在和已知的混杂因素。使用对数二项式回归模型估计调整后的相对风险（ARR）。
与非肥胖母亲所生的巨大儿婴儿相比，肥胖母亲所生的巨大儿婴儿死胎率更高（每 1000 例总出生人数中，6.55 例 vs. 0.54 例）。在控制混杂因素后，肥胖 II 型和 III 型妇女的死胎风险增加[肥胖 II 型 ARR = 2.37（2.07-2.72）；肥胖 III 型 ARR = 9.06（7.61-10.78）]。
肥胖相关的胎儿过度生长是死胎的一个重要危险因素，尤其是在肥胖 II 型和肥胖 III 型妇女中。这一发现强调需要采取更有效的临床和公共卫生策略来解决孕前肥胖问题，并优化妊娠体重增加。
