Neonatology, Epidemiology, Centre Hospitalier Universitaire de la Reunion, Saint-Pierre, Reunion, FRANCE
Obsterics and Gynecology, The University of Adelaide, Adelaide, South Australia, Australia.
BMJ Open. 2020 Jul 28;10(7):e036549. doi: 10.1136/bmjopen-2019-036549.
To investigate in singleton term pregnancies (≥37 weeks gestation) if applying optimal gestational weight gains (optGWG) on our population could have an effect on the incidence of late-onset preeclampsia (LOP).
18.5-year-observational cohort study (2001-2019).
Centre Hospitalier Universitaire Hospitalier Sud Reunion's maternity (French overseas department, Indian Ocean), the only maternity providing services to take care of all preeclamptic cases in an area with approximately 360 000 inhabitants.
Simulation rates of LOP between women achieving optimal versus inappropriate GWG (insufficient and excessive) in the non-overweight, overweight and class I-III obesity categories.
Among 66 373 singleton term pregnancies with a live birth, and 716 LOP (≥37 weeks, LOP37), the GWG could be determined in 87% of cases. In a logistic regression model validating the independent association of optGWG, maternal ages and body mass index (BMI), primiparity, smoking habit, chronic hypertension with term preeclampsia, optGWG reduced the risk of LOP37, aOR 0.74, p=0.004. Primiparity, higher maternal BMI, chronic hypertension and higher maternal age increased the risk of LOP37. The 'protective' effect of optGWG appeared stronger in patients with overweight and obesity in a linear manner: 0.57% versus 1.07% (OR 0.53, p=0.003), overweight; class I obese (30-34.9 kg/m²), 0.70% vs 1.56% (OR 0.44, p=0.01); severe obesity (≥35 kg/m²) 0.86% vs 2.55% (OR 0.33, p=0.06). All patients with overweight/obesity together, OR 0.42, p<0.0001.
Overweight and obesity may not result in a higher risk of developing LOP at term when a optGWG is achieved. The results of this large retrospective population cohort study suggest that targeted and strictly monitored interventions on achieving an optGWG might represent an effective method to reduce the rate of LOP and would have the potential to halve its rate in women with overweight/obesity. These findings suggest a potentially achievable pathway to actively counterbalance the morbid effects of high BMIs, so we solicit adequately powered prospective trials.
在≥37 周足月单胎妊娠（gestation）中，研究应用最佳妊娠体重增长（optimal gestational weight gains，optGWG）对晚期子痫前期（late-onset preeclampsia，LOP）发生率的影响。
18.5 年观察性队列研究（2001-2019 年）。
法国海外省留尼汪岛南大学医院产科（印度洋），该产科是唯一一家为大约 36 万居民提供服务以治疗所有子痫前期病例的产科。
非超重、超重和 I-III 级肥胖患者中，达到最佳 GWG（不足和过多）的女性与 GWG 不适当（不足和过多）的女性发生 LOP 的模拟发生率。
在 66373 例足月单胎活产妊娠和 716 例 LOP（≥37 周，LOP37）中，87%的病例可以确定 GWG。在验证 optGWG 与母亲年龄和体重指数（body mass index，BMI）、初产妇、吸烟习惯、慢性高血压与足月子痫前期的独立关联的逻辑回归模型中，optGWG 降低了 LOP37 的风险，比值比（odds ratio，OR）为 0.74，p=0.004。初产妇、较高的母亲 BMI、慢性高血压和较高的母亲年龄增加了 LOP37 的风险。optGWG 的“保护”作用呈线性方式在超重和肥胖患者中更为明显：0.57%比 1.07%（OR 0.53，p=0.003），超重；I 级肥胖（30-34.9 kg/m²），0.70%比 1.56%（OR 0.44，p=0.01）；严重肥胖（≥35 kg/m²），0.86%比 2.55%（OR 0.33，p=0.06）。所有超重/肥胖患者的 OR 为 0.42，p<0.0001。
当达到最佳 GWG 时，超重和肥胖可能不会增加晚期子痫前期的风险。这项大型回顾性人群队列研究的结果表明，针对实现最佳 GWG 的目标和严格监测干预可能是降低 LOP 发生率的有效方法，并有可能将超重/肥胖妇女的 LOP 发生率减半。这些发现表明，实现积极平衡高 BMI 不良影响的潜在可行途径，因此我们需要进行充分的前瞻性试验。
