Sormunen-Harju Heidi, Koivusalo Saila, Gissler Mika, Metsälä Johanna
Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Information Services Department, THL Finnish Institute for Health and Welfare, Helsinki, Finland.
Acta Obstet Gynecol Scand. 2021 Mar;100(3):489-496. doi: 10.1111/aogs.14028. Epub 2020 Nov 2.
Maternal obesity is associated with an increased risk of several pregnancy complications. In the second pregnancy, previous pregnancy and other medical history provide additional information about individual morbidity risk. In this study, we assess the risk of pregnancy complications in the second pregnancy by maternal body mass index (BMI) and evaluate how first-pregnancy complications and preexisting conditions modify these associations.
We have used nationwide data on all women (n = 48 963) experiencing their first and second pregnancy between 2006 and 2013 in Finland. The associations between the full scale of maternal BMI and pregnancy complications (gestational diabetes, gestational hypertension and preeclampsia) were analyzed using logistic regression and restricted cubic spline regression models and interactions between BMI and first-pregnancy complications, pregestational diabetes or chronic hypertension were tested.
The risk of pregnancy complications increased with adiposity. Unadjusted probability of second-pregnancy gestational diabetes with BMI of 25 kg/m was 56% and 8.4% among women with and without first-pregnancy gestational diabetes, respectively. The corresponding figures with BMI of 30 kg/m were 64% and 17%. Adjusted odds ratio (OR) (95% CI) for second-pregnancy gestational diabetes with BMI of 25 kg/m was 45 (34-59) and 3.3 (2.6-4.0) among women with and without first-pregnancy gestational diabetes, respectively, when compared with women with BMI of 20 kg/m and no first-pregnancy gestational diabetes. Adjusted OR (95% CI) for second-pregnancy gestational hypertension among women with BMI of 25 kg/m was 42 (26-66) and 2.3 (1.4-3.8) among women with and without first-pregnancy hypertensive disorder, respectively, when compared with women with BMI of 20 kg/m and no first-pregnancy hypertensive disorder. The risk of preeclampsia increased with adiposity independent of first-pregnancy complications. Pregestational diabetes or chronic hypertension did not modify the association between adiposity and any of the second-pregnancy complications.
As maternal BMI increases, the risk of complications increases in the second pregnancy. The risk of gestational diabetes and hypertension is, however, highest among women with complications in the first pregnancy.
孕妇肥胖与多种妊娠并发症风险增加相关。在第二次妊娠时，既往妊娠情况及其他病史可提供有关个体发病风险的更多信息。在本研究中，我们通过孕妇体重指数（BMI）评估第二次妊娠时的妊娠并发症风险，并评估首次妊娠并发症及既往存在的疾病如何改变这些关联。
我们使用了芬兰2006年至2013年间所有经历首次和第二次妊娠的女性（n = 48963）的全国性数据。使用逻辑回归和受限立方样条回归模型分析了孕妇BMI全范围与妊娠并发症（妊娠期糖尿病、妊娠期高血压和子痫前期）之间的关联，并检验了BMI与首次妊娠并发症、孕前糖尿病或慢性高血压之间的相互作用。
妊娠并发症风险随肥胖程度增加而升高。BMI为25kg/m²的第二次妊娠女性中，有和没有首次妊娠妊娠期糖尿病的女性，未调整的妊娠期糖尿病概率分别为56%和8.4%。BMI为30kg/m²时，相应数字分别为64%和17%。与BMI为20kg/m²且无首次妊娠妊娠期糖尿病的女性相比，BMI为25kg/m²的第二次妊娠女性中，有和没有首次妊娠妊娠期糖尿病的女性，调整后的比值比（OR）（95%CI）分别为45（34 - 59）和3.3（2.6 - 4.0）。与BMI为20kg/m²且无首次妊娠高血压疾病的女性相比，BMI为25kg/m²的女性中，有和没有首次妊娠高血压疾病的女性，第二次妊娠妊娠期高血压的调整后OR（95%CI）分别为42（26 - 66）和2.3（1.4 - 3.8）。子痫前期风险随肥胖程度增加，与首次妊娠并发症无关。孕前糖尿病或慢性高血压并未改变肥胖与任何第二次妊娠并发症之间的关联。
随着孕妇BMI增加，第二次妊娠时并发症风险增加。然而，首次妊娠有并发症的女性中，妊娠期糖尿病和高血压风险最高。
