Université de Paris, CRESS, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, DHU Risks in pregnancy, Paris, France.
Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Int J Obes (Lond). 2021 Jan;45(1):258-265. doi: 10.1038/s41366-020-00691-4. Epub 2020 Oct 22.
Obesity has significant implications for the health of pregnant women. However, few studies have quantified its association with maternal mortality or examined the relevant underlying causes and the role of care, although this remains the most severe maternal outcome. Our objectives were to quantify the risk of maternal death by prepregnancy body mass index and to determine whether obesity affected the quality of care of the women who died.
This is a national population-based case-control study in France. Cases were 364 maternal deaths from the 2007-2012 National Confidential Enquiry. Controls were 14,681 parturients from the nationally representative 2010 perinatal survey. We studied the association between categories of prepregnancy BMI and maternal death by multivariable logistic regression, estimating adjusted odds ratios and 95% confidence intervals, overall and by specific causes of death. Individual case reviews assessed the quality of care provided to the women who died, by obesity status.
Compared with women with normal BMI, underweight women (<18.5 kg/m) had an adjusted OR of death of 0.75 (95% CI, 0.42-1.33), overweight women (25-29.9 kg/m) 1.65 (95% CI, 1.24-2.19), women with class 1 obesity (30-34.9 kg/m) 2.22 (95% CI, 1.55-3.19) and those with class 2-3 obesity (≥35 kg/m) 3.40 (95% CI, 2.17-5.33). Analysis by cause showed significant excess risk of maternal death due to cardiovascular diseases, venous thromboembolism, hypertensive complications and stroke in women with obesity. Suboptimal care was as frequent among women with (35/62, 57%) as without obesity (136/244, 56%), but this inadequate management was directly related to obesity among 14/35 (40%) obese women with suboptimal care. Several opportunities for improvement were identified.
The risk of maternal death increases with BMI; it multiplied by 1.6 in overweight women and more than tripled in pregnant women with severe obesity. Training clinicians in the specificities of care for pregnant women with obesity could improve their outcomes.
肥胖对孕妇健康有重大影响。然而，很少有研究定量分析肥胖与产妇死亡率的关系，也很少研究相关的根本原因和护理的作用，尽管这是最严重的产妇结局。我们的目的是定量分析孕前体重指数与产妇死亡的风险，并确定肥胖是否影响了死亡产妇的护理质量。
这是一项在法国进行的全国性基于人群的病例对照研究。病例为 2007-2012 年全国机密调查中的 364 例产妇死亡。对照组为 2010 年全国围产期调查中具有代表性的 14681 名产妇。我们通过多变量逻辑回归研究了孕前 BMI 类别与产妇死亡之间的关系，估计了调整后的比值比和 95%置信区间，整体和按特定死因进行了估计。对每个病例的审查评估了根据肥胖状况向死亡产妇提供的护理质量。
与正常 BMI 的女性相比，体重不足（<18.5kg/m）的女性死亡的调整比值比为 0.75（95%可信区间，0.42-1.33），超重（25-29.9kg/m）的女性为 1.65（95%可信区间，1.24-2.19），1 类肥胖（30-34.9kg/m）的女性为 2.22（95%可信区间，1.55-3.19），2-3 类肥胖（≥35kg/m）的女性为 3.40（95%可信区间，2.17-5.33）。按死因分析显示，肥胖女性心血管疾病、静脉血栓栓塞、高血压并发症和中风导致的产妇死亡风险显著增加。在有（35/62，57%）和无肥胖（136/244，56%）的女性中，护理不充分的情况同样常见，但在 14/35（40%）护理不充分的肥胖女性中，这种不充分的管理直接与肥胖有关。发现了一些可以改进的机会。
产妇死亡的风险随着 BMI 的增加而增加；超重女性的风险增加 1.6 倍，重度肥胖的孕妇增加三倍以上。培训临床医生了解肥胖孕妇护理的特殊性可以改善她们的结局。
