Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Paediatr Perinat Epidemiol. 2021 Jul;35(4):459-468. doi: 10.1111/ppe.12741. Epub 2020 Nov 20.
Current pregnancy weight gain guidelines were developed based on implicit assumptions of a small group of experts about the relative seriousness of adverse health outcomes. Therefore, they will not necessarily reflect the values of women.
To estimate the seriousness of 11 maternal and child health outcomes that have been consistently associated with pregnancy weight gain by engaging patients and health professionals.
We collected data using an online panel approach with a modified Delphi structure. We selected a purposeful sample of maternal and child health professionals (n = 84) and women who were pregnant or recently postpartum (patients) (n = 82) in the United States as panellists. We conducted three concurrent panels: professionals only, patients only, and patients and professionals. During a 3-round online modified Delphi process, participants rated the seriousness of health outcomes (Round 1), reviewed and discussed the initial results (Round 2), and revised their original ratings (Round 3). Panellists assigned seriousness ratings (0, [not serious] to 100 [most serious]) for infant death, stillbirth, preterm birth, gestational diabetes, preeclampsia, small-for-gestational-age (SGA) birth, large-for-gestational-age (LGA) birth, unplanned caesarean delivery, maternal obesity, childhood obesity, and maternal metabolic syndrome.
Each panel individually came to a consensus on all seriousness ratings. The final median seriousness ratings combined across all panels were highest for infant death (100), stillbirth (95), preterm birth (80), and preeclampsia (80). Obesity in children, metabolic syndrome in women, obesity in women, and gestational diabetes had median seriousness ratings ranging from 55 to 65. The lowest seriousness ratings were for SGA birth, LGA birth, and unplanned caesarean delivery (30-40).
Professionals and women rate some adverse outcomes as being more serious than others. These ratings can be used to establish the range of pregnancy weight gain associated with the lowest risk of a broad range of maternal and child health outcomes.
目前的妊娠增重指南是基于一小部分专家对不良健康结果相对严重程度的隐含假设制定的。因此，它们不一定反映女性的价值观。
通过让患者和卫生专业人员参与，估计与妊娠增重一直相关的 11 项母婴健康结果的严重程度。
我们使用具有改良 Delphi 结构的在线小组方法收集数据。我们选择了美国的母婴健康专业人员（n=84）和孕妇或最近产后的妇女（患者）（n=82）作为小组参与者，进行了三个同时进行的小组：仅专业人员、仅患者和患者和专业人员。在三轮在线改良 Delphi 过程中，参与者对健康结果的严重程度进行了评分（第一轮），审查和讨论了初步结果（第二轮），并修改了他们的原始评分（第三轮）。小组成员为婴儿死亡、死产、早产、妊娠糖尿病、子痫前期、小于胎龄儿（SGA）出生、大于胎龄儿（LGA）出生、计划外剖宫产、产妇肥胖、儿童肥胖和产妇代谢综合征分配严重程度评分（0，[不严重]至 100[最严重]）。
每个小组单独对所有严重程度评分达成共识。结合所有小组的最终中位数严重程度评分最高的是婴儿死亡（100）、死产（95）、早产（80）和子痫前期（80）。儿童肥胖、女性代谢综合征、女性肥胖和妊娠糖尿病的中位数严重程度评分在 55 到 65 之间。SGA 出生、LGA 出生和计划外剖宫产的严重程度评分最低（30-40）。
专业人员和妇女对一些不良结果的评估比其他结果更严重。这些评分可用于确定与广泛母婴健康结果风险最低相关的妊娠增重范围。
