Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia.
Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia.
Am J Perinatol. 2021 Jul;38(8):759-765. doi: 10.1055/s-0040-1721698. Epub 2020 Dec 25.
This study aimed to examine the association between interpregnancy body mass index (BMI, kg/m) change and intrapartum cesarean delivery in multiparous women without a history of cesarean delivery.
We conducted a retrospective cohort study of all women who had more than one singleton pregnancy at 23 weeks' gestation or greater at MedStar Washington Hospital Center from January 2009 to June 2018. We excluded women who had a history of cesarean delivery, prelabor cesarean delivery, and contraindications for vaginal delivery. Interpregnancy BMI change was calculated by the change of early pregnancy BMI measured in the office. Women were categorized according to the interpregnancy BMI change (BMI loss more than 2 kg/m, BMI change ± 2 kg/m, and BMI gain more than 2 kg/m). The primary outcome was an intrapartum cesarean delivery. Multivariable logistic regression was performed to calculate adjusted odds ratio (aOR) with 95% confidence interval (CI) after adjusting for predefined covariates.
Of 2,168 women who were analyzed, 258 (12%), 1,192 (55%), and 718 (33%) had interpregnancy BMI loss more than 2 kg/m, BMI change ± 2 kg/m, and BMI gain more than 2 kg/m, respectively. Women with BMI gain more than 2 kg/m compared with those with BMI change ± 2 kg/m had increased odds of intrapartum cesarean delivery (7.4 vs. 4.5%; aOR: 1.78; 95% CI: 1.10-2.86) and cesarean delivery for arrest disorders (3.1 vs. 1.1%; aOR: 3.06; 95% CI: 1.30-7.15). Women with BMI loss more than 2 kg/m compared with those with BMI change ± 2 kg/m had similar rates of cesarean delivery.
Compared with interpregnancy BMI change ± 2 kg/m, interpregnancy BMI gain 2 kg/m was associated with increased odds of intrapartum cesarean delivery.
· BMI gain between pregnancies was associated with intrapartum cesarean delivery.. · BMI loss between pregnancies was not associated with intrapartum cesarean delivery.. · Our study suggests that at least maintaining weight between pregnancies is beneficial..
本研究旨在探讨既往无剖宫产史的多产妇孕期体重指数（BMI，kg/m²）变化与分娩期剖宫产的关系。
我们对 2009 年 1 月至 2018 年 6 月在 MedStar 华盛顿医院中心进行的 23 周以上单胎妊娠的所有女性进行了回顾性队列研究。我们排除了有剖宫产史、产前剖宫产和阴道分娩禁忌证的女性。孕期体重指数变化通过在诊室测量的早期妊娠体重指数的变化来计算。根据孕期体重指数变化（体重指数减少超过 2kg/m²、体重指数变化±2kg/m²和体重指数增加超过 2kg/m²）将女性进行分类。主要结局为分娩期剖宫产。多变量逻辑回归用于计算调整后的比值比（aOR），并在调整了预设协变量后计算 95%置信区间（CI）。
在 2168 名被分析的女性中，分别有 258 名（12%）、1192 名（55%）和 718 名（33%）女性孕期体重指数减少超过 2kg/m²、体重指数变化±2kg/m²和体重指数增加超过 2kg/m²。与体重指数变化±2kg/m²的女性相比，体重指数增加超过 2kg/m²的女性分娩期剖宫产的几率增加（7.4%比 4.5%；aOR：1.78；95%CI：1.10-2.86）和剖宫产治疗阻滞性疾病（3.1%比 1.1%；aOR：3.06；95%CI：1.30-7.15）。与体重指数变化±2kg/m²的女性相比，体重指数减少超过 2kg/m²的女性剖宫产率相似。
与孕期体重指数变化±2kg/m²相比，孕期体重指数增加 2kg/m²与分娩期剖宫产的几率增加相关。
·孕期体重指数增加与分娩期剖宫产相关。·孕期体重指数减轻与分娩期剖宫产无关。·我们的研究表明，至少在孕期保持体重是有益的。
