Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Am J Perinatol. 2023 Mar;40(4):387-393. doi: 10.1055/s-0041-1727230. Epub 2021 Apr 20.
The aim of the study is to examine the impact of maternal interpregnancy body mass index (BMI) change on subsequent offspring mortality risk.
This is a retrospective cohort study of women who had two consecutive live singleton deliveries of at least 20 weeks' gestation from the Utah Population Database. Our exposure was defined as interpregnancy BMI change from the date of first delivery to the conception date of subsequent pregnancy. We categorized BMI change as: < - 1, -1 to 0, 0 to <1 (reference), 1 to 2, 2 to 4, ≥4 kg/m. Our primary outcome was all-cause age-specific mortality during four time periods: neonatal (≤28 days), infant (29 days to <1 year old), childhood ((≥1 to <5 years old), and late childhood (5 to <18 years old). We also examined mortality specifically attributed to congenital anomalies. Analyses used Cox proportional hazard models stratified by full term (≥37 weeks) and preterm (<37 weeks) deliveries. All models were adjusted for relevant confounders.
Of 266,752 women, among full-term deliveries, women with a BMI increase of 4 kg/m or more had an increased risk of neonatal mortality in their subsequent pregnancy (hazard ratio or HR = 1.72, 95% confidence interval or CI: 1.23-2.41) Women who lost 1 kg/m or more between deliveries also had increased neonatal mortality (HR = 1.46, 95% CI: 1.04-2.05). There were no differences in infant, early, or late childhood mortality by interpregnancy BMI change. Maternal interpregnancy interval weight loss of 1 kg/m or more and weight gain of ≥4 kg/m also had increased risk of mortality associated with congenital anomalies or conditions arising during the neonatal period following their subsequent delivery.
Women with significant interpregnancy weight gain and modest weight loss have a significant increased risk of neonatal mortality following their subsequent pregnancy.
· Significant weight gain between deliveries increases the risk of neonatal death.. · Modest weight loss between deliveries increases the risk of neonatal death.. · This risk may be partially explained by increased risk of congenital malformations..
本研究旨在探讨孕产妇孕期体重指数（BMI）变化对后代死亡风险的影响。
这是一项回顾性队列研究，纳入了来自犹他州人口数据库的连续两次至少 20 周龄的活单胎分娩的女性。我们的暴露因素定义为从首次分娩日期到后续妊娠受孕日期的孕期体重指数变化。我们将 BMI 变化分为以下几类：< -1、-1 至 0、0 至 <1（参考）、1 至 2、2 至 4、≥4kg/m。主要结局为四个时间段内的全因年龄特异性死亡率：新生儿期（≤28 天）、婴儿期（29 天至<1 岁）、儿童期（≥1 岁至<5 岁）和晚儿童期（5 岁至<18 岁）。我们还检查了特定归因于先天畸形的死亡率。分析采用 Cox 比例风险模型，按足月（≥37 周）和早产（<37 周）分娩分层。所有模型均根据相关混杂因素进行调整。
在 266752 名女性中，在足月分娩中，BMI 增加 4kg/m 或以上的女性在随后的妊娠中新生儿死亡风险增加（风险比或 HR=1.72，95%置信区间或 CI：1.23-2.41）。两次分娩之间体重减轻 1kg/m 或以上的女性新生儿死亡风险也增加（HR=1.46，95%CI：1.04-2.05）。孕期 BMI 变化与婴儿期、幼儿期或晚儿童期死亡率无关。孕期体重减轻 1kg/m 或以上和体重增加≥4kg/m 也增加了随后分娩后新生儿期和先天畸形或新生儿期后出现的其他疾病相关死亡的风险。
孕期体重显著增加和适度减轻的女性在随后的妊娠中新生儿死亡风险显著增加。
·分娩间体重显著增加会增加新生儿死亡的风险。·分娩间适度减重会增加新生儿死亡的风险。·这种风险可能部分归因于先天畸形的风险增加。
