Medical Faculty, Lazarski University, 02-662 Warsaw, Poland.
Division of Gynecological Surgery, University Hospital, 33 Polna Str., 60-535 Poznan, Poland.
Nutrients. 2021 Apr 7;13(4):1213. doi: 10.3390/nu13041213.
The associations between maternal pre-pregnancy obesity and low birth weight (LBW, <2500 g) remain inconclusive. Therefore, birth weight in a Polish prospective cohort of 912 mothers was investigated depending on the pre-pregnancy body mass index (BMI). The whole cohort and the subgroup of gestational weight gain (GWG) in the range of the Institute of Medicine (IOM) recommendations, as well as 'healthy' women (who did not develop diabetes or hypertension in this pregnancy) were investigated. Adjusted odds ratios (AOR) of the newborn outcomes (with 95% confidence intervals, CI) for obesity (BMI ≥ 30 kg/m) vs. normal BMI (18.5-24.9 kg/m) were calculated using multiple logistic regression. Risk profiles (in the Lowess method) were presented for BMI values (kg/m) and threshold BMI values were calculated. (1) In the cohort, LBW affected 6.6% of pregnancies, fetal growth restriction (FGR) 2.3%, and macrosomia 10.6%. (2) The adjusted risk of macrosomia was more than three-fold higher for obesity compared to normal BMI in the whole cohort (AOR = 3.21 (1.69-6.1), < 0.001) and the result was maintained in the subgroups. A 17-fold higher adjusted LBW risk for obesity was found (AOR = 17.42 (1.5-202.6), = 0.022), but only in the normal GWG subgroup. The FGR risk profile was U-shaped: in the entire cohort, the risk was more than three times higher for obesity (AOR = 3.12 (1.02-9.54), = 0.045) and underweight (AOR = 3.84 (1.13-13.0), = 0.031). (3) The risk profiles showed that the highest BMI values were found to be associated with a higher risk of these three newborn outcomes and the threshold BMI was 23.7 kg/m for macrosomia, 26.2 kg/m for LBW, and 31.8 kg/m for FGR. These results confirm the multidirectional effects of obesity on fetal growth (low birth weight, fetal growth restriction, and macrosomia). The results for LBW were heavily masked by the effects of abnormal gestational weight gain.
母亲孕前肥胖与低出生体重（LBW，<2500 克）之间的关联仍不确定。因此，研究了波兰前瞻性队列中的 912 名母亲的出生体重，依据的是孕前体重指数（BMI）。研究了整个队列以及美国医学研究所（IOM）建议的妊娠期体重增加（GWG）范围内的亚组和“健康”女性（在此次妊娠中未患糖尿病或高血压）。使用多变量逻辑回归计算肥胖（BMI≥30kg/m）与正常 BMI（18.5-24.9kg/m）的新生儿结局（95%置信区间，CI）的调整比值比（AOR）。（1）在该队列中，LBW 影响了 6.6%的妊娠，胎儿生长受限（FGR）为 2.3%，巨大儿为 10.6%。（2）与正常 BMI 相比，肥胖组的巨大儿风险增加了三倍以上，整个队列的 AOR 为 3.21（1.69-6.1），<0.001，在亚组中结果仍然保持。肥胖组 LBW 的调整后风险增加了 17 倍（AOR=17.42（1.5-202.6），=0.022），但仅在正常 GWG 亚组中。FGR 风险呈 U 型：在整个队列中，肥胖的风险增加了三倍以上（AOR=3.12（1.02-9.54），=0.045），体重不足的风险也增加了三倍（AOR=3.84（1.13-13.0），=0.031）。（3）风险曲线表明，最高的 BMI 值与这三种新生儿结局的风险增加有关，巨大儿的 BMI 阈值为 23.7kg/m，LBW 的 BMI 阈值为 26.2kg/m，FGR 的 BMI 阈值为 31.8kg/m。这些结果证实了肥胖对胎儿生长的多向影响（低出生体重、胎儿生长受限和巨大儿）。LBW 的结果受到异常 GWG 影响的严重掩盖。
