Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.
Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.
Eur J Obstet Gynecol Reprod Biol. 2021 Jul;262:129-133. doi: 10.1016/j.ejogrb.2021.05.025. Epub 2021 May 15.
To compare the neonatal and maternal adverse outcomes among women with cerclage and prepregnancy body mass index (BMI) < versus > 30 kg/m STUDY DESIGN: This retrospective cohort study utilized the U.S. Vital Statistics Datasets from 2011-2013. Inclusion criteria were women with non-anomalous singletons, with cerclage placement, without diabetes or hypertensive disorders, and who delivered at 20-41 weeks. The primary outcome was the composite neonatal adverse outcome (Apgar score below 5 at 5 min, birth injury, assisted ventilation for more than 6 h, neonatal seizure, or neonatal death). The secondary outcomes included the composite maternal adverse outcome (admission to intensive care unit, maternal transfusion, ruptured uterus, unplanned hysterectomy, or unplanned operating room procedure), chorioamnionitis, and cesarean delivery. Multivariable Poisson regression models with robust error variance were used, while adjusting for confounders. Adjusted relative risk with 95 % confidence intervals were calculated.
Of the 22,466 live births that met the inclusion criteria during the study period, 6427 (28.6 %) had cerclage and prepregnancy BMI ≥ 30 kg/m. The composite neonatal adverse outcome was significantly increased (aRR 1.45; 95 % CI 1.33-1.60) among women with cerclage and BMI ≥ 30 kg/m when compared to those with BMI < 30 kg/m. The composite maternal adverse outcome was similar (aRR 0.93; 95 % CI 0.72-1.20) among the two groups. Chorioamnionitis (aRR 1.46; 95 % CI 1.24-1.72) and cesarean delivery (aRR 1.24; 95 % CI 1.19-1.29) were higher in women with cerclage and BMI ≥ 30 kg/m.
Among pregnancies with cerclage and delivery at 20-41 weeks, the risk of the composite neonatal adverse outcome was modestly increased in newborns delivered by women with BMI ≥ 30 kg/m than those delivered by women with BMI < 30 kg/m. No significant difference was found in the risk of the composite maternal adverse outcome.
比较行宫颈环扎术且孕前体质量指数（BMI）< versus > 30kg/m2的女性的新生儿和产妇不良结局。
本回顾性队列研究使用了 2011 年至 2013 年美国生命统计数据集。纳入标准为非畸形单胎、行宫颈环扎术、无糖尿病或高血压疾病且孕 20-41 周分娩的女性。主要结局为复合新生儿不良结局（5 分钟时 Apgar 评分<5、出生损伤、辅助通气>6 小时、新生儿癫痫发作或新生儿死亡）。次要结局包括复合产妇不良结局（入住重症监护病房、产妇输血、子宫破裂、计划外子宫切除术或计划外手术室手术）、绒毛膜羊膜炎和剖宫产。采用具有稳健误差方差的多变量泊松回归模型进行调整，同时调整混杂因素。计算调整后的相对风险和 95%置信区间。
在研究期间，符合纳入标准的 22466 例活产儿中，6427 例（28.6%）行宫颈环扎术且孕前 BMI≥30kg/m2。与 BMI<30kg/m2的女性相比，行宫颈环扎术且 BMI≥30kg/m2的女性复合新生儿不良结局显著增加（调整相对风险 1.45；95%置信区间 1.33-1.60）。两组间复合产妇不良结局相似（调整相对风险 0.93；95%置信区间 0.72-1.20）。行宫颈环扎术且 BMI≥30kg/m2的女性绒毛膜羊膜炎（调整相对风险 1.46；95%置信区间 1.24-1.72）和剖宫产（调整相对风险 1.24；95%置信区间 1.19-1.29）的风险较高。
在孕 20-41 周行宫颈环扎术且分娩的妊娠中，与 BMI<30kg/m2的女性相比，BMI≥30kg/m2的女性新生儿复合新生儿不良结局的风险略有增加，但复合产妇不良结局的风险无显著差异。
