Department of Obstetrics and Gynaecology, Institution of Clinical Sciences, University of Lund, Lund, Sweden.
Helsingborg Hospital, Helsingborg, Sweden.
BJOG. 2022 Apr;129(5):761-768. doi: 10.1111/1471-0528.16964. Epub 2021 Nov 8.
To investigate the risk of stillbirth or neonatal death before 45 post-menstrual weeks in relation to gestational duration, stratified by body mass index (BMI) and parity.
Retrospective study.
Data from the Swedish Medical Birth Register.
Singleton, cephalic births at between 39 and 42 weeks of gestation, 2005-2016 (n = 892 339).
Relative risk ratios for mortality in relation to gestational duration were stratified by parity and BMI, and were adjusted for maternal age, smoking, country of birth and educational level.
Primary outcome: stillbirth or neonatal death before 45 post-menstrual weeks.
stillbirth.
Among children of primiparous women, children born at 41 weeks of gestation, or later, were at increased risk of stillbirth or neonatal death before 45 post-menstrual weeks compared with children born between 39 and 40 weeks of gestation (aRR 1.29, 95% CI 1.10-1.52). For primiparous women with BMIs of <25, 25-29.9 and 30 kg/m , the corresponding aRRs were: 1.04 (95% CI 0.81-1.34), 1.25 (95% CI 0.94-1.66) and 1.52 (95% CI 1.10-2.10), respectively. No significant increase in risk with gestational age was detected for multiparous women, regardless of BMI class. Among primipara, the risk of stillbirth increased with gestational duration in all BMI classes, with the highest risk increase for BMI ≥ 30 kg/m , from 0.8/1000 at 40 -40 weeks of gestation to 4.0/1000 at 42 -42 weeks of gestation.
At 41 -42 weeks of gestation, pregnancy duration was associated with an increased risk for stillbirth or neonatal death before 45 post-menstrual weeks among primiparous women, especially among women who were obese. For multiparous women, no significant association between gestational duration and mortality was found.
In term pregnancies the risk for stillbirth and neonatal death is affected by gestational age, parity and BMI.
研究与体质量指数（BMI）和产次相关的 45 孕周前死产或新生儿死亡的风险与孕龄的关系。
回顾性研究。
瑞典医学出生登记处的数据。
2005 年至 2016 年间，单胎、头位分娩，孕龄 39 周至 42 周（n=892339）。
按产次和 BMI 分层，对与孕龄相关的死亡率的相对危险比进行调整，以校正母亲年龄、吸烟、出生国和教育水平。
主要结局：45 孕周前死产或新生儿死亡。
死产。
在初产妇的孩子中，与孕龄 39 至 40 周之间出生的孩子相比，孕龄 41 周或以上出生的孩子发生 45 孕周前死产或新生儿死亡的风险增加（aRR 1.29，95%CI 1.10-1.52）。对于 BMI<25、25-29.9 和 30kg/m2 的初产妇，相应的 aRR 分别为：1.04（95%CI 0.81-1.34）、1.25（95%CI 0.94-1.66）和 1.52（95%CI 1.10-2.10）。无论 BMI 类别如何，多产妇均未发现与孕龄相关的风险增加。在初产妇中，所有 BMI 类别中，随着孕周的增加，死产风险均增加，BMI≥30kg/m2 的风险增加最大，从 40-40 周的 0.8/1000 增加到 42-42 周的 4.0/1000。
在 41-42 孕周时，初产妇的孕龄与 45 孕周前死产或新生儿死亡风险增加相关，尤其是肥胖的初产妇。对于多产妇，孕龄与死亡率之间无显著相关性。
在足月妊娠中，死产和新生儿死亡的风险受孕龄、产次和 BMI 的影响。
