Liu Xue, Wang Huan, Yang Liu, Zhao Min, Magnussen Costan G, Xi Bo
Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
Front Nutr. 2022 Feb 14;9:811217. doi: 10.3389/fnut.2022.811217. eCollection 2022.
Gestational weight gain (GWG) reflects maternal nutrition during pregnancy. However, the associations between maternal GWG and adverse birth outcomes are inconclusive.
We aimed to examine the associations between maternal GWG and adverse birth outcomes according to maternal pre-pregnancy body mass index (BMI) categories in a large, multiethnic and diverse population in the U.S.
We used nationwide birth certificate data from the National Vital Statistics System to examine the association of GWG (below, within and above the Institute of Medicine [IOM] guidelines) with six adverse birth outcomes (preterm birth, low birthweight, macrosomia, small for gestational age [SGA], large for gestational age [LGA], and low Apgar score) according to the pre-pregnancy BMI categories (underweight to obesity grade 3). Multivariable logistic regression analyses were performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs).
A total of 9,191,842 women aged 18-49 years at delivery with live singleton births were included. Among them, 24.5% of women had GWG below IOM guidelines, 27.6% within the guidelines, and 47.9% above the guidelines. Compared with maternal GWG within guidelines, GWG below guidelines was associated with higher odds of preterm birth (OR = 1.52, 95%CI = 1.51-1.53), low birthweight (OR = 1.46, 95%CI = 1.45-1.47) and SGA (OR = 1.44, 95%CI = 1.43-1.45). In contrast, maternal GWG above guidelines was associated with higher odds of macrosomia (OR = 2.12, 95%CI = 2.11-2.14) and LGA (OR = 2.12, 95%CI = 2.11-2.14). In addition, maternal GWG below or above guidelines had slightly higher odds of low Apgar score (below guidelines: OR = 1.04, 95%CI = 1.03-1.06, above guidelines: OR = 1.17, 95%CI = 1.15-1.18). The results were largely similar among women with GWG below or above guidelines across pre-pregnancy BMI categories of underweight, overweight, and obesity grade 1 to grade 3.
Pregnant women with GWG below or above the IOM guidelines have increased odds of selected adverse infant birth outcomes. Monitoring maternal GWG could enable physicians to provide tailored nutrition and exercise advice as well as prenatal care to pregnant women to reduce the likelihood of adverse birth outcomes.
孕期体重增加（GWG）反映了孕期的母体营养状况。然而，母体GWG与不良分娩结局之间的关联尚无定论。
我们旨在在美国一个大型、多民族且多样化的人群中，根据孕前体重指数（BMI）类别，研究母体GWG与不良分娩结局之间的关联。
我们使用了来自国家生命统计系统的全国出生证明数据，根据孕前BMI类别（体重过轻至肥胖3级），研究GWG（低于、符合和高于医学研究所[IOM]指南）与六种不良分娩结局（早产、低出生体重、巨大儿、小于胎龄儿[SGA]、大于胎龄儿[LGA]和低Apgar评分）之间的关联。进行多变量逻辑回归分析以估计比值比（OR）和95%置信区间（CI）。
共纳入9,191,842名年龄在18 - 49岁、单胎活产的分娩女性。其中，24.5%的女性GWG低于IOM指南，27.6%符合指南，47.9%高于指南。与符合指南的母体GWG相比，低于指南的GWG与早产（OR = 1.52，95%CI = 1.51 - 1.53）、低出生体重（OR = 1.46，95%CI = 1.45 - 1.47）和SGA（OR = 1.44，95%CI = 1.43 - 1.45）的较高几率相关。相比之下，高于指南的母体GWG与巨大儿（OR = 2.12，95%CI = 2.11 - 2.14）和LGA（OR = 2.12，95%CI = 2.11 - 2.14）的较高几率相关。此外，低于或高于指南的母体GWG出现低Apgar评分的几率略高（低于指南：OR = 1.04，95%CI = 1.03 - 1.06，高于指南：OR = 1.17，95%CI = 1.15 - 1.18）。在体重过轻、超重以及肥胖1级至3级的孕前BMI类别中，GWG低于或高于指南的女性结果大致相似。
GWG低于或高于IOM指南的孕妇出现特定不良婴儿出生结局的几率增加。监测母体GWG可使医生为孕妇提供量身定制的营养和运动建议以及产前护理，以降低不良分娩结局的可能性。
