Departments of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, Northwestern University, Chicago, Illinois, University of Alabama at Birmingham, Birmingham, Alabama, University of Utah Health Sciences Center, Salt Lake City, Utah, Stanford University, Stanford, California, Columbia University, New York, New York, Brown University, Providence, Rhode Island, University of Texas Medical Branch, Galveston, Texas, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio, University of Texas Southwestern Medical Center, Dallas, Texas, University of Pennsylvania, Philadelphia, Pennsylvania, Duke University, Durham, North Carolina, and University of Pittsburgh, Pittsburgh, Pennsylvania; and the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Obstet Gynecol. 2022 May 1;139(5):866-876. doi: 10.1097/AOG.0000000000004753. Epub 2022 Apr 5.
To compare health care medical resource utilization in low-risk nulliparous pregnancies according to body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) categories.
This is a secondary analysis of a multicenter randomized controlled trial of induction of labor between 39 0/7 39 and 4/7 weeks of gestation compared with expectant management in low-risk nulliparous pregnant people, defined as those without standard obstetric indications for delivery at 39 weeks. Body mass index at randomization was categorized into four groups (lower than 25, 25-29, 30-39, and 40 or higher). The primary outcome of this analysis was time spent in the labor and delivery department from admission to delivery. Secondary outcomes included length of stay (LOS) postdelivery, total hospital LOS, and antepartum, intrapartum, and postpartum resource utilization, which were defined a priori. Multivariable generalized linear modeling and logistic regressions were performed, and 99% CIs were calculated.
A total of 6,058 pregnant people were included in the analysis; 640 (10.6%) had BMIs of lower than 25, 2,222 (36.7%) had BMIs between 25 and 29, 2,577 (42.5%) had BMIs of 30-39, and 619 (10.2%) had BMIs of 40 or higher. Time spent in the labor and delivery department increased from 15.1±9.2 hours for people with BMIs of lower than 25 to 23.5±13.6 hours for people with BMIs of 40 or higher, and every 5-unit increase in BMI was associated with an average 9.8% increase in time spent in the labor and delivery department (adjusted estimate per 5-unit increase in BMI 1.10, 99% CI 1.08-1.11). Increasing BMI was not associated with an increase in antepartum resource utilization, except for blood tests and urinalysis. However, increasing BMI was associated with higher odds of intrapartum resource utilization, longer total hospital LOS, and postpartum resource utilization. For example, every 5-unit increase in BMI was associated with an increase of 26.1% in the odds of antibiotic administration, 57.6% in placement of intrauterine pressure catheter, 5.1% in total inpatient LOS, 31.0 in postpartum emergency department visit, and 23.9% in postpartum hospital admission.
Among low-risk nulliparous people, higher BMI was associated with longer time from admission to delivery, total hospital LOS, and more frequent utilization of intrapartum and postpartum resources.
ClinicalTrials.gov, NCT01990612.
根据体重指数（BMI，体重除以身高的平方）类别比较低危初产妇的医疗保健资源利用情况。
这是一项对低危初产妇分娩的多中心随机对照试验的二次分析，比较了在 39 周+0/7 至 39 周+4/7 之间与期待管理的分娩诱导，低危初产妇定义为在 39 周时没有分娩标准产科指征的产妇。随机分组时的 BMI 分为四组（低于 25、25-29、30-39 和 40 或更高）。该分析的主要结局是从入院到分娩在产房和分娩部门的时间。次要结局包括产后住院时间（LOS）、总住院 LOS 以及产前、产时和产后资源利用，这些都事先定义好了。采用多变量广义线性模型和逻辑回归进行分析，并计算 99%置信区间。
共有 6058 名孕妇纳入分析；640 名（10.6%）的 BMI 低于 25，222 名（36.7%）的 BMI 在 25 到 29 之间，2577 名（42.5%）的 BMI 在 30 到 39 之间，619 名（10.2%）的 BMI 为 40 或更高。从 BMI 低于 25 的孕妇的 15.1±9.2 小时增加到 BMI 为 40 或更高的孕妇的 23.5±13.6 小时，BMI 每增加 5 个单位，在产房和分娩部门的时间平均增加 9.8%（每增加 5 个单位 BMI 的调整估计值为 1.10，99%CI 为 1.08-1.11）。BMI 增加与产前资源利用增加无关，除了血液检查和尿液分析。然而，BMI 增加与更高的产时资源利用、更长的总住院时间和产后资源利用有关。例如，BMI 每增加 5 个单位，抗生素使用率增加 26.1%，宫内压力导管放置率增加 57.6%，总住院 LOS 增加 5.1%，产后急诊就诊率增加 31.0%，产后住院率增加 23.9%。
在低危初产妇中，较高的 BMI 与从入院到分娩、总住院时间以及产时和产后资源利用频率的增加有关。
ClinicalTrials.gov，NCT01990612。
