孕产妇肥胖与早产表型的关联以及妊娠期糖尿病和先兆子痫的中介作用：一项前瞻性队列研究
Association of maternal obesity with preterm birth phenotype and mediation effects of gestational diabetes mellitus and preeclampsia: a prospective cohort study.
作者信息
Liu Kan, Chen Yixuan, Tong Jianing, Yin Aiqi, Wu Linlin, Niu Jianmin
机构信息
Department of Obstetrics, Shenzhen Maternity & Child Healthcare Hospital, The First School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China.
出版信息
BMC Pregnancy Childbirth. 2022 Jun 1;22(1):459. doi: 10.1186/s12884-022-04780-2.
BACKGROUND
The association between maternal obesity and preterm birth remains controversial and inconclusive, and the effects of gestational diabetes mellitus (GDM) and preeclampsia (PE) on the relationship between obesity and preterm birth have not been studied. We aimed to clarify the relationship between prepregnancy body mass index (BMI) and the phenotypes of preterm birth and evaluate the mediation effects of GDM and PE on the relationship between prepregnancy BMI and preterm birth.
METHODS
We conducted a prospective cohort study of 43,056 women with live singleton births from 2017 through 2019. According to the WHO International Classification, BMI was classified as underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5-25 kg/m2), overweight (BMI 25-30 kg/m2) and obese (BMI ≥30 kg/m2). Preterm birth was defined as gestational age less than 37 weeks (extremely, < 28 weeks; very, 28-31 weeks; and moderately, 32-36 weeks). The clinical phenotypes of preterm birth included spontaneous preterm birth (spontaneous preterm labor and premature rupture of the membranes) and medically indicated preterm birth. We further analyzed preterm births with GDM or PE. Multivariable logistic regression analysis and causal mediation analysis were performed.
RESULTS
Risks of extremely, very, and moderately preterm birth increased with BMI, and the highest risk was observed for obese women with extremely preterm birth (OR 3.43, 95% CI 1.07-10.97). Maternal obesity was significantly associated with spontaneous preterm labor (OR 1.98; 95% CI 1.13-3.47), premature rupture of the membranes (OR 2.04; 95% CI 1.08-3.86) and medically indicated preterm birth (OR 2.05; 95% CI 1.25-3.37). GDM and PE mediated 13.41 and 36.66% of the effect of obesity on preterm birth, respectively. GDM mediated 32.80% of the effect of obesity on spontaneous preterm labor and PE mediated 64.31% of the effect of obesity on medically indicated preterm birth.
CONCLUSIONS
Maternal prepregnancy obesity was associated with all phenotypes of preterm birth, and the highest risks were extremely preterm birth and medically indicated preterm birth. GDM and PE partially mediated the association between obesity and preterm birth.
背景
母亲肥胖与早产之间的关联仍存在争议且尚无定论，妊娠期糖尿病（GDM）和子痫前期（PE）对肥胖与早产关系的影响尚未得到研究。我们旨在阐明孕前体重指数（BMI）与早产表型之间的关系，并评估GDM和PE对孕前BMI与早产关系的中介作用。
方法
我们对2017年至2019年43,056名单胎活产妇女进行了一项前瞻性队列研究。根据世界卫生组织国际分类，BMI分为体重过轻（BMI＜18.5kg/m²）、正常体重（BMI 18.5 - 25kg/m²）、超重（BMI 25 - 30kg/m²）和肥胖（BMI≥30kg/m²）。早产定义为孕周小于37周（极早早产，＜28周；早早产，28 - 31周；中度早产，32 - 36周）。早产的临床表型包括自发性早产（自发性早产和胎膜早破）和医源性早产。我们进一步分析了合并GDM或PE的早产情况。进行了多变量逻辑回归分析和因果中介分析。
结果
极早早产、早早产和中度早产的风险随BMI增加而升高，肥胖妇女极早早产的风险最高（OR 3.43，95%CI 1.07 - 10.97）。母亲肥胖与自发性早产（OR 1.98；95%CI 1.13 - 3.47）、胎膜早破（OR 2.04；95%CI 1.08 - 3.86）和医源性早产（OR 2.05；95%CI 1.25 - 3.37）显著相关。GDM和PE分别介导了肥胖对早产影响的13.41%和36.66%。GDM介导了肥胖对自发性早产影响的32.80%，PE介导了肥胖对医源性早产影响的64.31%。
结论
母亲孕前肥胖与早产的所有表型相关，最高风险是极早早产和医源性早产。GDM和PE部分介导了肥胖与早产之间的关联。
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