Nguyen Hoang Yen, Park Bo, Rossi Jordan, Tse Beverly, Cryer Alicia, Yao Ruofan
Department of Gynecology and Obstetrics, Loma Linda University School of Medicine, Loma Linda, CA (Drs Nguyen, Park, Rossi, Tse, Cryer, and Yao).
Department of Public Health, California State University, Fullerton, Fullerton, CA (Dr Park).
AJOG Glob Rep. 2023 Apr 15;3(2):100211. doi: 10.1016/j.xagr.2023.100211. eCollection 2023 May.
Maternal obesity has risen in the United States in recent decades.
This study aimed to evaluate the impact of maternal obesity on the risk for spontaneous preterm delivery and the risk for overall preterm delivery among patients with cervical cerclage placement.
This was a retrospective study in which data from the California Office of Statewide Health Planning and Development linked birth file from 2007 to 2012 were used, yielding a total of 3654 patients with and 2,804,671 patients without cervical cerclage placement. Exclusion criteria included patients with missing information on body mass index, multiple gestation, anomalous pregnancies, and gestations <20 weeks or >42 weeks. Patients in each group were identified and were further categorized based on body mass index with the nonobese group defined as having a body mass index of <30 kg/m, the obese group defined as having a body mass index of 30 to 40 kg/m, and the morbidly obese group defined as having a body mass index >40 kg/m. The risks for overall and spontaneous preterm delivery were compared between patients without obesity and those with obesity or those with morbid obesity patients. The analysis was stratified by cerclage placement.
Among patients who underwent cerclage placement, the risk for spontaneous preterm delivery was not significantly different in the obese and morbidly obese group when compared with the nonobese group (24.2% vs 20.6%; adjusted odds ratio, 1.18; 95% confidence interval, 0.97-1.43; and 24.5% vs 20.6%; adjusted odds ratio, 1.12; 0.78-1.62, respectively). However, among patients without cerclage placement, the obese and morbidly obese groups had a higher risk for spontaneous preterm delivery than the nonobese group (5.1% vs 4.4%; adjusted odds ratio, 1.04; 1.02-1.05; and 5.9% vs 4.4%; adjusted odds ratio, 1.03; 1.00-1.07, respectively). The risks for overall preterm delivery at <37 weeks' gestation were higher for the obese and morbidly obese groups than for the nonobese group among patients with cerclage (33.7% vs 28.2%; adjusted odds ratio, 1.23; 1.03-1.46; and 32.1% vs 28.2%; adjusted odds ratio, 1.01; 0.72-1.43, respectively). Similarly, among patients without cerclage placement, the risks for preterm delivery at <37 weeks' gestation were higher for the obese and morbidly obese groups than for the nonobese group (7.9% vs 6.8%; adjusted odds ratio, 1.05; 1.04-1.06; and 9.3% vs 6.8%; adjusted odds ratio, 1.10; 1.08-1.13, respectively).
Among patients who received a cervical cerclage for the prevention of preterm birth, obesity was not associated with an increased risk for spontaneous preterm delivery. However, it was associated with an overall increased risk for preterm delivery.
近几十年来，美国孕产妇肥胖率有所上升。
本研究旨在评估孕产妇肥胖对接受宫颈环扎术患者自然早产风险及总体早产风险的影响。
这是一项回顾性研究，使用了加利福尼亚州全州卫生规划和发展办公室2007年至2012年的关联出生档案数据，共有3654例接受宫颈环扎术的患者和2804671例未接受宫颈环扎术的患者。排除标准包括体重指数信息缺失、多胎妊娠、异常妊娠以及孕周<20周或>42周的患者。确定每组患者，并根据体重指数进一步分类，非肥胖组定义为体重指数<30kg/m，肥胖组定义为体重指数30至40kg/m，病态肥胖组定义为体重指数>40kg/m。比较非肥胖患者与肥胖或病态肥胖患者的总体早产和自然早产风险。分析按是否进行环扎术分层。
在接受环扎术的患者中，肥胖组和病态肥胖组的自然早产风险与非肥胖组相比无显著差异（分别为24.2%对20.6%；调整优势比，1.18；95%置信区间，0.97 - 1.43；以及24.5%对20.6%；调整优势比，1.12；0.78 - 1.62）。然而，在未进行环扎术的患者中，肥胖组和病态肥胖组的自然早产风险高于非肥胖组（分别为5.1%对4.4%；调整优势比，1.04；1.02 - 1.05；以及5.9%对4.4%；调整优势比，1.03；1.00 - 1.07）。在接受环扎术的患者中，肥胖组和病态肥胖组妊娠<37周时的总体早产风险高于非肥胖组（分别为33.7%对28.2%；调整优势比，1.23；1.03 - 1.46；以及32.1%对28.2%；调整优势比，1.01；0.72 - 1.43）。同样，在未进行环扎术的患者中，肥胖组和病态肥胖组妊娠<37周时的早产风险高于非肥胖组（分别为7.9%对6.8%；调整优势比，1.05；1.04 - 1.06；以及9.3%对6.8%；调整优势比，1.10；1.08 - 1.13）。
在接受宫颈环扎术以预防早产的患者中，肥胖与自然早产风险增加无关。然而，它与总体早产风险增加有关。
