Fleenor Rebecca E, Harmon Duncan T, Gazi Melissa, Szychowski Jeff, Harper Lorie M, Tita Alan T N, Subramaniam Akila
Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.
Devision of Maternal-Fetal Medicine, St. Luke's Clinic, Maternal Fetal Medicine, Boise, Idaho.
Am J Perinatol. 2024 May;41(S 01):e1885-e1894. doi: 10.1055/a-2096-7842. Epub 2023 May 22.
This study aimed to compare the risks of adverse perinatal outcomes by body mass index (BMI) categories in healthy pregnant individuals delivered by term elective repeat cesarean (ERCD) to describe an optimal timing of delivery in otherwise healthy patients at the highest-risk BMI threshold.
A secondary analysis of a prospective cohort of pregnant individuals undergoing ERCD at 19 centers in the Maternal-Fetal Medicine Units Network from 1999 to 2002. Nonanomalous singletons undergoing prelabor ERCD at term were included. The primary outcome was composite neonatal morbidity; secondary outcomes included composite maternal morbidity and individual components of the composites. Patients were stratified by BMI classes and to identify a BMI threshold for which morbidity was the highest. Outcomes were then examined by completed week's gestation, between BMI classes. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI).
A total of 12,755 patients were included in analysis. Patient's with BMI ≥ 40 had the highest rates of newborn sepsis, neonatal intensive care unit admissions, and wound complications. While a weight-related response was observed between BMI class and neonatal composite morbidity ( < 0.001), only those with BMI ≥ 40 had significantly higher odds of composite neonatal morbidity (aOR: 1.4, 95% CI: 1.0-1.8). In analyses of patients with BMI ≥ 40 ( = 1,848), there was no difference in the incidence of composite neonatal or maternal morbidity across weeks' gestation at delivery; however, as gestational age approached 39 to 40 weeks, rates of adverse neonatal outcomes decreased, only to increase again at 41 weeks' gestation. Of note, the odds of the primary neonatal composite were the highest at 38 weeks compared with 39 weeks (aOR: 1.5, 95% CI: 1.1-2.0).
Neonatal morbidity is significantly higher in pregnant individuals with BMI ≥40 delivering by ERCD. Despite this increased perinatal morbidity, delivery prior to 39 and after 41 weeks in these patients is associated with increased neonatal risks.
· Obese patients without additional comorbidities have higher rates of neonatal morbidity.. · Patients with BMI ≥ 40 carry the highest odds of poor perinatal outcomes.. · Earlier timing of delivery does not appear to reduce this risk..
本研究旨在比较健康孕妇通过择期足月重复剖宫产（ERCD）分娩时，按体重指数（BMI）分类的围产期不良结局风险，以确定在BMI处于最高风险阈值的健康孕妇中最佳的分娩时机。
对1999年至2002年在母胎医学单位网络19个中心接受ERCD的孕妇前瞻性队列进行二次分析。纳入足月产前接受ERCD的非畸形单胎。主要结局是综合新生儿发病率；次要结局包括综合孕产妇发病率及综合指标的各个组成部分。患者按BMI类别分层，以确定发病率最高的BMI阈值。然后按孕周和BMI类别检查结局。采用多变量逻辑回归计算调整后的优势比（aOR）和95%置信区间（CI）。
共有12755例患者纳入分析。BMI≥40的患者新生儿败血症、新生儿重症监护病房入院率和伤口并发症发生率最高。虽然在BMI类别和新生儿综合发病率之间观察到与体重相关的反应（P<0.001），但只有BMI≥40的患者发生综合新生儿发病率的几率显著更高（aOR：1.4，95%CI：1.0-1.8）。在对BMI≥40的患者（n=1848）的分析中，分娩时各孕周的综合新生儿或孕产妇发病率无差异；然而，随着孕周接近39至40周，不良新生儿结局发生率下降，但在孕41周时又再次上升。值得注意的是，与39周相比，主要新生儿综合指标在38周时的几率最高（aOR：1.5，95%CI：1.1-2.0）。
BMI≥40的孕妇通过ERCD分娩时，新生儿发病率显著更高。尽管围产期发病率增加，但这些患者在39周前和41周后分娩与新生儿风险增加有关。
· 无其他合并症的肥胖患者新生儿发病率较高。· BMI≥40的患者围产期不良结局几率最高。· 提前分娩似乎并不能降低这种风险。
