Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia.
Am J Perinatol. 2024 Apr;41(6):669-676. doi: 10.1055/s-0043-1776975. Epub 2023 Nov 16.
This study aimed to determine the impact of pregnancy weight gain above National Academy of Medicine (NAM) guidelines on cesarean delivery rates following induction.
This is a secondary analysis of a prospective cohort study of patients who underwent induction at a single tertiary care center between July 2017 and July 2019. Included in the primary study were patients undergoing term (≥37 weeks) labor induction with a singleton gestation, intact membranes, and unfavorable cervical examination (Bishop score of ≤6 and cervical dilation ≤ 2 cm). Eligibility for this analysis was limited to patients with a documented prenatal body mass index (BMI) < 20 weeks' gestation. The primary exposure was gestational weight gain greater than NAM guidelines (WGGG) for a patient's initial BMI category. The primary outcome was cesarean delivery for any indication.
Of 1,610 patients included in the original cohort, 1,174 (72.9%) met inclusion criteria for this analysis and 517 (44.0%) of these had weight gain above NAM guidelines. Of the entire cohort, 60.0% were Black and 52.7% had private insurance. In total, 160 patients (31%) with WGGG underwent cesarean compared with 127 patients (19.3%) without WGGG ( < 0.001), which equates to a 59% increased odds of cesarean when controlling for initial BMI category, parity, gestational diabetes, and indication for induction (Adjusted Odds Ratio [aOR] 1.58, 95% confidence interval [CI] 1.17-2.12). Among only nulliparous patients, WGGG was associated with an increased odds of cesarean (26.4 vs. 38.2%, aOR 1.50, 95% CI 1.07-2.10). In multiparous patients, however, there was no difference in cesarean between those with and without WGGG (8.8 vs. 14.1%, aOR 1.85, 95% CI 0.96-3.58).
This study demonstrates that weight gain above NAM guidelines is associated with more than a 50% increased odds of cesarean. Patients should be informed of this association as gestational weight gain may be a modifiable risk factor for cesarean delivery.
· Weight gain above NAM guidelines was associated with a 59% increased odds of cesarean delivery.. · Nulliparous patients with weight gain above NAM guidelines are at higher risk of cesarean delivery.. · No difference in cesarean delivery among multiparous patients regardless of gestational weight gain..
本研究旨在确定孕期体重增加超过美国医学科学院（NAM）指南对诱导分娩后剖宫产率的影响。
这是对单中心于 2017 年 7 月至 2019 年 7 月间进行诱导分娩的患者进行的前瞻性队列研究的二次分析。主要研究包括在足月（≥37 周）分娩时进行诱导的单胎妊娠、胎膜完整和宫颈检查不顺利（Bishop 评分≤6 和宫颈扩张≤2cm）的患者。本分析的入选标准仅限于有记录的产前体重指数（BMI）<20 周妊娠的患者。主要暴露因素是患者初始 BMI 类别下的孕期体重增加超过 NAM 指南（WGGG）。主要结局是任何原因的剖宫产。
在最初的队列中纳入了 1610 名患者，其中 1174 名（72.9%）符合本分析的纳入标准，其中 517 名（44.0%）的体重增加超过了 NAM 指南。在整个队列中，60.0%为黑人，52.7%有私人保险。共有 160 名（31%）WGGG 患者行剖宫产，127 名（19.3%）无 WGGG 患者行剖宫产（<0.001），这意味着在控制初始 BMI 类别、产次、妊娠糖尿病和诱导指征后，剖宫产的可能性增加了 59%（调整后的优势比[aOR]1.58，95%置信区间[CI]1.17-2.12）。在仅初产妇中，WGGG 与剖宫产的可能性增加相关（26.4%比 38.2%，aOR 1.50，95%CI 1.07-2.10）。然而，在多产妇中，WGGG 与无 WGGG 患者的剖宫产率无差异（8.8%比 14.1%，aOR 1.85，95%CI 0.96-3.58）。
本研究表明，孕期体重增加超过 NAM 指南与剖宫产几率增加超过 50%有关。应告知患者这一关联，因为孕期体重增加可能是剖宫产的一个可改变的危险因素。
· 体重增加超过 NAM 指南与剖宫产几率增加 59%有关。· 体重增加超过 NAM 指南的初产妇发生剖宫产的风险更高。· 多产妇无论孕期体重增加与否，剖宫产率均无差异。
