Department of Obstetrics and Gynecology, 2780 Geisinger Health System , Danville, PA, USA.
Department of Obstetrics and Gynecology, 389402 Jefferson Health-Abington , Abington, PA, USA.
J Osteopath Med. 2024 May 16;124(10):447-453. doi: 10.1515/jom-2024-0025. eCollection 2024 Oct 1.
The obesity epidemic in the United States is continuing to worsen. Obesity is a known risk factor for pregnancy morbidity. However, many studies use the patient's body mass index (BMI) at the time of delivery, do not stratify by class of obesity, or utilize billing codes as the basis of their study, which are noted to be inaccurate.
This study aims to investigate the prepregnancy BMI class specific risks for pregnancy and neonatal complications based on a prepregnancy BMI class.
We conducted a retrospective cohort study of 40,256 pregnant women with 55,202 singleton births between October 16, 2007 and December 3, 2023. We assessed the risk of pregnancy and neonatal morbidity based on the maternal prepregnancy BMI category. The primary outcome was composite maternal morbidity, including hypertensive disorders of pregnancy (i.e., gestational hypertension [GHTN] and preeclampsia), and gestational diabetes mellitus (GDM), adjusted for pregestational diabetes mellitus and chronic hypertension (cHTN). Secondary maternal outcomes included preterm premature rupture of membranes (PPROM), preterm delivery (PTD<37 and <32 weeks), induction of labor (IOL), cesarean delivery (CD), and postpartum hemorrhage (PPH). Neonatal outcomes included a composite adverse outcome (including stillbirth, intraventricular hemorrhage (IVH), hypoglycemia, respiratory distress syndrome [RDS], APGAR [Appearance, Pulse, Grimace, Activity, and Respiration] <7 at 5 min, and neonatal intensive care unit [NICU] admission), birthweight, fetal growth restriction (FGR), and macrosomia.
Composite maternal morbidity (odds ratio [OR] 4.40, confidence interval [CI] 3.70-5.22 for class III obesity [BMI≥40.0 kg/m] compared with normal BMI), hypertensive disorders of pregnancy (HDP), GDM, PTD, IOL, CD, PPH, neonatal composite morbidity, hypoglycemia, RDS, APGAR<7 at 5 min, NICU admission, and macrosomia showed a significant increasing test of trend among BMI classes. Increased BMI was protective for FGR.
Our data provides BMI-class specific odds ratios (ORs) for adverse pregnancy outcomes. Increased BMI class significantly increases the risk of HDP, GDM, IOL, CD, composite adverse neonatal outcomes, and macrosomia, and decreases the risk of FGR. Attaining a healthier BMI category prior to conception may lower pregnancy morbidity.
美国的肥胖症 epidemic 持续恶化。肥胖是 pregnancy morbidity 的已知危险因素。然而，许多研究使用患者分娩时的体重指数（BMI），不按 obesity 类别进行分层，或使用计费代码作为研究基础，这些都是不准确的。
本研究旨在根据 pregnancy BMI class 调查 pregnancy 和新生儿并发症的 prepregnancy BMI class 特定风险。
我们进行了一项回顾性队列研究，纳入了 2007 年 10 月 16 日至 2023 年 12 月 3 日期间的 40256 名 pregnant women 和 55202 名 singleton 分娩。我们根据母亲的 prepregnancy BMI 类别评估了 pregnancy 和新生儿发病率的风险。主要结局是复合母体发病率，包括妊娠高血压疾病（即 gestational hypertension [GHTN] 和 preeclampsia）和 gestational diabetes mellitus（GDM），调整了 pregestational diabetes mellitus 和 chronic hypertension（cHTN）。次要母体结局包括 preterm premature rupture of membranes（PPROM）、preterm delivery（PTD<37 和 <32 周）、induced labor（IOL）、cesarean delivery（CD）和 postpartum hemorrhage（PPH）。新生儿结局包括复合不良结局（包括 stillbirth、intraventricular hemorrhage [IVH]、hypoglycemia、respiratory distress syndrome [RDS]、APGAR [Appearance, Pulse, Grimace, Activity, and Respiration] <7 at 5 min 和 neonatal intensive care unit [NICU] admission）、birthweight、fetal growth restriction（FGR）和 macrosomia。
复合母体发病率（肥胖类别 III [BMI≥40.0 kg/m] 与正常 BMI 相比的优势比 [OR] 4.40，95%置信区间 [CI] 3.70-5.22）、妊娠高血压疾病（HDP）、GDM、PTD、IOL、CD、PPH、新生儿复合发病率、低血糖、RDS、APGAR<7 分 5 分钟、NICU 入院和 macrosomia 显示 BMI 类别之间存在显著的趋势检验。较高的 BMI 对 FGR 有保护作用。
我们的数据提供了 BMI-class specific odds ratios（ORs），用于预测不良 pregnancy 结局。较高的 BMI 类别显著增加了 HDP、GDM、IOL、CD、新生儿复合不良结局和 macrosomia 的风险，并降低了 FGR 的风险。在 conception 之前达到更健康的 BMI 类别可能会降低 pregnancy 发病率。
