AI for Good Research Lab, Microsoft Corporation, Redmond, Washington.
Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington.
JAMA Pediatr. 2024 Sep 1;178(9):906-913. doi: 10.1001/jamapediatrics.2024.2455.
Rates of maternal obesity are increasing in the US. Although obesity is a well-documented risk factor for numerous poor pregnancy outcomes, it is not currently a recognized risk factor for sudden unexpected infant death (SUID).
To determine whether maternal obesity is a risk factor for SUID and the proportion of SUID cases attributable to maternal obesity.
DESIGN, SETTING, AND PARTICIPANTS: This was a US nationwide cohort study using Centers for Disease Control and Prevention National Center for Health Statistics linked birth-infant death records for birth cohorts in 2015 through 2019. All US live births for the study years occurring at 28 weeks' gestation or later from complete reporting areas were eligible; SUID cases were deaths occurring at 7 to 364 days after birth with International Statistical Classification of Diseases, Tenth Revision cause of death code R95 (sudden infant death syndrome), R99 (ill-defined and unknown causes), or W75 (accidental suffocation and strangulation in bed). Data were analyzed from October 1 through November 15, 2023.
Maternal prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared).
SUID.
Of 18 857 694 live births eligible for analysis (median [IQR] age: maternal, 29 [9] years; paternal, 31 [9] years; gestational, 39 [2] weeks), 16 545 died of SUID (SUID rate, 0.88/1000 live births). After confounder adjustment, compared with mothers with normal BMI (BMI 18.5-24.9), infants born to mothers with obesity had a higher SUID risk that increased with increasing obesity severity. Infants of mothers with class I obesity (BMI 30.0-34.9) were at increased SUID risk (adjusted odds ratio [aOR], 1.10; 95% CI, 1.05-1.16); with class II obesity (BMI 35.0-39.9), a higher risk (aOR, 1.20; 95% CI, 1.13-1.27); and class III obesity (BMI ≥40.0), an even higher risk (aOR, 1.39; 95% CI, 1.31-1.47). A generalized additive model showed that increased BMI was monotonically associated with increased SUID risk, with an acceleration of risk for BMIs greater than approximately 25 to 30. Approximately 5.4% of SUID cases were attributable to maternal obesity.
The findings suggest that infants born to mothers with obesity are at increased risk of SUID, with a dose-dependent association between increasing maternal BMI and SUID risk. Maternal obesity should be added to the list of known risk factors for SUID. With maternal obesity rates increasing, research should identify potential causal mechanisms for this association.
美国的孕产妇肥胖率正在上升。尽管肥胖是众多不良妊娠结局的一个有据可查的危险因素，但目前它并不是突发性婴儿死亡（SUID）的公认危险因素。
确定肥胖是否是 SUID 的危险因素，以及肥胖导致 SUID 的比例。
设计、地点和参与者：这是一项美国全国性队列研究，使用疾病控制和预防中心国家卫生统计中心的链接出生-婴儿死亡记录，对 2015 年至 2019 年的出生队列进行研究。所有研究年份完整报告地区 28 周胎龄或以上的所有活产婴儿均符合条件；SUID 病例是指在出生后 7 至 364 天内死亡，国际疾病分类，第十版死因代码为 R95（婴儿猝死综合征）、R99（未明和不明原因）或 W75（床上意外窒息和绞杀）的病例。数据于 2023 年 10 月 1 日至 11 月 15 日进行分析。
产妇孕前体重指数（BMI；计算方法为体重（千克）除以身高（米）的平方）。
SUID。
在符合分析条件的 1857694 名活产婴儿中（中位数[IQR]年龄：母亲 29[9]岁；父亲 31[9]岁；妊娠 39[2]周），有 16545 例死于 SUID（SUID 发生率为 0.88/1000 活产婴儿）。在调整混杂因素后，与 BMI 正常（18.5-24.9）的母亲相比，肥胖母亲所生的婴儿 SUID 风险更高，且随着肥胖程度的加重而增加。I 类肥胖（BMI 30.0-34.9）母亲所生婴儿 SUID 风险增加（校正优势比[aOR]，1.10；95%CI，1.05-1.16）；II 类肥胖（BMI 35.0-39.9）母亲所生婴儿风险更高（aOR，1.20；95%CI，1.13-1.27）；III 类肥胖（BMI≥40.0）母亲所生婴儿风险更高（aOR，1.39；95%CI，1.31-1.47）。广义加性模型显示，BMI 升高与 SUID 风险呈单调相关，BMI 大于约 25 至 30 时风险加速。大约 5.4%的 SUID 病例归因于母亲肥胖。
研究结果表明，肥胖母亲所生婴儿 SUID 风险增加，且随着母亲 BMI 的增加，SUID 风险呈剂量依赖性增加。肥胖应被添加到 SUID 的已知危险因素列表中。随着孕产妇肥胖率的上升，应研究确定这种关联的潜在因果机制。
