Department of Medical and Surgical Sciences for Mother, Division of Obstetrics, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy.
Department of Diagnostic and Clinical Medicine and Public Health, Statistics Unit, University of Modena and Reggio Emilia, Modena, Italy.
PLoS One. 2024 Aug 6;19(8):e0308441. doi: 10.1371/journal.pone.0308441. eCollection 2024.
Small (SGA) and large (LGA) for gestational age infants have higher risks of infant morbidity when compared to those who are appropriate for gestational age (AGA). Increasing pre-pregnancy maternal BMI and gestational weight gain (GWG) are associated with higher risks of LGA and lower risks of SGA infants; however, their direct effects on infant morbidity are unknown. Therefore, we intended to 1) assess how maternal pre-pregnancy BMI, GWG, and birthweight (categorized as SGA, AGA or LGA) affect infant morbidity and 2) estimate at entry of care the risk of infant morbidity according to pre-pregnancy BMI and possible GWG.
we used Consortium on Safe Labor data, a retrospective observational cohort study collecting pregnancy and birth data from 2002 to 2008 in 12 US centers. The association between maternal BMI, GWG and infant morbidity was estimated in singleton gestations delivering ≥ 37 weeks using binomial logistic regression. Hypoxic composite neonatal morbidity was defined as any the following: stillbirth, neonatal death, resuscitation at birth, NICU admission, intracranial hemorrhage, PVH grade III and IV, neonatal seizures, NEC, meconium aspiration, CPAP or mechanical ventilation, RDS, and sepsis. Traumatic composite neonatal morbidity included shoulder dystocia or birth injuries.
In this study of 110,594 mother-infant dyads, a total of 8,369 (7.6%) infants experienced hypoxic, while 2,134 (1.9%) developed traumatic morbidity. The risk of hypoxic morbidity among SGA, AGA and LGA infants increased when mothers were overweight (aOR 1.26 [95%CI 1.18-1.34]) or obese (class 1: aOR 1.3 [1.2-1.4]; class 2: aOR 1.7 [1.5-1.9]; class 3: aOR 1.8 [1.6-2]) as opposed to normal weight, and when GWG exceeded (aOR 1.08 [1.02-1.014]) rather than remained within recommendations. The risk of traumatic morbidity increased with maternal obesity (class 1: aOR 1.3 [1.1-1.5]), whilst it dropped with GWG below recommendations (aOR 0.7 [0.6-0.8]). The risk of hypoxic events estimated at entry of care increased with maternal overweight (aOR 1.27 [1.19-1.35]) or obesity (class 1: aOR 1.4 [1.2-1.5]; class 2: aOR 1.7 [1.5-1.9]; class 3: aOR 1.8 [1.6-2.1]), and with possible GWG above (aOR 1.09 [1.03-1.015]) recommendations. The risk of traumatic morbidity increased with overweight (aOR 1.1 [1-1.3]) or obesity (class 1: aOR 1.4 [1.2-1.6]; class 2: aOR 1.3 [1-1.6]), with possible GWG above (aOR 1.2 [1-1.3]), as opposed to below recommendations (aOR 0.7 [0.6-0.8]).
While maternal pre-pregnancy BMI and GWG equally affected traumatic morbidity, the former had a greater impact on hypoxic complications. Therefore, weight control prior to pregnancy is at least as effective as avoiding excessive gestational weight gain to prevent neonatal morbidity.
与适合胎龄（AGA）的婴儿相比，小（SGA）和大（LGA）胎龄婴儿的婴儿发病率更高。孕前母亲 BMI 和妊娠体重增加（GWG）的增加与 LGA 风险的增加和 SGA 婴儿风险的降低有关；然而，它们对婴儿发病率的直接影响尚不清楚。因此，我们旨在 1）评估母亲孕前 BMI、GWG 和出生体重（分为 SGA、AGA 或 LGA）如何影响婴儿发病率，2）根据孕前 BMI 和可能的 GWG 估计进入护理时婴儿发病率的风险。
我们使用安全分娩联盟数据，这是一项回顾性观察队列研究，从 2002 年至 2008 年在 12 个美国中心收集妊娠和分娩数据。在≥37 周分娩的单胎妊娠中，使用二项逻辑回归估计母亲 BMI、GWG 和婴儿发病率之间的关联。缺氧复合新生儿发病率定义为以下任何一种情况：死胎、新生儿死亡、出生时复苏、新生儿重症监护病房入院、颅内出血、PVH 3 级和 4 级、新生儿癫痫、NEC、胎粪吸入、CPAP 或机械通气、RDS 和败血症。创伤性复合新生儿发病率包括肩难产或产伤。
在这项对 110594 对母婴对子的研究中，共有 8369 名（7.6%）婴儿出现缺氧，2134 名（1.9%）发生创伤性发病。当母亲超重（优势比 [OR] 1.26 [95%置信区间 1.18-1.34]）或肥胖（1 类：OR 1.3 [1.2-1.4]；2 类：OR 1.7 [1.5-1.9]；3 类：OR 1.8 [1.6-2]）时，SGA、AGA 和 LGA 婴儿的缺氧发病率风险增加，而当 GWG 超过（OR 1.08 [1.02-1.014]）而不是保持在建议范围内时，发病率风险降低。当母亲肥胖（1 类：OR 1.3 [1.1-1.5]）时，创伤性发病风险增加，而当 GWG 低于建议值（OR 0.7 [0.6-0.8]）时，发病风险降低。进入护理时估计的缺氧事件风险随着母亲超重（OR 1.27 [1.19-1.35]）或肥胖（1 类：OR 1.4 [1.2-1.5]；2 类：OR 1.7 [1.5-1.9]；3 类：OR 1.8 [1.6-2.1]）而增加，而 GWG 高于（OR 1.09 [1.03-1.015]）建议值时则增加。当母亲超重（OR 1.1 [1-1.3]）或肥胖（1 类：OR 1.4 [1.2-1.6]；2 类：OR 1.3 [1-1.6]）时，创伤性发病风险增加，而 GWG 高于（OR 1.2 [1-1.3]）建议值时，则高于 GWG 低于建议值（OR 0.7 [0.6-0.8]）时。
虽然母亲孕前 BMI 和 GWG 同样影响创伤性发病，但前者对缺氧并发症的影响更大。因此，在怀孕前控制体重至少与避免过度妊娠体重增加一样有效，以预防新生儿发病。
