Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Better Outcomes Registry and Network (BORN) Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Obesity (Silver Spring). 2024 Dec;32(12):2376-2387. doi: 10.1002/oby.24143. Epub 2024 Nov 5.
There is no clear evidence on the risk of gestational weight loss (GWL) for individuals with obesity. Our study aimed to assess the association between GWL and adverse perinatal outcomes among individuals with obesity.
This population-based retrospective cohort study examined individuals with prepregnancy BMI ≥ 30 kg/m who had a singleton pregnancy, using Ontario, Canada, birth registry data from 2012 to 2020. The primary outcome was a composite of adverse outcomes, including perinatal death and neonatal morbidity. The association between GWL and risk of adverse perinatal outcomes was estimated using generalized estimating equation models and restricted cubic spline regression analysis. Stratified analysis was conducted by obesity class.
Of the 157,205 individuals with obesity, 6.1% experienced GWL. Compared with adequate gestational weight gain, GWL was associated with an increased risk of a composite of adverse perinatal outcomes (adjusted risk ratio: 1.31; 95% CI: 1.22-1.39). Similar results were observed in the stratified analysis. Restricted cubic spline regression analysis revealed that average weekly gestational weight changes displayed a nonlinear U-shaped association, with a higher risk of a composite of adverse perinatal outcomes noted in the extremities, particularly toward GWL and excessive weight gain.
Our findings suggest that GWL may increase the risk of adverse perinatal outcomes across all obesity classes.
目前尚无明确证据表明肥胖个体存在妊娠体重丢失（GWL）风险。本研究旨在评估肥胖个体 GWL 与不良围产结局之间的关联。
本基于人群的回顾性队列研究纳入了 2012 年至 2020 年加拿大安大略省出生登记数据中 BMI≥30kg/m2 的单胎妊娠个体。主要结局为包括围产儿死亡和新生儿发病率在内的不良结局的复合结局。使用广义估计方程模型和限制性立方样条回归分析估计 GWL 与不良围产结局风险之间的关联。采用分层分析肥胖程度。
在 157205 名肥胖个体中，有 6.1%发生 GWL。与适当的妊娠体重增加相比，GWL 与不良围产结局的复合结局风险增加相关（调整风险比：1.31；95%CI：1.22-1.39）。分层分析也得出了类似的结果。限制性立方样条回归分析显示，平均每周妊娠体重变化呈非线性 U 型关联，在极端情况下，尤其是 GWL 和体重过度增加时，不良围产结局的复合风险更高。
我们的研究结果表明，GWL 可能会增加所有肥胖程度的不良围产结局风险。
