孕期体重增加与不良妊娠结局之间的关联：来自南亚和撒哈拉以南非洲的队列分析。
Association between gestational weight gain and adverse pregnancy outcomes: cohort analysis from South Asia and Sub-Saharan Africa.
作者信息
Sebastião Yuri V, Thiruvengadam Ramachandran, Khanam Rasheda, Mehmood Usma, Pervin Jesmin, Desiraju Bapu Koundinya, Kabole Fatma, Ahmed Salahuddin, Aktar Shaki, Chowdhury Nabidul Haque, Qazi Muhammad Farrukh, Nisar Imran, Khalid Javairia, Kasaro Margaret, Vwalika Bellington, Khan Waqasuddin, Nu U Tin, Rahman Monjur, Rahman Sayedur, Shaw Gary M, Stevenson David K, Xu Huan, Bakari Bihila Abdalla, Wadhwa Nitya, Zhang Ge, Sazawal Sunil, Aghaeepour Nima, Rahman Anisur, Jehan Fyezah, Baqui Abdullah H, Stringer Jeffrey S A, Bhatnagar Shinjini
机构信息
Division of Global Women's Health, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, Haryana, India.
出版信息
BMJ Public Health. 2025 Feb 4;3(1):e000900. doi: 10.1136/bmjph-2024-000900. eCollection 2025.
INTRODUCTION
Studies of gestational weight gain (GWG) and adverse pregnancy outcomes seldom focus on low-to-middle-income countries (LMICs), despite their high burden of morbidity and mortality. We examined GWG patterns and adverse pregnancy outcomes in a consortium of pregnancy cohorts from LMICs.
METHODS
We analysed data from five observational pregnancy cohorts in Bangladesh (two cohorts), India, Pakistan and Zambia. The study population comprised 15 286 singleton pregnancies with two or more maternal antenatal weight measurements. We estimated reference values for GWG using longitudinal models and calculated weight gain for gestational age Z-scores. We then estimated the associated risks of preterm birth, low birth weight, and small for gestational age, stratified by maternal body mass index (BMI), using marginal generalised linear models and plotted non-linear trends in the associations.
RESULTS
The median baseline maternal and gestational age were 24 years (IQR, 21-28) and 13 weeks (IQR 11-16), respectively, with 23% of participants having underweight BMI. The median GWG was 6.8 kg (4.2-9.4) and varied across cohorts from 6.1 kg (3.7-8.5; Bangladesh) to 7.0 kg (4.0-10.0; Zambia). The risk of preterm birth (13%) increased with lower GWG Z-scores among underweight (adjusted risk ratio (ARR), 1.4; 95% CI, 1.1 to 1.9 for lowest Z-score group) and normal BMI participants (ARR, 1.1; 95% CI, 1.0 to 1.2). The risk of low birth weight (25%) increased with lower GWG Z-scores in all BMI strata except obese participants (ARR, 1.7; 95% CI 1.5 to 1.9 among underweight). The risk of small for gestational age (36%) increased with lower GWG Z-scores in all BMI strata (ARR, 1.3; 95% CI 1.2 to 1.4 among underweight). In secondary analyses, alternative measures of GWG (adequacy ratio; INTERGROWTH-21) had associations that were consistent with those from our study-specific Z-scores, except for a less clear association between preterm birth and INTERGROWTH-21 Z-score.
CONCLUSION
GWG was associated with preterm birth, low birth weight and small for gestational age. Early pregnancy BMI modified the association between GWG and outcomes in the study setting.
引言
尽管中低收入国家（LMICs）的发病率和死亡率负担很高，但关于孕期体重增加（GWG）和不良妊娠结局的研究很少关注这些国家。我们在一个来自中低收入国家的妊娠队列联盟中研究了GWG模式和不良妊娠结局。
方法
我们分析了来自孟加拉国（两个队列）、印度、巴基斯坦和赞比亚的五个观察性妊娠队列的数据。研究人群包括15286例单胎妊娠，有两次或更多次孕妇产前体重测量数据。我们使用纵向模型估计GWG的参考值，并计算孕周Z评分的体重增加量。然后，我们使用边际广义线性模型，按孕妇体重指数（BMI）分层，估计早产、低出生体重和小于胎龄儿的相关风险，并绘制关联中的非线性趋势。
结果
孕妇基线年龄和孕周的中位数分别为24岁（四分位间距，21 - 28岁）和13周（四分位间距11 - 16周），23%的参与者BMI偏低。GWG的中位数为6.8千克（4.2 - 9.4千克），各队列有所不同，从6.1千克（3.7 - 8.5千克；孟加拉国）到7.0千克（4.0 - 10.0千克；赞比亚）。在体重偏低和BMI正常的参与者中，早产风险（13%）随着GWG Z评分降低而增加（最低Z评分组的调整风险比（ARR）为1.4；95%置信区间，1.1至1.9），以及BMI正常的参与者（ARR，1.1；95%置信区间，1.0至1.2）。除肥胖参与者外，所有BMI分层中低出生体重风险（25%）随着GWG Z评分降低而增加（体重偏低者中ARR为1.7；95%置信区间1.5至1.9）。所有BMI分层中小于胎龄儿风险（36%）随着GWG Z评分降低而增加（体重偏低者中ARR为1.3；95%置信区间1.2至1.4）。在二次分析中，GWG的替代测量指标（充足率；INTERGROWTH - 21）的关联与我们基于研究特定Z评分的关联一致，但早产与INTERGROWTH - 21 Z评分之间关联不太明确。
结论
GWG与早产、低出生体重和小于胎龄儿有关。在本研究环境中，孕早期BMI改变了GWG与结局之间的关联。
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