孕期体重管理或需结合孕前BMI
  • 纳入722839名孕妇数据,根据孕前BMI分为孕前低体重、正常、超重、肥胖组,并记录孕期增重;
  • 只有31.5%的孕妇孕期增重在正常范围;
  • 在孕前低体重女性中,孕期增重过少增加胎儿死亡风险,增重过多增加孕妇死亡风险;
  • 在孕前正常体重女性中,孕期增重过高或过低,都增加母婴围产期死亡事件发生率;
  • 在孕前超重女性中,孕期增重过低将增加母婴死亡风险,而增重过高者无统计学意义;
  • 在孕前肥胖女性中,增重过低会增加胎儿死亡风险。
主编推荐语
小笋干儿
该研究利用人群登记数据库分析,发现不同孕前BMI分组的人群中,孕期增重过高或过低对母婴围产期死亡的风险影响并不一致。总体来看,孕期增重过低与严重不良出生结局的风险呈正相关,而在孕前BMI较低的人群中,孕期增重过多与母婴不良结局也存在相关性。
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PLoS Medicine [IF:11.048]

Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004–2013

美国华盛顿州孕期体重增重与不良妊娠结局的关联:基于2004-2013年回顾性队列研究的人群

10.1371/journal.pmed.1003009

2019-12-30, Article

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Background: Suboptimal weight gain during pregnancy is a potentially modifiable risk factor. We aimed to investigate the association between suboptimal gestational weight gain and severe adverse birth outcomes by pre-pregnancy body mass index (BMI) categories, including obesity class I to III.
Methods and findings: We conducted a population-based study of pregnant women with singleton hospital births in Washington State, US, between 2004 and 2013. Optimal, low, and excess weight gain in each BMI category was calculated based on weight gain by gestational age as recommended by the American College of Obstetricians and Gynecologists and the Institute of Medicine. Primary composite outcomes were (1) maternal death and/or severe maternal morbidity (SMM) and (2) perinatal death and/or severe neonatal morbidity. Logistic regression was used to obtain adjusted odds ratios (AORs) and 95% confidence intervals. Overall, 722,839 women with information on pre-pregnancy BMI were included. Of these, 3.1% of women were underweight, 48.1% had normal pre-pregnancy BMI, 25.8% were overweight, and 23.0% were obese. Only 31.5% of women achieved optimal gestational weight gain. Women who had low weight gain were more likely to be African American and have Medicaid health insurance, while women with excess weight gain were more likely to be non-Hispanic white and younger than women with optimal weight gain in each pre-pregnancy BMI category. Compared with women who had optimal weight gain, those with low gestational weight gain had a higher rate of maternal death, 7.97 versus 2.63 per 100,000 (p = 0.027). In addition, low weight gain was associated with the composite adverse maternal outcome (death/SMM) in women with normal pre-pregnancy BMI and in overweight women (AOR 1.12, 95% CI 1.04–1.21, p = 0.004, and AOR 1.17, 95% CI 1.04–1.32, p = 0.009, respectively) compared to women in the same pre-pregnancy BMI category who had optimal weight gain. Similarly, excess gestational weight gain was associated with increased rates of death/SMM among women with normal pre-pregnancy BMI (AOR 1.20, 95% CI 1.12–1.28, p < 0.001) and obese women (AOR 1.12, 95% CI 1.01–1.23, p = 0.019). Low gestational weight gain was associated with perinatal death and severe neonatal morbidity regardless of pre-pregnancy BMI, including obesity classes I, II, and III, while excess weight gain was associated with severe neonatal morbidity only in women who were underweight or had normal BMI prior to pregnancy. Study limitations include the ascertainment of pre-pregnancy BMI using self-report, and lack of data availability for the most recent years.
Conclusions: In this study, we found that most women do not achieve optimal weight gain during pregnancy. Low weight gain was associated with increased risk of severe adverse birth outcomes, and in particular with maternal death and perinatal death. Excess gestational weight gain was associated with severe adverse birth outcomes, except for women who were overweight prior to pregnancy. Weight gain recommendations for this group may need to be reassessed. It is important to counsel women during pregnancy about specific risks associated with both low and excess weight gain.

First Authors:
U Vivian Ukah

Correspondence Authors:
U Vivian Ukah

All Authors:
U Vivian Ukah,Hamideh Bayrampour,Yasser Sabr,Neda Razaz,Wee Shian Chan,Kenneth I Lim,Sarka Lisonkova

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