Maternal prepregnancy obesity and cause-specific stillbirth
Maternal prepregnancy obesity and cause-specific stillbirth
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DOI：
10.3945/ajcn.115.112250
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发表时间：
2015-10-01
影响因子：
7.1
通讯作者：
Simhan, Hyagriv N.
中科院分区：
文献类型：
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作者：
Bodnar, Lisa M.;Parks, W. Tony;Simhan, Hyagriv N.
背景：在高收入国家，母亲肥胖是导致死产的最重要的可改变的原因之一，但支持这种联系的途径仍然不清楚。目的：我们估计了母亲孕前体重指数(BMI)与由病理生理因素或原因定义的死产风险之间的关联。设计：采用病例队列设计，我们从宾夕法尼亚州匹兹堡玛格妮-妇女医院(2003-2010)68437例符合条件的分娩队列中随机抽取1829例单胎分娩，并将所有剩余的死产病例作为补充。死产根据可能的死亡原因(S)(母亲的医疗条件、产科并发症、胎儿畸形、胎盘疾病和感染)进行分类。一个临床专家小组审查了医疗记录、胎盘组织切片和病理报告，以及所有死产的胎儿尸检报告。胎儿死亡的原因是通过使用来自尤尼斯·肯尼迪·施莱弗国家儿童健康和人类发展研究所的死胎合作研究网络世界死因协议来指定的。结果：瘦、超重、肥胖和重度肥胖儿的死产率分别为7.7‰、10.6‰、13.9‰和17.3‰。调整后的死产比(95%AS)分别为1.4(1.1，1.8)超重，1.8(1.3，2.4)肥胖，2.0(1.5，2.8)严重肥胖女性；当仅限于产前死产时，相关性增强。肥胖和重度肥胖与胎盘疾病、高血压、胎儿畸形和脐带异常引起的死产有关。体重指数与胎盘早剥、产科疾病或感染引起的死产无关。结论：肥胖与死产似乎存在多种机制。减少肥胖母亲死产的干预措施应该考虑以高血压和胎盘疾病引起的死产为目标，这是这一高危群体中胎儿死亡的最常见原因。
Background: In high-income countries, maternal obesity is one of the most important modifiable causes of stillbirth, yet the pathways underpinning this association remain unclear.Objective: We estimated the association between maternal prepregnancy body mass index (BMI) and the risk of stillbirth defined by pathophysiologic contributors or causes.Design: Using a case-cohort design, we randomly sampled 1829 singleton deliveries from a cohort of 68,437 eligible deliveries at Magee-Womens Hospital in Pittsburgh, Pennsylvania (2003-2010), and augmented it with all remaining cases of stillbirth for a total of 658 cases. Stillbirths were classified based on probable cause(s) of death (maternal medical conditions, obstetric complications, fetal abnormalities, placental diseases, and infection). A panel of clinical experts reviewed medical records, placental tissue slides and pathology reports, and fetal postmortem reports of all stillbirths. Causes of fetal death were assigned by using the Stillbirth Collaborative Research Networlanitial Causes of Fetal Death protocol from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Proportional hazards models were used to estimate the BMI-stillbirth association after adjustment for confounders.Results: The rate of stillbirth among lean, overweight, obese, and severely obese women was 7.7, 10.6, 13.9, and 17.3 per 1000 live-born and stillborn infants, respectively. Adjusted stillbirth HRs (95% as) were 1.4 (1.1, 1.8) for overweight, 1.8 (1.3, 2.4) for obese, and 2.0 (1.5, 2.8) for severely obese women, respectively, compared with lean women; associations strengthened when limited to antepartum stillbirths. Obesity and severe obesity were associated with stillbirth resulting from placental diseases, hypertension, fetal anomalies, and umbilical cord abnormalities. BMI was not related to stillbirth caused by placental abruption, obstetric conditions, or infection.Conclusions: Multiple mechanisms appear to link obesity to stillbirth. Interventions to reduce stillbirth among obese mothers should consider targeting stillbirth due to hypertension and placental diseases the most common causes of fetal death in this at-risk group.