Examining the trimester-specific effects of low gestational weight gain on birthweight: the BOSHI study
Examining the trimester-specific effects of low gestational weight gain on birthweight: the BOSHI study
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DOI：
10.1017/s2040174420000240
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发表时间：
2021-04-01
影响因子：
1.7
通讯作者：
Metoki，Hiroto
中科院分区：
文献类型：
--
作者：
Oba，Mari S.;Murakami，Yoshitaka;Metoki，Hiroto
低妊娠体重增加（GWG）是一个已知的低出生体重的危险因素。虽然以前的研究已经检查了GWG和出生体重之间的关系，但每个孕期低GWG对特定时期的影响仍不清楚。本研究旨在量化日本妇女妊娠期低GWG对出生体重的直接影响。使用来自队列研究的围产期数据，我们分析了2006年10月至2010年5月间在妇产科医院分娩的孕妇。我们关注的是孕前体重指数（BMI）低于25 kg/m2的女性。暴露是低GWG。将妊娠期细分为三个月，使用边际结构模型估计低妊娠期特异性GWG对出生体重的直接影响。这些模型由一个直接的无环图指导，该图包含了潜在的混杂因素，包括孕前BMI、年龄、怀孕期间吸烟、身高和胎次。我们分析了563名女性及其家庭。在第一、第二和第三孕期结束时，平均累积GWG分别为0.9、6.2和10.7 kg。大约14.0%的妇女的总体重低于日本卫生、劳动和福利部建议的范围。低GWG对第一、第二和第三孕期出生体重的直接影响分别为65.9 g(95%可信区间：11.4,120.5),- 195.4 g（- 263.4, - 127.4）和- 188.8 g（- 292.0, - 85.5）。在调整孕前BMI和其他协变量后，妊娠中期和晚期体重增加不足对出生体重有负面影响。
Low gestational weight gain (GWG) is a known risk factor of low birthweight. Although studies have previously examined the associations between GWG and birthweight, the period-specific effects of low GWG in each trimester remain unclear. This study aimed to quantify the trimester-specific direct effects of low GWG in Japanese women on birthweight. Using perinatal data from a cohort study, we analyzed pregnant women delivered at an obstetrics/gynecology hospital between October 2006 and May 2010. We focused on women with a pre-pregnancy body mass index (BMI) below 25 kg/m2. The exposure was low GWG. The gestation period was subdivided into trimesters, and the direct effects of low trimester-specific GWG on birthweight were estimated using marginal structural models. These models were guided by a direct acyclic graph that incorporated potential confounders, including pre-pregnancy BMI, age, smoking during pregnancy, height, and parity. We analyzed 563 women and their families. The mean cumulative GWG by the end of the first, second, and third trimesters was 0.9, 6.2, and 10.7 kg, respectively. Approximately 14.0% of the women gained total weight below the range recommended by Japanese Ministry of Health, Labour and Welfare. The direct effects of low GWG on birthweight were 65.9 g (95% confidence interval: 11.4, 120.5), −195.4 g (−263.4, −127.4), and −188.8 g (−292.0, −85.5) for the first, second, and third trimesters, respectively. Insufficient weight gain in the second and third trimesters had a negative impact on birthweight after adjusting for pre-pregnancy BMI and other covariates.