Pregnancy weight gain and risk of neonatal complications - Macrosomia, hypoglycemia, and hyperbilirubinemia
Pregnancy weight gain and risk of neonatal complications - Macrosomia, hypoglycemia, and hyperbilirubinemia
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DOI：
10.1097/01.aog.0000242568.75785.68
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发表时间：
2006-11-01
影响因子：
7.2
通讯作者：
Ferrara, Assiamira
中科院分区：
文献类型：
--
作者：
Hedderson, Monique M.;Weiss, Noel S.;Ferrara, Assiamira
目的：探讨超出医学研究所 (IOM) 建议范围的妊娠期体重增加以及母亲体重增加率是否与新生儿并发症相关。 方法：在 1996-1998 年北加州 Kaiser Permanente 医疗保健计划中产下单胎且在妊娠 24-28 周时未患有妊娠期糖尿病的 45,245 名妇女中，我们对三个病例组进行了一项巢式病例对照研究：巨大儿（出生体重超过 4,500 g，n=391）、新生儿低血糖（血浆葡萄糖低于 40 mg/dL，n=328）和高胆红素血症（血清胆红素 20 mg/dL 或更高，n=432）和一个对照组（n=652）。审查医疗记录以确定妇女的孕前和产前体重。 结果：调整年龄、种族、胎次、血糖筛查值以及分娩周数和最后一次体重测量时间的差异后，体重增加超过 IOM 建议的妇女生下巨大儿的可能性是其三倍（比值比 [OR] 3.05，95% 置信区间 [CI] 2.19-4.26），婴儿出现低血糖（OR 1.38，95% CI 1.01-1.89）或高胆红素血症（OR 1.43，95% CI 1.061.93）的可能性是体重增加在推荐范围内的女性的近 1.5 倍。与推荐范围内的女性相比，体重增加低于 IOM 建议的女性生下巨大儿的可能性较小（OR 0.38，95% CI 0.20-0.70），但生下患有低血糖或高胆红素血症的婴儿的可能性相同。使用其他对怀孕期间体重增加进行分类的方法也获得了类似的结果。 结论：母亲体重增加超过 IOM 建议与所研究结果的风险增加相关。
OBJECTIVE: To examine whether pregnancy weight gains outside the Institute of Medicine (IOM) recommendations and rates of maternal weight gain are associated with neonatal complications.METHODS: In a cohort of 45,245 women who delivered singletons at Kaiser Permanente Medical Care Program Northern California in 1996-1998 and who did not have gestational diabetes as of 24-28 weeks of gestation, we conducted a nested case-control study with three case groups: macrosomia (birth weight more than 4,500 g, n=391), neonatal hypoglycemia (plasma glucose less than 40 mg/dL, n=328), and hyperbilirubinemia (serum bilirubin 20 mg/dL or more, n=432) and one control group (n=652). Medical records were reviewed to ascertain the woman's prepregnancy and predelivery weight.RESULTS: Adjusting for age, race-ethnicity, parity, plasma glucose screening value, and difference in weeks between delivery and time when last weight was measured, women who gained more than recommended by the IOM were three times more likely to have an infant with macrosomia (odds ratio [OR] 3.05, 95% confidence interval [CI] 2.19-4.26), and nearly 1.5 times as likely to have an infant with hypoglycemia (OR 1.38, 95% CI 1.01-1.89), or hyperbilirubinemia (OR 1.43, 95% CI 1.061.93) than women whose weight gain was in the recommended range. Women who gained less than the IOM recommendations were less likely than women in the recommended range to have an infant with macrosomia (OR 0.38, 95% CI 0.20-0.70), but equally likely to have an infant with hypoglycemia or hyperbilirubinemia. Similar results were obtained using other means of categorizing weight gain during pregnancy.CONCLUSION: Maternal weight gain above the IOM recommendations was associated with an increased risk of the outcomes studied.