Pre-pregnancy body mass index change between pregnancies and preterm birth in the following pregnancy
Pre-pregnancy body mass index change between pregnancies and preterm birth in the following pregnancy
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DOI：
10.1111/j.1365-3016.2009.01029.x
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发表时间：
2009-05-01
影响因子：
2.8
通讯作者：
Basso, Olga
中科院分区：
文献类型：
--
作者：
Chen, Aimin;Klebanoff, Mark A.;Basso, Olga
母亲孕前体重指数（BMI）可能会影响早产风险。然而，尚不清楚两次怀孕期间体重指数的变化如何影响下次怀孕的早产风险。我们在围产期合作项目中研究了这种效应，当时肥胖并不常见，引产率也很低。该分析包括 1892 名初产妇，其第一次登记（指标）妊娠是单胎活产，第二次登记（结果）妊娠是连续单胎妊娠（两次妊娠均在妊娠 20-51 周内）。我们使用 Cox 回归模型计算结果妊娠时早产的风险比 (HR)，作为降低的 BMI（75(th) 百分位）的函数，与稳定的 BMI（25(th)-75(th) 百分位）相比，并根据怀孕指数和其他协变量调整孕前 BMI。体重指数降低与早产风险非显着增加相关，调整后 HR 1.17 [95% 置信区间] 0.90，1.53]； BMI 增加的影响几乎为零（调整后的 HR 1.08 [0.83, 1.41]）。在BMI线性变化的模型中，每增加1 kg/m(2)，HR就会增加0.96 [0.89, 1.03]。对于指数妊娠早产的女性（HR 1.49 [0.90, 2.44]）和指数妊娠时 BMI < 25 kg/m(2) 的女性（HR 1.30 [0.98, 1.71]），与 BMI 降低相关的估计值较高。本研究主要涉及自然分娩的低体重至正常体重女性，由于样本量较小，可能会出现 II 型错误。需要使用当代数据来研究体重指数变化对超重和肥胖女性的影响。
Maternal pre-pregnancy body mass index (BMI) may affect the risk of preterm birth. However, it is unclear how changes in BMI between pregnancies modify the risk of preterm birth in the following pregnancy. We studied this effect in the Collaborative Perinatal Project, when obesity was uncommon and the prevalence of induction of labour was low. This analysis included 1892 primiparae whose first enrolled ( index) pregnancy was a singleton livebirth and the second enrolled ( outcome) pregnancy was a consecutive singleton pregnancy ( both pregnancies within 20-51 weeks of gestation). We used the Cox regression model to calculate the hazard ratio (HR) of preterm birth at the outcome pregnancy as a function of reduced BMI (75(th) percentile), compared with stable BMI (25(th)-75(th) percentile), adjusted for pre-pregnancy BMI at the index pregnancy and other covariates.Body mass index reduction was associated with a non-significant increased risk of preterm birth, adjusted HR 1.17 [95% confidence interval 0.90, 1.53]; BMI increase had effects close to null (adjusted HR 1.08 [0.83, 1.41]). In the model with linear BMI change, each 1 kg/m(2) increase was associated with an HR of 0.96 [0.89, 1.03]. The estimates associated with a BMI reduction were higher in women whose index pregnancy ended preterm (HR 1.49 [0.90, 2.44]) and in those with BMI < 25 kg/m(2) at the index pregnancy (HR 1.30 [0.98, 1.71]). This study involved mainly low-to-normal weight women with spontaneous deliveries, and might suffer from type II error owing to small sample size. The effect of BMI change in overweight and obese women needs to be studied using contemporary data.