Weight Loss in Obese Pregnant Women and Risk for Adverse Perinatal Outcomes
Weight Loss in Obese Pregnant Women and Risk for Adverse Perinatal Outcomes
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DOI：
10.1097/aog.0000000000000677
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发表时间：
2015-03-01
影响因子：
7.2
通讯作者：
Devlieger, Roland
中科院分区：
文献类型：
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作者：
Bogaerts, Annick;Ameye, Lieveke;Devlieger, Roland
目的：探讨肥胖孕妇体重减轻与相关孕产妇和新生儿结局之间的关系。方法：纳入 2009 年至 2011 年间佛兰德斯（比利时北部）所有活产单胎足月（妊娠 37 周或以上）孕妇（N=18,053）。评估的结果包括妊娠高血压、低出生体重（2,500克或以下）、小于胎龄（小于第10个百分位）新生儿、巨大儿（出生体重4,000克或以上）、大于胎龄（大于第90个百分位）新生儿、紧急剖腹产以及入住新生儿重症监护病房。通过多重逻辑回归分析计算每个肥胖类别的体重变化类别（体重减轻较大[5公斤或以上]、体重减轻较小[0至5公斤之间]、妊娠期体重增加较低[0或以上且小于5公斤]、妊娠期体重适当增加[5或以上至9公斤或以下，参考]和妊娠期体重增加过多[大于9公斤]）（I 30-34.9，II） 35-39.9，III 40 或更高）根据胎次、母亲和胎龄进行调整。结果：在总人口中，854 名（4.7%）肥胖孕妇报告体重减轻。体重减轻和体重增加低与 I 级肥胖女性妊娠高血压发生率降低相关（体重减轻调整比值比较大 [OR] 0.31，95% 置信区间 [CI] 0.11-0.84；体重减轻较小调整 OR 0.46 95% CI 0.21-0.99；体重增加低调整 OR 0.71 95% CI 0.54-0.93），减少体重紧急剖宫产率有所下降，但仅限于 II 级肥胖患者（调整后体重减轻较大 OR 0.24，95% CI 0.07-0.78；调整后体重减轻较小 OR 0.50，95% CI 0.26-0.97；调整后体重较低 OR 0.55，95% CI 0.38-0.79），以及巨大儿和大于胎龄儿减少所有类型肥胖女性的新生儿中，III 级肥胖女性的下降幅度最大（调整后体重减轻较大 OR 0.15，95% CI 0.05-0.49；巨大儿调整后体重减轻较小 OR 0.37，95% CI 0.15-0.90）。在不同的肥胖类别中，体重减轻与低出生体重、小于胎龄新生儿或入住新生儿重症监护病房之间没有关联。结论：肥胖孕妇的体重减轻与围产期风险降低相关，但与该富裕地区 III 级肥胖妇女的低出生体重或小于胎龄新生儿的发生率无关。应考虑对肥胖女性建议的妊娠期体重增加范围进行分层。
OBJECTIVE: To examine the association between weight loss in obese pregnant women and relevant maternal and neonatal outcomes.METHODS: All liveborn singleton term (37 weeks of gestation or greater) births in obese women between 2009 and 2011 in Flanders (the northern part of Belgium) were included (N=18,053). Outcomes assessed included gestational hypertension, low (2,500 g or less) birth weight, small-for-gestational-age (less than the 10th percentile) neonates, macrosomia (birth weight 4,000 g or greater), large-for-gestational-age (greater than 90th percentile) neonates, emergency caesarean delivery, and admission to a neonatal intensive care unit. Risk for adverse outcomes was calculated by multiple logistic regression analysis for weight change categories (greater weight loss [5 kg or greater], lesser weight loss [between 0 and 5 kg], low gestational weight gain [0 or greater and less than 5 kg], adequate gestational weight gain [5 or greater to 9 kg or less, reference], and excessive gestational weight gain [greater than 9 kg]) in each obesity class (I 30-34.9, II 35-39.9, III 40 or greater) adjusted for parity and maternal and gestational age.RESULTS: In the total population, 854 (4.7%) obese pregnant women reported weight loss. Weight loss and low weight gain were associated with a decreased incidence of gestational hypertension for women with class I obesity (greater weight loss adjusted odds ratio [OR] 0.31, 95% confidence interval [CI] 0.11-0.84; lesser weight loss adjusted OR 0.46 95% CI 0.21-0.99; low gain adjusted OR 0.71 95% CI 0.54-0.93), a reduction in the rate of emergency cesarean delivery, but only in those with class II obesity (greater weight loss adjusted OR 0.24, 95% CI 0.07-0.78; lesser weight loss adjusted OR 0.50, 95% CI 0.26-0.97; low gain adjusted OR 0.55, 95% CI 0.38-0.79), and decreased macrosomia and large-for-gestational-age neonates in women in all classes of obesity, with the highest decrease for women with class III obesity (greater weight loss adjusted OR 0.15, 95% CI 0.05-0.49; lesser weight loss adjusted OR 0.37, 95% CI 0.15-0.90 for macrosomia). No association between weight loss and low birth weight, small-for-gestational-age neonates, or admission to the neonatal intensive care unit was shown in the different obesity classes.CONCLUSION: Weight loss in obese pregnant women was associated with reduced perinatal risks but not with the rate of low birth weight or small-for-gestational-age neonates in obese women from class III in this affluent region. Stratification of recommended gestational weight gain ranges in obese women should be considered.