The impact of interpregnancy weight change on birthweight in obese women
The impact of interpregnancy weight change on birthweight in obese women
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DOI：
10.1016/j.ajog.2012.12.018
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发表时间：
2013-03-01
影响因子：
9.8
通讯作者：
Hopkins, Sarah A.
中科院分区：
文献类型：
--
作者：
Jain, Arun P.;Gavard, Jeffrey A.;Hopkins, Sarah A.
目的：本研究的目的是评估肥胖妇女从第一胎到第二胎妊娠体重变化对大胎龄（LGA）和小胎龄（SGA）婴儿风险的影响。研究设计：以人群为基础的历史队列分析，对1998-2005年间在密苏里州分娩了头两个单胎活婴的10444名肥胖妇女进行研究。妊娠体重变化计算为第一次妊娠和第二次妊娠的孕前体重指数（BMI）之差。比较LGA和SGA出生的3个解释性体重变化组：(1)体重减轻组（>= 2 BMI单位），(2)体重增加组（>= 2 BMI单位）和(3)参照组（BMI维持在2单位以内）。使用多元逻辑回归计算LGA和SGA出生的校正优势比（aOR）。用线性逐线性chi(2)检验评估剂量-反应关系。结果：与参照组相比，解释性体重减轻与LGA婴儿风险降低相关（aOR, 0.61； 95%可信区间，0.52-0.73），而解释性体重增加与LGA婴儿风险增加相关（aOR, 1.37； 95%可信区间，1.21-1.54）。解释性BMI变化与SGA婴儿的风险无关，除了体重减轻80个BMI单位。LGA婴儿风险存在显著的剂量-反应关系（P < 0.001），但SGA婴儿风险不存在（P = 0.840）。结论：肥胖妇女轻度至中度的解释性体重减轻可降低LGA婴儿后续出生的风险，但不会增加SGA婴儿的风险。解释间隔可能是肥胖妇女减肥目标的关键时期。
OBJECTIVE: The purpose of this study was to estimate the impact of interpregnancy weight change from first to second pregnancies in obese women on the risk of large-for-gestational-age (LGA) and small-for-gestational-age (SGA) infants.STUDY DESIGN: A population-based historical cohort analysis of 10,444 obese women in Missouri who delivered their first 2 singleton live infants from 1998-2005. Interpregnancy weight change was calculated as the difference between prepregnancy body mass index (BMI) of the first and second pregnancies. LGA and SGA births were compared among 3 interpregnancy weight change groups: (1) weight loss (>= 2 BMI units), (2) weight gain (>= 2 BMI units), and (3) reference group (BMI maintained within 2 units). Adjusted odds ratios (aOR) were calculated for LGA and SGA births with the use of multiple logistic regression. A dose-response relationship was assessed with a linear-by-linear chi(2) test.RESULTS: Compared with the reference group, interpregnancy weight loss was associated with lower risk of an LGA infant (aOR, 0.61; 95% confidence interval, 0.52-0.73), whereas interpregnancy weight gain was associated with increased risk of an LGA infant (aOR, 1.37; 95% confidence interval, 1.21-1.54). Interpregnancy BMI change was not related to SGA infant risk, except for weight loss of >8 BMI units. A significant dose-response relationship was observed for LGA infant risk (P < .001), but not SGA infant risk (P = .840).CONCLUSION: Mild-to-moderate interpregnancy weight loss in obese women reduced the risk of subsequent birth of LGA infants without increasing the risk of SGA infants. The interpregnancy interval may be a crucial period for targeting weight loss in obese women.