Maternal overweight and obesity and risks of severe birth-asphyxia-related complications in term infants: a population-based cohort study in Sweden.
Maternal overweight and obesity and risks of severe birth-asphyxia-related complications in term infants: a population-based cohort study in Sweden.
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DOI：
10.1371/journal.pmed.1001648
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发表时间：
2014-05
期刊：
影响因子：
15.8
通讯作者：
Cnattingius S
中科院分区：
文献类型：
--
作者：
Persson M;Johansson S;Villamor E;Cnattingius S
Martina Persson和他的同事利用瑞典国家数据库调查了妊娠早期产妇体重指数与足月分娩婴儿严重窒息相关结局之间的关系。产妇超重和肥胖增加妊娠和分娩并发症以及新生儿死亡率的风险，但其机制尚不清楚。该研究的目的是调查妊娠早期产妇体重指数（BMI）与足月（≥37周）分娩婴儿严重窒息相关结局之间的关系。一项基于医学出生登记数据的瑞典全国队列研究包括了1992年至2010年间瑞典所有活产单胎足月婴儿。采用Logistic回归分析，在调整了产妇身高、产妇年龄、胎次、母亲吸烟习惯、教育程度、出生国家和婴儿出生年份等因素后，获得5分钟和10分钟时Apgar评分在0到3分之间、胎吸综合征和新生儿癫痫发作的95% ci的比值比（ORs）。在1,764,403名足月新生儿中，86%的人有妊娠早期BMI和Apgar评分数据。有1380名婴儿在5分钟时Apgar评分为0-3分（绝对风险= 0.8 / 1000），894名婴儿在10分钟时Apgar评分为0-3分（绝对风险= 0.5 / 1000）。与BMI正常（18.5-24.9）母亲的婴儿相比，10分钟Apgar评分0-3的调整后的or （95% CI）如下：BMI 25-29.9: 1.32 (1.10-1.58)；Bmi 30-34.9: 1.57 (1.20-2.07)；Bmi 35-39.9: 1.80 (1.15-2.82)；BMI≥40:3.41（1.91 ~ 6.09）。5分钟时Apgar评分0-3分、胎便吸入和新生儿癫痫发作的ORs与母亲BMI相似。研究的一个局限性是缺乏关于产科干预和新生儿复苏效果的数据。足月婴儿发生严重窒息相关结局的风险随着母亲超重和肥胖而增加。鉴于接触的高流行率和研究结果的严重性，这些结果具有潜在的公共卫生相关性，应在其他人群中得到证实。预防育龄妇女超重和肥胖对改善围产期健康很重要。在过去的30年里，经济、技术和生活方式的变化创造了大量便宜、容易获得、高热量的食物。再加上对体力活动的需求减少，这种情况导致世界大部分地区的体重增加。因此，与1980年相比，超重或肥胖在许多高收入、低收入和中等收入国家更为普遍。据全球估计，1980年至2008年间，超重或肥胖成年人的比例增加了10%以上。随着超重成为一种全球流行病，其在育龄妇女中的流行率也有所增加。超重或肥胖的孕妇是一个值得关注的问题，因为这可能给婴儿和母亲带来相关的健康风险。为了更清楚地界定这些风险，有必要进行研究。在这项研究中，研究人员调查了与母亲超重相关的并发症，这些并发症可能会阻碍婴儿在分娩过程中获得足够的氧气（新生儿窒息）。所有胎儿在宫缩期间都会缺氧，然而，长时间的缺氧会影响婴儿的长期发育。为了探索这种风险，研究人员依赖于一种被称为阿普加评分的通用评分系统。阿普加评分通常在出生后1分钟、5分钟和10分钟进行记录，通过评估心率、呼吸努力、肤色、反射和肌肉张力来计算。分娩过程中的缺氧会影响得分。一个正常的分数在7-10之间。身体质量指数（BMI）是一种使用身高和体重的计算方法，用于评估母亲在怀孕期间的体重状况（即正常、超重、肥胖）。研究人员使用瑞典医疗出生登记处（一个包括自1973年以来瑞典几乎所有出生的数据库）选择了1992年至2010年间发生的单胎出生记录。该登记处还纳入了产前护理数据，研究人员进一步选择了包括首次产前检查时测量的体重和身高在内的记录。BMI是通过体重和身高测量来计算的。基于BMI范围，将体重组定义为正常、超重和肥胖I、II和III级，研究人员分析并比较了每组低Apgar评分婴儿（Apgar 0-3）的数量。大多数Apgar 0-3的婴儿是体重正常的母亲生的。相比之下，超重和肥胖母亲所生婴儿的低阿普加得分比例更高。研究人员发现，低Apgar评分的比率随着母亲BMI的增加而增加：作者发现，5分钟低Apgar评分的比率从体重不足妇女（BMI <18.5）的婴儿的0.4 / 1000增加到肥胖III级妇女（BMI≥40）的婴儿的2.4 / 1000。此外，超重（BMI 25.0-29.9）与5分钟时Apgar评分低的风险增加55%相关；I级肥胖（BMI 30-34.9）和II级肥胖（BMI 35.0-39.9）的风险分别增加近2倍和2倍以上；肥胖等级ΙΙΙ （BMI≥40.0），风险增加3倍以上。最后，母亲超重和肥胖也会增加新生儿癫痫发作和胎粪吸入的风险。这些发现表明，超重或肥胖妇女的婴儿出现缺氧的风险会增加。鉴于世界上许多国家超重和肥胖的高发率，这些发现很重要，并表明预防育龄妇女超重或肥胖因此对其子女的健康很重要。本研究的一个局限性是缺乏临床干预和新生儿复苏效果的数据，这些数据可能是在出生时进行的。此外，阿普加评分是基于五个变量，分数低并不是确定婴儿是否缺氧的最直接方法。然而，这些发现表明，围产期窒息的早期检测与超重和肥胖妇女的婴儿特别相关，尽管需要更多的研究来证实其他人群的结果。请通过本摘要的在线版本http://dx.doi.org/10.1371/journal.pmed.1001648访问这些网站。美国国立卫生研究院解释并计算身体质量指数，国立卫生研究院还定义了阿普加评分系统，英国国家卫生服务机构有关于超重孕妇的信息，英国海外发展研究所在其“未来饮食”出版物中讨论了饮食变化如何导致全球健康危机，有关瑞典卫生保健系统的信息是可用的，英语信息可从国家委员会获得瑞典的卫生和福利
Martina Persson and colleagues use a Swedish national database to investigate the association between maternal body mass index in early pregnancy and severe asphyxia-related outcomes in infants delivered at term. Please see later in the article for the Editors' Summary Maternal overweight and obesity increase risks of pregnancy and delivery complications and neonatal mortality, but the mechanisms are unclear. The objective of the study was to investigate associations between maternal body mass index (BMI) in early pregnancy and severe asphyxia-related outcomes in infants delivered at term (≥37 weeks). A nation-wide Swedish cohort study based on data from the Medical Birth Register included all live singleton term births in Sweden between 1992 and 2010. Logistic regression analyses were used to obtain odds ratios (ORs) with 95% CIs for Apgar scores between 0 and 3 at 5 and 10 minutes, meconium aspiration syndrome, and neonatal seizures, adjusted for maternal height, maternal age, parity, mother's smoking habits, education, country of birth, and year of infant birth. Among 1,764,403 term births, 86% had data on early pregnancy BMI and Apgar scores. There were 1,380 infants who had Apgar score 0–3 at 5 minutes (absolute risk = 0.8 per 1,000) and 894 had Apgar score 0–3 at 10 minutes (absolute risk = 0.5 per 1,000). Compared with infants of mothers with normal BMI (18.5–24.9), the adjusted ORs (95% CI) for Apgar scores 0–3 at 10 minutes were as follows: BMI 25–29.9: 1.32 (1.10–1.58); BMI 30–34.9: 1.57 (1.20–2.07); BMI 35–39.9: 1.80 (1.15–2.82); and BMI ≥40: 3.41 (1.91–6.09). The ORs for Apgar scores 0–3 at 5 minutes, meconium aspiration, and neonatal seizures increased similarly with maternal BMI. A study limitation was lack of data on effects of obstetric interventions and neonatal resuscitation efforts. Risks of severe asphyxia-related outcomes in term infants increase with maternal overweight and obesity. Given the high prevalence of the exposure and the severity of the outcomes studied, the results are of potential public health relevance and should be confirmed in other populations. Prevention of overweight and obesity in women of reproductive age is important to improve perinatal health. Please see later in the article for the Editors' Summary Economic, technologic, and lifestyle changes over the past 30 years have created an abundance of cheap, accessible, high-calorie food. Combined with fewer demands for physical activity, this situation has lead to increasing body mass throughout most of the world. Consequently, being overweight or obese is much more common in many high-income and low-and middle-income countries compared to 1980. Worldwide estimates put the percentage of overweight or obese adults as increasing by over 10%, between 1980 and 2008. As being overweight becomes a global epidemic, its prevalence in women of reproductive age has also increased. Pregnant women who are overweight or obese are a cause for concern because of the possible associated health risks to both the infant and mother. Research is necessary to more clearly define these risks. In this study, the researchers investigated the complications associated with excess maternal weight that could hinder an infant from obtaining enough oxygen during delivery (neonatal asphyxia). All fetuses experience a loss of oxygen during contractions, however, a prolonged loss of oxygen can impact an infant's long-term development. To explore this risk, the researchers relied on a universal scoring system known as the Apgar score. An Apgar score is routinely recorded at one, five, and ten minutes after birth and is calculated from an assessment of heart rate, respiratory effort, and color, along with reflexes and muscle tone. An oxygen deficit during delivery will have an impact on the score. A normal score is in the range of 7–10. Body mass index (BMI) a calculation that uses height and weight, was used to assess the weight status (i.e., normal, overweight, obese) of the mother during pregnancy. Using the Swedish medical birth registry (a database including nearly all the births occurring in Sweden since 1973) the researchers selected records for single births that took place between 1992 to 2010. The registry also incorporates prenatal care data and researchers further selected for records that included weight and height measurement taken during the first prenatal visit. BMI was calculated using the weight and height measurement. Based on BMI ranges that define weight groups as normal, overweight, and obesity grades I, II, and III, the researchers analyzed and compared the number of low Apgar scoring infants (Apgar 0–3) in each group. Mothers with normal weight gave birth to the majority of infants with Apgar 0–3. In comparison the proportion of low Apgar scores were greater in babies of overweight and obese mothers. The researchers found that the rates of low Apgar scores increased with maternal BMI: the authors found that rates of low Apgar score at 5 minutes increased from 0.4 per 1,000 among infants of underweight women (BMI <18.5) to 2.4 per 1,000 among infants of women with obesity class III (BMI ≥40). Furthermore, overweight (BMI 25.0–29.9) was associated with a 55% increased risk of low Apgar scores at 5 minutes; obesity grade I (BMI 30–34.9) and grade II (BMI 35.0–39.9) with an almost 2-fold and a more than 2-fold increased risk, respectively; and obesity grade ΙΙΙ (BMI ≥40.0) with a more than 3-fold increase in risk. Finally, maternal overweight and obesity also increase the risks for seizures and meconium aspiration in the neonate. These findings suggest that the risk of experiencing an oxygen deficit increases for the babies of women who are overweight or obese. Given the high prevalence of overweight and obesity in many countries worldwide, these findings are important and suggest that preventing women of reproductive age from becoming overweight or obese is therefore important to the health of their children. A limitation of this study is the lack of data on the effects of clinical interventions and neonatal resuscitation efforts that may have been performed at the time of birth. Also Apgar scoring is based on five variables and a low score is not the most direct way to determine if the infant has experienced an oxygen deficit. However, these findings suggest that early detection of perinatal asphyxia is particularly relevant among infants of overweight and obese women although more studies are necessary to confirm the results in other populations. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001648. The US National Institutes of Health explains and calculates body mass index The NIH also defines the Apgar scoring system The United Kingdom's National Health Service has information for pregnant woman who are overweight The UK-based Overseas Development Institute discusses how changes in diet have led to a worldwide health crisis in its “Future Diets” publication Information about the Swedish health care system is available Information in English is available from the National Board of Health and Welfare in Sweden
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