Pregnancy weight gain by gestational age and BMI in Sweden: a population-based cohort study
Pregnancy weight gain by gestational age and BMI in Sweden: a population-based cohort study
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DOI：
10.3945/ajcn.115.110197
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发表时间：
2016-05-01
影响因子：
7.1
通讯作者：
Cnattingius, Sven
中科院分区：
文献类型：
--
作者：
Johansson, Kari;Hutcheon, Jennifer A.;Cnattingius, Sven
背景：妊娠期体重增加 z 分数图最近被提议作为一种新工具，用于对妊娠期体重增加进行分类，并建立体重增加与不良母婴结局之间的联系。然而，现有的图表数量很少，基于小样本，并且不以人口为基础。 目的：我们为按早孕体重指数（BMI）分层的瑞典妇女创建了基于人群的妊娠期体重增加胎龄 z 评分图表。 设计：从瑞典哥特兰郡和斯德哥尔摩郡接受产科护理的妇女获得系列产前电子病历。研究人群仅限于非异常、单胎、足月妊娠，且无孕前高血压或糖尿病。使用多级线性回归将体重不足、正常体重、超重和肥胖级女性的重复体重增加测量值表达为孕龄的函数。观察到的体重增加范围与当前医学研究所 (IOM) 的妊娠体重增加建议进行了对比。结果：总共纳入了来自 141,767 名孕妇的 711,615 次连续产前体重测量。估计妊娠每周的体重增加的平滑平均值、标准差和选定的百分位数（第 3、10、50、90 和 97）。总体重增加和体重增加率随着孕前BMI的增加而下降。在所有 BMI 类别中，观察到的妊娠期体重增加范围比 IOM 目前推荐的范围要宽得多。结论：所提出的基于人群的妊娠期体重增加图表可用于将母亲体重增加表示为孕龄标准化 z 分数，并考虑早期妊娠 BMI。 z 分数可用于更好地了解妊娠体重增加与母婴健康并发症之间的关系。
Background: Pregnancy weight-gain z score charts have recently been proposed as a new tool for classifying gestational weight gain and establishing the link between weight gain and adverse maternal and infant outcomes. However, existing charts are few in number, were based on small sample sizes, and were not population based.Objective: We created population-based pregnancy weight-gain for-gestational-age z score charts for Swedish women who were stratified by early pregnancy body mass index (BMI).Design: Serial prenatal electronic medical records were obtained from women who were receiving obstetrical care in the Swedish counties of Gotland and Stockholm. The study population was restricted to nonanomalous, singleton, term pregnancies with no prepregnancy hypertension or diabetes. A multilevel linear regression was used to express the repeated weight-gain measurements as a function of gestational age in underweight, normal-weight, overweight, and obese class women. Observed weight-gain ranges were contrasted with current Institute of Medicine (IOM) pregnancy weight-gain recommendations.Results: A total of 711,615 serial prenatal weight measurements from 141,767 pregnant women were included. The smoothed means, SDs, and selected percentiles (3rd, 10th, 50th, 90th, and 97th) of weight gain were estimated for each week of gestation. The total weight gain and rate of weight gain decreased with increasing prepregnancy BMI. In all BMI categories, the observed range of pregnancy weight gain was considerably broader than the range currently recommended by the IOM.Conclusions: The presented population-based pregnancy weight gain charts can be used to express maternal weight gain as gestational age standardized z scores with early pregnancy BMI taken into consideration. The z scores can be used to obtain a better understanding of the relation between pregnancy weight gain and maternal and infant health complications.