Gestational weight gain and obesity: is 20 pounds too much?
Gestational weight gain and obesity: is 20 pounds too much?
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DOI：
10.1016/j.ajog.2013.04.035
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发表时间：
2013-09
影响因子：
9.8
通讯作者：
Hibbard, Judith U.
中科院分区：
文献类型：
--
作者：
Kominiarek, Michelle A.;Seligman, Neil S.;Dolin, Cara;Gao, Weihua;Berghella, Vincenzo;Hoffman, Matthew;Hibbard, Judith U.
根据体重变化和肥胖级别比较肥胖妇女的母婴结局。来自安全分娩联盟的队列研究从2002年到2008年对20950名单身、足月、活产的肥胖女性进行了研究。通过多因素Logistic回归分析计算体重变化类别[体重下降(0 Kg)、低体重(0−4.9 kg)、正常(5.0−9.0 kg)、高体重增加(>；9.0 kg)]在每个肥胖类别(I30.0−34.9 kg/m2、II35.0−39.9 kg/m2和III≥40 kg/m2)中的不良结局风险，并以体重变化为连续变量进行预测概率计算。体重减轻与第I级产妇剖宫产减少(未产妇OR 0.21，95%CI 0.11−0.42；经产OR 0.61，95%CI 0.45−.83)和小于胎龄儿的增加(第I级OR 1.8，95%CI 1.3−2.5；II级OR 2.2，95%CI 1.5−3.2；III级OR 1.7，95%CI 1.1−2.6)相关。高体重增加与较大胎龄儿的增加相关(I级OR 2.4，95%CI 1.9−2.9；II级OR 1.7，95%CI 1.3−2.1；III级OR 1.6，95%CI 1.3−2.1)。随着体重变化的增加，剖宫产和LGA婴儿的预测概率也增加。对于所有肥胖类别，预测的低出生体重概率从未超过4%，但SGA随着体重变化的减少而增加。当女性(I、II、III级)体重减轻时，不良结局(剖腹产、产后出血、SGA、LGA、NICU入院)的平均预测概率最低。当体重增加低于国际移民组织目前对肥胖妇女的建议时，似乎会出现最佳的孕产妇和新生儿结局。关于妊娠体重变化的长期结果还需要进一步研究。
To compare maternal and neonatal outcomes in obese women according to weight change and obesity class. Cohort study from the Consortium on Safe Labor of 20,950 obese women with a singleton, term, livebirth from 2002–2008. Risk for adverse outcomes was calculated by multiple logistic regression analysis for weight change categories [weight loss (<0kg), low (0−4.9kg), normal (5.0−9.0kg), high weight gain (>9.0 kg)] in each obesity class (I 30.0−34.9kg/m2, II 35.0−39.9kg/m2, and III ≥40 kg/m2) and by predicted probabilities with weight change as a continuous variable. Weight loss was associated with decreased cesareans for class I women (nulliparas OR 0.21, 95%CI 0.11−0.42; multiparas OR 0.61, 95%CI 0.45−.83) and increased small for gestational age (SGA) infants (class I OR 1.8, 95%CI 1.3−2.5; class II OR 2.2, 95%CI 1.5−3.2; class III OR 1.7, 95%CI 1.1−2.6). High weight gain was associated with increased large for gestational age (LGA) infants (class I OR 2.4, 95%CI 1.9−2.9; class II OR 1.7, 95% CI 1.3−2.1; class III OR 1.6, 95%CI 1.3−2.1). As weight change increased, the predicted probability for cesareans and LGA infants increased. The predicted probability of low birth weight never exceeded 4% for all obesity classes, but SGA increased with decreased weight change. The lowest average predicted probability of adverse outcomes (cesarean, postpartum hemorrhage, SGA, LGA, NICU admission) occurred when women (class I,II,III) lost weight. Optimal maternal and neonatal outcomes appear to occur when weight gain is less than current IOM recommendations for obese women. Further study of long-term outcomes is needed with respect to gestational weight changes.
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影响因子：
2
作者：
Flick, Amy A.;Brookfield, Kathleen F.;Gonzalez-Quintero, Victor Hugo
通讯作者：
Gonzalez-Quintero, Victor Hugo
影响因子：
9.8
作者：
Kominiarek MA;Vanveldhuisen P;Hibbard J;Landy H;Haberman S;Learman L;Wilkins I;Bailit J;Branch W;Burkman R;Gonzalez-Quintero VH;Gregory K;Hatjis C;Hoffman M;Ramirez M;Reddy UM;Troendle J;Zhang J;Consortium on Safe Labor
通讯作者：
Consortium on Safe Labor
影响因子：
7.2
作者：
Cedergren, Marie I.
通讯作者：
Cedergren, Marie I.
影响因子：
3.3
作者：
Thornton, Yvonne S.;Smarkola, Claudia;Ishoof, Sabriya B.
通讯作者：
Ishoof, Sabriya B.
影响因子：
7.2
作者：
Bianco, AT;Smilen, TW;Lockwood, CJ
通讯作者：
Lockwood, CJ