Influence of weight gain on risk for cesarean delivery in obese pregnant women by class of obesity: pregnancy risk assessment monitoring system (PRAMS)
Influence of weight gain on risk for cesarean delivery in obese pregnant women by class of obesity: pregnancy risk assessment monitoring system (PRAMS)
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DOI：
10.1080/14767058.2020.1802714
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发表时间：
2020-08-06
影响因子：
1.8
通讯作者：
Berghella, Vincenzo
中科院分区：
文献类型：
--
作者：
McCurdy, Rebekah J.;Delgado, David J.;Berghella, Vincenzo
背景目前，美国（US）的所有肥胖女性都被建议在怀孕期间增加相同数量的体重，无论肥胖的类别如何。有限的文献研究了剖宫产的风险，以及通过特定肥胖类别可能减轻这种风险。目的通过对肥胖妇女（由孕前体重指数[BMI]确定）的肥胖分类，确定体重增加对剖宫产率的影响。研究设计回顾性队列，来自美国妊娠风险评估监测系统（PRAMS）。具体而言，确定了每种BMI等级（体重不足、正常体重、超重、I级肥胖、II级肥胖和III级肥胖）的未经调整的剖宫产几率。这些几率随后通过影响妊娠期体重增加或剖宫产风险的人口统计学和产前护理因素进行调整。最后，通过多变量logistic回归分析发现，体重增加（不足20磅）与肥胖妇女剖宫产率之间存在关联。60 431名妇女（包括21，208例剖宫产）纳入本研究，根据BMI调整剖宫产的比值比（OR）：体重不足0.92（95% CI 0.83，1.01），正常体重对照组超重1.38（95% CI 1.32，1.45），I级肥胖1.77（95% CI 1.68，1.88），II类肥胖2.17（95% CI 2.02，2.34）和III类肥胖3.07（95% CI 2.82，3.34）。I级和II级肥胖女性更有可能在体重过度增加的情况下进行剖宫产，与体重适当增加的同类肥胖女性相比，I级OR为1.20（95% CI 1.06，1.36），II级OR为1.24（1.04，1.48）。体重增加对III级肥胖妇女剖宫产的风险没有影响。结论虽然肥胖是剖宫产的危险因素，但妊娠期间适当增加体重可以降低剖宫产的危险性。体重增加11-20磅与肥胖（特别是I类和II类）个体中剖腹产的风险最小相关。
Background Currently, all obese women in the United States (US) are recommend to gain the same amount of weight during pregnancy, regardless of class of obesity. Limited literature has looked at the risk of cesarean, and possible mitigation of this risk, by specific class of obesity. Objective To determine the influence of weight gain on the odds of cesarean delivery for obese women (as determined by pre-pregnancy body mass index [BMI]), by class of obesity. Study design Retrospective cohort, from the Pregnancy Risk Assessment Monitoring System (PRAMS) in the US. Specifically, the unadjusted odds of cesarean delivery were determined for each class of BMI (underweight, normal weight, overweight, class I obesity, class II obesity, and class III obesity). These odds were then adjusted by demographic and prenatal care factors influencing either weight gain during pregnancy or risk of cesarean delivery. Finally, the association of weight gain (insufficient 20 lbs) on the odds of cesarean delivery in obese women was notedviamultivariate logistic regression analysis. Results 60,431 women (including 21,208 with a cesarean delivery) were included in this study, with an adjusted odds ratios (OR) of cesarean delivery by BMI: underweight 0.92 (95% CI 0.83, 1.01), normal weight (referent group), overweight 1.38 (95% CI 1.32, 1.45), class I obesity 1.77 (95% CI 1.68, 1.88), class II obesity 2.17 (95% CI 2.02, 2.34), and class III obesity 3.07 (95% CI 2.82, 3.34). Class I and II obese women are more likely to have a cesarean with excessive weight gain, with class I OR 1.20 (95% CI 1.06, 1.36) and class II OR 1.24 (1.04, 1.48) when compared to women in their same class of obesity with adequate weight gain. There was no difference in risk for cesarean for class III obese women by weight gain. Conclusion Although obesity is a known risk factor for cesarean delivery, this risk is thought to be mitigatable by appropriate weight gain during the pregnancy. Weight gain of 11-20 pounds was associated with the least risk of cesarean delivery among obese (specifically class I and II) individuals.