Population attributable fractions of perinatal outcomes for nulliparous women associated with overweight and obesity, 1990-2014
Population attributable fractions of perinatal outcomes for nulliparous women associated with overweight and obesity, 1990-2014
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DOI：
10.5694/mja17.00344
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发表时间：
2018-02-19
影响因子：
11.4
通讯作者：
Black, Kirsten I.
中科院分区：
文献类型：
--
作者：
Cheney, Kate;Farber, Rachel;Black, Kirsten I.
目的：调查 25 年来澳大利亚未生育女性妊娠早期超重和肥胖的患病率；估计该人群中因超重和肥胖导致的不良围产期结局的比例。设计：队列研究；电子产妇数据的回顾性分析。背景、参与者：1990 年 1 月至 2014 年 12 月在悉尼皇家阿尔弗雷德王子医院（悉尼一家城市教学医院）分娩的 42 582 名单胎妊娠未产妇。主要结果指标：孕产妇体重指数 (BMI)、社会人口特征以及选定的孕产妇、出生和新生儿结局；通过降低首次怀孕前女性超重和肥胖的发生率（人口归因分数，PAF）可以避免不良围产期结局的比例。结果：未产孕妇的超重发生率从 12.7%（1990-1994 年）增加到 16.4%（2010-2014 年）；同期肥胖患病率从4.8%上升至7.3%，而BMI正常范围的比例则从73.5%下降至68.2%。在整个研究期间，主要不良孕产妇和新生儿结局的 PAF 有所增加； 2010-2014年期间，23.8%的先兆子痫、23.4%的巨大胎儿和17.0%的妊娠期糖尿病可归因于超重和肥胖。 2010 年至 2014 年间，超重和肥胖女性的 BMI 类别下降了一项：先兆子痫的 19%、巨大儿的 15.9%、妊娠期糖尿病的 14.2%、剖腹产的 8.5%、低胎龄出生体重的 7.1%、产后出血的 6.8%、入院的 6.5%特殊护理托儿所，5.8% 早产，3.8%的胎儿畸形是可以避免的。结论：过去25年来，随着孕产妇超重和肥胖患病率的增加，超重和肥胖导致的围产期不良结局的比例也在上升。通过减少孕前母亲体重的肥胖预防策略，可以避免这些结果的很大一部分。
Objective: To examine the prevalence across 25 years of overweight and obesity among nulliparous Australian women during early pregnancy; to estimate the proportions of adverse perinatal outcomes attributable to overweight and obesity in this population.Design: Cohort study; retrospective analysis of electronic maternity data.Setting, participants: 42 582 nulliparous women with singleton pregnancies giving birth at the Royal Prince Alfred Hospital, an urban teaching hospital in Sydney, January 1990 - December 2014.Main outcome measures: Maternal body mass index (BMI), socio-demographic characteristics, and selected maternal, birth and neonatal outcomes; the proportion of adverse perinatal outcomes that could be averted by reducing the prevalence of overweight and obesity in women prior to first pregnancies (population attributable fraction, PAF).Results: The prevalence of overweight among nulliparous pregnant women increased from 12.7% (1990-1994) to 16.4% (2010-2014); the prevalence of obesity rose from 4.8% to 7.3% in the same period, while the proportion with normal range BMIs fell from 73.5% to 68.2%. The PAFs for key adverse maternal and neonatal outcomes increased across the study period; during 2010-2014, 23.8% of pre-eclampsia, 23.4% of fetal macrosomia, and 17.0% of gestational diabetes were attributable to overweight and obesity. Were overweight and obese women to have moved down one BMI category during 2010-2014, 19% of pre-eclampsia, 15.9% of macrosomia, 14.2% of gestational diabetes, 8.5% of caesarean deliveries, 7.1% of low for gestational age birthweight, 6.8% of post partum haemorrhage, 6.5% of admissions to special care nursery, 5.8% of prematurity, and 3.8% of fetal abnormality could have been averted.Conclusions: Over the past 25 years, the proportions of adverse perinatal outcomes attributable to overweight and obesity have risen with the increasing prevalence of maternal overweight and obesity. A substantial proportion of these outcomes might be averted with obesity prevention strategies that reduce pre-pregnancy maternal weight.