Trends in Prepregnancy Obesity and Association With Adverse Pregnancy Outcomes in the United States, 2013 to 2018.
Trends in Prepregnancy Obesity and Association With Adverse Pregnancy Outcomes in the United States, 2013 to 2018.
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DOI：
10.1161/jaha.120.020717
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发表时间：
2021-09-07
影响因子：
5.4
通讯作者：
Khan SS
中科院分区：
文献类型：
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作者：
Wang MC;Freaney PM;Perak AM;Greenland P;Lloyd-Jones DM;Grobman WA;Khan SS
人群中肥胖的患病率随着不良妊娠结局（APO）率的增加而增加。量化孕前肥胖的当代趋势以及与相关APO（早产，低出生体重和妊娠相关高血压）的相关性，可以为预防策略提供信息，以优化女性和后代的心脏代谢健康。我们使用国家卫生统计中心出生证明数据进行了一项系列横断面研究，其中包括2013年至2018年间单胎活产的15至44岁女性，并按种族/民族（非西班牙裔白色人、非西班牙裔黑人、西班牙裔和非西班牙裔亚洲人）分层。我们量化了孕前肥胖的年患病率（体重指数≥30.0 kg/m2;如果是非西班牙裔亚洲人，体重指数≥27.5 kg/m2）。然后，我们使用多变量logistic回归（比值比和人群归因分数）估计了肥胖相关APO与正常体重指数（18.5-24.9 kg/m2; 18.5-22.9 kg/m2，如果是非西班牙裔亚洲人）的校正相关性。在2013年至2018年期间，20139891名女性中，孕前肥胖的患病率增加：非西班牙裔白色（21.6%-24.8%），非西班牙裔黑人（32.5%-36.2%），西班牙裔（26.0%-30.5%）和非西班牙裔亚洲（15.3%-18.6%）女性（所有P趋势< 0.001）。2013年至2018年，与肥胖相关的APO的调整后比值比（95% CI）增加，到2018年，非西班牙裔黑人的范围为1.27（1.25-1.29），非西班牙裔白色女性为1.94（1.92-1.96）。肥胖与妊娠高血压相关性最强，与早产和低出生体重相关性不一致。肥胖相关APO的人群归因分数在研究期间增加：非西班牙裔白色女性（10.6%-14.7%）、非西班牙裔黑人女性（3.7%-6.9%）、西班牙裔女性（7.0%-10.4%）和非西班牙裔亚裔女性（7.4%-9.7%）（所有女性的P趋势< 0.01）。孕前肥胖的患病率和肥胖相关APO的负担增加，主要由妊娠相关高血压驱动，并且在人种/种族亚组中存在差异。
The prevalence of obesity in the population has increased in parallel with increasing rates of adverse pregnancy outcomes (APOs). Quantifying contemporary trends in prepregnancy obesity and associations with interrelated APOs (preterm birth, low birth weight, and pregnancy‐associated hypertension) together and individually can inform prevention strategies to optimize cardiometabolic health in women and offspring. We performed a serial, cross‐sectional study using National Center for Health Statistics birth certificate data including women aged 15 to 44 years with live singleton births between 2013 and 2018, stratified by race/ethnicity (non‐Hispanic White, non‐Hispanic Black, Hispanic, and non‐Hispanic Asian). We quantified the annual prevalence of prepregnancy obesity (body mass index ≥30.0 kg/m2; body mass index ≥27.5 kg/m2 if non‐Hispanic Asian). We then estimated adjusted associations using multivariable logistic regression (odds ratios and population attributable fractions) for obesity‐related APOs compared with normal body mass index (18.5–24.9 kg/m2; 18.5–22.9 kg/m2 if non‐Hispanic Asian). Among 20 139 891 women, the prevalence of prepregnancy obesity increased between 2013 and 2018: non‐Hispanic White (21.6%–24.8%), non‐Hispanic Black (32.5%–36.2%), Hispanic (26.0%–30.5%), and non‐Hispanic Asian (15.3%–18.6%) women (P‐trend < 0.001 for all). Adjusted odds ratios (95% CI) for APOs associated with obesity increased between 2013 and 2018, and by 2018, ranged from 1.27 (1.25–1.29) in non‐Hispanic Black to 1.94 (1.92–1.96) in non‐Hispanic White women. Obesity was most strongly associated with pregnancy‐associated hypertension and inconsistently associated with preterm birth and low birth weight. Population attributable fractions of obesity‐related APOs increased over the study period: non‐Hispanic White (10.6%–14.7%), non‐Hispanic Black (3.7%–6.9%), Hispanic (7.0%–10.4%), and non‐Hispanic Asian (7.4%–9.7%) women (P‐trend < 0.01 for all). The prevalence of prepregnancy obesity and burden of obesity‐related APOs have increased, driven primarily by pregnancy‐associated hypertension, and vary across racial/ethnic subgroups.