Gestational Weight Gain and Maternal and Neonatal Outcomes in Underweight Pregnant Women: A Population-Based Historical Cohort Study
Gestational Weight Gain and Maternal and Neonatal Outcomes in Underweight Pregnant Women: A Population-Based Historical Cohort Study
复制标题
DOI：
10.1007/s10995-016-2220-9
复制
发表时间：
2017-05-01
影响因子：
2.3
通讯作者：
Gavard, Jeffrey A.
中科院分区：
文献类型：
--
作者：
Gavard, Jeffrey A.
目的根据2009年修订的国际医学研究所(IOM)指南，评估妊娠体重增加对低体重妇女母婴结局的影响的数据有限。方法对2002-2008年间密苏里州21,674名体重不足的妇女进行了一项基于人口的历史队列研究，这些妇女分娩的是活产、单胎、足月婴儿。以2009年国际移民组织推荐的28-40磅为参考组，用多元Logistic回归方法计算了妊娠体重增加类别的调整优势比。结果体重增加40磅的女性与体重增加28-40磅的女性相比，先兆子痫(AOR1.94，95%CI1.56-2.42，P<；0.001)、剖宫产(AOR1.40，95%CI1.28-1.53，P<；0.001)、大胎儿(AOR2.32，95%CI2.00-2.70，P<；0.001)和1min APGAR评分及Lt；小于胎龄儿的危险度显著降低(AOR0.53，95%CI0.48-0.59，P<；0.001)。体重增加28磅的女性与体重增加28-40磅的女性相比，患上小于胎龄儿的几率显著更高(AOR1.85，95%CI1.69-2.03p<；0.001)，而患先兆子痫(AOR0.72，95%CI0.53-0.96p<；0.001)的几率显著降低(AOR0.5095%CI0.39-0.63，p<；0.001)。结论体重增加超过IOM推荐标准的妇女发生许多不良结局的风险较高，但SGA婴儿的风险较低。体重低于国际移民组织推荐标准的妇女患SGA婴儿的风险较高，但对先兆子痫和LGA婴儿具有保护作用。需要对其他短期和长期孕产妇/婴儿结局进行前瞻性研究，以评估国际移民组织指南的效力。
Objective Limited data are available that estimate the effect of gestational weight gain on maternal and neonatal outcomes in underweight women according to revised 2009 Institute of Medicine (IOM) guidelines. Methods A population-based historical cohort study of 21,674 underweight women in Missouri delivering liveborn, singleton, term infants in 2002-2008 was conducted. Adjusted odds ratios were calculated for gestational weight gain categories with multiple logistic regression, using the 2009 IOM recommended 28-40 pounds as the reference group. Results Women gaining > 40 pounds compared to women gaining 28-40 pounds had significantly higher odds for preeclampsia (aOR 1.94, 95% CI 1.56-2.42, p < 0.001), cesarean delivery (aOR 1.40, 95% CI 1.28-1.53, p < 0.001), large-for-gestational-age (LGA) infant (aOR 2.32, 95% CI 2.00-2.70, p < 0.001), and 1 min APGAR score < 4 (aOR 1.36, 95% CI 1.01-1.83, p < 0.05) and significantly lower odds for small-for-gestational-age (SGA) infant (aOR 0.53, 95% CI 0.48-0.59, p < 0.001). Women gaining < 28 pounds compared to women gaining 28-40 pounds had significantly higher odds for SGA infant (aOR 1.85, 95% CI 1.69-2.03, p < 0.001) and significantly lower odds for preeclampsia (aOR 0.72, 95% CI 0.53-0.96, p < 0.05) and LGA infant (aOR 0.50, 95% CI 0.39-0.63, p < 0.001). Conclusion Women gaining more than the IOM recommendation were at higher risk for many adverse outcomes, but at lower risk for SGA infants. Women gaining less than the IOM recommendation were at higher risk for SGA infants but were protective for preeclampsia and LGA infants. Prospective studies of other short- and long-term maternal/infant outcomes are needed to evaluate the efficacy of the IOM guideline.