Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index
Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index
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DOI：
10.3109/14767058.2011.638953
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发表时间：
2012-05-01
影响因子：
1.8
通讯作者：
Adamo, K. B.
中科院分区：
文献类型：
--
作者：
Ferraro, Z. M.;Barrowman, N.;Adamo, K. B.
目的：探讨孕妇孕前体重指数（BMI）和孕期增重（GWG）对大于胎龄儿（LGA）出生体重（>= 90 th % ile）的影响。方法：我们检查了4321对来自渥太华和金斯顿（OaK）出生队列的母婴。进行多变量logistic回归分析（控制孕周和母亲年龄、孕前体重、产次、吸烟），并计算比值比（OR）。结果：在怀孕前，共有23.7%的妇女超重，16.2%的妇女肥胖。只有29.3%的妇女达到了医学研究所（IOM）建议的GWG目标，而57.7%超过了指南。调整吸烟、产次、年龄、母亲身高，并达到IOM推荐的GWG，与BMI正常的妇女相比，孕前超重（OR 1.99; 95%CI 1.17-3.37）或肥胖（OR 2.64; 95%CI 1.59-4.39）与LGA发生率较高相关。在同一模型中，超过GWG指南与LGA发生率较高相关（OR 2.86; 95% CI 2.09-3.92），产次也是如此（OR 1.49; 95% CI 1.22-1.82）。吸烟（OR 0.53; 95% CI 0.35-0.79）与LGA发生率降低相关。对于超过GWG指南的超重（OR 3.59; 95%CI 2.60-4.95）或肥胖（OR 6.71; 95%CI 4.83-9.31）的女性，也估计了与LGA的校正相关性。结论：妊娠前超重或肥胖，体重超过IOM 2009 GWG指南，大大增加了女性生育更大婴儿的机会。生活方式干预，旨在优化GWG结合健康饮食和运动策略在怀孕期间，应调查，以确定其对LGA新生儿和下游儿童肥胖的影响。
Objective: To determine the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on large-for-gestational-age (LGA) birth weight (>= 90th % ile). Methods: We examined 4321 mother-infant pairs from the Ottawa and Kingston (OaK) birth cohort. Multivariate logistic regression (controlling for gestational and maternal age, pre-pregnancy weight, parity, smoking) were performed and odds ratios (ORs) calculated. Results: Prior to pregnancy, a total of 23.7% of women were overweight and 16.2% obese. Only 29.3% of women met GWG targets recommended by the Institute of Medicine (IOM), whereas 57.7% exceeded the guidelines. Adjusting for smoking, parity, age, maternal height, and achieving the IOM's recommended GWG, overweight (OR 1.99; 95% CI 1.17-3.37) or obese (OR 2.64; 95% CI 1.59-4.39) pre-pregnancy was associated with a higher rate of LGA compared to women with normal BMI. In the same model, exceeding GWG guidelines was associated with higher rates of LGA (OR 2.86; 95% CI 2.09-3.92), as was parity (OR 1.49; 95% CI 1.22-1.82). Smoking (OR 0.53; 95% CI 0.35-0.79) was associated with decreased rates of LGA. The adjusted association with LGA was also estimated for women who exceeded the GWG guidelines and were overweight (OR 3.59; 95% CI 2.60-4.95) or obese (OR 6.71; 95% CI 4.83-9.31). Conclusion: Pregravid overweight or obesity and gaining in excess of the IOM 2009 GWG guidelines strongly increase a woman's chance of having a larger baby. Lifestyle interventions that aim to optimize GWG by incorporating healthy eating and exercise strategies during pregnancy should be investigated to determine their effects on LGA neonates and down-stream child obesity.