Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas
Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas
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DOI：
10.1097/01.aog.0000139515.97799.f6
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发表时间：
2004-10-01
影响因子：
7.2
通讯作者：
Caughey, AB
中科院分区：
文献类型：
--
作者：
Stotland, NE;Hopkins, LM;Caughey, AB
目的探讨过度体重增加和剖宫产之间的关联是如何修改婴儿出生体重在nondiabetic women.METHODS：我们设计了一个回顾性队列研究的单胎，长期，未经产的妇女头先露是在一个单一的大学医院。排除糖尿病受试者。进行了双变量和多变量分析。回归模型控制产妇年龄，产妇孕前体重指数，胎龄，种族，吸烟，出生体重，和delivery.RESULTS：妇女获得上述医学研究所guidolines更有可能有一个剖腹产，即使出生体重小于4,000 g。在多变量分析中，体重过度增加的妇女剖腹产的优势比为1.40（95%置信区间1.22-1.59）。当绝对体重增加（总妊娠体重增加减去出生体重和胎盘重量）用于多变量分析时，过度体重增加仍然是剖宫产的独立预测因素。虽然巨大儿是一个更强的预测剖宫产比体重增加单独，过度体重增加比巨大儿在我们的coherent.CONCLUSION：过度体重增加在怀孕期间是一个独立的危险因素剖宫产，即使出生体重并不过分。除巨大儿外，其他机制可能与体重增加和剖宫产之间的关系有关。我们估计，在美国每年约有288，000例初次剖宫产手术中，如果没有妇女获得超过医学研究所建议的，则可以预防64，000例。((C)2004年美国妇产科医师学院。）。
OBJECTIVE To examine how the association between excessive-weight gain and cesarean birth is modified by infant birth weight in nondiabetic women.METHODS: We designed a retrospective cohort study of singleton, term, nulliparous women with cephalic presentation is delivering at a single university hospital. Subjects with diabetes were excluded. Bivariate and multivariate anal, uses were performed. Regression models controlled for maternal age, maternal prepregnancy body mass index, gestational age, ethnicity, smoking, birth weight, and date of delivery.RESULTS: Women gaining above Institute of Medicine guidolines were more likely to have a cesarean birth, even if birth weight was less than 4,000 g. In the multivariate analysis, women with excessive weight gain had an odds ratio of 1.40 (95% confidence interval 1.22-1.59) for cesarean birth. When absolute weight gain (total pregnancy weight gain minus birth weight and placental weight) was used in the multivariate analysis, excessive weight gain was still an independent predictor of cesarean delivery. Although macrosomia was a stronger predictor of cesarean than weight gain alone, excessive weight gain was much more common than macrosomia in our cohort.CONCLUSION: Excessive weight gain during pregnancy is an independent risk factor for cesarean birth, even when birth weight is not excessive. Other mechanisms besides macrosomia may be involved in the association between high weight gain and cesarean birth. We estimate that of the approximately 288,000 primary cesarean deliveries performed in nulliparas annually in the United States, 64,000 would be prevented if no women gained above Institute of Medicine recommendations. ((C) 2004 by The American College of Obstetricians and Gynecologists.).