PDF(Pubmed)
Abstract：
The Institute of Medicine pregnancy weight gain guidelines were developed without evidence linking high weight gain to maternal cardiometabolic disease and child obesity. The upper limit of current recommendations may be too high for the health of the pregnant individual and child.
The aim of this study was to identify the range of pregnancy weight gain for pregnancies within a normal body mass index (BMI) range that balances the risks of high and low weight gain by simultaneously considering 10 different health conditions.
We used data from an United States prospective cohort study of nulliparae followed until 2 to 7 y postpartum (N = 2344 participants with a normal BMI). Pregnancy weight gain z-score was the main exposure. The outcome was a composite consisting of the occurrence of ≥1 of 10 adverse health conditions that were weighted for their seriousness. We used multivariable Poisson regression to relate weight gain z-scores with the weighted composite outcome.
The lowest risk of the composite outcome was at a pregnancy weight gain z-score of -0.6 SD (standard deviation) (equivalent to 13.1 kg at 40 wk). The weight gain ranges associated with no more than 5%, 10%, and 20% increase in risks were -1.0 to -0.2 SD (11.2-15.3 kg), -1.4 to 0 SD (9.4-16.4 kg), and -2.0 to 0.4 SD (7.0-18.9 kg). When we used a lower threshold to define postpartum weight increase in the composite outcome (>5 kg compared with >10 kg), the ranges were 1.6 to -0.7 SD (8.9-12.6 kg), -2.2 to -0.3 SD (6.3-14.7 kg), and ≤0.2 SD (≤17.6 kg). Compared with the ranges of the current weight gain guidelines (-0.9 to -0.1 SD, 11.5-16 kg), the lower limits from our data tended to be lower while upper limits were similar or lower.
If replicated, our results suggest that policy makers should revisit the recommended pregnancy weight gain range for individuals within a normal BMI range.
The aim of this study was to identify the range of pregnancy weight gain for pregnancies within a normal body mass index (BMI) range that balances the risks of high and low weight gain by simultaneously considering 10 different health conditions.
We used data from an United States prospective cohort study of nulliparae followed until 2 to 7 y postpartum (N = 2344 participants with a normal BMI). Pregnancy weight gain z-score was the main exposure. The outcome was a composite consisting of the occurrence of ≥1 of 10 adverse health conditions that were weighted for their seriousness. We used multivariable Poisson regression to relate weight gain z-scores with the weighted composite outcome.
The lowest risk of the composite outcome was at a pregnancy weight gain z-score of -0.6 SD (standard deviation) (equivalent to 13.1 kg at 40 wk). The weight gain ranges associated with no more than 5%, 10%, and 20% increase in risks were -1.0 to -0.2 SD (11.2-15.3 kg), -1.4 to 0 SD (9.4-16.4 kg), and -2.0 to 0.4 SD (7.0-18.9 kg). When we used a lower threshold to define postpartum weight increase in the composite outcome (>5 kg compared with >10 kg), the ranges were 1.6 to -0.7 SD (8.9-12.6 kg), -2.2 to -0.3 SD (6.3-14.7 kg), and ≤0.2 SD (≤17.6 kg). Compared with the ranges of the current weight gain guidelines (-0.9 to -0.1 SD, 11.5-16 kg), the lower limits from our data tended to be lower while upper limits were similar or lower.
If replicated, our results suggest that policy makers should revisit the recommended pregnancy weight gain range for individuals within a normal BMI range.
摘要：
背景：医学研究所制定的妊娠体重增加指南没有证据表明高体重增加与母体心脏代谢疾病和儿童肥胖有关。当前建议的上限可能对怀孕个人和儿童的健康过高。
目的：这项研究的目的是通过同时考虑10种不同的健康状况，确定正常体重指数（BMI）范围内孕妇的妊娠体重增加范围，以平衡高体重增加和低体重增加的风险。
方法：我们使用了一项美国前瞻性队列研究的数据，该研究对产后2至7岁的未产妇进行了随访（N=2344名BMI正常的参与者）。妊娠体重增加z评分是主要暴露量。结果是一个复合结果，由10种不良健康状况中的≥1种的发生组成，这些不良健康状况对其严重性进行了加权。我们使用多变量泊松回归将体重增加z分数与加权综合结果相关联。
结果：复合结局的最低风险是在-0.6SD（标准偏差）的妊娠体重增加z评分（相当于40周时的13.1kg）。与不超过5%相关的增重范围，10%,风险增加20%，为-1.0至-0.2SD(11.2-15.3kg)，-1.4至0SD（9.4-16.4kg），和-2.0至0.4SD（7.0-18.9kg）。当我们使用较低的阈值来定义复合结局的产后体重增加（>5公斤，>10公斤），范围为1.6至-0.7SD（8.9-12.6kg），-2.2至-0.3SD（6.3-14.7kg），≤0.2SD(≤17.6kg)。与当前体重增加指南的范围相比（-0.9至-0.1SD，11.5-16kg),我们数据的下限倾向于更低,而上限相似或更低.
结论：如果重复，我们的研究结果提示,政策制定者应重新评估BMI正常范围内个体的推荐孕期增重范围.
目的：这项研究的目的是通过同时考虑10种不同的健康状况，确定正常体重指数（BMI）范围内孕妇的妊娠体重增加范围，以平衡高体重增加和低体重增加的风险。
方法：我们使用了一项美国前瞻性队列研究的数据，该研究对产后2至7岁的未产妇进行了随访（N=2344名BMI正常的参与者）。妊娠体重增加z评分是主要暴露量。结果是一个复合结果，由10种不良健康状况中的≥1种的发生组成，这些不良健康状况对其严重性进行了加权。我们使用多变量泊松回归将体重增加z分数与加权综合结果相关联。
结果：复合结局的最低风险是在-0.6SD（标准偏差）的妊娠体重增加z评分（相当于40周时的13.1kg）。与不超过5%相关的增重范围，10%,风险增加20%，为-1.0至-0.2SD(11.2-15.3kg)，-1.4至0SD（9.4-16.4kg），和-2.0至0.4SD（7.0-18.9kg）。当我们使用较低的阈值来定义复合结局的产后体重增加（>5公斤，>10公斤），范围为1.6至-0.7SD（8.9-12.6kg），-2.2至-0.3SD（6.3-14.7kg），≤0.2SD(≤17.6kg)。与当前体重增加指南的范围相比（-0.9至-0.1SD，11.5-16kg),我们数据的下限倾向于更低,而上限相似或更低.
结论：如果重复，我们的研究结果提示,政策制定者应重新评估BMI正常范围内个体的推荐孕期增重范围.
