背景:与适合胎龄(AGA)的婴儿相比,胎龄婴儿小(SGA)和大(LGA)的婴儿发病风险更高。孕前孕妇BMI和妊娠期体重增加(GWG)的增加与LGA的风险较高和SGA婴儿的风险较低相关;然而,它们对婴儿发病率的直接影响尚不清楚。因此,我们打算1)评估孕妇孕前BMI,GWG,和出生体重(归类为SGA,AGA或LGA)影响婴儿发病率,2)根据孕前BMI和可能的GWG估计婴儿发病率的风险。
方法:我们使用了安全劳工数据联盟,一项回顾性观察性队列研究,收集2002年至2008年美国12个中心的妊娠和分娩数据.产妇BMI之间的关联,使用二项逻辑回归估计在分娩≥37周的单胎妊娠中GWG和婴儿的发病率。低氧复合新生儿发病率定义为以下任何一种:死产,新生儿死亡,出生时复苏,NICU入院,颅内出血,PVHIII和IV级,新生儿癫痫,NEC,胎粪吸入,CPAP或机械通气,RDS,还有败血症.创伤性复合新生儿发病率包括肩难产或出生损伤。
结果:在这项对110,594个母婴二叉的研究中,共有8,369名(7.6%)婴儿出现缺氧,而2,134(1.9%)发展为创伤性发病率。SGA中缺氧发病的风险,当母亲超重(aOR1.26[95CI1.18-1.34])或肥胖(1级:aOR1.3[1.2-1.4];2级:aOR1.7[1.5-1.9];3级:aOR1.8[1.6-2])时,AGA和LGA婴儿增加,而不是正常体重,以及当GWG超过(aOR1.08[1.02-1.014])而不是保持在建议范围内时。外伤性发病率的风险随着母亲肥胖而增加(1级:aOR1.3[1.1-1.5]),而GWG低于建议(aOR0.7[0.6-0.8])。母亲超重(aOR1.27[1.19-1.35])或肥胖(1级:aOR1.4[1.2-1.5];2级:aOR1.7[1.5-1.9];3级:aOR1.8[1.6-2.1]),以及上述可能的GWG(aOR1.09[1.03-1.015])建议。创伤发病率的风险随着超重(aOR1.1[1-1.3])或肥胖(1级:aOR1.4[1.2-1.6];2级:aOR1.3[1-1.6])而增加,与上述可能的GWG(AOR1.2[1-1.3]),与以下建议相反(aOR0.7[0.6-0.8])。
结论:虽然孕前BMI和GWG同样影响创伤性发病率,前者对缺氧并发症的影响较大。因此,怀孕前控制体重至少与避免妊娠期体重过度增加以预防新生儿发病一样有效.
BACKGROUND: Small (SGA) and large (LGA) for gestational age infants have higher risks of infant morbidity when compared to those who are appropriate for gestational age (AGA). Increasing pre-pregnancy maternal BMI and gestational weight gain (GWG) are associated with higher risks of LGA and lower risks of SGA infants; however, their direct effects on infant morbidity are unknown. Therefore, we intended to 1) assess how maternal pre-pregnancy BMI, GWG, and birthweight (categorized as SGA, AGA or LGA) affect infant morbidity and 2) estimate at entry of care the risk of infant morbidity according to pre-pregnancy BMI and possible GWG.
METHODS: we used Consortium on Safe Labor data, a retrospective observational cohort study collecting pregnancy and birth data from 2002 to 2008 in 12 US centers. The association between maternal BMI, GWG and infant morbidity was estimated in singleton gestations delivering ≥ 37 weeks using binomial logistic regression. Hypoxic composite neonatal morbidity was defined as any the following: stillbirth, neonatal death, resuscitation at birth, NICU admission, intracranial hemorrhage, PVH grade III and IV, neonatal seizures, NEC, meconium aspiration, CPAP or mechanical ventilation, RDS, and sepsis. Traumatic composite neonatal morbidity included shoulder dystocia or birth injuries.
RESULTS: In this study of 110,594 mother-infant dyads, a total of 8,369 (7.6%) infants experienced hypoxic, while 2,134 (1.9%) developed traumatic morbidity. The risk of hypoxic morbidity among SGA, AGA and LGA infants increased when mothers were overweight (aOR 1.26 [95%CI 1.18-1.34]) or obese (class 1: aOR 1.3 [1.2-1.4]; class 2: aOR 1.7 [1.5-1.9]; class 3: aOR 1.8 [1.6-2]) as opposed to normal weight, and when GWG exceeded (aOR 1.08 [1.02-1.014]) rather than remained within recommendations. The risk of traumatic morbidity increased with maternal obesity (class 1: aOR 1.3 [1.1-1.5]), whilst it dropped with GWG below recommendations (aOR 0.7 [0.6-0.8]). The risk of hypoxic events estimated at entry of care increased with maternal overweight (aOR 1.27 [1.19-1.35]) or obesity (class 1: aOR 1.4 [1.2-1.5]; class 2: aOR 1.7 [1.5-1.9]; class 3: aOR 1.8 [1.6-2.1]), and with possible GWG above (aOR 1.09 [1.03-1.015]) recommendations. The risk of traumatic morbidity increased with overweight (aOR 1.1 [1-1.3]) or obesity (class 1: aOR 1.4 [1.2-1.6]; class 2: aOR 1.3 [1-1.6]), with possible GWG above (aOR 1.2 [1-1.3]), as opposed to below recommendations (aOR 0.7 [0.6-0.8]).
CONCLUSIONS: While maternal pre-pregnancy BMI and GWG equally affected traumatic morbidity, the former had a greater impact on hypoxic complications. Therefore, weight control prior to pregnancy is at least as effective as avoiding excessive gestational weight gain to prevent neonatal morbidity.