评价孕期体重指数(BMI)变化对妊娠结局的影响,包括胎龄大婴儿(LGA),胎龄小婴儿(SGA),巨大儿,妊娠糖尿病(GDM)和剖宫产(CS)。
观察性队列研究的系统评价和荟萃分析。
在Cochrane进行了文献检索,MEDLINE,EMBASE,CINAHL,全球卫生和MIDIRS数据库。
观察性队列研究,参与者的奇偶校验从0到1。
使用具有95%CI的校正OR(aOR)来评估妊娠间BMI变化与5个结局之间的关联。
925065名从产次0到1的单胎妇女被纳入从924项确定研究中选出的11项研究的荟萃分析。孕间BMI(>3个BMI单位)的大幅增加与LGA的风险增加相关(aOR1.85,95%CI1.71至2.00,p<0.001),GDM(aOR2.28,95%CI1.97至2.63,p<0.001),与参考类别相比,巨大儿(aOR1.54,95%CI0.939至2.505)和CS(aOR1.72,95%CI1.32至2.24,p<0.001),SGA风险降低(aOR0.83,95%CI0.70至0.99,p=0.044)。孕间BMI降低与LGA分娩风险降低相关(aOR0.70,95%CI0.55~0.90,p<0.001)和GDM(aOR0.80,95%CI0.62~1.03),SGA风险增加(aOR1.31,95%CI1.06至1.63,p=0.014)。首次怀孕时BMI正常(<25kg/m2)的妇女与首次怀孕时BMI≥25kg/m2的妇女相比,两次怀孕之间BMI大幅增加的妇女患LGA(aOR2.10,95%CI1.93至2.29)和GDM(aOR3.10,95%CI2.74至3.50)的风险更高。
两次怀孕之间增加体重会增加患GDM的风险,CS和LGA,并降低随后怀孕中SGA的风险。怀孕之间的体重减轻可降低GDM和LGA的风险,并增加SGA的风险。建议在第一次和第二次怀孕之间保持体重稳定,以减少不良结局的风险。
CRD42016041299。
To evaluate the effect of
interpregnancy body mass index (BMI) change on pregnancy outcomes, including large-for-gestational-age babies (LGA), small-for-gestational-age babies (SGA), macrosomia, gestational diabetes mellitus (GDM) and caesarean section (CS).
Systematic review and meta-analysis of observational cohort studies.
Literature searches were performed across Cochrane, MEDLINE, EMBASE, CINAHL, Global Health and MIDIRS databases.
Observational cohort studies with participants parity from 0 to 1.
Adjusted ORs (aORs) with 95% CIs were used to evaluate the association between
interpregnancy BMI change on five outcomes.
925 065 women with singleton births from parity 0 to 1 were included in the meta-analysis of 11 studies selected from 924 identified studies. A substantial increase in
interpregnancy BMI (>3 BMI units) was associated with an increased risk of LGA (aOR 1.85, 95% CI 1.71 to 2.00, p<0.001), GDM (aOR 2.28, 95% CI 1.97 to 2.63, p<0.001), macrosomia (aOR 1.54, 95% CI 0.939 to 2.505) and CS (aOR 1.72, 95% CI 1.32 to 2.24, p<0.001) compared with the reference category, and a decreased risk of SGA (aOR 0.83, 95% CI 0.70 to 0.99, p=0.044). An
interpregnancy BMI decrease was associated with a decreased risk of LGA births (aOR 0.70, 95% CI 0.55 to 0.90, p<0.001) and GDM (aOR 0.80, 95% CI 0.62 to 1.03), and an increased risk of SGA (aOR 1.31, 95% CI 1.06 to 1.63, p=0.014). Women with a normal BMI (<25kg/m2) at first pregnancy who have a substantial increase in BMI between pregnancies had a higher risk of LGA (aOR 2.10, 95% CI 1.93 to 2.29) and GDM (aOR 3.10, 95% CI 2.74 to 3.50) when compared with a reference than women with a BMI ≥25 kg/m2 at first pregnancy.
Gaining weight between pregnancies increases risk of developing GDM, CS and LGA, and reduces risk of SGA in the subsequent pregnancy. Losing weight between pregnancies reduces risk of GDM and LGA and increases risk of SGA. Weight stability between first and second pregnancy is advised in order to reduce risk of adverse outcomes.
CRD42016041299.