目的:研究妊娠合并辅助生殖技术(ART)的病态肥胖孕妇的产母特征和结局。
方法:这项横断面研究查询了医疗保健成本和利用项目的全国住院患者样本。研究人群为2012年1月至2015年9月的48,365例ART妊娠患者,包括非肥胖患者(n=45,125,93.3%)。I-II类肥胖(n=2445,5.1%),和III类肥胖(n=795,1.6%)。根据疾病和预防控制中心的定义,使用多变量二元逻辑回归模型评估分娩时的严重孕产妇发病率。
结果:III类肥胖组患者更有可能患有高血压疾病(调整优势比(aOR)3.03,95%置信区间(CI)2.61-3.52),糖尿病(aOR3.08,95CI2.64-3.60),胎龄新生儿大(aOR3.57,95CI2.77-4.60),与非肥胖组相比,子宫内胎儿死亡(aOR2.03,95CI1.05-3.94)。即使与I-II类肥胖组相比,III类肥胖组中高血压疾病(aOR1.35,95CI1.14-1.60)和糖尿病(aOR1.39,95CI1.17-1.66)的风险增加仍然很高。在控制了先验选择的临床后,怀孕,和交付因素,与非肥胖患者相比,III类肥胖患者在分娩时发生严重孕产妇发病率的可能性高70%(8.2%vs4.4%,OR1.70,95CI1.30-2.22)而那些I-II类肥胖的人不是(4.1%vs4.4%,OR0.87,95CI0.70-1.08)。
结论:美国国家层面的分析结果表明,妊娠合并ART的病态肥胖孕妇增加了胎儿和产妇不良结局的风险。
OBJECTIVE: To examine feto-maternal characteristics and outcomes of morbidly obese pregnant patients who conceived with assisted reproductive technology (ART).
METHODS: This cross-sectional study queried the Healthcare Cost and Utilization Project\'s National Inpatient Sample. Study population was 48,365 patients with ART pregnancy from January 2012 to September 2015, including non-obesity (n = 45,125, 93.3%), class I-II obesity (n = 2445, 5.1%), and class III obesity (n = 795, 1.6%). Severe maternal morbidity at delivery per the Centers for Disease and Control Prevention definition was assessed with multivariable binary logistic regression model.
RESULTS: Patients in the class III obesity group were more likely to have a hypertensive disorder (adjusted-odds ratio (aOR) 3.03, 95% confidence interval (CI) 2.61-3.52), diabetes mellitus (aOR 3.08, 95%CI 2.64-3.60), large for gestational age neonate (aOR 3.57, 95%CI 2.77-4.60), and intrauterine fetal demise (aOR 2.03, 95%CI 1.05-3.94) compared to those in the non-obesity group. Increased risks of hypertensive disease (aOR 1.35, 95%CI 1.14-1.60) and diabetes mellitus (aOR 1.39, 95%CI 1.17-1.66) in the class III obesity group remained robust even compared to the class I-II obesity group. After controlling for priori selected clinical, pregnancy, and delivery factors, patients with class III obesity were 70% more likely to have severe maternal morbidity at delivery compared to non-obese patients (8.2% vs 4.4%, aOR 1.70, 95%CI 1.30-2.22) whereas those with class I-II obesity were not (4.1% vs 4.4%, aOR 0.87, 95%CI 0.70-1.08).
CONCLUSIONS: The results of this national-level analysis in the United States suggested that morbidly obese pregnant patients conceived with ART have increased risks of adverse fetal and maternal outcomes.