{"title":"肥胖和剖宫产的几率增加。","authors":"Quetzal A Class","doi":"10.1080/0167482X.2021.1967926","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Knowledge of the associations between obesity and cesarean delivery (CD) is limited by previous research that does not separate the highest BMI classes.</p><p><strong>Methods: </strong>We identified 25,604 pregnancies in retrospective electronic medical records at an inner-city academic hospital between 2000 and 2015. We examined the association between BMI at pre-pregnancy and delivery, as well as gestational weight gain (GWG), and rates of CD, gestational diabetes mellitus (GD), and pregnancy-induced hypertension (PIH) using logistic regression and chi-square.</p><p><strong>Results: </strong>CD increased with each increase in delivery BMI class [<i>X</i><sup>2</sup> (7, <i>N</i> = 25,604) =151.40, <i>p</i> < .0001]. GD and PIH also significantly increased across each BMI class. Each increasing BMI class predicted 1.21 times greater odds of CD even after adjusting for maternal age, year of birth, GD, and PIH [OR = 1.21 (95% CI, 1.07-1.37)]. As compared with the IOM recommended GWG, less weight gain offered mitigation of CD and GD, though less than the recommended GWG for women who were obese pre-pregnancy also increased odds of preterm birth, low birth weight, and stillbirth.</p><p><strong>Conclusions: </strong>Increasing BMI is associated with increasing rates of adverse obstetric outcomes. There exists a \"dose-dependent\" effect of BMI on CD and limiting GWG may be associated with mitigated risk for this outcome, but increased risk for offspring adverse birth outcomes.</p>","PeriodicalId":50072,"journal":{"name":"Journal of Psychosomatic Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"5","resultStr":"{\"title\":\"Obesity and the increasing odds of cesarean delivery.\",\"authors\":\"Quetzal A Class\",\"doi\":\"10.1080/0167482X.2021.1967926\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Knowledge of the associations between obesity and cesarean delivery (CD) is limited by previous research that does not separate the highest BMI classes.</p><p><strong>Methods: </strong>We identified 25,604 pregnancies in retrospective electronic medical records at an inner-city academic hospital between 2000 and 2015. We examined the association between BMI at pre-pregnancy and delivery, as well as gestational weight gain (GWG), and rates of CD, gestational diabetes mellitus (GD), and pregnancy-induced hypertension (PIH) using logistic regression and chi-square.</p><p><strong>Results: </strong>CD increased with each increase in delivery BMI class [<i>X</i><sup>2</sup> (7, <i>N</i> = 25,604) =151.40, <i>p</i> < .0001]. GD and PIH also significantly increased across each BMI class. Each increasing BMI class predicted 1.21 times greater odds of CD even after adjusting for maternal age, year of birth, GD, and PIH [OR = 1.21 (95% CI, 1.07-1.37)]. As compared with the IOM recommended GWG, less weight gain offered mitigation of CD and GD, though less than the recommended GWG for women who were obese pre-pregnancy also increased odds of preterm birth, low birth weight, and stillbirth.</p><p><strong>Conclusions: </strong>Increasing BMI is associated with increasing rates of adverse obstetric outcomes. There exists a \\\"dose-dependent\\\" effect of BMI on CD and limiting GWG may be associated with mitigated risk for this outcome, but increased risk for offspring adverse birth outcomes.</p>\",\"PeriodicalId\":50072,\"journal\":{\"name\":\"Journal of Psychosomatic Obstetrics & Gynecology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2022-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"5\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Psychosomatic Obstetrics & Gynecology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1080/0167482X.2021.1967926\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/8/27 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Psychosomatic Obstetrics & Gynecology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/0167482X.2021.1967926","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/8/27 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 5
摘要
背景:肥胖与剖宫产(CD)之间关系的认识受到先前研究的限制,这些研究没有区分BMI最高的类别。方法:我们在2000年至2015年期间在市中心一家学术医院的回顾性电子病历中发现了25,604例妊娠。我们使用logistic回归和卡方检验了孕前和分娩时的BMI、妊娠体重增加(GWG)、CD、妊娠糖尿病(GD)和妊娠高血压(PIH)发生率之间的关系。结果:CD随分娩BMI分级的增加而增加[X2 (7, N = 25,604) =151.40, p < 0.0001]。GD和PIH也在各个BMI等级中显著增加。即使在调整了母亲的年龄、出生年份、GD和PIH后,每增加一个BMI等级预测CD的几率增加1.21倍[OR = 1.21 (95% CI, 1.07-1.37)]。与IOM推荐的GWG相比,体重增加较少可以减轻CD和GD,尽管孕前肥胖妇女的GWG低于推荐的GWG也增加了早产、低出生体重和死胎的几率。结论:BMI增加与产科不良结局发生率增加有关。BMI对CD存在“剂量依赖”效应,限制GWG可能与此结果的风险降低有关,但增加了后代不良出生结局的风险。
Obesity and the increasing odds of cesarean delivery.
Background: Knowledge of the associations between obesity and cesarean delivery (CD) is limited by previous research that does not separate the highest BMI classes.
Methods: We identified 25,604 pregnancies in retrospective electronic medical records at an inner-city academic hospital between 2000 and 2015. We examined the association between BMI at pre-pregnancy and delivery, as well as gestational weight gain (GWG), and rates of CD, gestational diabetes mellitus (GD), and pregnancy-induced hypertension (PIH) using logistic regression and chi-square.
Results: CD increased with each increase in delivery BMI class [X2 (7, N = 25,604) =151.40, p < .0001]. GD and PIH also significantly increased across each BMI class. Each increasing BMI class predicted 1.21 times greater odds of CD even after adjusting for maternal age, year of birth, GD, and PIH [OR = 1.21 (95% CI, 1.07-1.37)]. As compared with the IOM recommended GWG, less weight gain offered mitigation of CD and GD, though less than the recommended GWG for women who were obese pre-pregnancy also increased odds of preterm birth, low birth weight, and stillbirth.
Conclusions: Increasing BMI is associated with increasing rates of adverse obstetric outcomes. There exists a "dose-dependent" effect of BMI on CD and limiting GWG may be associated with mitigated risk for this outcome, but increased risk for offspring adverse birth outcomes.
期刊介绍:
The Journal of Psychosomatic Obstetrics and Gynecology was founded in 1982 in order to provide a scientific forum for obstetricians, gynecologists, psychiatrists and psychologists, academic health professionals as well as for all those who are interested in the psychosocial and psychosomatic aspects of women’s health. Another of its aims is to stimulate obstetricians and gynecologists to pay more attention to this very important facet of their profession.