孕前体重指数及孕期体重增长对妊娠结局的影响

目的　探讨孕前体重指数及孕期体重增长对妊娠结局的影响。　方法　将 1998年 6月至1999年 6月间在我院行产前检查并住院分娩的 32 2 5例足月单胎初产妇按孕前体重指数分为低于标准体重、标准体重和高于标准体重三组 ,并随访其妊娠结局。　结果　 (1)高于标准体重组孕产妇的妊娠并发症发生率 (32 .1% ) ,明显高于标准体重组 (18.0 % )和低于标准体重组 (2 0 .0 % ) ,具有统计学意义(P值均 <0 .0 5 ) ,而低于标准体重组和标准体重组孕产妇间的妊娠并发症发生率则差异无显著性 (P>0 .0 5 )。(2 )新生儿体重与三组孕妇的孕期体重增长具有直线相关关系 (相关系数 r分别为 0 .5 96 ,0 .32 8和 0 .2 49,P值均 <0 .0 1)。(3)低于标准体重组和标准体重组孕妇孕期体重增长≥ 18kg时 ,妊娠高血压综合征的发病率明显增加 (10 .5 % ) ;而高于标准体重组孕妇孕期体重增长≥ 9kg时 ,其妊娠高血压综合征发病率就显著增加 (2 0 .2 % )。　结论　 (1)孕前体重指数及孕期体重增长是妊娠并发症发生的重要影响因素。(2 )孕妇的体重增长对新生儿的体重有重要的影响作用 ;3.孕前体重指数不超过2 4,孕期体重增长适宜者 ,可获得良好的妊娠过程和结局。     

The Effect of Gestational Weight Gain by Body Mass Index on Maternal and Neonatal Outcomes

ObjectiveTo evaluate the effects of gestational weight gain on maternal and neonatal outcomes in different body mass index (BMI) classes.MethodsWe compared maternal and neonatal outcomes based on gestational weight gain in underweight, normal weight, overweight, obese, and morbidly obese (BMI ≥ 40.00) women. The study group was a population-based cohort of women with singleton gestations who delivered between April 1, 2001, and March 31, 2007, drawn from the Newfoundland and Labrador Provincial Perinatal Program Database. Univariate analyses and multivariate logistic regression analyses (controlling for maternal age, parity, smoking status, partnered status, and gestational age) were performed and odds ratios (ORs) were calculated.ResultsOnly 30.6% of women gained the recommended amount of weight during pregnancy; 52.3% of women gained more than recommended, and 17.1% gained less than recommended. In women with normal pre-pregnancy BMI, excess weight gain was associated with increased rates of gestational hypertension (OR 1.27; 95% CI 1.08–1.49), augmentation of labour (OR 1.09; 95% CI 1.01–1.18), and birth weight ≥ 4000 g (OR 1.21; 95% CI 1.10–1.34). In overweight women, excess weight gain was associated with increased rates of gestational hypertension (OR 1.31; 95% CI 1.10–1.55) and birth weight ≥4000 g (OR 1.30; 95% CI 1.15–1.47). In women who were obese or morbidly obese, excess weight gain was associated with increased rates of birth weight ≥4000 g (OR 1.20; 95% CI 1.07–1.34) and neonatal metabolic abnormality (OR 1.31; 95% CI 1.00–1.70). In morbidly obese women, poor weight gain was associated with less use of epidural analgesia (OR 0.34; 95% CI 0.12–0.95). In women who were of normal weight, overweight, or obese, the rate of adverse outcome (Caesarean section, gestational hypertension, birth weight < 2500 g or birth weight ≥4000 g) was lower in women with recommended weight gain than in those with excess weight gain. Adverse outcomes were reduced in nulliparous morbidly obese women who had poor weight gain (OR 0.18; 95% CI 0.04–0.83).ConclusionThe effects of gestational weight gain on pregnancy outcome depend on the woman’s pre-pregnancy BMI. Pregnancy weight gains of 6.7–11.2 kg (15–25lb) in overweight and obese women, and less than 6.7 kg (15lb) in morbidly obese women are associated with a reduction in the risk of adverse outcome.     

Gestational Weight Gain of Pregnant African American Adolescents Affects Body Mass Index 18 Years Later

ObjectiveTo determine if gestational weight gain (GWG) in adolescents is associated with long‐term weight increases 12 years and 18 years after delivery of a first child and the differential effects of weight gain during pregnancy that is inadequate, the appropriate amount, and excessive based on the 2009 Institute of Medicine (IOM) recommendations.DesignSecondary data analysis of data from a randomized controlled trial.SettingMemphis, Tennessee.ParticipantsTwo hundred ninety‐eight (298) primiparous low‐income Black women who were adolescents at the time of their first pregnancies.MethodLinear regression was used to examine the relationship between body mass index (BMI) at 12 and 18 years postdelivery and GWG, parity, prepregnancy BMI, and smoking.ResultsThe total sample experienced a significant BMI increase from prepregnancy to 12 years and 18 years postdelivery. More than 50% of the women had a BMI increase greater than 10 kg/m². By 18 years postdelivery, 85% were overweight or obese. Prepregnancy BMI and GWG had a positive significant effect on BMI 12 and 18 years later, whereas smoking had a negative effect. Those who gained excessive weight based on the IOM recommendations had a significantly higher BMI compared with those who gained appropriately.ConclusionGestational weight gain had long‐term effects on BMI in a minority adolescent population. Excessive pregnancy weight gain is likely to contribute to long‐term weight retention, especially if adolescents are overweight or obese when they become pregnant with their first children. Intervention during pregnancy to limit GWG has the potential of limiting long‐term negative health consequences that result from overweight and obesity in minority women.     

Evaluating Body Mass Index–Specific Trimester Weight Gain Recommendations: Differences Between Black and White Women

Introduction: We compared the gestational weight gains of black and white women with the 2009 Institute of Medicine (IOM) recommendations to better understand the potential for successful implementation of these guidelines in clinical settings. Methods: Prenatal and birth data for 2760 women aged 18 to 40 years with term singleton births from 2004 through 2007 were abstracted. We examined race differences in mean trimester weight gains with adjusted linear regression and compared race differences in the distribution of women who met the IOM recommendations with chi‐square analyses. We stratified all analyses by prepregnancy body mass index. Results: Among normal‐weight and obese women, black women gained less weight than white women in the first and second trimesters. Overweight black women gained significantly less than white women in all trimesters. For both races in all body mass index categories, a minority of women (range 9.9%‐32.4%) met the IOM recommended gains for the second and third trimesters. For normal‐weight, overweight, and obese black and white women, 49% to 80% exceeded the recommended gains in the third trimester, with higher rates of excessive gain for white women. Discussion: Less than half of the sample gained within the IOM recommended weight gain ranges in all body mass index groups and in all trimesters. The risk of excessive gain was higher for white women. For both races, excessive weight gain began by the second trimester, suggesting that counseling about the importance of weight gain during pregnancy should begin earlier, in the first trimester or prior to conception.     

Body Mass Index and spontaneous miscarriage

Objective

We compared the incidence of spontaneous miscarriage in women categorised as obese, based on a Body Mass Index (BMI) >29.9 kg/m², with women in other BMI categories.

Study design

In a prospective observational study conducted in a university teaching hospital, women were enrolled at their convenience in the first trimester after a sonogram confirmed an ongoing singleton pregnancy with fetal heart activity present. Maternal height and weight were measured digitally and BMI calculated. Maternal body composition was measured by advanced bioelectrical impedance analysis.

Results

In 1200 women, the overall miscarriage rate was 2.8% (n = 33). The mean gestational age at enrolment was 9.9 weeks. In the obese category (n = 217), the miscarriage rate was 2.3% compared with 3.3% in the overweight category (n = 329), and 2.3% in the normal BMI group (n = 621). There was no difference in the mean body composition parameters, particularly fat mass parameters, between those women who miscarried and those who did not.

Conclusions

In women with sonographic evidence of fetal heart activity in the first trimester, the rate of spontaneous miscarriage is low and is not increased in women with BMI > 29.9 kg/m² compared to women in the normal BMI category.     

Maternal Lean Body Mass and Birth-Weight

Summary: Maternal lean body mass at booking was estimated according to a formula employing the body mass index and maternal age in a sample of 511 women who booked in the first trimester of pregnancy. The significance of this parameter in comparison with established predictors of birth-weight such as maternal weight, height, smoking, parity, gestational age and sex of the infant was examined using bivariate correlations and multiple regression analysis. Maternal lean body mass was found to be the most important determinant of birth-weight for gestation percentile. Cigarette smoking had a negative effect on birth-weight which was independent of maternal physique. The effect of maternal size on birth-weight is largely mediated through constitutional and genetic factors rather than nutrition.     

Age at Menarche and Its Association with Excess Weight and Body Fat Percentage in Girls in the Southwestern Region of the Brazilian Amazon

Study ObjectiveTo analyze age at menarche and its association with excess weight and body fat percentage.DesignSchool-based cross-sectional survey.SettingSouthwestern region of the Brazilian Amazon.ParticipantsThe sample was made up of 727 girls, in the 8- to 16-year age range, divided into 3 groups: early, normal, and late menarche, from public and private schools, selected through proportional stratified random sampling.Interventions and Main Outcome MeasuresBioimpedance was used to measure body fat percentage and body mass index, applying the Global School-Based Student Health Survey questionnaire to categorize behavior variables. Age at menarche was determined using the status quo method. Sexual maturity was assessed through self-assessment according to criteria described by Tanner.ResultsOverall age at menarche was 11.52 (±1.35), early 10.48 (±0.78), normal 12.39 (±0.50) and late 14.27 (±0.51) years. Prevalence of excess weight and body fat was 28.3% (206/727) and 44.3% (322/727), among those with menarche. There was a positive association between excess weight and body fat with age at early menarche (P = .000 and .015).ConclusionAge at menarche among girls from the Amazon region is similar to that of industrialized countries. Prevalence of excess weight and body fat was high, and there was evidence of an association between age with early menarche and excess weight. Trends in age at menarche and stage of sexual maturation should be monitored with related factors, to adopt obesity control strategies from an early age.     

Lifestyle Factors Related to Postpartum Weight Gain and Body Image in Bottle- and Breastfeeding Women

Objective: To explore the relationship of lifestyle variables to postpartum weight gain and body image attitudes of bottle- and breastfeeding women.
Design: Mail survey of new mothers at approximately 4 months postpartum.
Setting: Southwestern community.
Participants: One hundred one bottle-feeding women (69% white, 20% Hispanic, 11 % other) and 106 breastfeeding women [76% white, 19% Hispanic, 5% other) without diabetes. Bottle- and breastfeeding women did not differ on gestational weight gain or weight gain sustained postpartum.
Main outcome Measures: Postpartum weight gain (relative to prepregnancy weight) and body image attitudes.
Results: Feeding method (breast or bottle) was not associated with postpartum weight gain in the sample as a whole. Bottle-feeding mothers with higher postpartum gains exercised less, had higher fat intake habits, and were more dissatisfied with body image than mothers with lower gains. Breastfeeding mothers with higher and lower gains did not differ on any lifestyle factors. Overall lifestyle and psychologic skill in managing emotions were related negatively to postpartum body image dissatisfaction in both groups of women.
Conclusions: Breastfeeding women did not differ from bottle-feeding women in sustained postpartum weight gain. In bottle-feeding women, lifestyle factors were associated with levels of weight gain. Lifestyle-focused programs for weight management would potentially benefit these women.     

Effect of Maternal Body Mass Index on the Retinal Microvasculature in Pregnancy

OBJECTIVE:: To estimate the effects of maternal body mass index (BMI) and pregnancy weight gain on the retinal microvasculature among pregnant women. METHODS:: We studied 814 pregnant women aged 18-46 years who were recruited as part of the Growing Up in Singapore Toward Health Outcomes study, an ongoing birth cohort study from two government hospitals in Singapore since 2009. Recalled prepregnancy weight was recorded, and maternal anthropometric measurements of weight and height were performed at 26 weeks of gestation together with retinal photography. RESULTS:: In multiple linear regression models, each standard deviation increase of 26-week pregnancy BMI (4.57) was associated with narrower retinal arteriolar caliber (by 1.58 micrometers, P<.001), wider venular caliber (by 1.28 micrometers, P=.02), and increased retinal venular tortuosity (P=.01). Compared with mothers with normal weight, obese mothers (prepregnancy BMI greater than 30.0) had narrower retinal arteriolar caliber (118.81 compared with 123.38 micrometers, P<.001), wider retinal venular caliber (175.81 compared with 173.01 micrometers; P<.01), and increased retinal venular tortuosity (129.92 compared with 121.49×10; P<.01). Pregnant women whose BMI-specific weight gain from prepregnancy to 26 weeks of gestation was above Institute of Medicine recommendations had narrower retinal arteriolar caliber (120.68 micrometers) than women with ideal (121.91 micrometers) and less than ideal weight gain (123.17), respectively (Ptrend=.05). CONCLUSION:: These data indicate that greater prepregnancy BMI and pregnancy BMI are associated with adverse retinal microvascular measures, suggesting that maternal obesity has an effect on her microcirculation. LEVEL OF EVIDENCE:: III.     

孕妇体质量及其他因素与分娩巨大儿的相关性研究

目的:探讨孕妇孕前和孕期体质量及有关因素与分娩巨大儿的相关性,为其预防提供指导。方法:选择2013年1月1日至2014年12月31日在四川大学华西第二医院住院分娩符合纳入标准的孕产妇10044例,其中分娩巨大儿466例,非巨大儿9578例。采用Logistics回归分析孕妇体质量及其他因素(妊娠期糖尿病、分娩巨大儿史、多胎妊娠等)与分娩巨大儿的相关性及不同BMI分类与分娩巨大儿的相关性。结果:(1)孕前BMI、孕期总体质量增长、妊娠期糖尿病及既往分娩过巨大儿是分娩巨大儿的独立危险因素(P0.05);多胎妊娠是分娩巨大儿的保护因素(P0.05)。(2)通过BMI分层后,对于孕前BMI正常者,孕期体质量增长过少和多胎妊娠是分娩巨大儿的保护因素(P0.05);孕期总体质量增长、孕期体质量增长过多、有巨大儿分娩史是分娩巨大儿的独立危险因素(P0.05)。对于孕前体质量过轻者,孕期总体质量增长和孕期体质量增长过多是分娩巨大儿独立危险因素(P0.05)。对于孕前超重的孕妇,孕期总体质量增长和妊娠期糖尿病是分娩巨大儿独立危险因素(P0.05)。结论:孕前BMI过高、孕期体质量增长过多、发生妊娠期糖尿病及既往分娩巨大儿史均可使再次妊娠发生巨大儿的风险明显增高;孕前不同BMI孕妇其分娩巨大儿的危险因素有不同,孕期体质量增长过多可能增加孕前偏瘦和体质量正常孕妇巨大儿的发生风险。     

A Rare Pelvic Mass: Osteosarcoma of the Body of the Uterus

A rare, enormous, unresectable, osteosarcoma of the uterus is reported. This obstructed ureters, enclosed rectum, bladder, aorta and vena cava, and metastasized to peritoneum, lungs and liver causing death of the patient by renal and pulmonary failure.     

胎儿出生体重与孕期体重指数变化的相关性

目的 :探讨胎儿出生体重与孕期母亲体重指数的相关性。方法 :选择 2 0 0 2年 1月至 2 0 0 2年 10月在我院产前检查并分娩且无内科合并症及产科并发症的初产孕妇 190 0例 ,分别测量并计算孕前体重、分娩前体重、孕期体重变化及体重指数变化 ,采用偏相关分析胎儿出生体重与孕期体重指数的相关性。结果 :无论是控制身高、孕前体重还是控制孕期体重变化都发现胎儿出生体重与孕期体重指数的变化均呈正相关。结论 :胎儿出生体重与孕期体重指数的变化有较好的正相关性。     

Age of Menarche in a Longitudinal US Cohort

Study Objective

Menarche is a critical milestone in a woman's life, and historically has been determined using several approaches. The goals of this study were to: (1) determine age at menarche from multiple reports of parents and adolescent participants in a prospective study; (2) examine factors affecting age at menarche; and (3) determine correlates of menarche and pubertal tempo.

Perinatal Outcomes and Satisfaction with Care in Women with High Body Mass Index

Introduction: The majority of studies on pregnant women with high body mass index (BMI) have focused on medical complications and birth outcome, rather than these women's encounters with health care providers. The aims were to identify the proportion of pregnant women with high BMIs (≥30); compare maternal characteristics and pregnancy and birth outcomes; and assess the experiences of prenatal, intrapartum, and postnatal care in women with high (≥30) and lower (<30) BMIs. Methods: Data were collected through questionnaires and antenatal records from 919 women recruited in mid‐pregnancy at 3 hospitals in the north of Sweden, with a follow‐up questionnaire 2 months after birth. Results: The prevalence of obesity was 15.2%. Women with high BMIs were more often aged 35 years or older and less likely to have a university education. They had more negative attitudes regarding being pregnant and reported more childbirth fear compared to women with lower BMIs, but they did not differ in regard to their feelings about the approaching birth or the first weeks with the newborn. They reported more pregnancy complications and had less continuity of caregiver. High BMI was associated with labor induction and emergency cesarean birth. No differences were found in birth complications; birth experience; or satisfaction with prenatal, intrapartum, or postnatal care. Discussion: The findings reveal that women who are obese have more complicated pregnancies and births but are generally satisfied with the care they receive. There are some differences in the way they experience care. Health care providers have a delicate task to provide sufficient information about health risks while still offering respect, encouragement, and support.     

Analyses of Nutrients and Body Mass Index as Risk Factor for Preeclampsia

Background

Little is known about the pathogenesis of preeclampsia. Many factors are identified as risk factors for preeclampsia including nutrients and obesity. The aim of this study was to assess whether nutrients and body mass index (BMI) are risk factors for preeclampsia.

Methods

This was a case–control study at the Department of Obstetric and Gynecology in Dr. M. Djamil Hospital, Padang, Indonesia. A total of 140 patients were enrolled in this study with 70 cases and 70 controls. All subjects completed an interview for their nutritional status and prepregnancy BMI after delivery. The nutritional status was assessed by Food Frequency Questionnaire and then analyzed by Nutrisurvey Program. The independent samples t test was used for nutritional status, and Chi-square test was used for BMI. For nutrients, logistic regression procedures were employed to calculate potential risk factors associated with preeclampsia.

Results

Prevalence of abnormal BMI was more common in the preeclampsia group compared with those without preeclampsia 19 (27.1%) versus 12 (17.1%) but not found as a significant risk factor in this study (p = 0.222). Deficiency of vitamin E (OR 1.76, 95% CI 10.2 ± 30.5), zinc (OR 99.4, 95% CI 1.37 ± 7219), fat (OR 59.1, 95% CI 3.14 ± 500), calcium (OR 109, 95% CI 0.29 ± 40,041), vitamin C (OR 19.5, 95% CI 2.52 ± 151) were associated with increased risk of preeclampsia. Excess of carbohydrate was associated with increased risk of preeclampsia (OR 52.9, 95% CI 0.801 ± 3495).

Conclusions

Deficiency of vitamin E, zinc, fat, calcium, and vitamin C, and excess of calories and carbohydrate were associated with increased risk of preeclampsia.