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Adverse pregnancy outcomes attributable to overweight and obesity across maternal birth regions: a Swedish population-based cohort study
The Lancet Public Health ( IF 25.4 ) Pub Date : 2024-10-02 , DOI: 10.1016/s2468-2667(24)00188-9
Maryam Shirvanifar, Viktor H Ahlqvist, Michael Lundberg, Kyriaki Kosidou, Ángel Herraiz-Adillo, Daniel Berglind, Cecilia Magnusson, Pontus Henriksson

Background

Whether there are differences in the contribution of overweight and obesity to adverse pregnancy outcomes between migrant and non-migrant women in high-income countries, which might increase health inequalities, remains unclear. Therefore, in this study, we aimed to estimate the contribution (including the proportion and number of attributable cases) of overweight and obesity to a wide range of adverse pregnancy outcomes in Swedish-born and migrant women.

Methods

This population-based cohort study used nationwide population registries in Sweden. All outcomes and covariates were collected from the Medical Birth Register (delivery and maternal characteristics), National Patient Register (inpatient and specialised outpatient care), the Cause of Death Register (all deaths in Sweden), the Longitudinal Integrated Database for Health Insurance and Labour Market Studies (socioeconomic data), and the Total Population Register (maternal birth country data). Women with missing records of BMI at the first antenatal visit, country of birth, or covariates, were excluded from the study. BMI was measured during the first antenatal visit. Maternal country of birth was categorised into Sweden and seven super-regions. The proportion (ie, population attributable fractions [PAFs]) and the number of adverse pregnancy outcomes attributable to overweight and obesity were calculated, adjusting for maternal age, gestational age at first antenatal visit, maternal parity, smoking status, maternal somatic conditions, child's sex, socioeconomic and demographic variables.

Findings

We identified 2 228 416 singleton pregnancies between Jan 1, 2000, and Dec 31, 2020 of 1 245 273 women. 254 778 (11·4%) pregnancies with missing records of BMI at the first antenatal visit, country of birth, or covariates were excluded, which resulted in a final analytical cohort of 1 973 638 pregnancies carried by 1 164 783 women. The overall mean maternal age of the study population was 30·8 years (SD 5·1). As estimated by PAFs, overweight and obesity contributed to a large proportion of adverse pregnancy outcomes: gestational diabetes (52·1% [95% CI 51·0–53·2]), large-for-gestational age (36·9% [36·2–37·6]), pre-eclampsia (26·5% [25·7–27·3]), low Apgar score (14·7% [13·5–15·9]), infant mortality (12·7% [9·8–15·7]), severe maternal morbidity (henceforth referred to as a near-miss event; 8·5% [6·0–11·0]), and preterm birth (5·0% [4·4–5·7]) in the total study population. PAFs varied between maternal birth regions.

Interpretation

Interventions to reduce overweight and obesity have the potential to mitigate the burden of adverse pregnancy outcomes and possibly reduce inequalities in reproductive health. Therefore, public health practice and policy should prioritise efforts to prevent overweight and obesity among women of childbearing age.

Funding

Swedish Research Council.


中文翻译:


孕产妇出生地区超重和肥胖导致的不良妊娠结局:一项基于瑞典人口的队列研究


 背景


目前尚不清楚高收入国家的移民和非移民妇女的超重和肥胖对不良妊娠结局的影响是否存在差异,这可能会加剧健康不平等。因此,在这项研究中,我们的目的是估计超重和肥胖对瑞典出生和移民妇女的各种不良妊娠结局的影响(包括可归因病例的比例和数量)。

 方法


这项基于人群的队列研究使用了瑞典全国人口登记处。所有结果和协变量均来自医疗出生登记(分娩和产妇特征)、国家患者登记(住院和专科门诊护理)、死亡原因登记(瑞典的所有死亡)、健康保险和劳工纵向综合数据库市场研究(社会经济数据)和总人口登记(孕产妇出生国家数据)。第一次产前检查、出生国或协变量缺失记录的女性被排除在研究之外。体重指数是在第一次产前检查时测量的。母亲的出生国分为瑞典和七个超级地区。计算了由于超重和肥胖导致的不良妊娠结局的比例(即人口归因分数[PAF])和数量,并根据母亲年龄、第一次产前检查胎龄、产妇胎次、吸烟状况、母亲身体状况、儿童状况进行调整。性别、社会经济和人口变量。

 发现


我们在 2000 年 1 月 1 日至 2020 年 12 月 31 日期间确定了 1 245 273 名女性中有 2 228 416 名单胎妊娠。排除了首次产前检查时缺少 BMI、出生国或协变量记录的 254 778 (11·4%) 名孕妇,最终分析队列为 1 164 783 名妇女所怀的 1 973 638 名孕妇。研究人群的总体平均孕产妇年龄为 30·8 岁 (SD 5·1)。根据 PAF 估计,超重和肥胖导致了很大一部分不良妊娠结局:妊娠期糖尿病 (52·1% [95% CI 51·0–53·2])、大于胎龄 (36·9% [36·2–37·6])、先兆子痫 (26·5% [25·7–27·3])、低 Apgar 评分 (14·7% [13·5–15·9])、婴儿死亡率(12·7% [9·8–15·7])、严重孕产妇发病率(以下称为未遂事件;8·5% [6·0–11·0])和早产(总研究人群中的 5·0% [4·4–5·7])。不同产妇出生地区的 PAF 有所不同。

 解释


减少超重和肥胖的干预措施有可能减轻不良妊娠结局的负担,并可能减少生殖健康方面的不平等。因此,公共卫生实践和政策应优先考虑预防育龄妇女超重和肥胖。

 资金


瑞典研究委员会。
更新日期:2024-10-03
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