This study was undertaken to determi ne the relative con-tribution of abnormal pregravid maternal body habitus and diabetes on the prevalence of large -for -gestational -age infants.Maternal and neonatal reco rds for ...This study was undertaken to determi ne the relative con-tribution of abnormal pregravid maternal body habitus and diabetes on the prevalence of large -for -gestational -age infants.Maternal and neonatal reco rds for singleton term(≥37weeks’estimated gestational age)deliveries January1997through June 2001were reviewed.Subjects were characterized by pregravid body mass index(BMI ),divided into underweight (BMI <19.8kg /m 2 ),normal(BMI 19.8-25kg /m 2 ),overweight (BMI 25.1-30kg /m 2 ),and obese(BMI >30kg /m 2 )subgroups.Diabetes was classified as gestational,treated with diet alone(A1GDM),or with insulin(A2GDM),and pregestaional diabetes(PDM).Newborn weight greater than the 90t h percentile for gestational age,based on published local birth weight data,defined large for gestational age(LGA).The risk of LGA delivery for underweight,overweight,and obese women were compared with that o f women with nor-mal pregravid BMI.Multiple regression models,including parity,newborn sex,BMI,race,and d iabetes,were constructed to examine the relative effect of abnormal BMI and diabetes on the risk of the delivery of an LGA infant.Complete data for 12,950deliveries were included(1,64013.0%underweight,2,99123.7%overweight,and2,92823.2%obese).LGA delivery affected 11.8%of the study sample;303(2.3%)of subjects had A1GDM,whereas 94(0.7%)had A2GDM,and 133(1.6%)had PDM.Compared with normal BMI subjec ts,obese womenwere at elevated risk for LGA delivery(16.8%vs 10.5%;P<.0001)as were overweight women(12.3%vs 10.5%;P =.01).Diabetes was also a risk factor for LGA deliv-ery(A1GDM:29.4%vs 11.4%A2GDM:29.8%vs 11.7%;PDM:38.3%vs 11.6%;P <.0001for each).Other risk factors for LGA delivery included parity(13.2%vs 9.5%;P <.0001),and male gender(14.3%vs 9.3%;P <.0001).Black race and low pre-gravid BMI were associated with a low er risk of LGA de-livery(9.0%vs 13.7%;P <.0001)and(6.4%vs10.5%;P =.006),respectively.Multiple regressio n revealed the independent influence of pregravid obesity and PDM,increasing the risk of LGA deliv ery(BMI >30kg /m 2Adjusted odds ratio(AOR)=1.6),and PDM(AOR=4.4).Obesity and pregestational diabetes are inde-pendently associated an increased r isk of LGA delivery.The impact of abnormal body habitus o n birth weight grows as BMI increases.Diabetes has the greatest affect on the normal and underweight population.With the increasing prevalence and relative frequency o f overweight and obe-sewomen in pregnancy compared with d iabetes(46.7%vs4.1%),abnormal maternal body habitus exh ibits the strongest influence on the prevalen ce of LGA delivery in our population.展开更多
文摘This study was undertaken to determi ne the relative con-tribution of abnormal pregravid maternal body habitus and diabetes on the prevalence of large -for -gestational -age infants.Maternal and neonatal reco rds for singleton term(≥37weeks’estimated gestational age)deliveries January1997through June 2001were reviewed.Subjects were characterized by pregravid body mass index(BMI ),divided into underweight (BMI <19.8kg /m 2 ),normal(BMI 19.8-25kg /m 2 ),overweight (BMI 25.1-30kg /m 2 ),and obese(BMI >30kg /m 2 )subgroups.Diabetes was classified as gestational,treated with diet alone(A1GDM),or with insulin(A2GDM),and pregestaional diabetes(PDM).Newborn weight greater than the 90t h percentile for gestational age,based on published local birth weight data,defined large for gestational age(LGA).The risk of LGA delivery for underweight,overweight,and obese women were compared with that o f women with nor-mal pregravid BMI.Multiple regression models,including parity,newborn sex,BMI,race,and d iabetes,were constructed to examine the relative effect of abnormal BMI and diabetes on the risk of the delivery of an LGA infant.Complete data for 12,950deliveries were included(1,64013.0%underweight,2,99123.7%overweight,and2,92823.2%obese).LGA delivery affected 11.8%of the study sample;303(2.3%)of subjects had A1GDM,whereas 94(0.7%)had A2GDM,and 133(1.6%)had PDM.Compared with normal BMI subjec ts,obese womenwere at elevated risk for LGA delivery(16.8%vs 10.5%;P<.0001)as were overweight women(12.3%vs 10.5%;P =.01).Diabetes was also a risk factor for LGA deliv-ery(A1GDM:29.4%vs 11.4%A2GDM:29.8%vs 11.7%;PDM:38.3%vs 11.6%;P <.0001for each).Other risk factors for LGA delivery included parity(13.2%vs 9.5%;P <.0001),and male gender(14.3%vs 9.3%;P <.0001).Black race and low pre-gravid BMI were associated with a low er risk of LGA de-livery(9.0%vs 13.7%;P <.0001)and(6.4%vs10.5%;P =.006),respectively.Multiple regressio n revealed the independent influence of pregravid obesity and PDM,increasing the risk of LGA deliv ery(BMI >30kg /m 2Adjusted odds ratio(AOR)=1.6),and PDM(AOR=4.4).Obesity and pregestational diabetes are inde-pendently associated an increased r isk of LGA delivery.The impact of abnormal body habitus o n birth weight grows as BMI increases.Diabetes has the greatest affect on the normal and underweight population.With the increasing prevalence and relative frequency o f overweight and obe-sewomen in pregnancy compared with d iabetes(46.7%vs4.1%),abnormal maternal body habitus exh ibits the strongest influence on the prevalen ce of LGA delivery in our population.
