懷孕、生產相關併發症可能與肥胖有關


  Feb. 27, 2006(內華達州雷諾市訊)-肥胖的比例在懷孕年齡的婦女有上升趨勢,但是對於肥胖比例上升與對懷孕與生產相關併發症之間的關係卻所知不多;Elizabeth Baraban博士於美國預防醫學會年會中發表這項試驗結果,她暗示這些併發症可能戲劇化地上升,特別是在西班牙裔與非裔美國女性。
  
  Baraban醫師在發表會中表示,這些併發症會增加媽媽與嬰兒的發病率與死亡率;她來自加州洛杉磯健康部門,以及喬治亞洲亞特蘭大疾病管制局。
  
  Baraban醫師與其同事檢閱1991年至2003年之間,超過2百萬住進洛杉磯郡立醫院生產婦女的病歷,其中99%成功生產;種族/信仰在整個試驗期間比例有所變動,55.2%至59.2%為西班牙裔,21.5%至25.5%為白人,7.6%至10.0%為美裔黑人,而8.1%至8.9%為亞洲人。
  
  使用ICD-9診斷碼,研究者確認與肥胖有關的併發症,包括妊娠糖尿病、與懷孕相關的高血壓、早產、剖腹產、難產與巨嬰。
  
  Baraban向Medacpae表示,有許多文獻探討這些併發症與肥胖之間的關係,但是目前為止並沒有將這些因素放在一起檢視的研究。
  
  研究者根據種族/信仰計算併發症與年齡相關的盛行率,並且檢驗盛行率每年的變化。
  
  結果顯示,所有種族/信仰以年齡校正的併發症發生率,從1991年到2003年持續上升;所有併發症每年的平均變化率顯著地上升(P<.0001),除了巨嬰症外。
  
  更令人吃驚的是,妊娠糖尿病發生率的增加,整體而言,從1991年的每1000個活產中14.6例,上升到2003年的48.1例;其中西班牙裔婦女的發生率增加235%,每年平均增加10%(P<.001),非裔美人的發生率上升160%,每年平均增加8%(P<.0001)。
  
  與懷孕相關的高血壓從每1000個活產41.2例增加到55.5例,其中以非裔美人增加的幅度最大(43%),每年平均增加5%(P<.0001);早產的比例從每1000名活產39.3例增加到61.4例,西班牙裔增加的幅度最高,平均增加60%;剖腹產的比例從每1000名活產209.9例增加到300.8例,西班牙裔剖腹產的比例增加47%,是所有種族/信仰族群中增加最多的。
  
  難產比例增加最多的是非裔美人,平均增加42%,所有年齡與種族/信仰族群發生巨嬰症的比例從1991年到1995年是增加的,隨後開始遞減,除了非裔美人之外,這個族群巨嬰症的比例每年增加1%(P<.001)。
  
  Baraban醫師向Medscape表示,這些向上增加的趨勢令我們吃驚,現在的社會強調產前照護,且注重懷孕時的危險因子,但是這些情況卻持續增加。
  
  這項試驗的一個限制是並未包括母親的體重或是身體質量指數;Baraban醫師在發表會中表示,我們假設肥胖與這些併發症盛行率上升有關,但是該試驗並未清楚地證實這項關係;需要更多的試驗來確定肥胖是否直接影響懷孕與生育併發症。
  
  疾病管制局Joanna Buffington醫師,同時也是該發表會的引言人表示,我並不認為這樣的結果是令人吃驚的,目前有足夠的證據顯示肥胖確實是與妊娠糖尿病及其他併發症有關,有許多理由可以解釋肥胖與健康之間的關係;Buffington醫師並未參與這項試驗。
  
  Baraban醫師強調告訴生育年齡婦女相關危險因子的資訊是很重要的,對醫師而言,了解這些併發症的發生率持續增加,並且儘早向他們的病患解釋這些是很重要的,不論是在懷孕前、生產前以及生產後。
  
  Buffington醫師的結論是,我並不認為病患了解這些併發症;他認為對於一般執業者最大的挑戰在於試著面對許多重要的預防性課題,包括這項;產前照護是強調這些課題很好的機會。
  
  該試驗獨立資助;作者表示無相關資金往來。

Trends in Pregnancy, Birth Com

By Katherine Kahn, DVM
Medscape Medical News

Feb. 27, 2006 (Reno, Nevada) — Obesity rates have been on the rise among women of childbearing age, but little is known about how increasing obesity rates influence the prevalence of pregnancy and birth complications. Elizabeth Baraban, MPH, PhD, presented findings here at the annual meeting of the American College of Preventive Medicine that suggest these complications may be dramatically increasing, especially among Hispanic and African-American women.

"These complications increase morbidity and mortality for both mother and infant," Dr. Baraban said during her presentation. She is from the Los Angeles County Department of Health in California and the Centers for Disease Control and Prevention in Atlanta, Georgia.

Dr. Baraban and colleagues reviewed discharge data from more than 2 million women admitted to Los Angeles County hospitals for delivery between 1991 and 2003, representing 99% of all recorded births. Although the racial/ethnic make-up of the study varied somewhat over the course of this study, 55.2% to 59.2% were Hispanic, 21.5% to 25.5% were white, 7.6% to 10% were African American, and 8.1% to 8.9% were Asian.

Using ICD-9 diagnostic codes, the researchers identified complications known to be associated with obesity: gestational diabetes, pregnancy-related hypertension, preterm birth, cesarean delivery, shoulder dystocia, and macrosomia.

"There is a good deal in the literature about these complications and their relation to obesity, but no one has looked at all of them together," Dr. Baraban told Medscape.

The researchers calculated age-adjusted prevalence for each complication by race/ethnicity, and also examined rates of change per year.

Results showed that the age-adjusted prevalence of all complications increased from 1991 to 2003 for all racial/ethnic groups. Average rates of change per year also showed statistically significant increases for all complications (P < .0001), except for macrosomia.

Most striking was the increase in prevalence of gestational diabetes; overall, from 14.6 per 1000 live births in 1991 to 48.1 per 1000 live births in 2003. Hispanics experienced a 235% overall increase, with an average yearly increase of 10% per year (P < .001). African Americans had a 160% increase in gestational diabetes, with an average yearly increase of 8% (P < .0001).

Pregnancy-related hypertension increased from 41.2 to 55.5 per 1000 live births. The increase was most dramatic among African-American (43%), with a 5% average yearly increase (P < .0001). Preterm births increased from 39.3 to 61.4 per 1000 live births. Hispanics showed the highest overall increase at 60%. Cesarean deliveries increased from 209.9 to 300.8 per 1000 live births. Hispanics had an increase in cesarean deliveries of 47%, the largest increase among the racial/ethnic groups.

The most significant increase in shoulder dystocias was among African-American women, with an overall increase of 42%. The overall prevalence of macrosomia among all age and racial/ethnic groups increased from 1991 to 1995 but it then decreased, except among African-American births, among which the prevalence increased by an average 1% per year (P < .001).

"That all of these conditions had an upward trend was surprising to us, given that there's such an emphasis now on prenatal care and risk factors during pregnancy. But yet these conditions are increasing," Dr. Baraban told Medscape.

One limitation of the study was that it did not include maternal weight or body mass index. "We hypothesize that obesity is related to the increase in these conditions, but could not directly study that association with this data," Dr. Baraban said in her presentation. "More study is needed to determine if the obesity epidemic is directly impacting pregnancy and birth complications."

"I don't think these findings are surprising," commented Joanna Buffington, MD, MPH, from the Centers for Disease Control and Prevention, who moderated the session at which the study was presented. "There's currently enough evidence to suggest that obesity is certainly one of the contributors related to gestational diabetes and other complications. There are many reasons we need to be addressing [obesity] for health, and this is one more." Dr. Buffington was not involved in the study.

Dr. Baraban stressed the importance of providing risk factor information to women of childbearing age. "It's important for physicians to know that these conditions are increasing and that they address these with their patients as early as possible, starting before conception and through the prenatal and postnatal periods," Dr. Baraban said.

Dr. Buffington concurred. "I don't think patients are aware [of these complications]. I think the biggest challenge for providers in general is trying to deal with the multitude of preventive issues that are important, including this one. Prenatal care is one opportunity to address those things."

This study was independently funded. The authors report no pertinent financial disclosures.

Preventive Medicine 2006: Session 35 — Practicing Public Health: Frontline Reports. Presented February 25, 2006.

Reviewed by Peggy Keen, PhD, FNP

    
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