Objective Current literature on the risks and outcomes of obesity in pregnancy almost exclusively utilizes prepregnancy body mass index (BMI). Given the rising obesity rate across the United States along with a paucity of available information on the relationship between delivery BMI and maternal and neonatal outcomes, our study aimed to determine the association of maternal BMI at delivery with antepartum, intrapartum, and neonatal complications at an academic referral hospital.

Study Design This study is a secondary analysis of data collected for a prospective cohort study of Coronavirus Disease-2019 (COVID-19) in pregnancy. This analysis included all patients who delivered term singleton infants between May 1, 2020, and April 30, 2021, at the University of Iowa Hospitals and Clinics. Demographic and clinical data were obtained from the electronic medical record. The relationship between maternal BMI and maternal and neonatal characteristics of interest was assessed using logistic regression models. A statistical significance threshold of 0.05 was used for all comparisons.

Results There were 1,996 women who delivered term singleton infants during the study period. The median BMI at delivery was 31.7 kg/m² (interquartile range 27.9, 37.2), with 61.1% of women having a BMI ≥ 30.0 kg/m². Increasing BMI was significantly associated with nonreassuring fetal status, unscheduled cesarean birth, overall cesarean birth rate, postpartum hemorrhage, prolonged postpartum stay, hypertensive diseases of pregnancy, neonatal hypoglycemia, neonatal intensive care unit admission, decreased APGAR score at 1 minute, and increasing neonatal birth weight. Even when controlling for preexisting hypertension in a multivariate model, increasing BMI was associated with gestational hypertension and preeclampsia.

Conclusion Increased maternal BMI at delivery was associated with adverse perinatal outcomes. These findings have implications for clinical counseling regarding risks of pregnancy and delivery for overweight and obese patients and may help inform future studies to improve safety, especially by examining reasons for high cesarean rates.

Key Points

目的 目前关于妊娠期肥胖风险和结果的文献几乎完全利用孕前体重指数（BMI）。鉴于美国各地肥胖率不断上升，并且缺乏关于分娩 BMI 与孕产妇和新生儿结局之间关系的可用信息，我们的研究旨在确定孕产妇分娩时 BMI 与产前、产时和新生儿并发症之间的关系。学术转诊医院。

研究设计 本研究是对妊娠期冠状病毒病 2019 (COVID-19) 前瞻性队列研究收集的数据的二次分析。该分析包括 2020 年 5 月 1 日至 2021 年 4 月 30 日期间在爱荷华大学医院和诊所分娩的所有足月单胎婴儿的患者。从电子病历中获得人口统计和临床数据。使用逻辑回归模型评估母亲体重指数与母亲和新生儿感兴趣特征之间的关系。所有比较均使用 0.05 的统计显着性阈值。

结果 研究期间有 1,996 名妇女生下了足月单胎婴儿。分娩时 BMI 中位数为 31.7 kg/m ²（四分位距 27.9, 37.2），其中 61.1% 的女性 BMI ≥ 30.0 kg/m ²。 BMI增加与胎儿状况不放心、计划外剖腹产、总体剖宫产率、产后出血、产后停留时间延长、妊娠期高血压疾病、新生儿低血糖、新生儿重症监护病房入住、1分钟APGAR评分下降以及新生儿出生率增加显着相关。出生体重。即使在多变量模型中控制了先前存在的高血压，体重指数的增加也与妊娠期高血压和先兆子痫相关。

结论 产妇分娩时 BMI 增加与不良围产期结局相关。这些发现对超重和肥胖患者妊娠和分娩风险的临床咨询具有重要意义，并可能有助于为未来提高安全性的研究提供信息，特别是通过检查高剖宫产率的原因。

关键点