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The risk of complications in second pregnancy by maternal BMI: The role of first-pregnancy complications, pregestational diabetes and chronic hypertension.

母亲BMI对第二次妊娠并发症风险的影响: 第一次妊娠并发症、孕前糖尿病和慢性高血压的作用。

  • 影响因子:2.21
  • DOI:10.1111/aogs.14028
  • 作者列表:"Sormunen-Harju H","Koivusalo S","Gissler M","Metsälä J
  • 发表时间:2021-03-01
Abstract

INTRODUCTION:Maternal obesity is associated with an increased risk of several pregnancy complications. In the second pregnancy, previous pregnancy and other medical history provide additional information about individual morbidity risk. In this study, we assess the risk of pregnancy complications in the second pregnancy by maternal body mass index (BMI) and evaluate how first-pregnancy complications and preexisting conditions modify these associations. MATERIAL AND METHODS:We have used nationwide data on all women (n = 48 963) experiencing their first and second pregnancy between 2006 and 2013 in Finland. The associations between the full scale of maternal BMI and pregnancy complications (gestational diabetes, gestational hypertension and preeclampsia) were analyzed using logistic regression and restricted cubic spline regression models and interactions between BMI and first-pregnancy complications, pregestational diabetes or chronic hypertension were tested. RESULTS:The risk of pregnancy complications increased with adiposity. Unadjusted probability of second-pregnancy gestational diabetes with BMI of 25 kg/m2 was 56% and 8.4% among women with and without first-pregnancy gestational diabetes, respectively. The corresponding figures with BMI of 30 kg/m2 were 64% and 17%. Adjusted odds ratio (OR) (95% CI) for second-pregnancy gestational diabetes with BMI of 25 kg/m2 was 45 (34-59) and 3.3 (2.6-4.0) among women with and without first-pregnancy gestational diabetes, respectively, when compared with women with BMI of 20 kg/m2 and no first-pregnancy gestational diabetes. Adjusted OR (95% CI) for second-pregnancy gestational hypertension among women with BMI of 25 kg/m2 was 42 (26-66) and 2.3 (1.4-3.8) among women with and without first-pregnancy hypertensive disorder, respectively, when compared with women with BMI of 20 kg/m2 and no first-pregnancy hypertensive disorder. The risk of preeclampsia increased with adiposity independent of first-pregnancy complications. Pregestational diabetes or chronic hypertension did not modify the association between adiposity and any of the second-pregnancy complications. CONCLUSIONS:As maternal BMI increases, the risk of complications increases in the second pregnancy. The risk of gestational diabetes and hypertension is, however, highest among women with complications in the first pregnancy.

摘要

简介: 母亲肥胖与几种妊娠并发症的风险增加有关。在第二次怀孕中,以前的怀孕和其他病史提供了关于个体发病风险的额外信息。在这项研究中,我们通过母体体重指数 (BMI) 评估第二次妊娠中妊娠并发症的风险,并评估第一次妊娠并发症和先前存在的情况如何改变这些关联。 材料和方法: 我们使用了芬兰所有妇女 (n = 48 963) 在2006年至2013年间第一次和第二次怀孕的全国数据。使用logistic回归和限制性三次样条回归模型分析孕妇BMI与妊娠并发症 (妊娠期糖尿病、妊娠期高血压和子痫前期) 之间的关联,并测试BMI与首次妊娠并发症、孕前糖尿病或慢性高血压之间的相互作用。 结果: 妊娠并发症的风险随着肥胖的增加而增加。在具有和不具有首次妊娠糖尿病的妇女中,BMI为25千克kg/m2的第二次妊娠糖尿病的未校正概率分别为56% 和8.4%。BMI为30千克kg/m2的相应数字为64% 和17%。BMI为95% kg/m2的第二次妊娠糖尿病患者的校正比值比 (OR) (25千克CI) 分别为45 (34-59) 和3.3 (2.6-4.0)。与BMI为20千克kg/m2且无首次妊娠妊娠糖尿病的女性相比。BMI为95% kg/m2的女性中,第二次妊娠妊娠高血压的校正OR (25千克CI) 分别为42 (26-66) 和2.3 (1.4-3.8)。与BMI为20千克kg/m2且无首次妊娠高血压疾病的女性相比。先兆子痫的风险增加与肥胖无关的首次妊娠并发症。孕前糖尿病或慢性高血压并未改变肥胖与任何第二次妊娠并发症之间的关联。 结论: 随着产妇BMI的增加,再次妊娠并发症的风险增加。然而,妊娠糖尿病和高血压的风险在第一次怀孕时出现并发症的女性中最高。

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