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Association of Maternal Obesity With Longitudinal Ultrasonographic Measures of Fetal Growth
JAMA Pediatrics ( IF 26.1 ) Pub Date : 2018-01-01 , DOI: 10.1001/jamapediatrics.2017.3785
Cuilin Zhang 1 , Mary L. Hediger 1 , Paul S. Albert 2 , Jagteshwar Grewal 1 , Anthony Sciscione 3 , William A. Grobman 4 , Deborah A. Wing 5, 6 , Roger B. Newman 7 , Ronald Wapner 8 , Mary E. D’Alton 8 , Daniel Skupski 9 , Michael P. Nageotte 10 , Angela C. Ranzini 11 , John Owen 12 , Edward K. Chien 13 , Sabrina Craigo 14 , Sungduk Kim 2 , Katherine L. Grantz 1 , Germaine M. Buck Louis 1
Affiliation  

Importance Despite the increasing prevalence of pregravid obesity, systematic evaluation of the association of maternal obesity with fetal growth trajectories is lacking. Objective To characterize differences in fetal growth trajectories between obese and nonobese pregnant women, and to identify the timing of any observed differences. Design, Setting, and Participants The Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies–Singletons study enrolled cohorts of pregnant women at 12 US health care institutions. Obese women (with prepregnancy body mass index > 30) and nonobese women (prepregnancy body mass indexes, 19-29.9) without major chronic diseases were recruited between 8 weeks and 0 days’ gestation and 13 weeks and 6 days’ gestation. A mixed longitudinal randomization scheme randomized participants into 1 of 4 schedules for 2-dimensional and 3-dimensional ultrasonograms to capture weekly fetal growth data throughout the remainder of their pregnancies. Main Outcomes and Measures On each ultrasonogram, fetal humerus length, femur length, biparietal diameter, head circumference, and abdominal circumference were measured. Fetal growth curves were estimated using linear mixed models with cubic splines. Median differences in the fetal measures at each gestational week of the obese and nonobese participants were examined using the likelihood ratio and Wald tests after adjustment for maternal characteristics. Results The study enrolled 468 obese and 2334 nonobese women between 8 weeks and 0 days’ gestation and 13 weeks and 6 days’ gestation. After a priori exclusion criteria, 443 obese and 2320 nonobese women composed the final cohort. Commencing at 21 weeks’ gestation, femur length and humerus length were significantly longer for fetuses of obese woman than those of nonobese women. Differences persisted in obese and nonobese groups through 38 weeks’ gestation (median femur length, 71.0 vs 70.2 mm; P = .01; median humerus length, 62.2 vs 61.6 mm; P = .03). Averaged across gestation, head circumference was significantly larger in fetuses of obese women than those of nonobese women (P = .02). Fetal abdominal circumference was not greater in the obese cohort than in the nonobese cohort but was significantly larger than in fetuses of normal-weight women (with body mass indexes between 19.0-24.9) commencing at 32 weeks (median, 282.1 vs 280.2 mm; P = .04). Starting from 30 weeks’ gestation, estimated fetal weight was significantly larger for the fetuses of obese women (median, 1512 g [95% CI, 1494-1530 g] vs 1492 g [95% CI, 1484-1499 g]) and the difference grew as gestational age increased. Birth weight was higher by almost 100 g in neonates born to obese women than to nonobese women (mean, 3373.2 vs 3279.5 g). Conclusions and Relevance As early as 32 weeks’ gestation, fetuses of obese women had higher weights than fetuses of nonobese women. The mechanisms and long-term health implications of these findings are not yet established.

中文翻译:

孕产妇肥胖与胎儿生长的纵向超声测量的关联

重要性 尽管孕前肥胖的流行率越来越高,但缺乏对母体肥胖与胎儿生长轨迹关联的系统评估。目的 表征肥胖和非肥胖孕妇之间胎儿生长轨迹的差异,并确定任何观察到的差异发生的时间。设计、设置和参与者 Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies–Singletons 研究在美国 12 家医疗保健机构招募了一批孕妇。无重大慢性病的肥胖女性(孕前体重指数 > 30)和非肥胖女性(孕前体重指数,19-29.9)在妊娠 8 周至 0 天和妊娠 13 周和 6 天之间招募。一项混合纵向随机化方案将参与者随机分配到 4 个时间表中的 1 个进行 2 维和 3 维超声检查,以在他们怀孕的剩余时间内捕获每周胎儿生长数据。主要结果和测量每张超声检查胎儿的肱骨长度、股骨长度、双顶径、头围和腹围。使用三次样条的线性混合模型估计胎儿生长曲线。在调整母体特征后,使用似然比和 Wald 检验检查肥胖和非肥胖参与者每个妊娠周胎儿测量值的中位数差异。结果 该研究招募了 468 名肥胖女性和 2334 名非肥胖女性,他们分别是妊娠 8 周至 0 天和妊娠 13 周和 6 天之间。在先验排除标准之后,443 名肥胖女性和 2320 名非肥胖女性组成了最后的队列。从妊娠 21 周开始,肥胖女性胎儿的股骨长度和肱骨长度显着长于非肥胖女性的胎儿。肥胖组和非肥胖组的差异持续到妊娠 38 周(股骨长度中位数,71.0 对 70.2 毫米;P = .01;肱骨长度中位数,62.2 对 61.6 毫米;P = .03)。平均整个妊娠期,肥胖女性胎儿的头围显着大于非肥胖女性的胎儿 (P = .02)。从 32 周开始,肥胖队列的胎儿腹围并不比非肥胖队列大,但明显大于正常体重女性(体重指数在 19.0-24.9 之间)的胎儿(中位数,282.1 对 280.2 毫米;P = .04)。从怀孕 30 周开始,肥胖女性胎儿的估计胎儿体重明显更大(中位数,1512 g [95% CI, 1494-1530 g] vs 1492 g [95% CI, 1484-1499 g])并且差异随着胎龄的增加而增加。肥胖女性所生新生儿的出生体重比非肥胖女性高出近 100 克(平均分别为 3373.2 和 3279.5 克)。结论和相关性 早在妊娠 32 周时,肥胖女性的胎儿就比非肥胖女性的胎儿体重更高。这些发现的机制和长期健康影响尚未确定。结论和相关性 早在妊娠 32 周时,肥胖女性的胎儿就比非肥胖女性的胎儿体重更高。这些发现的机制和长期健康影响尚未确定。结论和相关性 早在妊娠 32 周时,肥胖女性的胎儿就比非肥胖女性的胎儿体重更高。这些发现的机制和长期健康影响尚未确定。
更新日期:2018-01-01
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