美国宾夕法尼亚大学Stefanie N Hinkle团队研究了妊娠期体重变化与50年后死亡风险的关联。相关论文于2023年10月19日发表在《柳叶刀》杂志上。

妊娠期高体重增加与产后体重保持率增加有关，但其长期影响尚不清楚。该研究旨在评估妊娠期体重变化是否与50多年后的死亡率相关。

围产期协作项目（CPP）是一个前瞻性的美国妊娠队列（1959-1965）。CPP死亡率关联研究将CPP参与者与截至2016年的国家死亡指数和社会保障死亡主文件联系起来。根据2009年美国国家医学院的建议，95%置信区间的校正后危险比（HR）估计了妊娠期体重增加和减少与妊娠前BMI死亡率之间的相关性。主要终点是全因死亡率。次要终点包括心血管和糖尿病的潜在死亡原因。

在46042名参与者中，20839人（45.3%）自称为黑人，21287人（46.2%）自称为白人。中位随访时间为52年，17901名（38.9%）参与者死亡。对于那些在怀孕前体重不足的人（BMI＜18.5 kg/m²；3809[9.4%]/40689人），高于建议的体重变化与心血管死亡率增加有关（HR 1.84），但与全因死亡率（1.14）或糖尿病相关死亡率（0.90）无关。

对于那些孕前体重正常的人（BMI 18.5–24.9 kg/m²；27921人[68.6%]），高于建议的体重变化与全因死亡率（HR1.09）和心血管死亡率（1.20）增加有关，但与糖尿病相关死亡率（0.95）无关。对于那些孕前超重的人（BMI为25.0-29.9 kg/m²；6251人[15.4%]），高于建议的体重变化与全因死亡率（1.12）和糖尿病相关死亡率（1.77）升高有关，但与心血管死亡率（1.12）无关。

对于孕前肥胖（≥30.0 kg/m²；2708人[6.7%]）的患者，妊娠体重变化与死亡率之间的所有相关性均具有广泛的置信区间，并且无法得出有意义的关系。在孕前体重正常的人群中，低于推荐水平的体重变化仅与糖尿病相关死亡率降低相关（0.62）。

这项研究的新发现支持了在建议范围内实现健康妊娠体重增加的重要性，并补充说，这一影响可能会超出妊娠窗口，延伸到长期健康，包括心血管和糖尿病相关死亡率。

附：英文原文

Title: Gestational weight change in a diverse pregnancy cohort and mortality over 50 years: a prospective observational cohort study

Author: Stefanie N Hinkle, Sunni L Mumford, Katherine L Grantz, Pauline Mendola, James L Mills, Edwina H Yeung, Anna Z Pollack, Sonia M Grandi, Rajeshwari Sundaram, Yan Qiao, Enrique F Schisterman, Cuilin Zhang

Issue&Volume: 2023-10-19

Abstract:

Background

High weight gain in pregnancy is associated with greater postpartum weight retention, yet long-term implications remain unknown. We aimed to assess whether gestational weight change was associated with mortality more than 50 years later.

Methods

The Collaborative Perinatal Project (CPP) was a prospective US pregnancy cohort (1959–65). The CPP Mortality Linkage Study linked CPP participants to the National Death Index and Social Security Death Master File for vital status to 2016. Adjusted hazard ratios (HRs) with 95% CIs estimated associations between gestational weight gain and loss according to the 2009 National Academy of Medicine recommendations and mortality by pre-pregnancy BMI. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular and diabetes underlying causes of mortality.

Findings

Among 46042 participants, 20839 (45·3%) self-identified as Black and 21287 (46·2%) as White. Median follow-up time was 52 years (IQR 45–54) and 17901 (38·9%) participants died. For those who were underweight before pregnancy (BMI <18·5 kg/m2; 3809 [9·4%] of 40689 before imputation for missing data]), weight change above recommendations was associated with increased cardiovascular mortality (HR 1·84 [95% CI 1·08–3·12]) but not all-cause mortality (1·14 [0·86–1·51]) or diabetes-related mortality (0·90 [0·13–6·35]). For those with a normal pre-pregnancy weight (BMI 18·5–24·9 kg/m2; 27921 [68·6%]), weight change above recommendations was associated with increased all-cause (HR 1·09 [1·01–1·18]) and cardiovascular (1·20 [1·04–1·37]) mortality, but not diabetes-related mortality (0·95 [0·61–1·47]). For those who were overweight pre-pregnancy (BMI 25·0–29·9 kg/m2; 6251 [15·4%]), weight change above recommendations was associated with elevated all-cause (1·12 [1·01–1·24]) and diabetes-related (1·77 [1·23–2·54]) mortality, but not cardiovascular (1·12 [0·94–1·33]) mortality. For those with pre-pregnancy obesity (≥30·0 kg/m2; 2708 [6·7%]), all associations between gestational weight change and mortality had wide CIs and no meaningful relationships could be drawn. Weight change below recommended levels was associated only with a reduced diabetes-related mortality (0·62 [0·48–0·79]) in people with normal pre-pregnancy weight.

Interpretation

This study's novel findings support the importance of achieving healthy gestational weight gain within recommendations, adding that the implications might extend beyond the pregnancy window to long-term health, including cardiovascular and diabetes-related mortality.

DOI: 10.1016/S0140-6736(23)01517-9

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01517-9/abstract