近日，澳大利亚莫纳什大学Aya Mousa团队报道了160万名妇女的观察数据中妊娠期体重增加和不良母婴结局风险：系统评价和荟萃分析。相关论文于2025年11月19日发表在《英国医学杂志》上。

为了综合来自世界不同地区和收入背景的当代人群（2009-24）关于妊娠期体重增加（GWG）与广泛临床结果之间关联的证据，为更新的全球相关GWG标准提供信息，研究组进行了所有语言的观察性研究，参与者人数超过300人，报告了按体重指数（BMI）和GWG分层的妊娠结果，参与者为年龄>18岁且单胎妊娠的女性。主要观察指标包括出生体重和剖宫产率、妊娠高血压疾病、早产、小于/大于胎龄儿、低出生体重、巨大儿、新生儿重症监护室（NICU）入院、呼吸窘迫、高胆红素血症和妊娠期糖尿病。

在纳入评估的16,030项研究中，40项符合入选标准（共1,608,711名孕妇）；其中6%（65,114名）为低体重，53%（607,258名）体重正常，19%（215,183名）超重，22%（252,970名）肥胖。 根据世界卫生组织BMI标准，孕期增重未达IOM建议标准与下列结果相关：新生儿出生体重较低（平均差值-184.54克，95%置信区间-278.03至-91.06）；剖宫产风险降低（比值比0.90，0.84-0.97）、大于胎龄儿发生率降低（0.67，0.61-0.74）及巨大儿发生率降低（0.68，0.58-0.80）；同时早产风险升高（1.63，1.33-1.90）、小于胎龄儿风险升高（1.49，1.37-1.61）、低出生体重风险升高（1.78，1.48-2.13）以及呼吸窘迫风险升高（1.29，1.01-1.63）。

而孕期增重超出IOM建议标准则与下列结果相关：新生儿出生体重较高（平均差值118.33克，53.80-182.85）；剖宫产风险升高（比值比1.37，1.30-1.44）、妊娠期高血压疾病风险升高（1.37，1.28-1.48）、大于胎龄儿风险升高（1.77，1.62-1.94）、巨大儿风险升高（1.78，1.60-1.99）及新生儿重症监护室入住率升高（1.26，1.09-1.45）；同时早产风险降低（0.71，0.64-0.79）和小于胎龄儿风险降低（0.69，0.64-0.75）。采用亚洲BMI标准时，孕期增重不足与妊娠期高血压疾病风险升高（3.58，1.37-9.39）和早产风险升高（1.69，1.25-2.30）相关，同时与大于胎龄儿风险降低（0.80，0.72-0.89）相关；而增重超标则与剖宫产风险升高（1.37，1.29-1.46）和大于胎龄儿风险升高（1.76，1.42-2.18）相关，同时与小于胎龄儿风险降低（0.62，0.53-0.74）及低出生体重风险降低（0.44，0.31-0.6）相关。

这项系统综述捕捉到了来自不同世界地区和收入环境的孕产妇年龄和BMI上升的趋势，并在所有BMI群体中取得了广泛的结果。不符合IOM建议的GWG与不良结局风险增加有关。这些发现将有助于为世界卫生组织倡议的进程提供信息，该倡议旨在优化全球相关的全球变暖全球目标标准，以改善世界各地区的围产期结果。

附：英文原文

Title: Gestational weight gain and risk of adverse maternal and neonatal outcomes in observational data from 1.6 million women: systematic review and meta-analysis

Author: Rebecca F Goldstein, Mahnaz Bahri Khomami, Chau Thien Tay, Parneet Sethi, Jasmine Liew, Lisa Moran, Cheryce L Harrison, Anjana Reddy, Sarah Lang, Bonnie Brammall, Sanjeeva Ranasinha, Monica C Flores-Urrutia, Cinthya Muoz-Manrique, Mariana Arruda Silva, Elaine Borghi, Suzanne Phelan, Helena Teede, Aya Mousa

Issue&Volume: 2025/11/19

Abstract:

Objective To synthesise evidence from contemporary populations (2009-24) across diverse world regions and income settings on associations between gestational weight gain (GWG) and broad clinical outcomes, to inform updated, globally relevant GWG standards.

Design Systematic review and meta-analysis.

Setting Observational studies in all languages, with >300 participants, reporting pregnancy outcomes stratified by body mass index (BMI) and GWG.

Participants Women aged >18 years with singleton pregnancies.

Main outcome measures Birth weight and rates of caesarean delivery, hypertensive disorders of pregnancy, preterm birth, small/large for gestational age infant, low birth weight, macrosomia, neonatal intensive care unit (NICU) admission, respiratory distress, hyperbilirubinaemia, and gestational diabetes.

Results Of 16030 studies, 40 met inclusion criteria (n=1608711); 6% (n=65114) of women had underweight, 53% (n=607258) had normal weight, 19% (n=215183) had overweight, and 22% (n=252970) had obesity. GWG was below or above Institute of Medicine (IOM) or study specific recommendations in 23% and 45%, respectively. Using World Health Organization BMI criteria, GWG below IOM recommendations was associated with lower birth weight (mean difference 184.54, 95% confidence interval 278.03 to 91.06); lower risk of caesarean delivery (odds ratio 0.90, 0.84 to 0.97), large for gestational age infant (0.67, 0.61 to 0.74), and macrosomia (0.68, 0.58 to 0.80); and higher risk of preterm birth (1.63, 1.33 to 1.90), small for gestational age infant (1.49, 1.37 to 1.61), low birth weight (1.78, 1.48 to 2.13), and respiratory distress (1.29, 1.01 to 1.63). GWG above IOM recommendations was associated with higher birth weight (mean difference 118.33, 53.80 to 182.85); higher risk of caesarean delivery (odds ratio 1.37, 1.30 to 1.44), hypertensive disorders of pregnancy (1.37, 1.28 to 1.48), large for gestational age infant (1.77, 1.62 to 1.94), macrosomia (1.78, 1.60 to 1.99), and NICU admission (1.26, 1.09 to 1.45); and lower risk of preterm birth (0.71, 0.64 to 0.79) and small for gestational age infant (0.69, 0.64 to 0.75). For Asian BMI criteria, GWG below recommendations was associated with higher risk of hypertensive disorders of pregnancy (3.58, 1.37 to 9.39) and preterm birth (1.69, 1.25 to 2.30) and lower risk of large for gestational age infant (0.80, 0.72 to 0.89). GWG above recommendations was associated with higher risk of caesarean delivery (1.37, 1.29 to 1.46) and large for gestational age infant (1.76, 1.42 to 2.18) and lower risk of small for gestational age infant (0.62, 0.53 to 0.74) and low birth weight (0.44, 0.31 to 0.6).

Conclusions This systematic review captured trends of rising maternal age and BMI from diverse world regions and income settings, with broad outcomes across all BMI groups. GWG outside IOM recommendations was associated with increased risk of adverse outcomes. These findings will help to inform the process of the WHO initiative to optimise globally relevant GWG standards for improved perinatal outcomes across world regions.

DOI: 10.1136/bmj-2025-085710

Source: https://www.bmj.com/content/391/bmj-2025-085710