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作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　October 2, 2009 — 根據10月美國婦產科醫學會(American Journal of Obstetrics Gynecology)期刊中一個大型案例控制研究結果，母親懷孕前肥胖和過重，與小孩的先天性心臟缺陷(congenital heart defects，CHDs)有關。
　　
　　美國疾病控制預防中心(CDC)所屬國家生育缺陷與發展失能中心主任Edwin Trevathan醫師在新聞稿中表示，先天心臟缺陷是生育缺陷中最常見的，在各種生育缺陷中，先天心臟缺陷是致病、致命和醫療資源耗費的首因。肥胖且計畫懷孕的婦女，與醫師商討，以在懷孕前達到健康體重將有助益。
　　
　　「National Birth Defects Prevention Study (NBDPS)」這項研究的分析目標，是評估懷孕前身體質量指數(BMI)和小孩之CHDs的關係。從1997至2004年間，NBDPS納入有CHDs的案例組嬰兒(n = 6,440人)和5,673名沒有生育缺陷的活產嬰兒進行比較。
　　
　　有關納入的所有CHDs，過重的校正勝算比為1.16(95%信心區間[CI]為1.05 - 1.29)、中度肥胖為1.15(95% CI，1.00 -1.32)、嚴重肥胖為1.31(95% CI，1.11 - 1.56)。與母親的BMI至少25.0 kg/m2有關的CHD類型為心錐動脈幹缺陷(法洛氏四合症)、全肺靜脈迴流異常、左心發育不全症候群、右心室出口(RVOT)缺陷(肺動脈瓣狹窄)以及中隔缺損(心房第二中隔缺損)。
　　
　　研究作者結論表示，這些發現支持之前的研究論述，也強調了肥胖與心錐動脈幹缺陷及RVOT缺陷的新關聯。
　　
　　第一作者、CDC所屬國家生育缺陷與發展失能中心的流行病學家Suzanne M. Gilboa博士表示，這些結果支持以前的研究，也提供了新證據，婦女懷孕前過重或肥胖，與某些心臟缺陷有關聯；這提供了另一個婦女維持健康體重的理由。母親肥胖除了對婦女本身的健康與已知的懷孕併發症有影響之外，對胎兒的健康也有風險。
　　
　　這項研究的限制包括，根據自我報告的身高體重計算BMI，懷孕前的BMI資料有部份漏失，NBDPS研究的回覆率為70%，無法確認母親體重和CHDs之間的因果關係。此外，位於麻塞諸塞州和紐澤西州的研究中心並未確認妊娠中止的嬰兒數，紐約只有在2000年開始確認妊娠中止的數量。
　　
　　NBDPS接受CDC資助。期刊文獻中表達的為作者的觀點，並不代表CDC的官方立場。
　　
　　Am J Obstet Gynecol.。線上發表於2009年10月1日。

Maternal Obesity, Overweight Linked to Congenital Heart Defects

By Laurie Barclay, MD
Medscape Medical News

October 2, 2009 — Maternal obesity and overweight before pregnancy are linked to congenital heart defects (CHDs) in the offspring, according to the results of a large case-control study reported in the October issue of the American Journal of Obstetrics Gynecology.

"Congenital heart defects are the most common types of birth defect, and among all birth defects, they are a leading cause of illness, death, and medical expenditures," Dr. Edwin Trevathan, director of the US Centers for Disease Control and Prevention's (CDC) National Center on Birth Defects and Developmental Disabilities, said in a news release. "Women who are obese and who are planning a pregnancy could benefit by working with their physicians to achieve a healthy weight before pregnancy."

The goal of this analysis from the National Birth Defects Prevention Study (NBDPS) was to evaluate associations between prepregnancy body mass index (BMI) and CHDs in the offspring. Case infants with CHDs (n = 6440) were compared vs 5673 liveborn control infants without birth defects enrolled in the NBDPS from 1997 to 2004.

For all CHDs combined, adjusted odds ratios were 1.16 for overweight status (95% confidence interval [CI], 1.05 - 1.29), 1.15 for moderate obesity (95% CI, 1.00 -1.32), and 1.31 for severe obesity (95% CI, 1.11 - 1.56). Phenotypes of CHD associated with maternal BMI of at least 25.0 kg/m2 were conotruncal defects (tetralogy of Fallot), total anomalous pulmonary venous return, hypoplastic left heart syndrome, right ventricular outflow tract (RVOT) defects (pulmonary valve stenosis), and septal defects (secundum atrial septal defect).

The study authors concluded that these findings supported those from previous research and also highlighted new associations between obesity and conotruncal defects and RVOT defects.

"These results support previous studies, as well as provide additional evidence, that there is an association between a woman being overweight or obese before pregnancy and certain types of heart defects," said lead author Suzanne M. Gilboa, PhD, epidemiologist at CDC's National Center on Birth Defects and Developmental Disabilities. "This provides another reason for women to maintain a healthy weight. In addition to the impact on a woman's own health and the known pregnancy complications associated with maternal obesity, the baby's health could be at risk."

Limitations of this study include BMI calculated from self-reported weight and height, some missing data for prepregnancy BMI, 70% response rate in the NBDPS, and inability to determine any causal relationship between maternal body weight and CHDs. In addition, study centers in Massachusetts and New Jersey did not ascertain case infants among pregnancy terminations, and New York began ascertaining pregnancy terminations only in the year 2000.

The NBDPS is funded by the CDC. The views expressed in the journal article are those of the study authors and do not necessarily represent the official position of the CDC.

Am J Obstet Gynecol. Published online October 1, 2009.