Relationship between prepregnancy body mass index and gestational age–specific risk of stillbirth and perinatal death in women with chronic hypertension
Notice bibliographique
Résumé
Background Obesity is a risk factor for stillbirth and perinatal death and is often accompanied by chronic hypertension. However, there are few studies on the relationship between prepregnancy body mass index and gestational age–specific risks of stillbirth and perinatal death in women with chronic hypertension. Objective This study aimed to examine the relationship between prepregnancy body mass index and gestational age–specific risks of stillbirth and perinatal death in the presence/absence of chronic hypertension. Study Design This was a retrospective cohort study of all singleton births in the United States from 2016 to 2017. Data were obtained from the live birth and fetal death certificates available from the National Center for Health Statistics. Piecewise additive mixed models were used to assess the relationship between prepregnancy body mass index and gestational age–specific risks of stillbirth and perinatal death in women with and without chronic hypertension, adjusted for potential confounders. Results were expressed as gestational age–specific adjusted hazard ratios and 95% confidence intervals. Results A total of 7,365,797 women were included in the study, of whom 255,464 (3.5%) were underweight; 3,233,710 (43.9%) had normal body mass index; 1,925,510 (26.1%) were overweight; and 1,065,958 (14.5%), 518,543 (7.0%), and 366,612 (5.0%) had obesity classes I, II, and III, respectively. Overall, stillbirth rates increased with increasing body mass index and were higher in women with chronic hypertension (14.2 per 1000 total births) than in those without chronic hypertension (4.7 per 1000 total births). The cumulative incidence of stillbirth increased at each gestational week, with the gradient increasing by body mass index category in women without chronic hypertension. However, this relationship was modified in women with chronic hypertension, for whom the increased risk of stillbirth by higher body mass index was reversed at 26 to 35 weeks of gestation. For example, at 31 weeks of gestation, the adjusted hazard ratio of women with a body mass index of 40 kg/m 2 vs those with a body mass index of 20 kg/m 2 and chronic hypertension was 0.78 (95% confidence interval, 0.65–0.93), whereas the adjusted hazard ratio of similar women without chronic hypertension was 1.39 (95% confidence interval, 1.30–1.48). The results were similar for perinatal death. Conclusion The relationship between prepregnancy body mass index and stillbirth is modified in the presence of chronic hypertension at 26 to 35 weeks of gestation when elevated body mass index is associated with a lower or similar relative risk of stillbirth and perinatal death. Nevertheless, women with chronic hypertension and elevated body mass index have higher absolute risks of stillbirth and perinatal death at all gestations. Our results suggest that, in women with obesity, optimal timing of delivery may differ depending on the presence or absence of chronic hypertension.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».