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Objective:To explore the characteristics of weekly gestational weight gain (GWG) in women with obesity and its correlation with the risk of macrosomia.Methods:Clinical data of women with singleton pregnancy and pre-pregnancy body mass index (PPBMI) ≥28 kg/m 2 were retrospectively analyzed, from January 2014 to December 2019, in Beijing Obstetrics and Gynecology Hospital, Capital Medical University (Beijing Maternal and Child Health Care Hospital). The participants were divided into three groups based on their PPBMI: group A (28-<30 kg/m 2), group B (30-<32 kg/m 2), and group C (≥32 kg/m 2). The study compared the characteristics of GWG among the three groups, explored the correlation between the weekly weight gain during each gestational stage and the risk of macrosomia, and discussed the impacts of the GWG pattern in women with different PPBMI on the risk of macrosomia. Chi-square (or Fisher's exact), Kruskal-Wallis, and Mann-Whitney U tests were performed for statistical analysis. Multivariate logistic regression was used to analyze the impact of weekly weight gain in specific gestational stages on macrosomia. Results:(1) A total of 2 046 participants were included in the study, with 982 in group A, 588 in group B, and 476 in group C. For all of the 2 046 cases, the median PPBMI was 30.1 kg/m 2 (29.0-31.9 kg/m 2), GWG was 10.5 kg (7.3-14.0 kg), and neonatal birth weight was 3 520 g (3 215-3 816 g) with 60 (2.9%) ≥4 500 g, and the biggest baby weighed 5 580 g. Out of the births analyzed, macrosomia occurred in 318 cases (15.5%). (2) Among the three groups (A, B and C), the differences in maternal age [32.0 years (29.0-35.0 years), 32.0 years (29.0-35.0 years) and 32.0 years (29.0-34.0 years), H=6.58] and women with a history of type 2 diabetes mellitus [0.9% (9/982), 0.3% (2/588) and 1.9% (9/476), χ2=6.61] were statistically significant (all P<0.05). (3) The weekly weight gain in each group exhibited a gradual upward trend before 20-24 weeks, reached a plateau at 24-32 weeks, peaked at 32-36 weeks, and subsequently declined. The weekly weight gain of group A in the pre-pregnancy to 14 weeks [0.14 kg/week (0.00-0.25 kg/week)], 14 to 20 weeks [0.25 kg/week (0.17-0.42 kg/week)], and 20 to 24 weeks [0.38 kg/week (0.25-0.63 kg/week)] were higher than those of group B [0.07 kg/week (－0.03-0.21 kg/week), 0.25 kg/week (0.10-0.42 kg/week), and 0.38 kg/week (0.22-0.60 kg/week)], respectively ( Z value was－3.73,－2.16, and－2.01, all P<0.05). Likewise, the weekly weight gain of group B in the above three stages were all higher than those of group C [0.07 kg/week (－0.10-0.21 kg/week), 0.17 kg/week (0.05-0.33 kg/week), and 0.25 kg/week (0.08-0.50 kg/week)], respectively ( Z value was－2.55,－3.28, and－3.25, all P<0.05). (4) The risk of macrosomia increased with the weekly weight gain in specific gestational stages in different PPBMI groups. In group A, the stages correlated with increased risk were 14-20 weeks [adjusted odd ratio ( aOR)=2.669, 95% CI: 1.378-5.169] and 20-24 weeks ( aOR=1.764, 95% CI: 1.143-2.723), while the stages were 20-24 weeks ( aOR=2.149, 95% CI: 1.156-3.996) and 36 weeks until delivery ( aOR=1.888, 95% CI: 1.268-2.810) in group B, and pre-pregnancy to 14 weeks ( aOR=3.515, 95% CI: 1.158-10.665) and 14-20 weeks ( aOR=3.021, 95% CI: 1.058-8.628) in group C (all P<0.05). The risk of macrosomia increased when the weekly weight gain of both risk-related stages in group A ( aOR=2.255, 95% CI: 1.029-4.940) ≥50th percentile, and group B ( aOR=4.399, 95% CI: 1.017-19.023) ≥75th percentile, and for group C ( aOR=3.404, 95% CI: 1.004-11.543) when the weekly weight gain above 25th percentile (all P<0.05). Conclusions:Weekly GWG demonstrates an observable gradual acceleration pattern in women with obesity. Therefore, clinical attention should be directed towards monitoring fluctuations in the weekly weight gain in this population, as excessive weekly weight gain before 24 gestational weeks is associated with an elevated risk of macrosomia.
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Objective:To analyze the maternal gestational weight gain (GWG) in women with pre-pregnancy obesity and its relationships with adverse pregnancy outcomes.Methods:This retrospective cohort study recruited 513 obese women (pre-pregnancy body mass index ≥30 kg/m 2) with singleton pregnancy in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2014 to December 2016. All participants were divided into three groups according to GWG: inadequate (GWG<5 kg, n=83), adequate (5 kg≤GWG≤9 kg, n=154), and excessive (GWG>9 kg, n=276) groups. Chi-square test, Fisher's exact test, Kruskal-Wallis test, and Mann-Whitney U test were used to compare the clinical data among the three groups, including GWG, pregnancy and neonatal outcomes, and labor process. Multivariate logistic regression was performed to analyze the association between maternal GWG and main pregnancy complications associated with obesity. Results:(1) Among 238 participants who gained more than 2.0 kg in the first trimester, 75.6% (180/238) were in the excessive group, while the rate was 34.9%(96/275) among the participants who gained less than 2.0 kg. (2) Postpartum body mass index retention (body mass index at six weeks postpartum minus pre-pregnancy body mass index) was the highest in the excessive group, followed by the adequate group and the inadequate group [0.8 kg/m 2 (0.0-2.2 kg/m 2) vs -0.7 kg/m 2 (-1.6 to 0.0 kg/m 2) vs -2.5 kg/m 2 (-3.2 to -1.5 kg/m 2), all P<0.05]. (3) The rates of primary cesarean section in the inadequate and adequate groups were 29.9% (20/67) and 32.6% (42/129), which were lower than that in the excessive group [43.3% (104/240), χ2=3.955 and 4.047, both P<0.05]. There were no statistically significant differences in the incidence of gestational hypertension, small/large for gestational age, or other major adverse pregnancy outcomes among the three groups (all P>0.05). The weight gain in the first trimester and before the oral glucose tolerance test were not correlated with gestational diabetes mellitus (GDM) ( aOR=1.038, 95% CI: 0.986-1.094, P=0.157; aOR=1.055, 95% CI: 1.000-1.113, P=0.051). The maternal weight gain of women with GDM during the 2nd, the 3rd, and the whole trimesters were lower than women without GDM respectively [3.0 kg (1.3-4.0 kg) vs 3.0 kg (2.0-5.0 kg), 4.0 kg (2.0-6.0 kg) vs 6.0 kg (4.0-8.0 kg), 9.0 kg (5.0-12.0 kg) vs 10.7 kg (7.5-15.0 kg); Z =-2.938, -6.352 and-4.104, all P<0.01]. Conclusions:In women with pre-pregnancy obesity, the first trimester is the critical window to control maternal GWG. GWG guidelines recommended by the Institute of Medicine could help to reduce the weight retention at six weeks postpartum, but couldn't reduce the risk of GDM, gestational hypertension, small/large for gestational age, or other major adverse pregnancy outcomes.
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Medical simulation training as a modern medical education has been used for decades in developed countries. Simulation based team training for obstetric emergency provides opportunities to re-hearse without risks to patients and helps overcome some limitations of the current medical education to improve the ability of medical staff to deal with obstetric emergencies, and improve adverse pregnancy out-comes. Simulation training is still at early stage in China. The Simulation Training Center of Beijing Ob-stetrics&Gynecology Hospital was established in June 2013. There are 100 medical staffs from our hospital and 406 from other hospitals who are trained using simulations to respond to acute obstetrical emergencies, including postpartum hemorrhage, neonatal recovery, shoulder dystocia and amniotic fluid embolism. Through introduction—on-scene simulation training—task report, we focus on learning, practical operation, emer-gency team and multidisciplinary coordination and communication skills training and through training, help learners understand the medical simulation training mode, and improve personal and team's ability to deal with the obstetric emergency. There is no doubt that simulation training will be further developed in China. Further research is required to investigate the application significance and feasibility of simulation training and access effectiveness of it.