肥胖对阴道孕酮治疗短宫颈患者早产风险的影响
这项回顾性队列研究纳入236例孕18-22周宫颈长度≤2.5cm并接受200mg阴道孕酮治疗的單胎孕妇，比较肥胖（BMI≥30）与非肥胖患者的自发性早产风险。结果显示肥胖组37周、34周和28周前自发性早产及新生儿重症监护 admission 的 odds 均显著升高，且 BMI 每增加1单位与更早自发性早产风险呈剂量反应关系。
要点
- 肥胖短宫颈孕妇使用阴道孕酮后37周前自发性早产 odds 仍升高（aOR=2.23）。
- 肥胖与 NICU admission 风险升高相关（aOR=2.26）。
- BMI 每增加1单位，34周前自发性早产 odds 增加7%。
核心结论
- 在接受阴道孕酮治疗短宫颈的患者中，肥胖与自发性早产及 NICU admission 的 odds 升高相关。
- BMI 与更早的自发性早产之间存在剂量反应关系。
研究设计与样本
- 单中心回顾性队列研究，纳入2015至2022年间236例单胎妊娠。
- 所有患者孕18-22周宫颈长度≤2.5 cm，并接受200 mg每晚阴道孕酮治疗。
- 按 BMI≥30 定义为肥胖，BMI<30 为非肥胖，比较两组结局。
主要发现
- 236例中60例（25%）为肥胖，176例（75%）为非肥胖。
- 肥胖组37周前自发性早产 adjusted OR=2.23（95% CI: 1.18-4.24）。
- 肥胖组34周前自发性早产 OR=2.68（95% CI: 1.27-5.65），28周前 OR=4.46（95% CI: 1.50-13.25）。
- 肥胖组 NICU admission adjusted OR=2.26（95% CI: 1.17-4.36）。
- BMI 每增加1单位，34周前自发性早产 OR=1.07（95% CI: 1.01-1.13），28周前 OR=1.10（95% CI: 1.02-1.18）。
关键数值与推荐
- 肥胖定义为 BMI≥30，非肥胖为 BMI<30。
- 短宫颈定义为孕18-22周宫颈长度≤2.5 cm。
- 阴道孕酮用法为200 mg每晚。
- 主要结局为37周前自发性早产；次要结局包括34周和28周前自发性早产、NICU admission、未足月胎膜早破及因宫颈持续缩短行宫颈环扎。
临床怎么用
- 对接受阴道孕酮治疗的短宫颈肥胖孕妇，应意识到其自发性早产风险可能仍较高。
- BMI 越高，早产风险似乎越大，可据此加强监测与咨询。
局限性
- 单中心回顾性设计可能限制外推性。
- 样本量236例，肥胖组60例，部分结局事件数较少。
- 未报告阴道孕酮吸收或依从性的直接测量数据。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: Vaginal progesterone reduces the risk of spontaneous preterm birth among patients with short cervix. However, obesity has been shown to alter the absorption of vaginal progesterone in other patient populations. Despite the rising prevalence of obesity in pregnancy, the impact of obesity on response to vaginal progesterone for preterm birth prevention remains poorly characterized. OBJECTIVE: To evaluate whether obesity is associated with spontaneous preterm birth (sPTB) among patients treated with vaginal progesterone for short cervix. METHODS: We conducted a retrospective cohort study of 236 singleton pregnancies at a single academic medical center between 2015 and 2022. All patients had a cervical length ≤2.5 cm between 18 and 22 weeks' gestation and were prescribed 200 mg nightly vaginal progesterone. Patients were classified as having obesity (body mass index [BMI] ≥30) or not (BMI <30). The primary outcome was sPTB before 37 weeks. Secondary outcomes included sPTB before 34 and 28 weeks, neonatal intensive care unit (NICU) admission, preterm prelabor rupture of membranes, and cerclage placement for continued shortening. Multivariable and propensity score-adjusted logistic regression models were used to estimate associations between BMI and outcomes. BMI was also modeled as a continuous variable to assess a dose-response relationship. RESULTS: Of the 236 patients, 60 (25%) had obesity and 176 (75%) did not. Compared to patients without obesity, those with obesity had higher odds of sPTB before 37 weeks (adjusted OR=2.23, 95% CI: 1.18-4.24), 34 weeks (OR=2.68, 95% CI: 1.27-5.65), and 28 weeks (OR=4.46, 95% CI: 1.50-13.25). Obesity was also associated with increased odds of NICU admission (adjusted OR=2.26, 95% CI: 1.17-4.36). When modeling BMI as a continuous variable, each 1-unit increase in BMI was associated with a 7% increase in the relative odds of sPTB <34 weeks (OR=1.07, 95% CI: 1.01-1.13) and a 10% increase in the relative odds of sPTB <28 weeks (OR=1.10, 95% CI: 1.02-1.18). CONCLUSION: Among patients treated with vaginal progesterone for short cervix, obesity was associated with higher odds of sPTB and NICU admission. There appears to be a dose-response relationship, with increasing BMI associated with greater odds of earlier sPTB.
引用
- Steelman M, Park J, Lee JH, et al. Impact of obesity on preterm birth in pregnancies prescribed vaginal progesterone for short cervix. Am J Obstet Gynecol MFM. 2026. PMID: 42128357. doi:10.1016/j.ajogmf.2026.101988
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。