Article

Associations of gestational weight loss with birth-related outcome: a retrospective cohort study

Institute of Social Paediatrics and Adolescent Medicine, Division of Epidemiology, Ludwig-Maximilians University of Munich, Munich, Germany.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.86). 11/2010; 118(1):55-61. DOI: 10.1111/j.1471-0528.2010.02761.x
Source: PubMed

ABSTRACT Although the prevention of gestational weight loss (GWL) has become a priority for clinicians in the past few decades, recent work has suggested that GWL may be beneficial for obese mothers. We aimed to identify the potential beneficial or adverse associations of GWL with pregnancy outcome stratified by maternal body mass index (BMI) category.
Retrospective cohort study.
Data on 709 575 singleton deliveries in Bavarian obstetric units from 2000-2007 were extracted from a standard dataset for which data are regularly collected for the national benchmarking of obstetric units.
We calculated the odds ratios (ORs) for adverse pregnancy outcome by GWL (explanatory variable) compared with nonexcessive weight gain with adjustment for confounders and stratification by BMI category (underweight, BMI < 18.5 kg/m²; normal weight, BMI = 18.5-24.9 kg/m²; overweight, BMI = 25-29.9 kg/m²; obese class I, BMI = 30-34.9 kg/m²; obese class II, BMI = 35-39.9 kg/m²; obese class III, BMI ≥ 40 kg/m²).
Pre-eclampsia, nonelective caesarean section, preterm delivery, small or large for gestational age (SGA/LGA) birth and perinatal mortality.
GWL was associated with a decreased risk of pregnancy complications, such as pre-eclampsia and nonelective caesarean section, in overweight and obese women [e.g. OR = 0.65 (95% confidence interval: 0.51, 0.83) for nonelective caesarean section in obese class I women]. The risks of preterm delivery and SGA births, by contrast, were significantly higher in overweight and obese class I/II mothers [e.g. OR = 1.68 (95% confidence interval: 1.37, 2.06) for SGA in obese class I women]. In obese class III women, no significantly increased risks of poor outcomes for infants were observed.
The association of GWL with a decreased risk of pregnancy complications appears to be outweighed by increased risks of prematurity and SGA in all but obese class III mothers.

Download full-text

Full-text

Available from: Andreas Beyerlein, Oct 13, 2014
1 Follower
 · 
114 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The incidence of preterm birth in developed countries is increasing, and in some countries, including the United States, it is almost as high as in developing countries. Demographic changes in women becoming pregnant can account for only a relatively small proportion of the increase. A significant proportion of spontaneous preterm birth continues to be of unknown cause. Experimental data from animal studies suggesting that maternal undernutrition may play a role in spontaneous, noninfectious, preterm birth are supported by observational data in human populations, which support a role for maternal prepregnancy nutritional status in determining gestation length. In addition, intakes or lack of specific nutrients during pregnancy may influence gestation length and thus the risk of preterm birth. As yet, the role of paternal nutrition in contributing to gestation length is unexplored.
    Annual Review of Nutrition 08/2010; 31:235-61. DOI:10.1146/annurev-nutr-072610-145141 · 10.46 Impact Factor
  • Journal of Hypertension 05/2011; 29(5):834-5. DOI:10.1097/HJH.0b013e3283462ca9 · 4.22 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To clarify whether mothers with gestational weight loss (GWL) were likely to have adverse effects on the placenta. Study design: Subjects who delivered viable singleton infants after 24 weeks of gestation were enrolled. A retrospective analysis to evaluate cases of GWL in association with the findings of the placenta and amniotic membrane after delivery was conducted. After consideration of confounders, a case-control study with matched pairs (1:2) was performed. Results: Of all subjects (5551 cases), 83 cases (1.5%) with GWL were found. Since the pre-pregnancy maternal body mass index (BMI) was significantly higher in cases, 166 controls with a matched BMI were selected. The neonatal birth weights, placental weights and the umbilical cord length in cases were significantly smaller than in controls (p < 0.05). Preterm delivery and small for gestational age (SGA) infants were more frequently observed in cases compared with controls [odds ratio (OR) 6.3; 95% confidence interval (CI) 3.3, 12.1, OR 4.3; 95% CI 1.9, 9.9]. pPROM were observed in 10.8% of the cases and 1.8% of the control (OR 6.6; 95% CI 1.7, 25.1). However, the frequencies of chorioamnionitis and the cervical length at second trimester were not different between the two groups. Conclusion: GWL is associated with SGA, small placenta, short umbilical cord length, preterm delivery and pPROM.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 02/2012; 25(10):1909-12. DOI:10.3109/14767058.2012.664666 · 1.21 Impact Factor