Gestational Weight Gain, Macrosomia, and Risk of Cesarean Birth in Nondiabetic Nulliparas

Department of Health Services and Policy Analysis, University of California, Berkeley, Berkeley, California, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 11/2004; 104(4):671-7. DOI: 10.1097/01.AOG.0000139515.97799.f6
Source: PubMed


To examine how the association between excessive weight gain and cesarean birth is modified by infant birth weight in nondiabetic women.
We designed a retrospective cohort study of singleton, term, nulliparous women with cephalic presentations delivering at a single university hospital. Subjects with diabetes were excluded. Bivariate and multivariate analyses were performed. Regression models controlled for maternal age, maternal prepregnancy body mass index, gestational age, ethnicity, smoking, birth weight, and date of delivery.
Women gaining above Institute of Medicine guidelines were more likely to have a cesarean birth, even if birth weight was less than 4,000 g. In the multivariate analysis, women with excessive weight gain had an odds ratio of 1.40 (95% confidence interval 1.22-1.59) for cesarean birth. When absolute weight gain (total pregnancy weight gain minus birth weight and placental weight) was used in the multivariate analysis, excessive weight gain was still an independent predictor of cesarean delivery. Although macrosomia was a stronger predictor of cesarean than weight gain alone, excessive weight gain was much more common than macrosomia in our cohort.
Excessive weight gain during pregnancy is an independent risk factor for cesarean birth, even when birth weight is not excessive. Other mechanisms besides macrosomia may be involved in the association between high weight gain and cesarean birth. We estimate that of the approximately 288,000 primary cesarean deliveries performed in nulliparas annually in the United States, 64,000 would be prevented if no women gained above Institute of Medicine recommendations.

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    • "Excess GWG has been linked to a number of adverse short- and long-term health outcomes in mothers and their offspring (Cox and Phelan, 2008), and excess weight is currently among the most common high-risk obstetric conditions (Galtier-Dereure et al., 2000). Overweight and obesity are linked to higher rates of cesarean sections and greater cost of obstetric care (Galtier-Dereure et al., 2000; Stotland et al., 2004; Vahratian et al., 2005). Additional complications associated with excess GWG have been described in detail (Rasmussen and Yaktine, 2009) and include increased risk of gestational diabetes, hypertension, preeclampsia, delivery complications, perinatal fatality, neural tube defects, neonatal hypoglycemia, and failure to initiate breastfeeding (Hilson et al., 1997, 2006; Galtier-Dereure et al., 2000; Kaiser et al., 2002, 2008; Thorsdottir et al., 2002). "
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    ABSTRACT: Women in the United States experience an increase in food cravings at two specific times during their life, (1) perimenstrually and (2) prenatally. The prevalence of excess gestational weight gain (GWG) is a growing concern due to its association with adverse health outcomes in both mothers and children. To the extent that prenatal food cravings may be a determinant of energy intake in pregnancy, a better understanding of craving etiology could be crucial in addressing the issue of excessive GWG. This paper reviews the available literature to corroborate and/or dispute some of the most commonly accepted hypotheses regarding the causes of food cravings during pregnancy, including a role of (1) hormonal changes, (2) nutritional deficits, (3) pharmacologically active ingredients in the desired foods, and (4) cultural and psychosocial factors. An existing model of perimenstrual chocolate craving etiology serves to structure the discussion of these hypotheses. The main hypotheses discussed receive little support, with the notable exception of a postulated role of cultural and psychosocial factors. The presence of cravings during pregnancy is a common phenomenon across different cultures, but the types of foods desired and the adverse impact of cravings on health may be culture-specific. Various psychosocial factors appear to correlate with excess GWG, including the presence of restrained eating. Findings strongly suggest that more research be conducted in this area. We propose that future investigations fall into one of the four following categories: (1) validation of food craving and eating-related measures specifically in pregnant populations, (2) use of ecological momentary assessment to obtain real time data on cravings during pregnancy, (3) implementation of longitudinal studies to address causality between eating disorder symptoms, food cravings, and GWG, and (4) development of interventions to ensure proper prenatal nutrition and prevent excess GWG.
    Frontiers in Psychology 09/2014; 5:1076. DOI:10.3389/fpsyg.2014.01076 · 2.80 Impact Factor
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    • "BMI calculated at time of delivery in our study was significantly higher in the comparison group (G3). G3 patients were more likely to be obese with a BMI ≥30 kg/m2, which might explain their increased rates of gestational diabetes28 and cesarean section deliveries.29,30 "
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    ABSTRACT: In this study, we aimed to assess the rate of adolescent delivery in a Saudi tertiary health care center and to investigate the association between maternal age and fetal, neonatal, and maternal complications where a professional tertiary medical care service is provided. A cross-sectional study was performed between 2005 and 2010 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. All primigravid Saudi women ≥24 weeks gestation, carrying a singleton pregnancy, aged <35 years, and with no chronic medical problems were eligible. Women were divided into three groups based on their age, ie, group 1 (G1) <16 years, group 2 (G2) ≥16 up to 19 years, and group 3 (G3) ≥19 up to 35 years. Data were collected from maternal and neonatal medical records. We calculated the association between the different age groups and maternal characteristics, as well as events and complications during the antenatal period, labor, and delivery. The rates of adolescent delivery were 20.0 and 16.3 per 1,000 births in 2009 and 2010, respectively. Compared with G1 and G2 women, G3 women tended to have a higher body mass index, a longer first and second stage of labor, more blood loss at delivery, and a longer hospital stay. Compared with G1 and G2 women, respectively, G3 women had a 42% and a 67% increased risk of cesarean section, and had a 52% increased risk of instrumental delivery. G3 women were more likely to develop gestational diabetes or anemia, G2 women had a three-fold increased risk of premature delivery (odds ratio 2.81), and G3 neonates had a 50% increased overall risk of neonatal complications (odds ratio 0.51). The adolescent birth rate appears to be low in central Saudi Arabia compared with other parts of the world. Excluding preterm delivery, adolescent delivery cared for in a tertiary health care center is not associated with a significantly increased medical risk to the mother, fetus, or neonate. The psychosocial effect of adolescent pregnancy and delivery needs to be assessed.
    International Journal of Women's Health 04/2014; 6(1):359-66. DOI:10.2147/IJWH.S57743
    • "Abnormal weight gain during the pregnancy puts the mother into increased risk of serious health problems such as risk of cesarean delivery, delivery complications, preeclampsia, and postpartum weight retention and therefore, increasing the long-term risk of weight-associated diseases. Negative complications for infants include hypoglycemia, microsomal, pre-maturity, low neonatal birth weight, greater offspring adiposity, and adverse cardiovascular risk-factors and seizures.[123456789] In the United States, Approximately 40% of normal-weight and 60% of overweight women gained excessive weight, during pregnancy.[10] "
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    ABSTRACT: Abnormal weight gain during pregnancy increases the adverse health outcomes during the pregnancy, delivery, and the postpartum period. Most of the pregnant women develop weight gain more than the recommended limits; therefore, interventions to manage such disproportionate weight gain are needed. In this paper, the design of the maternal centered life-style intervention study is described, which focuses on controlling weight gaining during pregnancy for all body mass index (BMI) groups. In our randomized field trial, 160 pregnant women with 6-10 weeks of gestational age who visit one of the participating Isfahan four urban public-health centers and 4 private obstetric offices are included. The maternal centered life-style intervention carried out by trained midwives is standardized in a protocol. All the participants are visited at 6-10, 11-15, 16-20, 21-25, 26-30, 31-34, 35-37, 38, 39, and 40 weeks of pregnancy. The women who are randomized in the intervention group receive maternal centered educational package of prenatal care for the pregnant woman and a log book in the first visit. Counselors accompany the pregnant women to maintain or develop a healthy life-style. Data collection will perform monthly measuring body weight, BMI. Because, we don't have structured protocol for weight management during pregnancy especially, in private sectors if the maternal centered life-style intervention proves to be effective, it will be suggested to merge this package to routine care. Therewith by empowering women to manage their weight the public-health burden can be reduced. Beside that private obstetricians also have structured protocol for their client management.
    Journal of research in medical sciences 08/2013; 18(8):683-7. · 0.65 Impact Factor
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