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Prepregnancy Weight and the Risk of Adverse Pregnancy Outcomes
Abstract
Obesity before pregnancy is associated with an increased risk of several adverse outcomes of pregnancy. The risk profiles among lean, normal, or mildly overweight women are not, however, well established.
We studied the associations between prepregnancy body-mass index (defined as the weight in kilograms divided by the square of the height in meters) and the frequency of late fetal death, early neonatal death, preterm delivery, and delivery of a small-for-gestational-age infant in a population-based cohort of 167,750 women in Sweden in 1992 and 1993. The women were categorized as follows, according to body-mass index: lean, less than 20.0; normal, 20.0 through 24.9; overweight, 25.0 through 29.9; and obese, 30.0 or more. The estimates were adjusted for maternal age, parity, smoking, education, whether the mother was living with the father, and maternal height.
Among nulliparous women, the odds ratios for late fetal death were increased among women with higher body-mass-index values as compared with lean women, as follows: normal women, 2.2 (95 percent confidence interval, 1.2 to 4.1); overweight women, 3.2 (95 percent confidence interval, 1.6 to 6.2); and obese women, 4.3 (95 percent confidence interval, 2.0 to 9.3). Among parous women, only obese women had a significant increase in the risk of late fetal death (odds ratio, 2.0; 95 percent confidence interval, 1.2 to 3.3). Among nulliparous women, the risk of very preterm delivery (at < or =32 weeks' gestation) was significantly increased among obese as compared with lean women (odds ratio, 1.6; 95 percent confidence interval, 1.1 to 2.3), whereas among parous women, the risk was highest among those who were lean. The risk of delivering a small-for-gestational-age infant decreased more with increasing body-mass index among parous than among nulliparous women.
Higher maternal weight before pregnancy increases the risk of late fetal death, although it protects against the delivery of a small-for-gestational-age infant.
... However, different studies have yielded varying results. In the study by Cnattingius et al (18), the opposite result was found for the association between maternal BMI and low fetal weight. The authors of that study claimed that obesity protected from fetuses with a low birth weight. ...
... However, they did not use individualized centiles. Perhaps the individual physiological characteristics of the mother were not taken into account (18). A newborn weighing 3,500 g would be considered normal for the general population and for a pregnant woman of normal weight. ...
... Research conducted in Sweden revealed that elevated maternal pre-pregnancy body mass index (BMI), a gauge of weight relative to height, was linked to heightened odds of adverse pregnancy outcomes [14]. Obesity elevates the likelihood of a medically indicated premature birth [15,16]. ...
... The findings from the study conducted by Baeten et al. reaffirmed that obesity significantly increased the risk of pregnancy complications and adverse outcomes [15]. Higher maternal pre-pregnancy BMI, a measure of weight for height, was associated with the increased risk of adverse pregnancy outcomes [14]. In our study preeclampsia was statistically significantly more frequent in the OB group and there were significant differences in type of obesity between group of pregnant women with and without preeclampsia. ...
Introduction. A significant proportion of women globally, consti tuting 38%, are obese, among whom 24.5% reside in Europe. Obe sity elevates the risk of premature birth due to associated maternal conditions, such as preeclampsia. The objectives were to assess: variations in demographic and clinical characteristics among preg nant women across groups; the impact of obesity on the incidence of preeclampsia and preterm delivery; and the influence of obesity on newborn characteristics.
Methods. One-year prospective study included 133 pregnant wom en gestational age 11-14 gestational week (GW), divided into two groups: OB (41.35%) and CG (58.65%). The data were analyzed using IBM SPSS version 23.
Results. There is statistically significant difference in average body mass index (BMI) (22.01 ± 1.83 vs. 30.26 ± 4.52; p < 0.001) and de livery time (37.94 ± 2.05 vs. 36.87 ± 2.45; p = 0.003) between CG and OB. Obese pregnant women developed preeclampsia significantly more often than normal weight (61.82% vs. 28.21%; p < 0.001). Body mass index has significant moderate predictive ability to predict preeclampsia (AUC 0.696 (95% CI: [0.601; 0.79]). Higher BMI (OR = 1.19, [1.09; 1.29], p < 0.0001) was associated with higher rates of pre eclampsia. Overweight (OR = 2.41, [1.07; 5.43], p = 0.0335), obesity class I, II and III (OR = 20.36, [4.32; 95.99], p = 0.0001) were associated with higher rates of preeclampsia. A poor negative correlation was found between BMI and GW of pregnancy outcome (p = -0.24; r2 = 0.104; p = 0.006). Higher BMI (β = -0.14, [-0.21; -0.07], p = 0.0002) was associated with lower values of GW of pregnancy outcome.
Conclusions. Presence of obesity or overweightness in the first tri mester of pregnancy poses a significant risk factor for preeclampsia and preterm delivery.
... Postpartum hemorrhage (PPH) was defined as blood loss of ≥ 500 mL within 24 h after vaginal delivery or ≥ 1000 mL after cesarean delivery. Severe PPH was defined as blood loss of ≥ 1000 mL within 24 h after delivery [19]. The primary outcome of this study was to determine the incidence of GDM and preeclampsia among women with ICP. ...
... In our study, cholesterol levels were not evaluated. It has been shown that women with higher BMI and impaired metabolic pathways may also be at increased risk for adverse outcomes of pregnancy [18,19]. We found no significant relationship between GDM and preeclampsia and obesity. ...
Purpose
To evaluate maternal and neonatal outcomes in patients with intrahepatic cholestasis of pregnancy (ICP).
Methods
Patients who gave birth in our hospital between January 2018 and March 2022 were retrospectively reviewed from the hospital database and patient file records. The study comprised 1686 patients, 54 in the ICP group and 1632 controls. Patients who had ICP after 20 weeks of gestation and were monitored and delivered at our facility were enrolled. Maternal demographic and obstetric characteristics data were examined. Perinatal outcomes were also assessed. Logistic regression analysis was used to determine adverse maternal outcomes.
Results
The mean age was 29 years. ART, GDM, and preeclampsia were significantly higher in the ICP group. The mean serum bile acid level was 19.3 ± 3 μmol/L in the ICP group. There was a higher risk of GDM and pre-eclampsia in women with ICP compared with those without and a significant association between ICP and adverse perinatal outcomes. There was a statistically significant relation between the presence of ICP and spontaneous preterm delivery, iatrogenic preterm delivery, 5th-minute Apgar scores < 7, and NICU requirement. No significant relationship was found between the presence of ICP and SGA and meconium. There was a significant relationship between the presence of ICP, mode of delivery, and PPH (p < 0.05). Those with ICP had a lower gestational week and birth weight, and higher rates of cesarean delivery and PPH.
Conclusion
ICP should prompt close monitoring and management to mitigate the potential exacerbation of adverse outcomes, including preeclampsia, GDM, and preterm birth.
... Postpartum hemorrhage (PPH) was de ned as blood loss of ≥ 500 mL within 24 hours after vaginal delivery or ≥ 1,000 mL after cesarean delivery. Severe postpartum hemorrhage was de ned as blood loss of ≥ 1,000 mL within 24 hours after delivery [19]. The primary outcome of this study was to determine the incidence of GDM and preeclampsia among women diagnosed with intrahepatic cholestasis. ...
... In our study, cholesterol levels were not evaluated. It has been shown that women with higher BMI and impaired metabolic pathways may also be at increased risk for adverse outcomes of pregnancy [18,19]. ...
Purpose
Intrahepatic cholestasis of pregnancy is the most common pregnancy-specific liver disease. It occurs in approximately 1/1000 to 1/10000 of pregnancies and usually resolves during the postpartum period without causing any hepatic sequelae or mortality in the mother. This is a condition complicated by itching in the body, increased liver enzymes and fasting bile acid levels (≥ 10 µmol/L). Although the relationship of intrahepatic cholestasis (ICP) with Gestational Diabetes Mellitus (GDM) and preeclampsia has been evaluated in studies, there are few studies examining the relationship of intrahepatic cholestasis with GDM and preeclampsia.
Methods
Patients who gave birth in our hospital between January 2018 and March 2022 were retrospectively reviewed from the hospital database and patient file records. Patients who were diagnosed with intrahepatic cholestasis and gave birth during the study period were retrospectively compared with all other patients who gave birth.
Results
In our study, consistent with previous studies, we demonstrated a higher risk of GDM and pre-eclampsia in women with ICP compared to those without ICP. In our study, we observed a significant correlation between ICP and adverse perinatal outcomes. There was a statistically significant relation between the presence of ICP and spontaneous preterm delivery, iatrogenic preterm delivery, 5th minute Apgar score < 7 and presence of Neonatal Care Unit (NICU). On the other hand, no significant relationship was found between the presence of ICP and the presence of Small Gestational Age (SGA) and meconium. In our study, there was a significant relationship between the presence of ICP and mode of delivery, and the presence of postpartum hemorrhage (PPH) (p < 0.05). Those with ICP were found to have a lower gestational week and birth weight at birth, and a higher rate of caesarean delivery and PPH.
Conclusion
Our study suggested that patients with ICP had increased risk of development of GDM and preeclampsia.
... In Germany, 26.2% of all women aged 18-29 years and 41.5% of all women in the age of 30-44 years have overweight or obesity [1]. In 2017, 15.7% of pregnant women in Germany were affected by obesity at the onset of their pregnancy [2]. The prevalence of overweight and obesity in childbearing women is increasing, as is the prevalence of obesity in the general population [3]. ...
... The high prevalence of overweight and obesity in women of childbearing age poses a major challenge to obstetricians, as it leads to an adverse maternal and fetal outcome [2,5,6]. Maternal body mass index (BMI) and weight gain during pregnancy are important factors for neonatal and maternal health both immediately postpartum as well into the future. ...
Introduction:
Maternal body mass index and gestational weight gain (GWG) are important factors for maternal and neonatal health. The objective of this study was to assess women's knowledge and examine adherence to the Institute of Medicine (IOM) criteria for weight gain during pregnancy by evaluating the information received from obstetricians and women's knowledge about GWG.
Methods:
This is an analytical semi-longitudinal observational study. Weight data from a not consecutive convenience sample of 389 women who gave birth at the Hannover Medical School in the period from 08/2020 to 07/2021 were taken from their maternal records. Immediately after giving birth the whole collective (n=389) was asked to participate in a questionnaire study including questions that were taken from the EMat Health Survey inquiring about their knowledge and received information about GWG and about their eating behavior. Here a subset of 202 women participated.
Results:
65% of the participants who answered the questionnaire reported that they had not been informed by their obstetrician about GWG recommendations. Additionally, a minority of women knew the correct IOM GWG category based on their pre-pregnancy weight. Meeting the IOM GWG guidelines did not depend on whether or not women received GWG recommendations or knew about the correct GWG category. The majority of women were not concerned about gaining too much weight during pregnancy. 20.7% of all women participating in the study were affected by obesity pre-pregnancy. According the IOM criteria for GWG 50.4% gained too much weight. The proportion of women exceeding IOM recommendations was highest in women with pre-pregnancy overweight and obesity (67%).
Discussion:
Weight gain outside of the IOM recommendations is widespread in our survey. Information received and knowledge about GWG recommendations were inadequate in our sample. Considering the fact that GWG outside recommended ranges can contribute to short- and long-term health complications, especially when a woman enters pregnancy already with overweight or obesity, identifying ways of achieving a healthier GWG is warranted.
... Accordingly, a pregnant woman's risk of developing pregnancy-induced hypertension rises by around 10% for every kilogram she accumulates. The findings of Cnattingius et al. [31] and Bhattacharya et al. [32], which demonstrated that obesity and, by extension, a higher BMI, are bigger risk factors for preeclampsia, are supported by this finding. The study identified BMI as a risk factor (odds ratio greater than 1). ...
... This means that on the average the women were overweight and hence at a significantly increased risk of developing hypertensive disorders during the period of their pregnancy. This finding corroborates with other studies in which BMI was reported as an independent risk factor for hypertensive disorders, such as Cnattingius et al. [31] and Bhattacharya et al. [32], which demonstrated that obesity and, by extension, a higher BMI, are bigger risk factors for preeclampsia. This finding is also in tandem with Chuka, et al [35] who found that the prevalence of hypertension was higher in those who were overweight and obese compared to those who were of a healthy weight, in their investigation to ascertain the relationship between BMI and hypertension in individuals living in the Arab Minch. ...
Aim: The goal of this study was to identify some risk and protective factors associated with hypertensive disorders among pregnant women in the Bolgatanga Regional Hospital of Ghana's Upper East Region.
Study Design: This study is a one case-control study design.
Place of Study: The study was conducted in the Antenatal clinic and Maternity ward of the Upper East Regional hospital in Bolgatanga.
Methodology: The study population consisted of pregnant women who were attending their antenatal care at the Bolgatanga regional hospital whose gestational ages were more than 20 weeks.
Hundred (100) study participants were selected using the purposive sampling technique (a non-probability sampling technique). Data for the study was gathered from the history of the 100 pregnant women who were visiting the Bolgatanga Regional Hospital for antenatal care. The analysis was conducted using the logistic regression model of STATA 14.
Results: The study disclosed that white blood cells (WBC), low-density lipoprotein cholesterol (LDL), placenta weight (PW), gestational weight (GW), body mass index (BMI) were statistically significant. BMI was discovered to have a positive association with hypertensive disorders (OR= 2.208, P= .025), whereas PW (OR=0.994, P= .085), GW (OR=0.815, P=.079), WBC (OR=0.719, P=.01), and LDL (OR=0.645, P= .027) were discovered to have negative associations with hypertensive disorders (odds ratios less than one).
Conclusion: The study identified BMI as a risk factor and PW, GW, WBC, and LDL as protective factors. On the basis of the analysis it was recommended that health professionals should raise the awareness of women on the risks of hypertensive disorders even before they become pregnant, especially maintaining healthy weight.
Keywords: Blood Pressure, Gestational hypertension, Gravidity, Parity, Body Mass Index, Cholestrol, Odds Ratio
... Additionally, most individuals who seek and undergo bariatric surgery are women, with the majority being of reproductive age. Further, evidence suggests that pregnancy outcomes of women with obesity in general tend to have worse outcomes when compared to women of normal BMI [6][7][8]. Among these women, the literature reports an increased incidence of complications, such as gestational diabetes mellitus (GDM), gestational hypertension, fertility issues, preeclampsia, macrosomia, higher rates of cesarean section, and its related complications, such as hemorrhage, wound infection, fetal macrosomia, and anesthesia-related complications [6][7][8][9][10][11]. ...
... Further, evidence suggests that pregnancy outcomes of women with obesity in general tend to have worse outcomes when compared to women of normal BMI [6][7][8]. Among these women, the literature reports an increased incidence of complications, such as gestational diabetes mellitus (GDM), gestational hypertension, fertility issues, preeclampsia, macrosomia, higher rates of cesarean section, and its related complications, such as hemorrhage, wound infection, fetal macrosomia, and anesthesia-related complications [6][7][8][9][10][11]. Other researchers demonstrated that a linear relationship exists between obesity and diabetes with an up to three-fold increase in GDM with increasing BMI [12][13][14]. ...
The fact that obesity has now become a worldwide epidemic and that traditional approaches to weight loss, including diet, behavioral modification, and physical activity have yielded poor weight loss outcomes is not new. On the other hand, there is substantial and growing evidence that bariatric surgery remains the most effective treatment option for many seeking significant, sustained weight loss. As the evidence grows demonstrating that bariatric surgery yields not only sustained weight loss but the resolution or remission of obesity-related comorbidities, such as sleep apnea, hypertension, and Type II diabetes mellitus, there is an increasing number of patients undergoing these procedures. Many patients seeking bariatric surgery are women of childbearing age. Since women with obesity are at risk for infertility and/or may suffer higher complication rates during pregnancy, many consider bariatric surgery a beneficial option, particularly those seeking to optimize their chances of having a family while minimizing risks. However, there remain mixed opinions as to whether there are risks inherent in having bariatric surgery, and whether those risks differ among bariatric procedures. What is more, there has been robust discussion in the literature regarding whether there is an “ideal” time to pursue pregnancy post-bariatric surgery. The aim of this review is to discuss the risks and benefits associated with pregnancy after bariatric surgery.
... The number of women with obesity of reproductive age has increased in the last decades contributing to a variety of pregnancy complications including gestational diabetes mellitus (GDM) and large for gestational age newborns [1][2][3][4]. Also, offspring born to mothers with obesity have increased risk of developing obesity in adulthood [5][6][7]. ...
... Subnetworks comprising metabolites of interest, i.e palmitoleoyl ethanolamide and N-acetyl-L-alanine, were further explored (Fig. 2, Supplementary Figs. 3,4). C To examine the robustness of the results, univariable analyses were performed in the total set of metabolites (annotated and non-annotated) ( Table 3). ...
Background/Objectives
Obesity in pregnancy associates with changes in the glucose-insulin axis. We hypothesized that these changes affect the maternal metabolome already in the first trimester of human pregnancy and, thus, aimed to identify these metabolites.
Patients/Methods
We performed untargeted metabolomics (HPLC-MS/MS) on maternal serum (n = 181, gestational weeks 4⁺⁰–11⁺⁶). For further analysis, we included only non-smoking women as assessed by serum cotinine levels (ELISA) (n = 111). In addition to body mass index (BMI) and leptin as measures of obesity and adiposity, we metabolically phenotyped women by their fasting glucose, C-peptide and insulin sensitivity (ISHOMA index). To identify metabolites (outcome) associated with BMI, leptin, glucose, C-peptide and/or ISHOMA (exposures), we used a combination of univariable and multivariable regression analyses with multiple confounders and machine learning methods (Partial Least Squares Discriminant Analysis, Random Forest and Support Vector Machine). Additional statistical tests confirmed robustness of results. Furthermore, we performed network analyses (MoDentify package) to identify sets of correlating metabolites that are coordinately regulated by the exposures.
Results
We detected 2449 serum features of which 277 were annotated. After stringent analysis, 15 metabolites associated with at least one exposure (BMI, leptin, glucose, C-peptide, ISHOMA). Among these, palmitoleoyl ethanolamine (POEA), an endocannabinoid-like lipid endogenously synthesized from palmitoleic acid, and N-acetyl-L-alanine were consistently associated with C-peptide in all the analyses (95% CI: 0.10–0.34; effect size: 21%; p < 0.001; 95% CI: 0.04–0.10; effect size: 7%; p < 0.001). In network analysis, most features correlating with palmitoleoyl ethanolamide and N-acetyl-L-alanine and associated with C-peptide, were amino acids or dipeptides (n = 9, 35%), followed by lipids (n = 7, 27%).
Conclusions
We conclude that the metabolome of pregnant women with overweight/obesity is already altered early in pregnancy because of associated changes of C-peptide. Changes of palmitoleoyl ethanolamide concentration in pregnant women with obesity-associated hyperinsulinemia may reflect dysfunctional endocannabinoid-like signalling.
... Inadequate prenatal weight gain is a significant risk factor for intra-uterine growth restriction, pre-term delivery, respiratory distress stillbirth and low birth weight in infants [2,3,14,15]. Obesity and excessive weight gain on the other hand are associated with adverse fetal and maternal outcomes such as preeclampsia, gestational diabetes mellitus, postdate pregnancy, induction of labour, caesarean section, perineal trauma, postpartum haemorrhage, retained placenta, macrosomia, meconium aspiration, neonatal birth trauma, stillbirths and neonatal hypoglycaemia [16][17][18][19][20][21] . Earlier research focused on the relationship between maternal weight and pregnancy complications but BMI is now widely accepted as a better measure of overweight or underweight [22] . ...
... The studies conducted so far relating to weight gain in pregnancy are from developed Western countries and there is a paucity of such data from developing countries [24] . In developed countries where preconception care is the norm, it is possible to know the pre-pregnancy weight of patients coming for antenatal care and therefore accurately assess their BMI and weight gain in pregnancy [18,21] . In developing countries like Nigeria where pre-conception care is hardly practiced, most studies on weight gain in pregnancy use booking weight in early gestation as pre-pregnancy weight [14] . ...
Background: Normal pregnancy is usually associated with weight gain. Abnormal weight gain in pregnancy could result in adverse neonatal and maternal outcome. Studies related to this in Nigeria are limited. Objective: The aim was to evaluate the pattern of weight gain in pregnancy and the feto-maternal outcome among women with different body mass indices attending antenatal clinic in the Federal capital territory (FCT). Study design: This was a longitudinal, multicentre study. Materials and Methods: Two hundred and twenty participants were recruited from 6 general hospitals in the FCT. Their body mass indices were calculated and they were categorized as underweight, normal weight, overweight and obese accordingly. They were followed up till 2 weeks postpartum. Maternal outcome sought included gestational hypertension, gestational diabetes and mode of delivery, postpartum haemorrhage, retained placenta and perineal injury. Neonatal outcomes included macrosomia, low birth weight, neonatal hypoglycaemia, shoulder dystocia, stillbirth and admission into special care baby unit (SCBU). Result: The mean age of participants was 28.8 years ±4.7 with parities ranging from 0-8. The majority of them (39%) were overweight. While most of the women (118, 56.2%) had normal weight gain (NWG) in pregnancy, 15(7.1%) had low weight gain (LWG) and 77(36.6%) had high weight gain (HWG). Most (95%) of the HWG was among the overweight and obese women. There was a higher induction rate and postpartum haemorrhage among HWG women and postdate among the obese group. There was no difference in neonatal outcome among the groups. Conclusion: This study demonstrated that HWG and LWG have more adverse pregnancy outcomes than NWG. Younger women (20-24years) with normal BMI at booking tend to gain suboptimal weight in pregnancy. HWG in pregnancy was commoner among overweight and obese women with increased induction of labour and postpartum haemorrhage among them. Postdate pregnancy was higher among the obese group. There was no difference in neonatal outcomes among the groups.
... Inadequate prenatal weight gain is a significant risk factor for intra-uterine growth restriction, pre-term delivery, respiratory distress stillbirth and low birth weight in infants [2,3,14,15]. Obesity and excessive weight gain on the other hand are associated with adverse fetal and maternal outcomes such as preeclampsia, gestational diabetes mellitus, postdate pregnancy, induction of labour, caesarean section, perineal trauma, postpartum haemorrhage, retained placenta, macrosomia, meconium aspiration, neonatal birth trauma, stillbirths and neonatal hypoglycaemia [16][17][18][19][20][21] . Earlier research focused on the relationship between maternal weight and pregnancy complications but BMI is now widely accepted as a better measure of overweight or underweight [22] . ...
... The studies conducted so far relating to weight gain in pregnancy are from developed Western countries and there is a paucity of such data from developing countries [24] . In developed countries where preconception care is the norm, it is possible to know the pre-pregnancy weight of patients coming for antenatal care and therefore accurately assess their BMI and weight gain in pregnancy [18,21] . In developing countries like Nigeria where pre-conception care is hardly practiced, most studies on weight gain in pregnancy use booking weight in early gestation as pre-pregnancy weight [14] . ...
... When looking at other classifiers that have a lower relation to pressure like π 1 , the result for this woman was similar to the group range. It would be interesting to understand the relationship between high BMI and pre-eclampsia in more depth as obesity is a known risk factor for pre-eclampsia [32][33][34][35] but in this case, the high BMI did not lead to early onset pre-eclampsia. ...
Computational models can be at the basis of new powerful technologies for studying and classifying disorders like pre-eclampsia, where it is difficult to distinguish pre-eclamptic patients from non-pre-eclamptic based on pressure when patients have a track record of hypertension. Computational models now enable a detailed analysis of how pregnancy affects the cardiovascular system. Therefore, new non-invasive biomarkers were developed that can aid the classification of pre-eclampsia through the integration of six different measured non-invasive cardiovascular signals. Datasets of 21 pregnant women (no early onset pre-eclampsia, n = 12; early onset pre-eclampsia, n = 9) were used to create personalised cardiovascular models through computational modelling resulting in predictions of blood pressure and flow waveforms in all major and minor vessels of the utero-ovarian system. The analysis performed revealed that the new predictors PPI (pressure pulsatility index) and RI (resistance index) calculated in arcuate and radial/spiral arteries are able to differentiate between the 2 groups of women (t-test scores of p < .001) better than PI (pulsatility index) and RI (Doppler calculated in the uterine artery) for both supervised and unsupervised classification. In conclusion, two novel high-performing biomarkers for the classification of pre-eclampsia have been identified based on blood velocity and pressure predictions in the smaller placental vasculatures where non-invasive measurements are not feasible.
... contractions or low position of the fetal head. Obesity was defined as a BMI ≥ 30 kg/m 2 according to the WHO classification and routine clinical use [12,18]. Only cases with a primary vaginal delivery attempt were included. ...
To evaluate the performance of cerebroplacental ratio (CPR) in predicting composite adverse perinatal outcome (CAPO) in women with obesity compared to non-obese women at term.
This is a retrospective cohort study in a single tertiary referral centre over a 3-year period. All singleton pregnancies with CPR measurements ≥ 37 + 0 weeks and estimated fetal weight ≥ 10th centile and attempted vaginal delivery were included and divided into two groups defined by pre-pregnancy body mass index (BMI) </≥ 30 kg/m2. The presence of at least one of the following outcome parameters was defined as CAPO: operative delivery (OD) due to intrapartum fetal compromise (IFC), admission to the neonatal intensive care unit, umbilical cord arterial pH ≤ 7.15, 5 min Apgar < 7. The prognostic performance of CPR MoM was evaluated using receiver operating characteristic (ROC) analysis.
The study cohort included 1207 pregnancies, of which 112 were women with a BMI ≥ 30 kg/m2. In obese women, CAPO occurred in 21 cases (18.8%) compared to 247 (22.6%) cases in women with BMI < 30 kg/m2 (p = 0.404). In the entire study cohort, CPR MoM was significantly lower in the CAPO and OD for IFC group. ROC analyses revealed a significant predictive value of low CPR MoM for CAPO in obese women (AUC = 0.64, p = 0.024). Furthermore, CPR was predictive for OD for IFC not only in obese (AUC = 0.72, p = 0.023) but also in non-obese (AUC = 0.61, p = 0.003) women.
Low CPR MoM was predictive for CAPO and OD for IFC in obese women without additional risk factors. However, the overall predictive performance of CPR for CAPO in obese women was poor.
... Here, the additional effect of gestational weight gain in women who are overweight or obese before pregnancy was also small. However, the children of underweight mothers, as well as for overweight and obese mothers, are also at risk of adverse outcomes [4][5][6][7][8][9]. The prevalence of maternal underweight in industrialized countries is lower compared to maternal overweight, which can range from 4% to 12% depending on the reported classification of being underweight [2,[9][10][11]. ...
Intrauterine growth restriction leads to an altered lipid and amino acid profile in the cord blood at the end of pregnancy. Pre-pregnancy underweight is an early risk factor for impaired fetal growth. The aim of this study was to investigate whether a pre-pregnancy body mass index (ppBMI) of <18.5 kg/m2, as early as at the beginning of pregnancy, is associated with changes in the umbilical cord metabolome. In a sample of the Survey of Neonates in Pomerania (SNIP) birth cohort, the cord blood metabolome of n = 240 newborns of mothers with a ppBMI of <18.5 kg/m2 with n = 208 controls (ppBMI of 18.5–24.9 kg/m2) was measured by NMR spectrometry. A maternal ppBMI of <18.5 kg/m2 was associated with increased concentrations of HDL4 cholesterol, HDL4 phospholipids, VLDL5 cholesterol, HDL 2, and HDL4 Apo-A1, as well as decreased VLDL triglycerides and HDL2 free cholesterol. A ppBMI of <18.5 kg/m2 combined with poor intrauterine growth (a gestational weight gain (GWG) < 25th percentile) was associated with decreased concentrations of total cholesterol; cholesterol transporting lipoproteins (LDL4, LDL6, LDL free cholesterol, and HDL2 free cholesterol); LDL4 Apo-B; total Apo-A2; and HDL3 Apo-A2. In conclusion, maternal underweight at the beginning of pregnancy already results in metabolic changes in the lipid profile in the cord blood, but the pattern changes when poor GWG is followed by pre-pregnancy underweight.
... According to Roach et al. [18], every additional fetus elevates the risk for GDM by 1.8 times. Additionally, obesity significantly increases the risk for gestational diabetes in both singleton and twin pregnancies [1,8,15,16,19,20], possibly due to an increased weight gain with twins and higher blood pressures both before and during pregnancy [15]. Consistent with these studies, data of this analysis also showed a significant association between GDM and overweight or obesity, with increasing odds ratios with each obesity level. ...
The prevalence of overweight and obese people worldwide has dramatically increased in the last decades and is yet to peak. At the same time and partly due to obesity and associated assisted reproduction, twinning rates showed a clear rise in the last years. Adverse fetomaternal outcomes are known to occur in singleton and twin pregnancies in overweight and obese women. However, the impact of the obesity levels as defined by the World Health Organization on the outcomes of twin pregnancies has not been thoroughly studied. Therefore, the purpose of this study is to examine how maternal overweight, and the level of obesity affect fetomaternal outcomes in twin pregnancies, hypothesizing a higher likelihood for adverse outcomes with overweight and each obesity level. This is a retrospective cohort study with 2,349 twin pregnancies that delivered at the Buergerhospital Frankfurt, Germany between 2005 and 2020. The mothers were divided into exposure groups depending on their pre-gestational body mass index; these were normal weight (reference group), overweight and obesity levels I, II, and III. A multivariate logistic regression analysis was performed to assess the influence of overweight and obesity on gestational diabetes mellitus, preeclampsia, postpartum hemorrhage, intrauterine fetal death, and a five-minutes Apgar score below seven. The adjusted odds ratio for gestational diabetes compared to normal weight mothers were 1.47, 2.79, 4.05, and 6.40 for overweight and obesity levels I, II and III respectively (p = 0.015 for overweight and p < 0.001 for each obesity level). Maternal BMI had a significant association with the risk of preeclampsia (OR 1.04, p = 0.028). Overweight and obesity did not affect the odds of postpartum hemorrhage, fetal demise, or a low Apgar score. While maternal overweight and obesity did not influence the fetal outcomes in twin pregnancies, they significantly increased the risk of gestational diabetes and preeclampsia, and that risk is incremental with increasing level of obesity.
... Jaiotza-pisu handiko haurrek arrisku handiagoa dute fetuaren heriotza, garaiz aurreko erditzea eta zesarea bidezko erditzea izateko [31]; gainera, arrisku handiagoa dute helduaroan obesitatea eta bestelako gaixotasun kronikoak garatzeko, 2. motako diabetesa, hipertentsioa, gaixotasun kardiobaskularrak eta minbizia barne [18]. Kontrara, jaiotza-pisu txikiko haurren heriotza-arriskua handiagoa da ohiko tamaina duen haur batekin alderatuta, eta arrisku handiagoa dute ere arnas arazoak, ikterizia eta jaioberriaren sepsia garatzeko [32]. ...
Haziera-aroan eta helduaroan obesitatea sufritzeko arriskua areagotzearekin erlazionatuta dauden faktoreen artean, umeen jaiotza-tamaina dugu. Era berean, umeen jaiotza-tamainan eragina dute gurasoen zenbait ezaugarri antropometrikok. Lan honen helburua da, gurasoen morfologia eta adipositateak seme-alaben jaiotza-pisuarekiko eta jaiotza-luzerarekiko duen erlazioa analizatzea Bilboaldeko familiez osatutako lagin batean. Aztertutako lagina, 391 amei eta 274 aitei dagokien bi datu-basetan oinarritzen da, non amen analisirako, 404 seme eta 368 alabaren jaiotza-datuak jaso diren, eta aiten analisian, 280 seme eta 252 alabenak. Haurren jaiotzaren ezaugarriekin loturiko aldagaiak, jaiotza-pisua eta jaiotza-luzera, indize ponderala, haurdunaldi-adina eta jaiotza-ordena dira. Gurasoen ezaugarri antropometrikoak dira, luzera bertikalak, zabalerak, zirkunferentziak, larruazalpeko tolesturak, pisua, gorputz-masaren indizea, gerri-aldaka indizea, gorputz-adar eta enborreko larruazalpeko tolesturen arteko lotura, larruazalpeko tolesturen batuketa eta antropometria-somatotipoaren osagaiak. Asoziazioen azterketarako, koaldagai ezberdinetara doitutako erregresio linealen analisiak erabili dira. Gurasoen zenbait ezaugarri antropometrikok, batez ere amen kasuan, asoziazio positiboa erakusten dute seme-alaben jaiotza-pisuarekin eta, hezur substratua oinarritzat duten gurasoen ezaugarri antropometrikoek ere lotura positiboa erakusten dute haurren jaiotza-luzerarekin. Seme-alaben sexua eta gurasoen adina, jaiotza-ordena eta haurdunaldi-adina ez du ematen gurasoen ezaugarri antropometrikoen eta seme-alaben jaiotza-tamainaren arteko asoziazioaren kausa nagusia direnik aztertutako laginean. Laburbilduz, ikerketa honetan behatutako asoziazioek gurasoen ezaugarri antropometriko batzuek seme-alaben jaiotza-tamainan eragina dutelaren ideia indartzen dute eta, beraz, osasun publiko ondorio garrantzitsuak izan ditzakete obesitatearen prebentzioan.
... In fact, an increased BMI was found as a risk factor for fetal macrosomia. However, obese women have a lower risk of low birth weight confirmed by other authors (32). On the other hand, obesity appears to increase rates of admission to neonatal intensive care units, and this may be a result of lower Apgar scores among newborns of overweight and obese women (33). ...
Background: Obesity is becoming a real challenge for public health among pregnant women. This study aimed to identify sociodemographic and lifestyle risk factors and outcomes linked to maternal obesity and overweight. Methods: A cross-sectional study was carried out from Nov 2021 to Dec 2022 in the maternity health facility of Mohammed VI Hospital, as well as in one of the main health centers with a delivery unit in Marrakech, Morocco. Parturients were divided into four categories according to their pre pregnancy BMI: underweight, normal weight, overweight and obese. We used the chi-square test (χ²) to analyze the sociodemographic and lifestyle factors associated with maternal obesity and overweight. The same tool was utilized to explore maternal and neonatal complications. Results: Overall, 400 parturient women with singleton pregnancies were included in the study. The prevalence of overweight and obesity was 29.8% and 31.5% respectively. Maternal age, type of housing, practicing sports, feelings about pregnancy were correlated with an increased risk of maternal obesity and being overweight. The risks of gestational diabetes, hypertension, anemia, cesarean delivery, and fetal macrosomia were higher among overweight and obese women compared to normal weight ones. The differences were significant (P<0.05). Conclusion: Maternal overweight and obesity are strongly linked with socio-economic, lifestyle, and psychological factors which can lead to serious complications for both mother and baby. Further research is needed to develop appropriate preventive measures and interventions for maternal obesity and overweight.
... [68] The increased LOS results in a higher cost of healthcare due to extra monitoring and specialised care needed to reduce the overall risk of maternal and neonatal deaths. [69,70] Our findings show that low BMI and obesity synergistically influence the proportion of institutional births in public health facilities. We observe a significant negative association (β = -0.61) between the interaction term and the % of institutional births in public health facilities. ...
A BSTRACT
Background
Institutional births ensure deliveries happen under the supervision of skilled healthcare personnel in an enabling environment. For countries like India, with high neonatal and maternal mortalities, achieving 100% coverage of institutional births is a top policy priority. In this respect, public health institutions have a key role, given that they remain the preferred choice by most of the population, owing to the existing barriers to healthcare access. While research in this domain has focused on private health institutions, there are limited studies, especially in the Indian context, that look at the enablers of institutional births in public health facilities. In this study, we look to identify the significant predictors of institutional birth in public health facilities in India.
Method
We rely on the National Family Health Survey (NFHS-5) factsheet data for analysis. Our dependent variable (DV) in this study is the % of institutional births in public health facilities. We first use Welch’s t -test to determine if there is any significant difference between urban and rural areas in terms of the DV. We then use multiple linear regression and partial F-test to identify the best-fit model that predicts the variation in the DV. We generate two models in this study and use Akaike’s Information Criterion (AIC) and adjusted R ² values to identify the best-fit model.
Results
We find no significant difference between urban and rural areas ( P = 0.02, α =0.05) regarding the mean % of institutional births in public health facilities. The best-fit model is an interaction model with a moderate effect size (Adjusted R2 = 0.35) and an AIC of 179.93, lower than the competitive model (AIC = 183.56). We find household health insurance (β = -0.29) and homebirth conducted under the supervision of skilled healthcare personnel (β = -0.56) to be significant predictors of institutional births in public facilities in India. Additionally, we observe low body mass index (BMI) and obesity to have a synergistic impact on the DV. Our findings show that the interaction between low BMI and obesity has a strong negative influence (β = -0.61) on institutional births in public health facilities in India.
Conclusion
Providing households with health insurance coverage may not improve the utilisation of public health facilities for deliveries in India, where other barriers to public healthcare access exist. Therefore, it is important to look at interventions that minimise the existing barriers to access. While the ultimate objective from a policy perspective should be achieving 100% coverage of institutional births in the long run, a short-term strategy makes sense in the Indian context, especially to manage the complications arising during births outside an institutional setting.
... In fact, an increased BMI was found as a risk factor for fetal macrosomia. However, obese women have a lower risk of low birth weight confirmed by other authors (32). On the other hand, obesity appears to increase rates of admission to neonatal intensive care units, and this may be a result of lower Apgar scores among newborns of overweight and obese women (33). ...
... These pregnancy complications may share underlying causes, as formulated in the concepts of great obstetrical syndromes 14,15,33 or ischemic placental disease. 16 Predisposing conditions for pregnancy complications 18 and obesity, 37 and any of which may contribute to a dysfunctional placenta as well as to CVD. 18,38 Women who have a pregnancy with 1 type of complication are at increased risk of a different complication in future pregnancies, which also points to shared underlying causes. 19,[39][40][41][42][43][44][45] These shared pathways contribute to the connections between pregnancy complications and CVD. ...
Background
Individual pregnancy complications are associated with increased maternal risk of cardiovascular disease. We assessed the link between a woman's total pregnancy history at 40 years of age and her relative risk of dying from atherosclerotic cardiovascular disease (ASCVD).
Methods and Results
This population‐based prospective study combined several Norwegian registries covering the period 1967 to 2020. We identified 854 442 women born after 1944 or registered with a pregnancy in 1967 or later, and surviving to 40 years of age. The main outcome was the time to ASCVD mortality through age 69 years. The exposure was a woman's number of recorded pregnancies (0, 1, 2, 3, or 4) and the number of those with complications (preterm delivery <35 gestational weeks, preeclampsia, placental abruption, perinatal death, and term or near‐term birth weight <2700 g). Cox models provided estimates of hazard ratios across exposure categories. The group with the lowest ASCVD mortality was that with 3 pregnancies and no complications, which served as the reference group. Among women reaching 40 years of age, risk of ASCVD mortality through 69 years of age increased with the number of complicated pregnancies in a strong dose–response fashion, reaching 23‐fold increased risk (95% CI, 10–51) for women with 4 complicated pregnancies. Based on pregnancy history alone, 19% of women at 40 years of age (including nulliparous women) had an increased ASCVD mortality risk in the range of 2.5‐ to 5‐fold.
Conclusions
Pregnancy history at 40 years of age is strongly associated with ASCVD mortality. Further research should explore how much pregnancy history at 40 years of age adds to established cardiovascular disease risk factors in predicting cardiovascular disease mortality.
... The impact of maternal obesity on pregnancy and perinatal outcomes is well-established 7 . There is an increased risk of pregnancy complications, includ-ing gestational diabetes, pre-eclampsia, preterm and post-term birth, cesarean delivery, large or small for gestational age infants, congenital anomalies, and increased perinatal mortality 8,9,10 . Bariatric surgery is an established treatment option for long-term weight loss, with over 50% of all surgeries performed on women of reproductive age 11,12 . ...
Background: Bariatric surgery is performed in obese women of reproductive age to help achieve a healthy prepregnancy weight to reduce the complications associated with obesity in pregnancy. However, these procedures can impact maternal nutrition and gestational weight gain (GWG). This study evaluates the maternal and neonatal outcomes in women with prepregnancy bariatric surgery and determines the impact on GWG. Methods: This study included 24 weeks gestation or more pregnancies, with a maternal BMI at delivery of 30 kg/m2 or more. It was categorized into two groups based on whether they had prepregnancy bariatric surgery (exposed) or not (unexposed). The outcomes included gestational diabetes (GDM), gestational hypertension (GHT), mode of delivery, preterm birth (PTB), GWG, birthweight (BW) and customized BW centiles, low birthweight (LBW), congenital anomalies, and admission to the neonatal intensive unit (NICU). Categorization was also done based on the adequacy of GWG (low, adequate, and excess). Results: A total of 8,323 women were included in the study, 194 of whom had prepregnancy bariatric surgery. After adjusting for confounders, the exposed group had a mean GWG 1.33 kg higher than the unexposed group (95% CI 0.55-2.13, p = 0.001). The exposed group had higher odds of PTB (aOR 1.78, 95% CI 1.16-2.74, p = 0.008), CD (aOR 6.52, 95% CI 4.28-9.93, p < 0.001), LBW in term babies (aOR 2.60, 95% CI 1.34-5.03, p = 0.005), congenital anomalies (aOR 2.64, 95% CI 1.21-5.77, p = 0.015), low APGAR score (aOR 3.75, 95% CI 1.12-12.5, p = 0.032) and 80.4g lesser birthweight (95% CI -153.0, -5.8; p = 0.034). More women in the low GWG category had LBW babies (28.6% versus 6.7% in the high GWG group, p = 0.033), lowest mean BW and median BW centiles (2775 grams versus 3289 grams in the high GWG group, p = 0.004 and 57.5% versus 74.5% in the high GWG group, p = 0.040, respectively). Conclusion: The findings of this study highlight differences in perinatal outcomes such as preterm birth, low birth weight, congenital anomalies, cesarean deliveries, and gestational weight gain between post-bariatric women and controls. These insights can help inform the planning and provision of appropriate maternity care to enhance patient safety and outcomes. The results of this study can also guide the counselling of reproductive age-group women who are planning to undergo bariatric surgery.
... For example, the obesity rate in China was considerably higher in 2017 than in 2007, suggesting that the number of overweight and obese women is increasing, with the prevalence of diabetes also rising (Li et al. 2021). Moreover, women who are overweight, obese, or have GDM are more likely to experience adverse maternal and neonatal outcomes (Cnattingius et al. 1998, Wendland et al. 2012. ...
Objective
This study investigated the relationship between maternal gestational weight gain (GWG) and the risk of adverse pregnancy outcomes in gestational diabetes mellitus (GDM)-negative pregnant women.
Methods
We did a retrospective cohort study between 1 July 2017, and 1 January 2020, at Women’s Hospital, Zhejiang University School of Medicine. Firstly, pregnant women were divided into subgroups according to the entire GWG (inadequate GWG, adequate GWG, and excessive GWG) and GDM status (positive and negative) during pregnancy. Secondly, the whole population of pregnant women with GDM was used as a reference to evaluate the relationship between GWG and adverse pregnancy outcomes in GDM-negative pregnant women. Lastly, subgroup analysis was conducted based on pre-pregnancy body mass index (pp-BMI).
Results
A total of 30,910 pregnant women were analysed. Included pregnancy women were divided into three groups based on GWG: 7569 (24.49%) pregnancy women had inadequate GWG, 13088 (42.34%) had adequate GWG, and 10,253 (33.17%) had excessive GWG. In addition to preterm birth and small for gestational age (SGA), the incidence of macrosomia and large for gestational age (LGA) continues to increase from inadequate GWG to excessive GWG groups. Pregnant women without GDM who have excessive GWG are at higher risk of macrosomia and LGA than pregnant women with GDM. Moreover, this risk increased with increasing pp-BMI. Pregnant women without GDM with inadequate GWG were at risk of preterm birth regardless of pp-BMI. Only those with inadequate GWG and pp-BMI < 18.5 kg/m² had an increased risk of SGA.
Conclusions
In conclusion, inappropriate GWG is strongly associated with adverse pregnancy outcomes, even if they do not have GDM. Therefore, this population should receive attention and management before and during pregnancy.
Impact Statement
What is already known on this subject? Several studies have focused on the GDM population and the risk of adverse pregnancy outcomes, but few have focused on GDM-negative populations. This is because GDM-negative women are perceived to be "safe," leading to less focus on themselves, which can lead to subsequent excessive weight gain during pregnancy. Whether this factor increases the risk of adverse pregnancy outcomes in this population remains unknown.
What do the results of this study add? Our study found an inverse relationship between GWG and GDM. Therefore, our study focuses on this group of GDM-negative pregnant women. Their excessive weight gain increases the risk of adverse pregnancy outcomes, even higher than GDM pregnant women.
What are the implications of these findings for clinical practice and/or further research? GWG is associated with adverse pregnancy outcomes. Therefore, pregnant women without GDM also need increased attention and management of their weight before and during pregnancy. Prenatal care providers can utilise tools such as diet, exercise counselling, weight tracking, and setting weight gain goals to reduce inappropriate weight gain and mitigate its adverse effects on pregnancy outcomes.
... More of the non-obese mothers delivered per vaginum (60%) than the obese mothers (45%), confirming previous studies that obese women have increased risk of complications during pregnancy and delivery 13,14,[29][30][31] .Obesity showed no significant association with neonatal outcome in our present study. In a similar study, Shroff et al studied midgestation maternal serum leptin levels which were significantly higher in the obese women compared to those with normal BMI but were markedly attenuated after adjustment for prepregnancy BMI 24 . ...
Background: Leptin is produced abundantly in adipose tissue and in human placental trophoblast so serum leptin concentration in BMI matched pregnant women is higher than non-pregnant women. The aim of the study was to compare serum leptin concentration of obese and non-obese pregnant Ghanaian women and to match it with pregnancy outcome.Method: This was a nested case control study, for which 80 antenatal women grouped into obese (cases) and nonobese (control) based on their booking body mass index (non-obese≤29.9kg/m2<obese). The participants had their mid gestation (20-24 weeks) serum stored until delivery and serum leptin concentration of the first 20 cases and 20 controls who delivered at the study site were compared to examine if it had effect on gestational outcome. Correlation between leptin concentration, gestational age at delivery and birth weight were assessed using Spearman’s correlation coefficient.Results: The ages, median (range) 31(20-39) of cases and controls 32 (17-40) were not significantly different. There was no significant difference between the serum leptin concentration of cases 1.9 (0.5-50) ng/ml and controls 1.9 (1.5-50) ng/ml (P>0.05) and these had no correlation with maternal BMI or with baby’s Apgar scores. Our study subsequently, found no correlation between maternal mid-gestational leptin concentration and gestational age at delivery, as well as with birth weight of neonates.Conclusion: Mid-gestational leptin concentration did not correlate with BMI in pregnant Ghanaian women and our study failed to find correlation between midgestational leptin concentration and gestational age at delivery.
... Further, the literature also points towards the maternal and neonatal complications arising from low BMI and obesity, increasing hospital length of stay (LOS) [58]. The increased LOS results in a higher cost of healthcare due to extra monitoring and specialized care needed to reduce the overall risk of maternal and neonatal deaths [59,60]. ...
Institutional births ensure deliveries happen under the supervision of skilled healthcare personnel in an enabling environment. For countries like India, with high neonatal and maternal mortalities, achieving 100% coverage of institutional births is a top policy priority. In this respect, public health institutions have a key role, given that they remain the preferred choice by most of the population, owing to the existing barriers to healthcare access. While research in this domain has focused on private health institutions, there are limited studies, especially in the Indian context, that look at the enablers of institutional births in public health facilities. In this study, we look to identify the significant predictors of institutional birth in public health facilities in India.
... The most significant risks are seen in high BMI nulliparous mothers, in whom the risk for neonatal deaths is more than doubled. 34,35 These risks are independent of structural defects or diabetes. Though preeclampsia was noted to be more common in women that experienced IUFD, even when preeclampsia was excluded, the risk of IUFD was documented to be increased in the obese women. ...
Over the previous three decades, the prevalence and growth of overweight and obese status has risen relentlessly in both the general population and pregnant women. This rise is seen in both higher pre-pregnancy body mass index measurements along with excessive weight gain during pregnancy. Maternal obesity has been shown to exacerbate co-morbidities such as insulin resistance, pregnancy induced hypertension, and infectious states in parturient mothers. These changes have been shown to subsequently increase rates of fetal anomalies and affect fetal growth, as well as various aspects of the delivery such as rates of instrumented vaginal deliveries and an increase in delivery by cesarean section. Maternal obesity increases fetal birth weight, influences the delivery room resuscitation of the neonate by increasing the need for respiratory support, and increases the risk of neonatal hypoxic ischemic encephalopathy. This review also looks at recent studies revealing the strong association between maternal and offspring obesity and other long-term neurodevelopmental outcomes of offspring.
... Maternal weight gain is one of the risk factors associated with adverse pregnancy outcomes for both mother and child [15][16][17] . There are some estimated thresholds for the trend of weight gain in pregnant women for healthier pregnancy period. ...
Class membership is a critical issue in health data sciences. Different types of statistical models have been widely applied to identify participants within a population with heterogeneous longitudinal trajectories. This study aims to identify latent longitudinal trajectories of maternal weight associated with adverse pregnancy outcomes using smoothing mixture model (SMM). Data were collected from the Khuzestan Vitamin D Deficiency Screening Program in Pregnancy. We applied the data of 877 pregnant women living in Shooshtar city, whose weights during the nine months of pregnancy were available. In the first step, maternal weight was classified and participants were assigned to only one group for which the estimated trajectory is the most similar to the observed one using SMM; then, we examined the associations of identified trajectories with risk of adverse pregnancy endpoints by applying logistic regression. Three latent trajectories for maternal weight during pregnancy were identified and named as low, medium and high weight trajectories. Crude estimated odds ratio (OR) for icterus, preterm delivery, NICU admission and composite neonatal events shows significantly higher risks in trajectory 1 (low weight) compared to trajectory 2 (medium weight) by 69% (OR = 1.69, 95%CI 1.20, 2.39), 82% (OR = 1.82, 95%CI 1.14, 2.87), 77% (OR = 1.77, 95%CI 1.17, 2.43), and 85% (OR = 1.85, 95%CI 1.38, 2.76), respectively. Latent class trajectories of maternal weights can be accurately estimated using SMM. It is a powerful means for researchers to appropriately assign individuals to their class. The U-shaped curve of association between maternal weight gain and risk of maternal complications reveals that the optimum place for pregnant women could be in the middle of the growth curve to minimize the risks. Low maternal weight trajectory compared to high had even a significantly higher hazard for some neonatal adverse events. Therefore, appropriate weight gain is critical for pregnant women.
Trial registration International Standard Randomized Controlled Trial Number (ISRCTN): 2014102519660N1; http://www.irct.ir/searchresult.php?keyword=&id=19660&number=1&prt=7805&total=10&m=1 (Archived by WebCite at http://www.webcitation.org/6p3lkqFdV).
... An enormous improvement in antenatal recommendations has resulted from a better understanding of the intricate relationships between the mother and fetus. To achieve healthy pregnancy outcomes, the Institute of Medicine (IOM) established guidelines regarding weight gain during pregnancy based on pre-pregnancy BMI [6,7] . Fewer studies have been conducted on the Asian population than have been conducted in the Western countries. ...
... This finding is consistent with the results of several previous studies that have reported that vaginal delivery is the most common mode of delivery in obese women. 15,16 LSCS was the second most common mode of delivery in the present study, accounting for 32.3% of patients. This is a higher rate than that reported in previous studies, which have reported rates of LSCS ranging from 10% to 30% in obese women. ...
Background: The increasing prevalence of obesity among women of childbearing age is a significant concern as it poses additional risks for both the mother and baby. This study aims to investigate the maternal and neonatal outcomes in pregnant women with obesity (BMI > 30) at a tertiary hospital to improve management strategies for this patient population. Methods: This study was a prospective observational study conducted at LD Hospital, Department of Obstetrics and Gynaecology, GMC Srinagar. The study included pregnant women with gestational age more than 28 weeks, BMI more than 30, delivering at the study hospital, and willing to participate. Detailed history and examination were performed, and data were documented. The women were followed up to delivery and postpartum until discharge, and their outcomes were studied. Data were collected using Microsoft Excel, and statistical analysis was performed using descriptive statistics. Results: Of the 130 patients, the majority were between 20-25 years of age, primi gravida, and had a BMI between 30-34.9 kg/m2. Gestational age ranged from 32-34 weeks to over 37 weeks. The most common event was preterm labor, affecting 19.2% of patients, followed by PPH, affecting 6.9% of patients. The least common event was eclampsia, affecting only 1.5% of patients. the majority of neonates had a weight in the range of 2.5-2.9 Kg, accounting for 65.4% of neonates. Only a small proportion of neonates had a birth weight less than 2.5 Kg (5.4%). The Apgar score, which measures the health of a newborn immediately after the birth, was less than 7 for 5.4% of neonates, while 94.6% of neonates had an Apgar score greater than or equal to 7. Conclusion: The study results emphasize the need for appropriate management strategies for obese pregnant women to reduce adverse outcomes. Early identification, close monitoring, and tailored interventions are crucial to reduce the risks associated with maternal obesity. Keywords: obese pregnant women, BMI >30kg/m2, gestational hypertension, preeclampsia, gestational diabetes mellitus
... 178 In addition, higher prepregnancy weights have been shown to increase the risk of late fetal deaths. 179 Obesity during pregnancy is associated with increased morbidity for both the mother and the child. A tenfold increase in the prevalence of hypertension and a 10 percent incidence of gestational diabetes have been reported in obese pregnant women. ...
Background:
Obesity is a public health issue worldwide. Conversational agents (CAs), also frequently called chatbots, are computer programs that simulate dialogue between people. Owing to better accessibility, cost-effectiveness, personalization, and compassionate patient-centered treatments, CAs are expected to have the potential to provide sustainable lifestyle counseling for weight management.
Objective:
This systematic review aimed to critically summarize and evaluate clinical studies on the effectiveness and feasibility of CAs with unconstrained natural language input for weight management.
Methods:
PubMed, Embase, the Cochrane Library (CENTRAL), PsycINFO, and ACM Digital Library were searched up to December 2022. Studies were included if CAs were used for weight management and had a capability for unconstrained natural language input. No restrictions were imposed on study design, language, or publication type. The quality of the included studies was assessed using the Cochrane risk-of-bias assessment tool or the Critical Appraisal Skills Programme checklist. The extracted data from the included studies were tabulated and narratively summarized as substantial heterogeneity was expected.
Results:
In total, 8 studies met the eligibility criteria: 3 (38%) randomized controlled trials and 5 (62%) uncontrolled before-and-after studies. The CAs in the included studies were aimed at behavior changes through education, advice on food choices, or counseling via psychological approaches. Of the included studies, only 38% (3/8) reported a substantial weight loss outcome (1.3-2.4 kg decrease at 12-15 weeks of CA use). The overall quality of the included studies was judged as low.
Conclusions:
The findings of this systematic review suggest that CAs with unconstrained natural language input can be used as a feasible interpersonal weight management intervention by promoting engagement in psychiatric intervention-based conversations simulating treatments by health care professionals, but currently there is a paucity of evidence. Well-designed rigorous randomized controlled trials with larger sample sizes, longer treatment duration, and follow-up focusing on CAs' acceptability, efficacy, and safety are warranted.
... 3 Obesity is linked to 2-4 times more chance of preeclampsia in different communities and is the most common identified attributable risk factor for this disorder. [4][5][6][7][8] Preeclampsia can cause growth restriction of fetus and prematurity. 9,10 The mortality rate is five times more for babies born to preeclamptic mothers than babies born to healthy mothers. ...
Background: Preeclampsia is a pregnancy-related condition characterized by new-onset hypertension and proteinuria. Preeclampsia is responsible for 20% to 80% of mortality among pregnant in developing countries. Preeclampsia may cause prematurity and fetal growth restriction. It is the most serious complication affecting 2-8% of all pregnancies. The mortality and morbidity rates among the babies of pre-eclampsia mothers is five times higher than that among babies born to healthy mothers. Objective: To find the association between pre-pregnancy Body Mass Index (BMI) and gestational weight gain with incidence of pre-eclampsia. Methods: Cross sectional Observational study was conducted among 140 cases. The study was conducted after obtaining approval from the ethics committee. Results: In this study, in 27.9% of cases overweight, and in 12.1% of cases obesity were seen. In 60.7% of cases severe preeclampsia, and 39.3% of cases mild preeclampsia was reported. Preeclampsia had no significant association with age, marital life, parity, but had a significant association with liquor, birth weight, and NICU admission. Conclusions: Pre pregnancy weight and Gestational weight gain were associated with high risk of preeclampsia.
... Maternal obesity before pregnancy is positively associated with increased risk of developing serious complications related to pregnancy and childbirth (1,2) as well as an increased risk of infant and child obesity (3). In addition to pre-pregnancy weight, excessive gestational weight gain (GWG) is also directly associated with increased risk of high birthweight (4) and subsequent obesity during childhood and adulthood (5)(6)(7). ...
Objective
To examine the association of gestational weight gain (GWG) among women with pre-pregnancy overweight or obesity with infant weight and BMI z-score at birth.
Methods
This study is a secondary analysis of a randomized controlled trial including data from 208 infants at birth born by mothers with pre-pregnancy BMI between 28 and 45 kg/m ² who completed the APPROACH study (randomized to a high-protein low-glycemic index diet or a moderate-protein moderate-glycemic index diet). This analysis pooled the two diet treatment groups together and data were analyzed using a linear mixed model.
Results
Limiting GWG by 1 kg was associated with lower birthweight (−16 g, P = 0.003), BMI z-score (−0.03SD, P = 0.019), weight z-score (−0.03SD, P = 0.004), and infant abdominal circumference (−0.06 cm, P = 0.039). Infants born by mothers whose GWG was ≤9 kg weighed less (122 g, 95% CI: 6–249, P = 0.040), had similar BMI z-score (0.2SD, 95% CI: −0.06 to 0.55, P = 0.120), and lower incidence of emergency cesarean deliveries (11.5% vs. 23.1%, P = 0.044) compared to infants born by mothers whose GWG was >9 kg. When women were classified into GWG quartiles, women in Q1 (GWG range: −7.0 to 3.2 kg) gave birth to smaller infants (3,420 g, P = 0.015) with lower BMI z-score (−0.5SD, P = 0.041) than women in Q2 (3.3–7.1 kg), Q3 (7.2–10.9 kg) and Q4 (11.1–30.2 kg).
Conclusions
Limiting GWG among women with pre-pregnancy overweight or obesity was associated with lower infant weight, BMI z-score, weight z-score, and abdominal circumference at birth. Moreover, GWG below the Institute of Medicine guideline of a maximum of 9 kg was associated with lower birthweight and fewer emergency cesarean deliveries.
It is widely recognized that weight at birth is an important indicator of fetal and neonatal health for both individuals and populations. Birth weight in particular is strongly associated with fetal, neonatal, and postneonatal mortality; infant and childhood morbidity; and long-term growth and development (1,2). According to the World Bank/World Health Organization (WHO) study of the global burden of disease, low birth weight (LBW) and other perinatal causes are a leading cause of death and disability (3). Of the 2.44 million global deaths resulting from perinatal causes, 97% occur in developing country settings. Thus LBW and perinatal mortality are public health problems of crucial importance in such settings.
Objective
To examine the effect of underweight maternal body mass index (BMI) on pregnancy complications and neonatal outcomes.
Design
Cohort study.
Setting
Tertiary academic center.
Patients
A total of 16,361 mothers who delivered a singleton between 2015-2021 with either a BMI <18.5kg/m2 (n=732) or normal BMI (18.5> BMI <23 or 25 kg/m2, n=15,629) at the initial prenatal visit or within six months of the initial visit.
Main Outcome Measures
Birthweight, gestational age, neonatal intensive care unit admission, preterm birth, and fetal death; obstetrical complications including pre-eclampsia/eclampsia, premature rupture of membranes, preterm premature rupture of membranes, and post-partum hemorrhage.
Results
Underweight women were younger and less likely to have private insurance (p<0.01 for both) than normal-weight women. Approximately 23% of infants born to underweight mothers were small for gestational age (SGA) and 15% were low birthweight versus 13.5% and 9% of infants of normal-weight mothers, respectively (p<0.01 for both). These differences remained significant after adjusting for potential confounders. In adjusted logistic regression models, underweight women had a decreased risk of premature rupture of membranes and post-partum hemorrhage compared to normal-weight women.
Conclusions
Underweight BMI during pregnancy is associated with an increased risk of small for gestational age and low birth weight infants and a decreased risk of premature rupture of membranes and post-partum hemorrhage. These findings suggest underweight BMI during pregnancy increases the risk of adverse neonatal outcomes, while maternal-related pregnancy outcomes are less affected.
Pregnant women with obesity are at greater risk of complications during pregnancy, peripartum and post-partum, compared to women with healthy BMI. Worldwide data demonstrating the changes in trends of maternal overweight and obesity prevalence informs service development to address maternal obesity, while directing resources to areas of greatest need. This systematic review and meta-analysis of population level data sought to evaluate global temporal changes in prevalence of maternal obesity and overweight/obesity, and compare trends between regions. Pooled prevalence of obesity and overweight/obesity was estimated using random effects meta-analysis. Temporal and geographical trends in prevalence of obesity and overweight/obesity were examined using linear regression. From 11,684 publications, 94 met inclusion criteria representing 121 study cohorts (Europe n = 71; North America n = 23; Australia/Oceania n = 10; Asia n = 5; South America n = 12), totalling 49,009,168 pregnancies. No studies from Africa met the inclusion criteria. Eighty studies (85.1%) were evaluated as having a low risk of bias and 14 studies (14.9%) moderate. In the most recent full decade (2010-2019), global prevalence of maternal obesity was estimated as 16.3% (95% confidence interval (CI): 15.1-17.5%), or approximately one in six pregnancies. Combined overweight/obesity in pregnancy had a pooled prevalence of 43.8% (95%CI: 42.2-45.4%), approaching half of all pregnancies. In each continent, an upward trend similar to the global trend was observed. North America demonstrated the highest prevalence (obesity: 18.7% (95%CI: 15.0-23.2%)); overweight/obesity: 47.0% (95%CI: 45.7-48.3%)) and Asia demonstrated the lowest prevalence (obesity: 10.8% (95%CI: 7.0-16.5%)); overweight/obesity: 28.5% (95%CI: 18.3-41.5%)). Both maternal obesity and combined overweight/obesity prevalence increased annually by 0.34% and 0.64% (p < 0.001), respectively. Our linear regression model estimates current global prevalence of maternal obesity as 20.9% (95%CI 18.6-23.1%) and projects that this will increase to 23.3% (95%CI 20.3-26.2%) by 2030. Globally, maternal obesity and overweight/obesity prevalence is high and increasing, but varies greatly between regions, being highest in North America and lower in Asia. Maternity services across the globe should be adequately resourced to cope with the complexity of needs of pregnant women living with obesity. Future public health interventions should focus on reversing the high prevalence of maternal obesity observed across the globe. The availability of population-level data and research varies between regions, with more data required to understand the needs of maternal populations in the continents of Africa and Asia. Globally, there is a need for improved harmonisation and publication of data for monitoring and improvement of maternal inequalities.
Background: Maternal obesity is associ- ated with stillbirth, but uncertainty per- sists around the effects of higher obesity classes. We sought to compare the risk of stillbirth associated with maternal obesity alone versus maternal obesity and additional or undiagnosed factors contributing to high-risk pregnancy.
Methods: We conducted a retrospective cohort study using the Better Outcomes Registry and Network (BORN) for single- ton hospital births in Ontario between 2012 and 2018. We used multivariable Cox proportional hazard regression and logistic regression to evaluate the rela- tionship between prepregnancy mater- nal body mass index (BMI) class and stillbirth (reference was normal BMI).
We treated maternal characteristics and obstetrical complications as independ- ent covariates. We performed mediator analyses to measure the direct and indirect effects of BMI on stillbirth through major common-pathway com- plications. We used fully adjusted and partially adjusted models, representing the impact of maternal obesity alone and maternal obesity with other risk factors on stillbirth, respectively.
Results: We analyzed data on 681 178 births between 2012 and 2018, of which 1956 were stillbirths. Class I obesity was associated with an increased incidence of stillbirth (adjusted hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.35–1.78). This
association was stronger for class III obesity (adjusted HR 1.80, 95% CI 1.44–2.24), and strongest for class II obesity (adjusted HR 2.17, 95% CI 1.83–2.57). Plotting point estimates for odds ratios, stratified by gestational age, showed a marked increase in the relative odds for stillbirth beyond 37 weeks’ gestation for those with obesity with and without other risk factors, compared with those with nor- mal BMI. The impact of potential medi- ators was minimal.
Interpretation: Maternal obesity alone and obesity with other risk factors are associated with an increased risk of still- birth. This risk increases with gesta- tional age, especially at term.
We investigated the association between maternal grandmaternal early pregnancy body mass index (BMI) and grandoffspring stillbirth risk in a Swedish population-based three-generation cohort of 176,908 grandmothers (F0), 197,579 mothers (F1), and 316,459 grandoffspring (F2) born 1997-2016. There were 998 stillbirths (risk, 3.2 per 1000 births). Compared with grandmaternal BMI 18.5-24.9, adjusted relative risks [RR (95% CI)] of grandoffspring stillbirth for BMI 25.0-29.9 and ≥30 were, respectively, 1.41 (1.15, 1.72) and 1.62 (1.14, 2.30). RR (95% CI) for corresponding maternal (F1) BMI categories were, respectively, 1.32 (1.06, 1.65) and 1.77 (1.39, 2.25). Maternal BMI mediated only 19% of this relation. Grandmaternal preeclampsia and maternal small-for-gestational age (SGA) birth were related to increased F2 stillbirth risk but did not mediate the association between grandmaternal BMI and grandoffspring stillbirth risk. To explore whether this association was explained by factors shared within families, we studied the relation of maternal full sisters’ BMI and stillbirth risk in 101,368 pregnancies. Stillbirth RR (95% CI) for full sisters’ BMI 25.0-29.9 and ≥30 compared with 18.5-24.9 were, respectively, 0.76 (0.51, 1.13) and 0.88 (0.55, 1.40). In conclusion, grandmaternal overweight and obesity are associated with grandoffspring stillbirth. This association is not fully explained by shared familial factors.
La vigilancia epidemiológica de la mujer gestante plantea interrogantes morales que merecen una cuidadosa evaluación para proponer un modelo ético de relación asistencial con equidad, autonomía, y responsabilidad. En la mujer gestante, su autonomía está limitada por la responsabilidad moral que conllevan las decisiones que tome sobre la vida y potencialidad del crecimiento fetal; y en el equipo de salud, por la equidad, neutralidad y efectividad en las respuestas ante las alteraciones en la evolución de la gestación y la presencia de factores de riesgo en la gestante. Aunque según el principio de autonomía de la disciplina de la Bioética "Todo ser humano de edad adulta y juicio sano tiene derecho a determinar lo que debe hacerse con su propio cuerpo " en el caso de la gestante, ni ella ni el equipo de salud, pueden ignorar los efectos negativos del ejercicio de ese derecho sobre la nueva vida que se gesta.
Importance:
Average gestational weight gain (GWG) increased during the COVID-19 pandemic, but it is not known whether this trend has continued.
Objective:
To examine patterns of GWG during the COVID-19 pandemic by delivery and conception timing through the second year of the pandemic.
Design, setting, and participants:
This cohort study is a retrospective review of birth certificate and delivery records from 2019 to 2022. Electronic health records were from the largest delivery hospital in Louisiana. Participants included all individuals giving birth from March 2019 to March 2022. Data analysis was performed from October 2022 to July 2023.
Exposure:
Delivery date (cross-sectionally) and conception before the pandemic (March 2019 to March 2020) and during the peak pandemic (March 2020 to March 2021) and late pandemic (March 2021 to March 2022).
Main outcomes and measures:
The primary outcome was GWG (total GWG and adherence to the 2009 Institute of Medicine recommendations) analyzed using linear and log-linear regression with control for covariates.
Results:
Among 23 012 total deliveries (8763 Black individuals [38.1%]; 11 774 White individuals [51.2%]; mean [SD] maternal age, 28.9 [5.6] years), 3182 individuals (42.0%) exceeded the recommended weight gain in the year proceeding the pandemic, 3400 (45.4%) exceeded recommendations during the peak pandemic, and 3273 (44.0%) exceeded recommendations in the late pandemic. Compared with those who delivered before the pandemic (reference), participants had higher total GWG if they delivered peak or late pandemic (adjusted β [SE], 0.38 [0.12] kg vs 0.19 [0.12] kg; P = .007). When cohorts were defined by conception date, participants who conceived before the pandemic but delivered after the pandemic started had higher GWG compared with those whose entire pregnancy occurred before the pandemic (adjusted β [SE], 0.51 [0.16] kg). GWG was lower in the pregnancies conceived after the pandemic started and the late pandemic (adjusted β [SE], 0.29 [0.12] kg vs 0.003 [0.14] kg; P = .003) but these participants began pregnancy at a slightly higher weight. Examining mean GWG month by month suggested a small decrease for March 2020, followed by increased mean GWG for the following year. Individuals with 2 pregnancies (1289 individuals) were less likely to gain weight above the recommended guidelines compared with their prepandemic pregnancy, but this association was attenuated after adjustment.
Conclusions and relevance:
In this cohort, individuals with critical time points of their pregnancy during the COVID-19 pandemic gained more weight compared with the previous year. The increased GWG leveled off as the pandemic progressed but individuals were slightly heavier beginning pregnancy.
Background
Gestational weight gain (GWG) is a risk factor for adverse pregnancy outcomes, future obesity and chronic diseases among women. However, has not received much attention in many low and middle-income countries such as Nigeria. We investigated the pattern, associated factors and pregnancy outcomes of GWG in Ibadan, Nigeria, using the Ibadan Pregnancy Cohort Study (IbPCS).
Methodology
The IbPCS is a multicentre prospective cohort study conducted among 1745 pregnant women recruited from four health facilities in Ibadan, Nigeria. GWG, the primary outcome, was categorised according to the Institute of Medicine’s classification into insufficient, adequate and excessive weight gain. Pregnancy outcomes were the secondary outcome variables. Logistic regression analysis (Adjusted odds ratios and 95% confidence interval CI) was used to examine associations, and Poisson regression analyses were used to investigate associations with outcomes.
Results
Only 16.9% of women had optimal GWG, 56.8% had excessive GWG, and 26.9% had insufficient GWG. Excessive GWG was associated with high income ’> #20,000-’ (AOR: 1.64, 95% CI: 1.25–2.17), being overweight (AOR: 2.12, 95% CI: 1.52–2.95) and obese (AOR: 1.47, 95% CI: 1.02–2.13) after adjusting for confounders. In contrast, increased odds of insufficient GWG have associated women with depression (AOR: 1.70, 95% CI 1.17–2.47). There was no significant association between inappropriate GWG and pregnancy outcomes However, there was an increased odds for postpartum haemorrhage (AOR: 2.44, 95% CI 1.14–5.22) among women with obesity and excessive GWG.
Conclusions
Excessive GWG was the most typical form of GWG among our study participants and was associated with high maternal income, and being overweight or obese. GWG needs to be monitored during antenatal care, and interventions that promote appropriate GWG should be implemented among pregnant women in Nigeria.
Background and objectives:The prevalence of maternal obesity has increased in recent years. This study aimed to assess the impact of mothers being of an average weight versus obese ones regarding pregnancy outcomes and to evaluate the association between the body-mass index and the modality of delivery. Methods:A retrospective study was carried out at Erbil Maternity Teaching Hospital from March-2018 to March-2019. Three hundred and twenty-six (n=326) pregnant women were included and divided into two groups. Group one (171) women with a healthy body mass index (18.5-24.9 kg/m2) and group two (155) women with body mass index (>30 kg/m2). We compared the two groups for maternal and neonatal outcomes of pregnancy. Results: A total of 155 women were obese. More than half (57.9%) of the normal-weight women had attended the antenatal care clinics, compared with (45.2%) of the obese group. Gravidity, parity, as well as the number of abortions, were significantly higher in Group II. The average gestation- al age of women in the normal-weight group was 38.83 weeks, which was more significant in comparison with obese women. On the other hand, the weight of the neonates of the obese group was 3.82 Kg, which was significantly higher than in neonates (3.49 Kg) of controls. Further, the head circumference of the neonates of the obese group (35.92 cm) was considerably higher. Conclusions: Obesity carries significant risks to maternal and fetal health. Effective public, as well as primary healthcare strategies, are mandatory to prevent and manage this dilemma at early stages.
Intrauterine fetal death (IUFD) is one of the adverse outcomes of pregnancy that can occur at any trimester. There are annually 2.6 million late stillbirths worldwide. Race, pregnancy at an advanced age or adolescent pregnancies, parity, multiple gestations, previous adverse pregnancy outcomes and previous stillbirth, postterm pregnancy and obesity are the main risk factors for fetal loss. Potential causes for IUFDs can be divided into four groups: (1) Maternal diseases, (2) Pathologies related to the fetus, (3) Placental and Umbilical Cord abnormalities, and (4) Infections. Macroscopic and histopathological examination of the fetus, placenta, umbilical cord and membranes, genetic evaluation and fetal autopsy are the essential components of the evaluation. The most valuable step for the determination of the cause is the evaluation of the placenta. The risk of coagulopathies increases if the onset of labor lasts longer than 4 weeks after IUFD. Dilatation and evacuation (D&E) or induction of labor are the two delivery methods. The choice between them depends on the experience of the clinician, the week of pregnancy, whether the autopsy is planned, and the patient decision. Infections, postpartum hemorrhage, genital tract lacerations, uterine rupture retained placenta and disseminated intravascular coagulopathy (DIC) are the most common complications of stillbirths. Currently, the Covid-19 outbreak caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which affects the whole world, is also being evaluated for adverse outcomes in pregnancy. Analyses point out that there may be an association with Covid-19 and IUFDs. Increasingly high-quality evidence will shed light on the management of pregnancy with Covid-19.KeywordsIntrauterine fetal deathIUFDStillbirthFetal lossCovid-19SARS-CoV-2
Background:
Appropriate growth charts are essential for fetal surveillance, to confirm that growth is proceeding normally and to identify pregnancies that are at risk. Many stillbirths are avoidable through antenatal detection of the small for gestational age fetus. In the absence of an international consensus on which growth chart to use, it is essential that clinical practice reflects outcome based evidence.
Objective:
We investigated the performance of four internationally used fetal weight standards and their ability to identify stillbirth risk in different ethnic and maternal size groups of a heterogeneous population.
Study design:
We analysed routinely-collected maternity data from over 2.2 million pregnancies. Three population based fetal weight standards (Hadlock, Intergrowth-21st (IG21) and World Health Organisation (WHO)) were compared with the customized Gestation Related Optimal Weight (GROW) standard adjusted for maternal height, weight, parity and ethnic origin. Small for gestational age (SGA) birthweight and stillbirth risk were determined for the two largest ethnic groups in our population (British-European and South Asian), in 5 body mass index (BMI) categories as well as 4 maternal size groups with normal BMI (18.5-25.0). Differences in trend between stillbirth and SGA rates were assessed by Clogg's Z test, and between stillbirths and BMI groups by Chi-square trend test.
Results:
Stillbirth rates (per 1000) were higher in South Asian (5.51) than British-European pregnancies (3.89; p<0.01) and increased in both groups with rising BMI (p<0.01). SGA rates were two to three-fold higher for South Asian compared to British-European babies according to population-average standards (Hadlock: 26.2 vs 12.2%; IG21: 12.1 vs 4.9%; WHO: 32.2 vs 16.0%) but were similar by customized GROW standard (14.0 vs 13.6%). Despite the wide variation, each standard's SGA cases had increased stillbirth risk compared to cases not SGA, with the height of risk inversely proportional to the rate of cases defined as SGA. All standards had similar stillbirth risk when the SGA rate was fixed at 10% by varying their respective thresholds for defining SGA. When analysed across BMI subgroups, SGA rate according to GROW followed the rise in stillbirth rate, while SGA rates according to Hadlock, IG21 and WHO fetal weight standards declined with increasing BMI, showing a difference in trend (p<0.01) to stillbirth rates across BMI groups. In the normal BMI subgroup, stillbirth rates showed little variation across maternal size groups; this trend was followed by GROW based SGA rates, while SGA defined by each population-average standard declined with increasing maternal size.
Conclusion:
Comparisons between population-average and customized fetal growth charts require examination of how well each standard identifies pregnancies at risk of adverse outcome within subgroups of any heterogeneous population. In both ethnic groups studied, rising maternal BMI was accompanied by increasing stillbirth risk, and this trend was reflected in more pregnancies being identified as SGA only by the customized standard. In contrast, SGA rates fell according to each population-average standard, thereby hiding the increased stillbirth risk associated with high maternal BMI.
To examine trends in overweight prevalence and body mass index of the US adult population.
Nationally representative cross-sectional surveys with an in-person interview and a medical examination, including measurement of height and weight.
Between 6000 and 13,000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 to 1962 (the first National Health Examination Survey [NHES I]), 1971 to 1974 (the first National Health and Nutrition Examination Survey [NHANES I]), 1976 to 1980 (NHANES II), and 1988 to 1991 (NHANES III phase 1).
In the period 1988 to 1991, 33.4% of US adults 20 years of age or older were estimated to be overweight. Comparisons of the 1988 to 1991 overweight prevalence estimates with data from earlier surveys indicate dramatic increases in all race/sex groups. Overweight prevalence increased 8% between the 1976 to 1980 and 1988 to 1991 surveys. During this period, for adult men and women aged 20 through 74 years, mean body mass index increased from 25.3 to 26.3; mean body weight increased 3.6 kg.
These nationally representative data document a substantial increase in overweight among US adults and support the findings of other investigations that show notable increases in overweight during the past decade. These observations suggest that the Healthy People 2000 objective of reducing the prevalence of overweight US adults to no more than 20% may not be met by the year 2000. Understanding the reasons underlying the increase in the prevalence of overweight in the United States and elucidating the potential consequences in terms of morbidity and mortality present a challenge to our understanding of the etiology, treatment, and prevention of overweight.
This study determined the relationship of maternal weight gain in pregnancy to its outcome. Mothers who were overweight at the start of pregnancy had the fewest fetal and neonatal deaths with a 16 pound weight gain at term. The optimal weight gain for normally proportioned mothers was 20 pounds and for underweight mothers 30 pounds. For all three groups perinatal mortality rates increased with weight gains less or more than these optimal values. Very low or very high pregnancy weight gains had only a modest influence on the frequency of common placental and fetal disorders. However, once one of these disorders was established, mortality rates from it usually increased severalfold when mothers had very low or very high weight gains. (AM. J. OBSTET. GYNECOL. 135:3, 1979.)
Objective.
—To determine, in a multivariate analysis, risk factors for preeclampsia that could be observed early in pregnancy and to establish whether these risk factors are different for nulliparas and multiparas.Design.
—A case-control study of preeclampsia.Setting.
—Women who gave birth at Northern California Kaiser Permanente Medical Centers in 1984 and 1985.Participants.
—Preeclamptic cases (n =139) were determined from discharge diagnosis of severe preeclampsia and by confirmation of blood pressures and proteinuria from medical records. Controls (n = 132) were randomly selected women who had no discharge diagnosis of any hypertensive disorder of pregnancy and who had no evidence of hypertension or proteinuria from medical record review.Main Variables Examined.
—Medical records were abstracted for information regarding maternal age, race, previous pregnancy history, family medical history, socioeconomic status, employment during pregnancy, body mass, and smoking and alcohol consumption.Results.
—Multiple logistic regression analyses confirmed that case patients were more likely than control patients to be nulliparous (adjusted odds ratio [OR], 5.4; 95% confidence interval [CI], 2.8 to 10.3) and that preeclampsia in a previous pregnancy greatly increased the risk in a subsequent one (adjusted OR, 10.8; 95% CI, 1.2 to 29.1). However, regardless of parity, preeclamptic women were also more likely to be of high body mass (adjusted OR, 2.7; 95% CI, 1.2 to 6.2), to work during pregnancy (adjusted OR, 2.1; 95% CI, 1.1 to 4.4), and to have a family history of hypertension (adjusted OR, 1.7; 95% CI, 0.92 to 3.2). Having a previous history of a spontaneous abortion was protective but only in multiparous women (adjusted OR for multiparas, 0.09; 95% CI, 0.02 to 0.48). In contrast, being black was a significant risk for preeclampsia but only in nulliparous women (adjusted OR for nulliparas, 12.3; 95% CI, 1.6 to 100.8).Conclusions.
—There are a number of risk factors for preeclampsia that may be determined early in a woman's pregnancy. Multiparas and nulliparas share certain risk factors but not others. A cohort investigation is needed to determine the ability of these risk factors to predict who develops preeclampsia.(JAMA. 1991;266:237-241)
This study determined the relationship of maternal weight gain in pregnancy to its outcome. Mothers who were overweight at the start of pregnancy had the fewest fetal and neonatal deaths with a 16 pound weight gain at term. The optimal weight gain for normally proportioned mothers was 20 pounds and for underweight mothers 30 pounds. For all three groups perinatal mortality rates increased with weight gains less or more than these optimal values. Very low or very high pregnancy weight gains had only a modest influence on the frequency of common placental and fetal disorders. However, once one of these disorders was established, mortality rates from it usually increased severalfold when mothers had very low or very high weight gains.
To identify components of smoking-related increased perinatal mortality, detailed analyses of data from the Ontario Perinatal Mortality Study (50,000 births, 1,300 deaths, 1960–1961) measured the relationship of maternal smoking .to birth weight, gestation, placental complications, and perinatal mortality. Cross-tabulations with other factors and multiple adjustment showed increases with amount smoked of birth weights <2500 gm, gestations <38 weeks, placenta previa, abruptio placentae, and perinatal mortality. These significant, smoking-related increases were independent of mother's height, weight, hospital status, age-parity group, birthplace, previous pregnancy history, weight gain, time of registration, and sex of child.
Maternal smoking had the strongest effect on birthweight in the 8 factor regression, and births <2500 gm increased directly with smoking level from 20% to 340% in 37 data subgroups. Births <38 weeks increased 20% and 50% and perinatal mortality increased 20% and 36% for <1 pack and 1 + pack smokers, respectively, adjusted for 7 other factors. Placental complications increased consistently with smoking level in all of 37 subgroups except for primiparous < 1 pack smokers. Adjusted rates increased 25% and 92% for placenta previa, 23% and 86% for abruptions among smokers of < 1 pack and 1 + packs, respectively. These complications carry high perinatal mortality risk, and account for one-third to one-half of the perinatal deaths attributable to maternal smoking.
Previous studies suggesting that maternal undernutrition increases the risk of preterm birth have suffered from several methodological shortcomings, including use of total gestational weight gain rather than net rate of gain in maternal tissue, inclusion of induced preterm deliveries, and error-prone gestational age measurements based solely on menstrual dates. The authors have attempted to overcome these shortcomings by investigating the potential etiologic roles of prepregnancy body mass index, net rate of maternal weight gain, height, and a number of other potential biological and sociodemographic determinants of spontaneous (i.e., noninduced) preterm birth in a cohort of 13,102 women with early ultrasound-confirmed gestational age who delivered at the Royal Victoria Hospital in Montreal, Quebec, Canada, between January 1, 1980 and March 31, 1989. Total weight gain, but not body mass index, was highly significantly associated with spontaneous preterm birth, averaging 14.6, 12.5, 9.9, and 9.1 kg, in women delivering at 37 or more, less than 37, less than 34, and less than 32 completed weeks, respectively. Although the relation persisted when weight gain was expressed as an overall rate, it disappeared when the analysis was based on net rate; mean net rates of gain were 0.28, 0.29, 0.27, and 0.27 kg/week, respectively. On the basis of multiple logistic regression analyses, significant determinants of birth at less than 37 weeks included maternal short stature; noncompletion of high school; unmarried status; smoking; diabetes; urinary tract infection within 2 weeks of delivery; prepregnancy hypertension; severe pregnancy-induced hypertension; and previous history of preterm delivery, low birth weight, or neonatal death. Most of these factors retained their significance for birth at less than 34 and less than 32 weeks. In fact, the effect of low maternal education was even stronger at these more severe "levels" of preterm birth. The authors conclude that prepregnancy weight-for-height and gestational weight gain are not important determinants of spontaneous preterm birth and that some previous studies have mistaken an effect of shortened gestation for its cause. Other biologic and social determinants, however, indicate priorities for future research and intervention.
This study was undertaken to determine the influences of increased maternal prepregnancy weight and increased gestational weight gain on pregnancy outcome.
This was a longitudinal retrospective study of 7407 term pregnancies delivered from 1987 through 1989. After excluding cases with multiple fetuses, stillbirths, fetal anomalies, no prenatal care, selected medical and surgical complications, and those with incomplete medical records, 3191 cases remained for analyses by determination of odds ratios for obstetric outcomes, by chi 2 tests for significant differences and by adjustment for risk factors with stepwise logistic regression.
Both increased maternal prepregnancy weight (body mass index) and increased maternal gestational weight gain were associated with increased risks of fetal macrosomia (p less than 0.0001), labor abnormalities (p less than 0.0001), postdatism (p = 0.002), meconium staining (p less than 0.001), and unscheduled cesarean sections (p less than 0.0001). They were also associated with decreased frequencies of low birth weight (p less than 0.001). The magnitude of the last was less than that of the other outcomes.
Increased maternal weight gain in pregnancy results in higher frequencies of fetal macrosomia, which in turn lead to increased rates of cesarean section and other major maternal and fetal complications. Because these costs of increased maternal weight gain appear to outweigh benefits, weight gain recommendations for pregnancy warrant careful review.
In 1985 and 1988 as part of the WHO's MONICA project two surveys of cardiovascular risk factors were conducted in the population aged 25 to 64 years and resident in the six districts of the Czech Republic collaborating in MONICA. Over a period of three years, the prevalence of smoking decreased from 46% to 41.8% (p less than 0.05) in men. Daily cigarette consumption declined from 17.9 to 15.1 (p less than 0.001) in men and from 11.1 to 10.1 (p less than 0.05) in women. Despite the unchanged prevalence of hypertension during the three years' period the proportion of population with elevated BP levels declined from 22.25% to 19.1% in men (p less than 0.05), and from 16.8% to 14.0% (p less than 0.05) in women as a result of better hypertension control. The prevalence of obesity in men rose from 18.5% to 23.9% (p less than 0.001). The proportion of individuals with a total cholesterol level over 5.2 mmol/l rose from 78.0% to 83.1% (p less than 0.001) in men and from 75.9% to 80.6% in women (p less than 0.01). The changes were favourable only in those risk factors that were actively influenced by the preventive programmes "A Chance for Three Million" in smoking habits, and the "National Programme of Hypertension Control". The authors believe that consistent nationwide preventive programmes might exert a beneficial effect on the profile of risk factors of the whole Czech population.
To describe maternal body mass index and to compare the use of maternal weight and body mass index for risk assessment at the initial prenatal visit, 6270 gravid women who were consecutively delivered of infants were studied. Body mass index increased with advancing maternal age, parity, and advancing gestational age and was significantly greater in black women than in nonblack women. Risks for the development of adverse outcome associated with maternal obesity, including development of gestational diabetes, preeclampsia, fetal macrosomia, and shoulder dystocia, were comparably predicted by either maternal weight or body mass index greater than 90th percentile. Maternal weight was as predictive of preeclampsia, macrosomia, and shoulder dystocia as was body mass index when these factors were analyzed as continuous variables, whereas increasing body mass index was more predictive of gestational diabetes. The prediction of factors associated with low maternal weights, small-for-gestational-age birth, prematurity, low birth weight, and perinatal death was equivalent for maternal weight and body mass index that was less than 10th percentile. This study indicates that in the initial risk assessment of outcomes related to maternal weight, the calculation of maternal body mass index offers no advantage over simply weighing the patient. This finding contrasts with results in nonpregnant women.
A causal connection between maternal nutrient intake and birth outcome is not universally accepted. In this paper further empirical support is provided, particularly in relation to the impact of maternal nutrition around the time of conception or very early in pregnancy. It is argued that the hypothesis that maternal nutrition has no connection with birthweight is very easily refuted.
It is suggested that there should be a new category of recommended dietary allowances; “women in anticipation of pregnancy”. The diet of 513 pregnant London women were recorded for 7 days during the first trimester of their pregnancy. Birthweight and nutrient intakes were found to be significantly correlated but only over the lower half of the birthweight range. The optimum birthweight range with the lowest perinatal and infant mortalities is 3,500–4,500 g and it is suggested that the nutrient intake of the 165 women who had babies in this optimum weight range provide tentative values for nutrient intake recommendations in anticipation of pregnancy, but are not claimed to be representative. The need for adjustments of recommendations for the individual, for example for a low body mass index, is discussed. A body mass index of 24 kg/m ² is recommended based on the median of the 165 women.
--To determine, in a multivariate analysis, risk factors for preeclampsia that could be observed early in pregnancy and to establish whether these risk factors are different for nulliparas and multiparas.
--A case-control study of preeclampsia.
--Women who gave birth at Northern California Kaiser Permanente Medical Centers in 1984 and 1985.
--Preeclamptic cases (n = 139) were determined from discharge diagnosis of severe preeclampsia and by confirmation of blood pressures and proteinuria from medical records. Controls (n = 132) were randomly selected women who had no discharge diagnosis of any hypertensive disorder of pregnancy and who had no evidence of hypertension or proteinuria from medical record review. MAIN VARIABLES EXAMINED:--Medical records were abstracted for information regarding maternal age, race, previous pregnancy history, family medical history, socioeconomic status, employment during pregnancy, body mass, and smoking and alcohol consumption.
--Multiple logistic regression analyses confirmed that case patients were more likely than control patients to be nulliparous (adjusted odds ratio [OR], 5.4; 95% confidence interval [Cl], 2.8 to 10.3) and that preeclampsia in a previous pregnancy greatly increased the risk in a subsequent one (adjusted OR, 10.8; 95% Cl, 1.2 to 29.1). However, regardless of parity, preeclamptic women were also more likely to be of high body mass (adjusted OR, 1.7; 95% Cl, 1.2 to 6.2), to work during pregnancy (adjusted OR, 2.1; 95% Cl, 1.1 to 4.4), and to have a family history of hypertension (adjusted OR, 1.7; 95% Cl, 0.92 to 3.2). Having a previous history of a spontaneous abortion was protective but only in multiparous women (adjusted OR for multiparas, 0.09; 95% Cl, 0.02 to 0.48). In contrast, being black was a significant risk for preeclampsia but only in nulliparous women (adjusted OR for nulliparas, 12.3; 95% Cl, 1.6 to 100.8).
--There are a number of risk factors for preeclampsia that may be determined early in a woman's pregnancy. Multiparas and nulliparas share certain risk factors but not others. A cohort investigation is needed to determine the ability of these risk factors to predict who develops preeclampsia.
Pregnancies that produced 56,857 children were analyzed to evaluate the relationship of the mothers' relative pregravid body weight to pregnancy outcome. Perinatal mortality rates progressively increased from 37 of 1000 in offspring of thin subjects to 121 of 1000 in the offspring of obese subjects (p less than 0.001). Nearly half of this mortality increase was due to preterm deliveries, particularly before 31 wk of gestation. More than half of the increase in preterm births was caused by acute chorioamnionitis. Other factors that made major contributions to the overall mortality increase were rises in the frequencies of older gravidas (ages 35-50 y), gravidas who had diabetes mellitus, children who had major congenital malformations, and dizygous twins.
The relationship of antenatal weight gain to pregnancy outcome was studied in 362 pairs of underweight women (less than 90% Metropolitan Relative Weight) and normal weight (90% to 110%) women who were matched for age, occupation, height, parity, race, and smoking habits. The mothers, selected from a study of pregnancy outcome in 1,080 middle-class women, had early and regular prenatal care. Regression analyses within each initial weight category revealed that there was no relationship between initial weight of mothers and birth weight of their infants, but birth weight increased significantly with antenatal weight gain (p less than .0001). A 1-kg maternal increase in weight was associated with a 12.85-gm increase in birth weight in offspring of underweight women and an 8.59-gm increase in offspring of normal weight women. Underweight women had significantly larger prenatal weight gains (9.3 vs. 8.5 kg), but there were no statistically significant differences in mean birth weight, gestational age, or Apgar scores between infants of women in the two weight groups. Very underweight women (less than 80% MRW) had lower-birth-weight infants, more preterm infants, and more infants with medical complications. Antenatal weight gain accounted for the greatest variation in birth weight among infants of underweight and normal weight women. When underweight mothers gained less than 9 kg, their infants had mean birth weights 361 gm less than the mean birth weights of infants of underweight women who gained more weight.
To investigate the effect of maternal fatness on the mortality of infants born preterm up to the corrected age of 18 months 795 mother-infant pairs were studied. Maternal fatness was defined by Quetelet's index (weight/(height] and all infants weighed less than 1850 g at birth. In 771 mother-infant pairs maternal age, complications of pregnancy, mode of delivery, parity, social class, and the baby's sex and gestation were analysed by a logistic regression model for associations with infant mortality (but deaths from severe congenital abnormalities and those occurring during the first 48 hours after birth were excluded). In a subgroup of 284 mother-infant pairs all infant deaths except those from severe congenital abnormalities were analysed in association with the infant's birth weight and gestation and the mother's height and weight; this second analysis included another 24 infants who had died within 48 hours after birth. In the first analysis mortality overall was 7% (55/771), rising from 4% (71/173) in thin mothers (Quetelet's index less than 20) to 15% (6/40) in mothers with grades II and III obesity (Quetelet's index greater than 30). After adjusting for major demographic and antenatal factors, including serious complications of pregnancy, maternal fatness was second in importance only to length of gestation in predicting death of infants born preterm. In the second analysis mortality overall was 15% (44/284), rising from 9% (5/53) in thin mothers to 47% (8/17) in mothers with grades II and III obesity. In both analyses the relative risk of death by 18 months post-term was nearly four times greater in infants born to obese mothers than in those born to thin mothers. In addition, maternal fatness was associated with reduced birth weight, whereas it is associated with macrosomia in term infants. These data differ fundamentally from those reported in full term babies of obese mothers. It is speculated that the altered metabolic milieu in obesity may reduce the ability of the fetus to adapt to extrauterine life if it is born preterm.
It is generally recognized that low birth weight can be caused by many factors. Because many questions remain, however, about which factors exert independent causal effects, as well as magnitude of these effects, a critical assessment and meta-analysis of the English and French language medical literature published from 1970 to 1984 were carried out. The assessment was restricted to singleton pregnacies of women who lived at sea level and who had no chronic illnesses. Extremely rare factors were also excluded, as were complications of pregnancy. In this way, 43 potential determinants were identified. A set of a priori methodological standards were established for each potential determinant. Studies that satisfactorily met (SM) or partially met (PM) these standards were used to assess the existence and magnitude of an independent causal effect on birth weight, gestational age, prematurity, and intrauterine growth retardation (IUGR). A total of 921 relevant publications were identified, of whihc 895 were successfully located and reviewed. Factors with well-established direct causal impacts on intrauterine growth include infant sex, racial/ethnic origin, maternal height, pre-pregnancy weight, paternal weight and height, maternal birth weight, parity, history or prior low-birth-weight infants, gestational weight gain and caloric intake, general morbidity and episodic illness, malaria, cigarette smoking, alcohol consumption, and tobacco chewing. In developing countries, the major determinants of IUGR are Black or Indian racial origin, poor gestational nutrition, low pre-pregnancy weight, short maternal stature, and malaria. In developed countries, the most important single factor, by far, is cigarette smoking, followed by poor gestational nutrition and low pre-pregnancy weight. For gestational duration, only pre-pregnancy weight, prior history of premature or spontaneous abortion, in utero exposure to diethylstilbestrol, and cigarette smoking have well-established causal effects, and the majority of prematurity occurring in both developing and developed country settings remains unexplained. Modifiable factors with large effects on intrauterine growth or gestational duration should be targeted for public health intervention in the two settings, with an emphasis on IUGR in developing countries and prematurity in developed countries. Future research should focus on factors of potential quantitative importance for which data are either unavailable or inconclusive. In developing countries, the most important of these for intrauterine growth are caloric expenditure (maternal work), antenatal care, and certain vitamins and trace elements. For prematurity, especially in developed countries, factors deserving further study include genital tract infection, antenatal care, maternal employment and physical activity, and stress and anxiety.
Obesity, the excessive storage of energy in the form of fat, is clearly associated with hypertension, hypercholesterolemia, diabetes (Type II), certain cancers, and other medical problems.
Chesley's classic long-term follow up study of eclamptic women clearly demonstrated the prognostic significance of parity in the differential diagnosis of various hypertensive diseases of pregnancy. Multiparous patients with eclampsia were different on long-term follow-up from primiparous eclamptic women. A logical conclusion from this observation is that multiparous and primiparous patient groups should be analyzed separately whenever hypertensive diseases of pregnancy are evaluated. This study is therefore an attempt to define the clinical profile of hypertension during pregnancy on the basis of parity alone. The prenatal and hospital records of 99 successive pregnant patients identified as hypertensive during a 1-year period at Mount Sinai Hospital Medical Center served as the study population. A group of 25 primiparous and 25 multiparous patients, all with uncomplicated pregnancies and normal deliveries in sequence during a 1-month period, served as normal nonhypertensive control groups. Various pregnancy parameters were statistically evaluated for study and control groups. Significant differences were found between hypertensive primiparous and multiparous patients in mean weight increase (p less than 0.05), gestational age at first increase in blood pressure (p less than 0.007), and time from first increase in blood pressure until delivery (p less than 0.008). The difference in birth weight was not significant between hypertensive groups. In contrast, among the control groups, multiparous patients had significantly larger offspring than primiparous patients (p less than 0.01). Weights of normal primiparous control women were almost identical to those of primiparous hypertensive women (3252.8 +/- 511.8 versus 3203.26 +/- 679.5 gm). Birth weights of offspring from multiparous hypertensive women, while not significantly different from those of primiparous hypertensive women, were significantly lower than those of multiparous control subjects (3093.94 +/- 898.7 versus 3593 +/- 305.6; p less than 0.01). No significant differences in a variety of laboratory findings, reflexes, edema, or mode of delivery were observed between the various groups. The clinical and laboratory presentation of hypertension in pregnancy may be similar between primiparous and multiparous patients. Nevertheless, clear differences do exist in both maternal presentation and impact of maternal disease on fetal growth and development. These differences strongly suggest a different pathophysiology as the underlying cause of hypertensive disease in primiparous and multiparous pregnant women.(ABSTRACT TRUNCATED AT 400 WORDS)
Between 1963 and 1969, the ‘Institut National de la Santé et de la Recherche Médicale’ carried out a prospective survey comprising 20,000 pregnancies, in 12 obstetric departments of public hospitals in Paris. A preliminary analysis has been done on 9,500 cases.
For these cases, the authors have studied some maternal characteristics known since the beginning of the pregnancy, and even before, and have examined how low birthweight and prematurity were distributed according to these variables. Separately, these characteristics are not predictive enough to isolate a group of high risk women. With a function calculated by a multiple regression with the whole set of the characteristics, it is possible to improve the prediction of the considered risks, and, at the same time, to point out the most predictive factors of these risks, factors which are different for low birthweight and for prematurity.
The multiple binary regression enables us to classify each woman in a high risk group or in a low risk group for low birth-weight, or prematurity according to the values of risk functions ΥA and ΥB for this woman, nevertheless with many errors of prediction; but this is only a first prediction, possible ‘before’ the beginning of the pregnancy, and has to be corrected and improved during successive examinations, by taking into account risks appearing during the course of the pregnancy.
The relation between body weight and overall mortality remains controversial despite considerable investigation.
We examined the association between body-mass index (defined as the weight in kilograms divided by the square of the height in meters) and both overall mortality and mortality from specific causes in a cohort of 115,195 U.S. women enrolled in the prospective Nurses' Health Study. These women were 30 to 55 years of age and free of known cardiovascular disease and cancer in 1976. During 16 years of follow-up, we documented 4726 deaths, of which 881 were from cardiovascular disease, 2586 from cancer, and 1259 from other causes.
In analyses adjusted only for age, we observed a J-shaped relation between body-mass index and overall mortality. When women who had never smoked were examined separately, no increase in risk was observed among the leaner women, and a more direct relation between weight and mortality emerged (P for trend < 0.001). In multivariate analyses of women who had never smoked and had recently had stable weight, in which the first four years of follow-up were excluded, the relative risks of death from all causes for increasing categories of body-mass index were as follows: body-mass index < 19.0 (the reference category), relative risk = 1.0; 19.0 to 21.9, relative risk = 1.2; 22.0 to 24.9, relative risk = 1.2; 25.0 to 26.9, relative risk = 1.3; 27.0 to 28.9, relative risk = 1.6; 29.0 to 31.9, relative risk = 2.1; and > or = 32.0, relative risk = 2.2 (P for trend < 0.001). Among women with a body-mass index of 32.0 or higher who had never smoked, the relative risk of death from cardiovascular disease was 4.1 (95 percent confidence interval, 2.1 to 7.7), and that of death from cancer was 2.1 (95 percent confidence interval, 1.4 to 3.2), as compared with the risk among women with a body-mass index below 19.0. A weight gain of 10 kg (22 lb) or more since the age of 18 was associated with increased mortality in middle adulthood.
Body weight and mortality from all causes were directly related among these middle-aged women. Lean women did not have excess mortality. The lowest mortality rate was observed among women who weighed at least 15 percent less than the U.S. average for women of similar age and among those whose weight had been stable since early adulthood.
To evaluate the relationship between stillbirth in singleton pregnancy (> or = 28 weeks gestation) and maternal weight (weight gain) from 24 completed weeks.
All fetal deaths (n = 210) at five delivery units during seven years in southern Sweden were analysed. To each case a control mother was selected, the only matching criteria being parity and place of delivery. Regression analysis was used for comparison of body weight gain in cases and controls.
Mothers experiencing stillbirth had a significantly lower mean body weight at 24 weeks gestation than control mothers (63.5 kg vs 67.3 kg; t = 2.4, p < 0.05). No significant difference between cases and controls was found in mean weight gain during pregnancy from 24 completed gestational weeks to delivery, even when the last three measurements before delivery for cases and controls were compared separately.
There is no difference in body weight gain between mothers with stillbirth and mothers giving birth to a live infant.
The effect of maternal build on the outcome of pregnancy was studied in two birth cohorts in Northern Finland, for 1966 and 1985-86. Prospectively collected data were available for 10,969 women in the earlier cohort and 9128 in the later one. The women in the earlier cohort were on average 2.9 cm shorter but 0.2 kg thinner and had 0.7 kg/m2 greater BMI. 13% of the women in the earlier cohort had a BMI below 20, but 24% in the later one, while 96% in both cohorts had BMI below 30. The women with low BMI were on average taller than the others, and at all BMI levels the women of the earlier cohort were shorter and lighter than those of the later one. The outcome of pregnancy was measured by the incidence of pre-term births and perinatal plus childhood deaths up to the age of 4 years, and the association of maternal body measurements with low birth weight (< 2500 g) and small for gestational age (SGA) infants was also studied. An additive logistic regression model was fitted in each analysis, to determine the probability of the outcome separately in terms of BMI, weight and height, adjusting for maternal age, parity, smoking, marital status, father's social class and place of residence. No evidence was found that BMI values 20-25, commonly judged as optimum for the mother's own longevity, predicted a better prognosis for the child than values below 20.(ABSTRACT TRUNCATED AT 250 WORDS)
To identify risk factors associated with severe preeclampsia and to determine whether these factors are similar in nulliparous and multiparous patients.
Patients whose pregnancies were complicated by severe preeclampsia (n = 70) were compared retrospectively to 18,964 non-preeclamptic controls. Information on maternal demographic factors; medical, obstetric, and family histories; and neonatal outcome was retrieved and analyzed by univariate and multivariate analysis.
By logistic regression, the only risk factors associated with the development of severe preeclampsia were severe obesity in all patients (adjusted odds ratio 3.5, 95% confidence interval [CI] 1.68-7.46) and a history of preeclampsia in multiparous patients (adjusted odds ratio 7.2, 95% CI 2.74-18.74).
Severe obesity and a history of preeclampsia are the only maternal risk factors identified for the development of severe preeclampsia.
Infants of women with preeclampsia are considered at high risk of fetal growth retardation. The purpose of our study was to determine whether the risk differed by parity.
We compared the outcomes of 133 case patients with preeclampsia (101 nulliparous women and 32 multiparous women) and 132 normotensive control patients (52 nulliparous women and 80 multiparous women) who delivered at Northern California Kaiser Permanente hospitals between 1984 and 1985.
Women with preeclampsia were more likely than control patients to deliver a small-for-gestational-age infant (adjusted odds ratio 7.0, 95% confidence interval 2.8 to 18.1). After we controlled for smoking status, age, Quetelet index, and race, multiparous women with preeclampsia were at greater risk of having a small-for-gestational-age infant (adjusted odds ratio 29.4, 95% confidence interval 5.2 to 167.5) than were nulliparous women (adjusted odds ratio 4.1, 95% confidence interval 1.2 to 14.1) when compared with normotensive control patients of similar parity. Although multiparous women with preeclampsia had higher mean arterial pressures and somewhat earlier onsets of elevated mean arterial pressure than nulliparous women with preeclampsia, neither of these variables predicted whether the infants would be small for gestational age.
Multiparous women with preeclampsia are at higher risk of having an infant with fetal growth retardation than are nulliparous women with preeclampsia.
Data from married women who participated in the 1980 National Natality Survey and the National Fetal Mortality Survey were used for a case-control study of antepartum and intrapartum stillbirth. Risk factors were identified by comparing antepartum deaths and intrapartum deaths to livebirths in separate logistic regression analyses. Risk of antepartum death was increased among black mothers, those having their first delivery, those aged 35 years or more, and those with less education. Smoking cigarettes was associated with increased risk. For intrapartum deaths, total abstention from alcohol during pregnancy was associated with increased risk in the best-fitting logistic model, as was first delivery. Body mass index was logit-linear in both models, with lower body mass index associated with lower risk. While some of these factors have already been associated with stillbirth, others have not; the new associations may reflect the continuum of loss over the gestational period, bias in the study, or clues to mechanisms by which the risk of death, before or during parturition, is increased.
To assess changes in the body mass index (BMI, weight (kg)/height2 (m2) and in the prevalence of obesity in Swedish men during the 1980s.
Data from two successive cross sectional surveys were used.
The whole of Sweden.
Subjects included in the analyses were 7055 men from a 1980-81 survey (response rate 83.4%) and 6081 men from a 1988-89 survey (response rate 79%). Men were aged 16-84 years and were a representative sample of Swedish males.
The results were based on self reported weight and height obtained during interview. After adjustment for sociodemographic variables, a significant increase in the mean BMI of the entire population of men was found between 1980-81 and 1988-89 (0.23 kg/m2; p < 0.001), with a particularly large increase in the 25-34 year age group (0.45 kg/m2; p < 0.0001) which corresponds to 1.4 kg for a man 180 cm tall). In manual workers this value was 0.25 kg/m2 (p < 0.0005). This increase was also reflected by a significant relative increase in the prevalence of the combination of overweight and obesity (BMI > 25 kg/m2) of about 19% (odds ratio = 1.19, 95% confidence intervals: 1.09, 1.29).
During the 1980s the mean BMI and the prevalence of overweight and obesity among adult Swedish men increased.
To assess changes in the body mass index (BMI, weight (kg)/height2 (m2)) and in the prevalence of obesity in Swedish women during the 1980s.
Data from two successive cross sectional surveys were used.
The whole of Sweden.
A total of 7419 women from a 1980-81 survey (response rate 84.6%) and 6306 women from a 1988-89 survey (response rate 80.3%), aged 16-84 years, and forming a representative sample of Swedish women.
The results were based on self reported weight and height during interview. The mean BMI of the whole population, adjusted for age, education level, socioeconomic group, region, and nationality, increased by 0.17 kg/m2 (p = 0.0056) over the eight year period. The increase was particularly pronounced in the group aged 25-34 years (0.74 kg/m2; p < 0.0001, which corresponds to more than 2 kg for a woman 168 cm tall). The higher mean BMI was also reflected in the relative increase in the prevalence of obesity (BMI > 28.6 kg/m2) by 19% (odds ratio (OR) = 1.19; 95% confidence interval (CI): 1.04, 1.37) and of the combination of overweight and obesity (BMI > 23.8 kg/m2) by 12% (OR = 1.12; 95% CI 1.03, 1.23) in the whole female population.
During the 1980s the mean BMI and the prevalence of overweight and obesity in adult Swedish women increased. An influence of the sociocultural environment on the body weight in women was stronger than that in men.
Available standard intrauterine growth curves based on birthweights underestimate foetal growth in preterm period. New growth curves are presented based on data from four Scandinavian centres for 759 ultrasonically estimated foetal weights in 86 uncomplicated pregnancies. Mean weight of boys exceeded that of girls by 2-3%. A uniform SD value of 12% of the mean weight was adopted for the standard curves as the true SD varied non-systematically between 9.1 and 12.4%. Applied to an unselected population of 8663 singleton births, before 210 days of gestation, 32% of birthweights were classified as small-for-gestational age (SGA; i.e. below mean - 2 SD); the corresponding figures were 11.1% for gestational ages between 210 and 258 days, and 2.6% for ages of 259 days or longer. The new growth curves reveal better the true distribution of SGA foetuses and neonates, and are suggested for use in perinatological practice.
Using data from the Behavioral Risk Factor Surveillance System, this study describes trends in the prevalence of overweight between 1987 and 1993.
Data were examined from 33 states participating in an ongoing telephone survey of health behaviors of adults (n = 387,704). Self-reported weights and heights were used to calculate sex-specific prevalence estimates of overweight for each year from 1987 to 1993. Time trends were evaluated with the use of linear regression.
Between 1987 and 1993, the age-adjusted prevalence of overweight increased by 0.9% per year for both sexes (from 21.9% to 26.7% among men and from 20.6% to 25.4% among women). The increasing linear trend was observed in all subgroups of the population but was most notable for Black men (1.5% per year) and men living in the Northeast (1.4% per year). Secular changes in smoking and leisure-time physical activity did not entirely account for the increase in overweight.
The prevalence of overweight among American adults increased by 5% between 1987 and 1993. Efforts are needed to explore the causes of this adverse trend and to find effective strategies to prevent obesity.
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