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Secular trends in pregnancy weight gain in German women and their influences on foetal outcome: A hospital-based study

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Increasing rates of overweight have been reported. In Germany, women of childbearing age are especially affected. Those women are at increased risks of several peri- and postnatal complications. The purpose of this study was to carry out Germany’s first study in terms of secular trends of overweight and weight gain during pregnancy related to foetal clinical outcomes (birth weight, Apgar score and umbilical blood pH). A database maintained by a large regional university hospital in Cologne, Germany was used to evaluate clinical routine data from 1996 to 2012. 11771 women (23.5 ± 5.4 years; 18–48 years), who gave birth to a live singleton child (>2000 gram) were included. Recommended weight gain during pregnancy was based on IOM guidelines: Total weight gain range for underweight (initial BMI < 18.5 kg/m2) is 12.5 - 18 kg/ 28–40 lbs respectively, for normal-weight (initial BMI 18.5 -24.9 kg/m2) is 11.5 - 16 kg/ 25–35 lbs respectively, for overweight (initial BMI 25.0-29.9 kg/m2) is 7–11.5 kg/ 15–25 lbs respectively and for obese (initial BMI ≥ 30.0 kg/m2) is 5–9 kg/ 11–20 lbs respectively. A one-way variance analysis was employed to test for differences in particular factors in various groups. Multiple linear regression analysis was used to model impact factors. Over the second analysed period (2005–2012), the number of women with high weight gain increased from 33.8% to 42.9% (p <0.001). 54.5% overweight and 57.7% obese women were affected (p <0.001). Women with high weight gain were 54.5% significantly more likely to give birth to an infant ≥ 4000 grams than women with normal (31.7%) or low weight gain (13.8%, p < 0.001). Women with normal weight gain had significantly better foetal outcomes in terms of the Apgar score at 5 min and umbilical cord blood pH. These data confirm an increase in maternal weight gain before and during pregnancy. An excessive weight gain is accompanied by macrosomia, lower Apgar scores and pH-value. Women should therefore be advised about the risks of obesity before and during pregnancy as well as excessive maternal weight gain during pregnancy.
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R E S E A R C H A R T I C L E Open Access
Secular trends in pregnancy weight gain in
German women and their influences on foetal
outcome: a hospital-based study
Nina Ferrari
1*
, Peter Mallmann
2
, Konrad Brockmeier
1,3
, Heiko Klaus Strüder
4
and Christine Graf
1,5
Abstract
Background: Increasing rates of overweight have been reported. In Germany, women of childbearing age are
especially affected. Those women are at increased risks of several peri- and postnatal complications. The purpose of
this study was to carry out Germanys first study in terms of secular trends of overweight and weight gain during
pregnancy related to foetal clinical outcomes (birth weight, Apgar score and umbilical blood pH).
Methods: A database maintained by a large regional university hospital in Cologne, Germany was used to evaluate
clinical routine data from 1996 to 2012. 11771 women (23.5 ± 5.4 years; 1848 years), who gave birth to a live singleton
child (>2000 gram) were included. Recommended weight gain during pregnancy was based on IOM guidelines: Total
weight gain range for underweight (initial BMI < 18.5 kg/m
2
) is 12.5 - 18 kg/ 2840 lbs respectively, for normal-weight
(initial BMI 18.5 -24.9 kg/m
2
) is 11.5 - 16 kg/ 2535 lbs respectively, for overweight (initial BMI 25.0-29.9 kg/m
2
)is
711.5 kg/ 1525 lbs respectively and for obese (initial BMI 30.0 kg/m
2
)is59kg/1120 lbs respectively.
A one-way variance analysis was employed to test for differences in particular factors in various groups. Multiple linear
regression analysis was used to model impact factors.
Results: Over the second analysed period (20052012), the number of women with high weight gain increased from
33.8% to 42.9% (p <0.001). 54.5% overweight and 57.7% obese women were affected (p <0.001). Women with high
weight gain were 54.5% significantly more likely to give birth to an infant 4000 grams than women with normal
(31.7%) or low weight gain (13.8%, p < 0.001). Women with normal weight gain had significantly better foetal
outcomes in terms of the Apgar score at 5 min and umbilical cord blood pH.
Conclusion: These data confirm an increase in maternal weight gain before and during pregnancy. An excessive
weight gain is accompanied by macrosomia, lower Apgar scores and pH-value. Women should therefore be advised
about the risks of obesity before and during pregnancy as well as excessive maternal weight gain during pregnancy.
Keywords: Pregnancy, Gestational weight gain, Birth weight, Apgar, Obesity, Umbilical cord blood pH
Background
Findings from the largest nationally and internationally
representative studies have shown that the number of
overweight and obese adults is increasing [1-3]. Over the
past two decades, in particular, the number of obese
German women in younger age groups (up to 35) has
increased [2]. Currently, 30% of 18 to 29 year old fe-
males show a BMI 25 kg/m
2
, 20.4% of these have been
classified as pre-obese (25 to < 30 kg/m
2
) and 9.6% as
obese (30 kg/m
2
). In the age group, 3039 year olds,
the prevalence reached 38% for overweight (BMI
25 kg/m
2
); 20.1% of these women have been classified as
pre-obese and 17.9% as obese.
Evidence has been presented for links between over-
weight/obesity and a variety of co-morbidities during
pregnancy. Overweight women seem to be twice as likely
and obese women 3.3 times as likely to develop pre-
eclampsia than normal-weight women (BMI < 25.0 kg/m
2
)
[4]. Similarly, the risk of developing gestational diabetes is
increased by 2.4% in overweight women and by 5.2% in
* Correspondence: n.ferrari@dshs-koeln.de
1
Cologne Centre for Prevention in Childhood and Youth/ Heart Centre
Cologne, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne,
Germany
Full list of author information is available at the end of the article
© 2014 Ferrari et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,
unless otherwise stated.
Ferrari et al. BMC Pregnancy and Childbirth 2014, 14:228
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obese women when compared to normal-weight women
[4]. It is particularly noticeable that overweight and obese
women gain much more weight during pregnancy than
normal-weight women [5,6]. Excessive weight gain during
pregnancy is associated with multiple maternal and neo-
natal complications like gestational hypertension, macro-
somia, birth complications, caesarean delivery, stillbirth,
low Apgar score at 5 minutes, hypoglycaemia or cardio-
vascular risk factors [7-11]. Women who gained more
than the recommended amount of weight during preg-
nancy according to [12] were more likely to have offspring
with greater BMI, waist, fat mass, lipid and inflammatory
profiles [11]. In addition, studies have found excessive ma-
ternal weight gain [12] in overweight women to be associ-
ated with a higher percentage of fat mass in their children
compared to children of normal-weight women [13].
Macrosomic new-borns are more at risk of developing
metabolic disorders over the long term [14,15]. Adverse
effects on foetal and neonatal parameters, described in
terms of the Apgar score, are also more likely [16-21]. The
children of overweight or obese women, for instance,
more commonly achieve lower Apgar scores at five mi-
nutes than the children of normal-weight mothers [22,23].
Although the Apgar score is a reasonable parameter to
evaluate the physical condition of new-born infants, it has
some limitations. Therefore, the measurement of umbil-
ical cord blood pH has been adopted as an addition to the
Apgar score for assessing the condition of the new-borns
[24]. A lower Apgar score is associated with lower levels
of umbilical cord pH, especially in morbidly obese women
(BMI >50 kg/m
2
)[25].
The objective of this analysis was therefore to carry
out Germanys first study into the secular trends of over-
weight, obesity and weight gain during pregnancy in re-
lationship to foetal clinical outcomes (birth weight,
Apgar, pH-value). In addition, it aimed to contribute to
the improvement of very early prevention by identifying
groups at risk for excessive weight gain and targeting
them for preventive interventions.
Methods
Cohorts
Routine data from 18976 pregnant women registered at the
Clinic for Gynaecology at the University Hospital of
Cologne between 1996 and the summer of 2012 was retro-
spectively analysed by the Cologne Centre for Prevention in
Childhood and Adolescence at the Heart Centre of the
University Hospital of Cologne. Therefore, the study was
exempt from ethical approval from the Ethics Committee
of the University Hospital of Cologne.
Women who met the following criteria were included in
the studys analysis: women were 1848 years of age when
they gave birth, women possessed a minimum body height
of one meter (3.28 feet), they were not experiencing a
multiple pregnancy, and the childs birth weight was at
least 2000 grams. The study population was limited to
childrens birth weight of at least 2000 grams, as there
were many incomplete and/or implausible datasets in chil-
dren weighing less than 2000 grams. Only data from
20002012 were used, because only this data had all ex-
posure and outcome data available. Therefore, a total of
11771 pregnant women were included in the study. Metric
measures are mainly presented in kilogram, gram and
meter for better reading. Imperial measures are cited in
tables as well.
Pre-pregnancy body weight as well as socioeconomic
data were queried during the routine prenatal care visits
in the Womens Clinic. Anthropometric maternal data
including age, height, pre-pregnancy weight, weight at
the end of pregnancy and the resulting (relative) weight
gain were assessed. BMI was calculated and classified ac-
cording to the reference values issued by the World
Health Organization (WHO); thus, a BMI 25 kg/m
2
was considered overweight and 30 kg/m
2
obese. The
perinatal weight gain was defined as the difference be-
tween the weight before entering pregnancy and the
weight determined just before delivery. The recom-
mended weight gain during pregnancy was based on a
function of the initial BMI (Table 1; [12]).
Biometric data of the new-born (birth weight, umbil-
ical blood pH, Apgar) were measured right after delivery.
The Apgar scores at one and five minutes after birth
serve as a surrogate parameter for the childs health/the
status of the new-born infant [26]. The Apgar score
ranges from 0 to 10 and comprises a series of five indi-
vidual tests performed on the new-borns: heart rate, re-
spiratory effort, muscle tone, reflex irritability and
colour. The umbilical artery blood pH at birth is com-
monly used to measure perinatal asphyxia and its meas-
urement has been used as an adjunct to the Apgar score
for assessing the new-borns condition [27].
This article considers the influence of pre-pregnancy
BMI and maternal (relative) weight gain over the past
12 years on neonatal outcomes including birth weight
(normal-weight 20003999 gram vs. 4000 gram),
Table 1 Weight gain recommendations during pregnancy
according to the Institute of Medicine 2009 [12]
Pre-pregnancy BMI Total weight gain
Range in kg Range in lbs
Underweight (BMI < 18.5 kg/m
2
) 12.5 18 28 - 40
Normal-weight (BMI 18.5 24.9 kg/m
2
) 11.5 16 25 - 35
Overweight (BMI 25.0 29.9 kg/m
2
)711.5 15 - 25
Obese (BMI > 30 kg/m
2
) 5-9 11-20
Source: Institute of Medicine (IOM) 2009; [12].
kg = kilogram; lbs = pounds.
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umbilical blood pH and (low) Apgar scores at one and five
minutes after birth.
Statistical analysis
The statistical analysis of the data set was performed
using the SPSS 21.0 data-analysis software (Statistical
Product and Service Solutions 21.0) for Windows.
Mean values and standard deviations (SD) were calcu-
lated using descriptive statistics for anthropometric
data. The chi-square test was also conducted to deter-
mine the indirect association between two categorical
variables. A one-way analysis of variance (ANOVA) was
employed to test for differences in particular factors in
various groups. A p-value less than 0.05 was considered
to be significant. All confidence intervals (CIs) were es-
timated at the 95% level. Multiple linear regression ana-
lysis was used to model impact factors.
Results
Maternal parameters and general weight gain
Pre-pregnancy maternal anthropometric data is shown
in Table 2.
5.0% of the women (n = 584) were considered under-
weight, 65.8% (n= 7681) normal-weight, 19.1% (n= 2225)
overweight and 10.2% (n = 1188) obese before pregnancy.
Table 3 shows the development of weight gain while tak-
ing the prenatal weight classification into account.
Gestational weight gain averaged 13.3 ± 5.6 kg and,
when the different years were taken into account, it be-
came evident that women gained less weight in 2000
(12.3 kg; 95% Cl: 11.9, 12.7), in 2001 (12.3 kg; 95% Cl:
11.9, 12.6) and in 2002 (12.5 kg; 95% Cl: 12.0, 12.9) than
women in 2010 (13.7 kg; 95%Cl: 13.4, 14.1), 2011 (13.9 kg;
95% Cl: 13.5, 14.2) and 2012 (13.7 kg; 95% Cl: 13.2, 14.2)
(p <0.05).
Relative weight gain
Depending on weight before pregnancy [12], 27.4% of
the women (n = 2514) gained less weight than the rec-
ommended amounts, 36.5% (n = 3347) were within the
range and 36.0% (n = 3303) gained more than the recom-
mended amount (p <0.001; see Figure 1). 54.5% of the
overweight and 57.7% of the obese pregnant women
gained more than the recommended amount, than
underweight and normal-weight women (13.2% and
29.3% respectively).
From 2000 to 2012, the values show a trend towards
excessive weight gain (p <0.001). Especially over the sec-
ond period (2005 to 2012), the number of women who
experienced excessive gestational weight gain increased
markedly from 33.8% to 42.9% (Figure 2).
Birth weight
The new-bornsweight at birth averaged 3280.9 ±
552.4 g. No significant differences in birth weight were
observed during the period from 2000 to 2012.
On average, the children born to underweight women
weighed 3081.8 g (95% Cl: 3037.2, 3126.4), those born to
normal-weight women weighed 3261.0 g (95% Cl: 3248.8,
3273.0), those born to overweight women weighed 3336.0 g
(95% Cl: 3313.2, 3358.9) and those born to obese women
weighed 3382.0 g (95% Cl: 3350.0, 3413.3). A significant dif-
ference between all groups was found (p <0.05) (Figure 3).
Birth weight depending on relative weight gain
At 3412.4 ± 552.8 grams, infants were significantly heavier
from women who had higher weight gain than those who
had normal or low weight gain during pregnancy (each
p <0.001; see Table 4). This finding was confirmed when
birth weights 4000 grams were examined. Women who
gained more than the recommended weight were signifi-
cantly more likely to give birth to an infant 4000 g
Table 2 Pre-pregnancy maternal anthropometric data
N Mean SD Range
Maternal age 11771 32.5 5.4 18.0-48.1
Maternal height in cm (in) 11771 167.2 (65.8) 6.7 (26.4) 108.0-192.0 (42.5-75.6)
Maternal weight in kg (lbs) 11684 66.7 (147.0) 14.3 (31.5) 37.0-174.8 (81.6-385.4)
Maternal BMI
+
11678 24.0 5.0 13.1-86.8
Maternal BMI classification (n;%)
$
: underweight (BMI < 18.5 kg/m
2
) 584 (5.0)
Normal-weight (BMI 18.5 24.9 kg/m
2
) 7681 (65.8)
Overweight (BMI 25.0 29.9 kg/m
2
) 2225 (19.1)
Obese (BMI > 30 kg/m
2
) 1188 (10.2)
Parity 11601 1.7 1.0 0-12
Pre-pregnancy maternal data of women who born a live singleton new-born between 2000 and 2012 at the Clinic for Gynaecology at the University Hospital
of Cologne/Germany.
+
Body Mass Index was calculated as bodyweight (kg) divided by height squared (m
2
);
$
Body Mass Index classification according to WHO guidelines;
cm = centimetre; in = inch; kg = kilogram; lbs = pounds; BMI = Body Mass Index; SD = standard deviation; Range = minimum and maximum.
Ferrari et al. BMC Pregnancy and Childbirth 2014, 14:228 Page 3 of 8
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(54.5%, n = 458) than women who were within (31.7%,
n = 267) or below the recommendations (13.8% n = 116,
p<0.001).
Regression analysis
Multiple linear regression analysis was carried out to ana-
lyse the individual factors that had an impact on the chil-
drens weight at birth. The initial model included parity,
country of origin (Germany or others), maternal age, pre-
pregnancy weight, weight gain, marital status (single,
married, widowed, divorced) as well as the mothersem-
ployment status (employed or unemployed). In the final
model, the variables of weight gain (β-coefficient: 0.228;
p<0.001),parity(β-coefficient: 0.092; p <0.001), maternal
age (β-coefficient: 0.029; p= 0.008), pre-pregnancy weight
(β-coefficient: 0.169; p <0.001), mothers employment
(β-coefficient: 0.063; p <0.001), marital status (β-coeffi-
cient: 0.032; p = 0.002), and country of origin (β-coeffi-
cient: 0.027; p = 0.010) explained 8.4% of the variance.
Foetal parameters
The average Apgar index at one minute after birth was
8.3 ± 1.7 and 9.4 ± 1.3 after five minutes. The average
umbilical blood pH-value was 7.3 ± 0.2. There was a sig-
nificant correlation between Apgar score at one and five
minutes and the pH-value (r = 0.085, p <0.001; r = 0.065,
p <0.001). No differences were found between pH-value
and BMI-classification, whereas there was a significant
difference in weight classes to Apgar values at one and
five minutes after birth between all groups (each p
<0.001). The new-born infants of obese and overweight
women showed significantly lower Apgar values at one
(p <0.001; p = 0.003) and at five minutes (p <0.001; p =
0.020) compared with the children of normal-weight
women (Figure 4).
There was a significant difference between recom-
mended weight gain during pregnancy and Apgar score
at 5 min (p = 0.013 adjusted by mode of delivery and
umbilical cord blood pH) as well as recommended
weight gain during pregnancy and umbilical cord blood
pH (p = 0.036 adjusted by mode of delivery and Apgar
score at 5 min).
Multiple linear regression analysis was used to identify
possible impact factors on the Apgar score at five mi-
nutes. Birth weight, marital status, pre-pregnancy
weight, mothers age, gestational weight gain during
pregnancy, parity, umbilical blood pH and mode of de-
livery were included in the model. In the final model,
the variables of birth weight (β-coefficient: 0.224;
p <0.001), pre-pregnancy weight (β-coefficient: 0.075; p
<0.001), mothersage(β-coefficient: 0.023; p = 0.031), par-
ity (β-coefficient: 0.036; p = 0.001), pH value (β-coeffi-
cient: 0.067; p <0.001), delivery mode vaginal operative
(β-coefficient: 0.099; p <0.001), delivery mode elective
Table 3 Total weight gain during pregnancy (mean) and 95% confidence intervals according to the pre-pregnancy
body mass index
BMI classification
+
n Mean ±SD in kg Mean ±SD in lbs 95% Cl in kg (lbs)
underweight (BMI < 18.5 kg/m
2
) 478 13.6 ± 5.0 30.0 ± 11.0 13.1-14.1 (28.9-31.1)
normal-weight (BMI 18.5 24.9 kg/m
2
) 6058 13.8 ± 5.2 30.4 ± 11.5 13.7-13.9 (30.2-30.6)
overweight (BMI 25.0 29.9 kg/m
2
) 1740 12.6 ± 5.9 27.8 ± 13.0 12.3-12.8 (27.1-28.2)
obese (BMI > 30 kg/m
2
) 917 10.7 ± 6.9 23.6 ± 15.2 10.3-11.0 (22.7-24.3)
+
Body Mass Index classification according to WHO guidelines; BMI = Body Mass Index; SD = standard deviation; kg = kilogram; lbs = pounds; 95% Cl: 95%
confidence intervals in kilogram and (pound).
Figure 1 Weight gain according to IOM guidelines [12] depending on weight classification. *Chi
2
-test.
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caesarean section (β-coefficient: 0.087; p <0.001) and de-
livery mode emergency caesarean section explained 9.0%
of the variance.
Discussion
Excess weight and obesity during pregnancy result in
major adverse effects on both mother and child later in
life [19,28,29]. The Avon Longitudinal Study of Parents
and Children (ALSPAC), for instance, revealed that chil-
dren born to women who experienced excessive gesta-
tional weight gain will be at risk of becoming obese and
suffering elevated blood pressure as well as elevated
blood parameters significantly more often than their
normal weight gain counterparts [11]. The weight gain
during pregnancy was correlated to the baseline BMI of
the mothers [6,9]. Many findings to date have described
possible long-term effects [30,31] but there are relatively
few studies into such short-term effects as congenital
malformations and mortality. The five-minute Apgar
score is used as a potential surrogate parameter for
physical condition, even if it has some limitations [26].
Experts recommend combining the Apgar score with
other more objective neonatal outcomes like umbilical
cord blood pH. No data related to secular trends in
Germany have yet been published. The presented study,
therefore, investigated the data from a regional database
for the Cologne area to establish (relative) weight gain
during pregnancy and possible associations with foetal
parameters (birth weight, Apgar score and umbilical
blood pH). Especially over the second analysed period
(2005 to 2012), the number of women who experienced
excessive gestational weight gain increased markedly
from 33.8% to 42.9%. Predominantly the overweight and
obese women gained more weight than recommended.
DeVader et al. [32] indicated that women experiencing
excessive weight gain during pregnancy but who were
classified as being of normal weight prior to conception
and before putting on too much weight, were at higher
Figure 2 Total weight gain during pregnancy according to IOM guidelines [12] depending on the year. *Chi
2
-test.
Figure 3 Birth weight in gram by pre-pregnancy weight classification. *one-way ANOVA.
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risk of preeclampsia, were more likely to require induced
labour and caesarean delivery, and had a higher ratio of
infants who were large for their gestational age.
In our study, multiple linear regression analysis showed
that weight gain during pregnancy had the highest impact
on birth weight, although the total variance explained only
8.4%. We were able to assess and adjust our results for
confounding bias. We acknowledge that our results may be
influenced by other important confounders, including
gestational age or dietary habits of the women in our study
population.
Nevertheless, in our study, foetal outcomes attributed to
high maternal weight gains are reflected in increased birth
weight, lower Apgar scores at one and five minutes after
birth, and lower umbilical cord blood pH compared with
women who gained weight within the recommended
range. Consistent with our study, Stotland et al. [9] also
provided evidence that underlined a relationship between
excessive weight gain, large size for gestational age, lower
Apgar scores (<7) at five minutes, and lower umbilical
cord blood pH. This may influence the development of in-
fants. Macrosomic new-borns are more likely than other
infants to be obese in childhood, adolescents and early
adulthood [33] and are at risk of cardiovascular and meta-
bolic risk factors later in life [15,34]. In addition, low
Apgar scores and lower umbilical cord blood pH are asso-
ciated with neonatal mortality and morbidity, spasticity
and long term outcomes like cerebral palsy [27,35,36].
Table 4 Mean and 95% confidence intervals (CIs) for birth
weight in gram by total maternal weight gain
Total maternal weight gain n Mean SD 95% Cl
Low weight gain 2514 3107.7 527.4 3086.5 - 3128.9
Normal weight gain 3347 3258.2 541.0 3239.8 3276.5
High weight gain 3303 3412.4 552.8 3394.0 3430.9
+
The recommended weight gain during pregnancy was based on a function of
the initial BMI according to IOM [12]; SD = standard deviation; 95% Cl: 95%
confidence intervals.
Figure 4 Apgar score at 1 and 5 minutes depending on weight classification. a. Apgar score at 1 min: depending on weight classification;
One way Anova p <0.001;
+
Apgar score at 1 min between underweight vs overweight women p = 0.014;
++
Apgar score at 1 min between
underweight vs. obese women p <0.001;
*
Apgar score at 1 min between normal-weight vs overweight women p = 0.003;
**
Apgar score at 1 min
between normal-weight vs. obese women p <0.001. b. Apgar score at 5 min; One way Anova p <0.001
+
Apgar score at 5 min between
underweight vs overweight women p = 0.014;
++
Apgar score at 5 min between underweight vs. obese women p = 0.001;
*
Apgar score at 5 min
between normal-weight vs overweight women p = 0.020;
**
Apgar score at 5 min between normal-weight vs. obese women p <0.001.
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Our data showed, that birth weight had the highest impact
on Apgar score at five minutes, although the total variance
is very small and findings must be interpreted with cau-
tion. Nevertheless, our findings demonstrate that preven-
tion of maternal excessive weight gain is important.
It should be noted that the presented study is limited to
theextentthatitonlyrecordedanthropometricdatabefore
pregnancy; smoking was not recorded as well as gestational
age, and that it only considered a regional situation. It was
possible to adjust our results for some confounding bias,
but not all. Although studies have often reported outcomes
in terms of birth weight, it should be noted that gestational
age has an important impact on foetal parameters. Gesta-
tional age is strongly associated with birth weight [37]. In
addition, the Apgar score at one and five minutes after birth
are directly related to gestational age [38]. Nevertheless,
Kitlinski et al. 2003 [39] found that within the interval of
3741 weeks no association between gestational age and a
low Apgar score was demonstrated, but a statistically sig-
nificant positive association between a gestational age of 41
3/7 weeks or more and Apgar score less than 7 at 5 minutes
was found. Furthermore, the authors demonstrated that the
mean umbilical artery pH decreased with increasing gesta-
tional age. Therefore, a substantial limitation of our retro-
spective study might be that data of gestational age was not
available. Another limitation might be the Apgar score. The
Apgar score, as a relatively subjective parameter, is an ex-
pression of the infantsphysiological condition. Therefore,
we used birth weight and umbilical blood pH as well, to de-
fine foetal outcome and neonatal condition [9,24,27,40].
Conclusion
In conclusion, the presented study demonstrated that the
prevalence of excessive weight gain during pregnancy has
increased markedly in the Cologne area over recent years
and that these results are closely associated with birth
weight, low Apgar score and umbilical blood pH. The main
strengths of the study are its consistent method, dataset
over 12 years, and the size of the examined collective.
Despite the mentioned limitations, our results confirm
the importance and contribute to the improvement of
early preventive measures by identifying women at risk
for excessive weight gain. The prevention of maternal
excessive weight gain is likely to benefit womens health
as well as that of their infants. Women should therefore
be advised about the risks of obesity during pregnancy
prior to conception and should be motivated by gynae-
cologists and midwives to take initial steps to avoid ex-
cessive weight gain during pregnancy.
Abbreviations
ANOVA: Analysis of variance; BMI: Body mass index; HDL: High density lipid;
i.e.: In example; in: Inch; IOM: Institute of Medicine; Lbs: Pound; SD: Standard
deviation; WHO: World Health Organization.
Competing interests
The authors declared that they have no conflict of interests.
Authorscontribution
Study concept: NF, PM, KB, CG; Data collection: PM; Data handling: NF, PM,
CG; Analysis: NF; Interpretation of data: NF, CG; Critical revision of the
manuscript: PM, KB, HKS, CG. All authors read and approved the final
manuscript.
Acknowledgements
We gratefully appreciate the Förderverein des Herzzentrums Köln and the
staff at the Clinic and Polyclinic for Gynaecology and Obstetrics, University
Hospital of Cologne, for their support. We would also like to thank Erica
Wineland-Thomson, Peter Wright, David Gordon Tansey and Christiane Klose
for critically reviewing the manuscript.
Author details
1
Cologne Centre for Prevention in Childhood and Youth/ Heart Centre
Cologne, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne,
Germany.
2
Clinic and Polyclinic for Gynaecology and Obstetrics, University
Hospital of Cologne, Kerpener Str. 34, 50931 Cologne, Germany.
3
Department
of Paediatric Cardiology, Heart Centre Cologne, University Hospital of
Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
4
Institute of Movement
and Neurosciences, Am Sportpark Müngersdorf 6, German Sport University
Cologne, 50933 Cologne, Germany.
5
Department for physical activity in
public health, Institute of Movement and Neurosciences, Am Sportpark
Müngersdorf 6, German Sport University Cologne, 50933 Cologne, Germany.
Received: 13 November 2013 Accepted: 9 July 2014
Published: 15 July 2014
References
1. Kurth BM: Erste Ergebnisse aus der Studie zur Gesundheit Erwachsener
in Deutschland(DEGS). Bundesgesundheitsbl 2012, 55:980990.
2. Mensink GBM, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T,
Scheidt-Nave C: Overweight and Obesity in Germany. Results of the
German Health Interview and Examination Survey for Adults (DEGS1).
Bundesgesundheitsbl 2013, 56:786794.
3. OECD: Health at a Glance. OECD Indicators. Paris: OECD Publishing; 2013.
4. Baeten JM, Bukusi EA, Lambe M: Pregnancy complications and outcome
among overweight and obese nulliparous women. Am J Public Health
2001, 91:436440.
5. Lowell H, Miller DC: Weight gain during pregnancy. Health Rep 2010,
21:3136.
6. Chu SY, Callaghan WM, Bish CL, DAngelo D: Gestational weight gain by
body mass index among US women delivering live birth, 20042005:
fueling future obesity. Am J Obstet Gynecol 2009, 200:271.e1-7.
7. Crane JM, White J, Murphy P, Burrage L, Hutchens D: The effect of
gestational weight gain by body mass index on maternal and neonatal
outcomes. J Obstet Gynaecol Ca 2009, 1:2835.
8. Hedderson MM, Weiss NS, Sacks DA, Pettitt DJ, Selby JV, Quesenberry CP,
Ferrara A: Pregnancy weight gain and risk of neonatal complications:
macrosomia, hypoglycemia and hyperbilirubinemia. Obstet Gynecol 2006,
108:11531161.
9. Stotland NE, Cheng YW, Hopkins L, Caughey AB: Gestational Weight Gain
and Adverse Neonatal Outcome Among Term Infants. Obstet Gynecol
2006, 108:635643.
10. Villamor E, Cnattingius S: Interpregnancy weight change and risk of
adverse pregnancy outcomes: a population-based study. Lancet 2006,
368:11641170.
11. Fraser A, Tilling K, Macdonald-Wallis C, Sattar N, Brion M-J, Benfield L,
Ness A, Deanfield J, Hingorani A, Nelson SM, Smith GD, Lawlor DA: Associ-
ation of maternal weight gain in pregnancy with offspring obesity and
metabolic and vascular traits in childhood. Circulation 2010,
121:25572564.
12. National Research Council: Weight Gain During Pregnancy: Reexamining the
Guidelines. Washington, DC: The National Academies Press; 2009.
13. Hull HR, Thornton JC, Ji Y, Paley C, Rosenn B, Mathews P, Navder K, Yu A,
Dorswy K, Gallegher D: Higher infant body fat with excessive gestational
weight gain in overweight women. Am J Obstet Gynecol 2011,
205:211.e17.
Ferrari et al. BMC Pregnancy and Childbirth 2014, 14:228 Page 7 of 8
http://www.biomedcentral.com/1471-2393/14/228
14. Green GW, Smiciklas-Wright H, Scholl TO, Karp RJ: Postpartum weight
change: how much of the weight gained in pregnancy will be lost after
delivery? Obstet Gynecol 1988, 71:701707.
15. Catalano PM, Farrell K, Thomas A, Huston-Presly L, Mencin P, de Mouzon SH,
Amini SB: Perinatal risk factors for childhood obesity and metabolic dys-
regulation. Am J Cli Nutr 2009, 90:13031313.
16. Vinayagam D, Chandraharan E: The Adverse Impact of Maternal Obesity
on Intrapartum and Perinatal Outcomes. ISRN Obstet and Gynecol 2012,
v2012:939762.
17. Calandra C, Abell DA, Beischer MA: Maternal obesity in pregnancy.
Obstet Gynecol 1980, 57:812.
18. Lashen H, Fear K, Sturdee DW: Obesity is associated with increase risk of
first trimester and recurrent miscarriage: matched casecontrol study.
Hum Reprod 2004, 19:16441646.
19. Cedergren MI: Maternal morbid obesity and the risk of adverse
pregnancy outcome. Obstet Gynecol 2004, 103:219224.
20. Catalano PM, Thomas A, Huston-Presly L, Amini SB: Increased fetal
adiposity: a very sensitive marker of abnormal in utero development.
Am J Obstet Gynecol 2003, 189:16981704.
21. Catalano PM: Obesity, insulin resistance and pregnancy outcome.
Reproduction 2010, 140:365371.
22. Sekhavat L, Fallah R: Could maternal pre-pregnancy body mass index
affect Apgar score? Arch Gynecol Obstet 2013, 287:1518.
23. Chen M, McNiff C, Madan J, Goodman E, Davis JM, Dammann O: Maternal
obesity and neonatal Apgar scores. J Matern Fetal Neonatal Med 2010,
23:8995.
24. Gilstrap LC, Leveno KJ, Burris J, Williams ML, Little BB: Diagnosis of birth
asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral
dysfunction. Am J Obstet Gynecol 1989, 161:825830.
25. Conner SN, Tuuli MG, Longman RE, Odibo AO, Macones GA, Cahill AG:
Impact of obesity on incision-to-delievry interval and neonatal outcome
at cesarean delivery. Am J Obstet Gynecol 2013, 209:386.e1-6.
26. ACOG: The Apgar score. Obstet Gynecol 2006, 107:12091212.
27. Malin GL, Morris RK, Khan KS: Strength of association between umbilical
cord pH and perinatal and long term outcomes: systematic review and
meta-analysis. BMJ 2010, 340:c1471.
28. Nohr EA, Bech BH, Vaeth M, Rasmussen KM, Henriksen TB, Olsen J: Obesity,
gesta- tional weight gain and preterm birth: a study within the Danish
National Birth Cohort. Paediatr Perinat Epidemiol 2007, 21:514.
29. Nohr EA, Vaeth M, Baker JL, Sorensen TIA, Olsen J, Rasmussen KM:
Combined associations of prepregnancy body mass index and
gestational weight gain with the outcome of pregnancy. Am J Clin Nutr
2008, 87:17501759.
30. Poston L: Gestational weight gain: influences on the long-term health of
the child. Curr Opin Clin Nutr Metab Care 2012, 15:252257.
31. Ovesen P, Rasmussen S, Kesmodel U: Effect of Prepregnancy Maternal
Overweight and Obesity on Pregnancy Outcome. Obstet Gynecol 2011,
118:305312.
32. DeVader SR, Neeley HL, Myles TD, Leet TL: Evaluation of gestational
weight gain guidelines for women with normal prepregnancy body
mass index. Obstet Gynecol 2007, 110:745751.
33. Rooney BL, Mathiason MA, Schauberger CW: Predictors of obesity in
childhood, adolescence and adulthood in a birth cohort. Matern Child
Health J 2011, 15:11661175.
34. Herrmann GM, Dallas LM, Haskell SE, Roghair RD: Neonatal macrosomia is
an independent risk factor for adult metabolic syndrome.
Neonatology 2010, 98:238244.
35. Moster D, Lie RT, Irgens LM, Bjerkedal T, Markestad T: The association of
Apgar score with subsequent death and cerebral palsy: a population-
based study in term infants. J Pediatr 2001, 138:798803.
36. Riet JEVD, Vandenbussche FP, Le Cessie S, Keirse MJ: Newborn assessment
and longterm adverse outcome: a systematic review. AJOG 1999,
180:10241029.
37. Lubchenco LO, Searls DT, Brazie JV: Neonatal mortality rate: Relationship
to birth weight and gestational age. J Pediatr 1972, 81:814822.
38. Catlin EA, Carpenter MW, Brann BS, Mayfield SR, Shaul PW, Goldstein M, Oh
W: The Apgar score revisited: Influence of gestational age. J Pediatr 1986,
109:865868.
39. Kitlinski MO, Källen K, Masal K, Olofsson P: Gestational age Dependent
reference values for pH in umbilical cord arterial blood at term.
Obstet Gynecol 2003, 102:338345.
40. Casey BM, McIntire DD, Leveno KJ: The continuing value of the apgar
score for assessment of newborn infants. N Engl J Med 2001, 334:467471.
doi:10.1186/1471-2393-14-228
Cite this article as: Ferrari et al.:Secular trends in pregnancy weight gain
in German women and their influences on foetal outcome: a hospital-
based study. BMC Pregnancy and Childbirth 2014 14:228.
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... Besides the effect of pre-pregnancy BMI (ppBMI), excessive GWG increases the risk for adverse pregnancy outcomes, LGA [8] and o/o in the offspring [9][10][11]. Similar to obesity prevalence, the number of women who experience excessive GWG is rising [12]. The GWG of two-thirds of women does not meet the current guidelines [13]. ...
... The GWG of two-thirds of women does not meet the current guidelines [13]. Especially pregnant women with o/o suffer from excessive GWG [12,14]. Still, there is no international consensus on how much weight women should gain depending on ppBMI. ...
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Purpose Obesity rates are rising, and the gestational weight gain (GWG) of most women does not comply with current guidelines. This study assesses the association of pre-pregnancy BMI (ppBMI) and GWG with the child’s weight development and investigates whether associations with GWG differ depending on ppBMI. Methods Data were obtained from the cohort study LIFE Child (Germany), comprising 691 mother–child pairs. Children’s weight was followed until age five. Associations between maternal ppBMI, GWG, and children’s weight were evaluated using regression analyses. Results The association between GWG and birth weight (BW) was significantly positive in normal and underweight (n/u) women (βGWG = 0.05, p < 0.01, 95% confidence interval (CI) 0.03—0.07), but not in women with overweight or obesity (o/o) (βGWG = 0.0002, p = 0.99, 95% CI −0.03 to 0.03). The risk of giving birth to an infant who was large for gestational age (LGA) increased with rising GWG in n/u women (OR = 1.6, p < 0.01, 95% CI 1.23—2.25). Women with o/o were at increased risk for a LGA baby regardless of GWG (OR = 3, p < 0.01, 95% CI 1.34—6.97). This trend persisted in the child’s weight development during the first 5 years of life. Conclusion Women with o/o might increase their offspring’s risk for higher weight at birth and in early childhood. In n/u women, GWG might be the more influential factor. Women should strive for normal weight before conception and should be more attentive to GWG.
... This is echoed by several studies which show that women with weight gain outside the recommended range have a higher incidence of pregnancy complications. 32,33 Our study also showed that excessive weight gain was associated with hypertensive disorders in pregnancy. An earlier study also showed that increased GWG was associated with an increased risk of preeclampsia. ...
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: The body mass index (BMI) before pregnancy and gestational weight gain (GWG) may have an association with the outcome of pregnancies. Preeclampsia, gestational diabetes, macrosomia show an association with the BMI. A retrospective analysis of the data collected from 720 pregnant mothers during the period from January 2017 to January 2019 in a tertiary health care centre. The chi-square test was done to assess the categorical data. : Gestational hypertension was significant in overweight women and those who gained weight above recommended range. (22.4% Vs. 0%; p <0.001) GDM was noted in a significant percentage of pregnant women within the recommended weight gain group. (12.4% Vs. 0%; p<0.001). : Pre-pregnancy dietary counselling, physical and lifestyle modifications have a role in bringing down the incidence of GDM and gestational hypertension.
... This systematic review and meta-analysis has three objectives: (1) to estimate the association of interpregnancy weight change with the risks of stillbirth and infant mortality at subsequent pregnancy; (2) to examine the dose-response association between interpregnancy weight change and risks of stillbirth and infant mortality and (3) to examine the association between interpregnancy weight change and risks of stillbirth and infant mortality in women stratified by BMI category of the index pregnancy. ...
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Introduction Interpregnancy weight change may impact two important adverse perinatal outcomes: stillbirth and infant mortality. This systematic review aims to synthesise the existing evidence on the association between interpregnancy weight change and stillbirth and infant mortality. Methods and analysis This systematic review and meta-analysis will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols guidelines and has been registered in the International Prospective Register of Systematic Reviews (PROSPERO). A comprehensive literature search of four online databases (Embase, Cochrane Libraries, Web of Science and Medline) will be conducted from inception to October 2023. Observational (longitudinal, cohort, case–control) and randomised controlled trials will be included. Interpregnancy weight/body mass index change between two consecutive pregnancies will be the exposure. The primary outcomes will be the incidence of stillbirth and infant mortality in subsequent pregnancy. The Cochrane Risk of Bias tool will be used to assess the risk of bias in the randomised controlled studies and the Risk of Bias in Non-Randomised Studies of Interventions tool will be used for observational studies. If there are sufficient data, a meta-analysis will be conducted to estimate the pooled effect size. Otherwise, qualitative descriptions of individual studies will be summarised. The heterogeneity will be statistically assessed using a χ ² test and I ² statistic. Ethics and dissemination Ethics approval is not required for this study as all results will be based on published papers. No primary data collection will be needed. Study findings will be presented at scientific conferences or published in a peer-reviewed scientific journal. Trial registration number A registration for this review has been submitted to PROSPERO under CRD42020222977.
... Despite the updated IOM's GWG targets include a more specific and narrower range based on ppBMI and apply to women of all ethnicities and statures, heterogeneity of race and ethnicity does exist and there is still approximately 36% of pregnant women gained weight above the IOM's guidelines [12][13][14]. For example, high rates of excessive GWG (EGWG) and pre-pregnancy overweight/obesity were reported in Europe (36% and 29%, respectively) and USA (44% and 59.5%, respectively) [15,16], while these figures were lower in China (27.6% and 6.1%, respectively) [17,18]. In addition, most of the current evidences displayed that inadequate and excessive GWG were related to poor pregnancy outcomes for non-diabetic women in Western or high-income countries [9,19,20], there is limited information regarding the impacts of the revised IOM's GWG targets on pregnancy outcomes in Asian women with GDM. ...
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Background Give the high background risk of adverse pregnancy outcomes (APOs), it is important to understand the associations of maternal pre-pregnancy body mass index (ppBMI), gestational weight gain (GWG) with APOs in women with gestational diabetes mellitus (GDM). We addressed the independent and joint associations of maternal ppBMI and GWG with APOs in Chinese women with GDM. Methods 764 GDM women with singleton delivery were studied and they were stratified into three weight groups by ppBMI (underweight, normal weight and overweight/obesity) following classification standards for Chinese adults and three GWG groups (inadequate, adequate, excessive GWG) by the 2009 Institute of Medicine guidelines, respectively. Univariate and multivariate logistic regression analyses were performed to estimate the odds ratios of APOs. Results Maternal overweight/obesity was associated with increased odds of pregnancy-induced hypertension [PIH, adjusted odds ratio (aOR): 2.828, 95% confidence interval (CI) 1.382–5.787], cesarean delivery (CS) (aOR 2.466, 95%CI 1.694–3.590), preterm delivery (aOR 2.466, 95%CI 1.233–4.854), LGA (aOR 1.664, 95%CI 1.120–2.472), macrosomia (aOR 2.682, 95%CI 1.511–4.760) and any pregnancy complication (aOR 2.766, 95%CI 1.840–4.158) compared with healthy weight. Inadequate GWG was less likely to develop PIH (aOR 0.215, 95%CI 0.055–0.835), CS (aOR 0.612, 95%CI 0.421–0.889) and any pregnancy complication (aOR 0.628, 95%CI 0.435–0.907), but had higher risk of preterm birth (aOR 2.261, 95%CI 1.089–4.692), while excessive GWG was more vulnerable to LGA (aOR 1.929, 95%CI 1.272–2.923), macrosomia (aOR 2.753, 95%CI 1.519–4.989) and any pregnancy complication (aOR 1.548, 95%CI 1.006–2.382) as compared to adequate GWG. Furthermore, compared to normal weight mothers with adequate GWG, obese mothers with excessive GWG had the highest risk of any pregnancy complication (aOR 3.064, 95%CI 1.636–5.739). Conclusions Maternal overweight/obesity and GWG were associated with APOs in the already high-risk settings of GDM. Obese mothers with excessive GWG may confer the greatest risk of adverse outcomes. It was very helpful to reduce the burden of APOs and benefit GDM women by promoting a healthy pre-pregnancy BMI and GWG.
... Physiological changes during pregnancy include a decrease in insulin sensitivity in various organ systems, such as white adipose tissue or the liver [8]. These changes are notably more pronounced and are associated with a threefold higher risk for gestational diabetes mellitus (GDM) in pregnant women with overweight/obesity than in those with normal weight [9,10]. The development of GDM is supported by leptin [11], which affects centres in the hypothalamus that regulate food intake, body weight, and metabolism, such as the arcuate nucleus [12]. ...
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Lifestyle during pregnancy impacts the health of the mother and child. However, the extent to which physical activity affects maternal biomarkers and factors that might influence birth weight remains unclear. We analysed data from two lifestyle interventions in which the effects of an exercise programme (2x/week, 60–90 min) on the course of pregnancy with regard to adipokines and offspring were evaluated. A total of 70 women participated in this study (45, intervention group; 25, control group). Anthropometric data and maternal fasting serum leptin and resistin levels were measured at three time points (approximately 14th (T1), 24th (T2), and 36th (T3) weeks of gestation). Neonatal/child data were retrieved from screening examinations. Independent of the intervention, we found a positive correlation between the fat mass at T1 and both leptin and resistin levels at all time points. Leptin level was significantly higher in the control group at T3; however, no differences between the groups were found for resistin. The birth weight was influenced by the birth length, fat mass at T1/T3, and resistin level at T2. The BMI-SDS at one year of age was influenced by maternal fat-free mass at T3 and resistin at T1/T2. Even if these results can only be interpreted cautiously, lifestyle interventions during pregnancy are important in promoting maternal and child health. Further randomised controlled trials and translational studies are warranted to clarify the underlying mechanisms.
... der metabolischen Gesundheit [8,11]. Trotz dieser Erkenntnisse zeigen verschiedene Studien, dass die Ernährungssituation der Kinder suboptimal [4,17] und die Übergewichtsprävalenz bei Eltern mit 28,1 % (Stand Mikrozensus 2017) nach wie vor hoch ist [10,19,30]. Die Auswertung des Instituts für Qualitätssicherung und Transparenz im Gesundheitswesen (IQTIG) hat sogar gezeigt, dass 2020 40 % der schwangeren Frauen bei der Erstuntersuchung übergewichtig waren [19]. ...
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AimNutrition in the first 1000 days of life is a relevant influencing factor for healthy (weight) development of children. Community- and population-based preventive approaches seem to be the most promising way in counteracting overweight (in childhood) and noncommunicable diseases. The aim of this study was to analyze the health care situation in terms of promoting nutritional health in the first 1000 days.Methods Based on an internet-based search of possible community-based practice projects, standardized, guideline-based interviews with experts from science and practice were conducted. The focus was on the general assessment of the health care situation or a possible need for action, as well as concrete recommendations, with special consideration of vulnerable groups. In all, 14 of 40 persons selected in a snowball procedure took part.ResultsAll experts rated the current health care situation in terms of nutrition as insufficient. They were critical of the lack of a structural and political framework, in particular the frequent time limits of a program. As a result, measures to promote nutritional health or comparable interventions could not be successfully established. Therefore, clearer support by political and other relevant stakeholders, e.g., health insurances, and networking with or embedding of this topic area in public health services was demanded.Conclusion From the experts’ point of view, our results confirm that the promotion of nutritional health in the first 1000 days is meaningful and important. However, there is a clear need to optimize care structures and the concrete, sustainable implementation of primary prevention services as well as low-threshold access for pregnant women and families in precarious living situations.
... Our study suggests that maternal prepregnancy overweight and excessive prepregnancy weight gain are risk factors for the development of macrosomia. This finding is consistent with the findings of several authors [20][21][22][23][24]. Due to the excessive accumulation of body fat before pregnancy in overweight or obese women and excessive prenatal waist circumference growth and alteration of maternal endocrine hormone levels combined with excessive attention to nutrition and fetal preservation after pregnancy, this makes overnutrition during pregnancy lead to an increase in the occurrence of huge babies year by year. ...
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Method: A retrospective selection of 93 women who were hospitalized in our hospital from March 2019 to May 2022 with a singleton pregnancy and delivered at term with macrosomia were the study group. And 356 women who delivered a normal size baby during the same period were the control group. The variables that were associated with the onset of macrosomia were screened from maternal medical records. Logistic regression models, random forest, and CART decision tree models were developed using the screened variables as input variables and whether they were macrosomia as outcome variables, respectively. The performance of the three models was evaluated by accuracy, precision, recall, F1 score, and receiver operating characteristic curve (ROC). Result: The risk prediction models for the onset of macrosomia, logistic regression model, random forest model, and decision tree, were successfully developed, with accuracies of 0.904, 1.000, and 0.901 in the training set and 0.926, 0.582, and 0.852 in the validation set, respectively. The AUC in the training set were 0.898, 1.000, and 0.789, and in the validation set were 0.906, 0.913, and 0.731, respectively. In general, the logistic regression model has the highest diagnostic efficiency, followed by the random forest model. Conclusion: Logistic regression models have high application value in the assessment of predicting the risk of macrosomia, and it is suggested that the advantages of logistic regression models and random forest models should be combined in future studies and applications to make them work better in the prediction of the risk of macrosomia.
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Context Gestational weight gain (GWG) is known to be a risk factor for offspring obesity, a precursor of cardiometabolic diseases. Accumulating studies have investigated the association of GWG with offspring cardiometabolic risk factors (CRFs), leading to inconsistent results. Objective This study synthesized available data from cohort studies to examine the effects of GWG on offspring CRFs. Data Source Four electronic databases, including PubMed, Web of Science, Scopus, and Embase, were searched through May 2023. Data Extraction Cohort studies evaluating the association between GWG and CRFs (fat mass [FM], body fat percentage [BF%], waist circumference [WC], systolic blood pressure [SBP] and diastolic blood pressure, high-density-lipoprotein cholesterol [HDL-C] and low-density-lipoprotein cholesterol, triglyceride [TG], total cholesterol, fasting blood glucose, and fasting insulin levels) were included. Regression coefficients, means or mean differences with 95% confidence intervals [CIs], or standard deviations were extracted. Data Analysis Thirty-three cohort studies were included in the meta-analysis. Higher GWG (per increase of 1 kg) was associated with greater offspring FM (0.041 kg; 95% CI, 0.016 to 0.067), BF% (0.145%; 95% CI, 0.116 to 0.174), WC (0.154 cm; 95% CI, 0.036 to 0.272), SBP (0.040 mmHg; 95% CI, 0.010 to 0.070), and TG (0.004 mmol/L; 95% CI, 0.001 to 0.007), and with lower HDL-C (–0.002 mmol/L; 95% CI, –0.004 to 0.000). Consistently, excessive GWG was associated with higher offspring FM, BF%, WC, and insulin, and inadequate GWG was associated with lower BF%, low-density lipoprotein cholesterol, total cholesterol, and TG, compared with adequate GWG. Most associations went non-significant or attenuated with adjustment for offspring body mass index or FM. Conclusions Higher maternal GWG is associated with increased offspring adiposity, SBP, TG, and insulin and decreased HDL-C in offspring, warranting a need to control GWG and to screen for cardiometabolic abnormalities of offspring born to mothers with excessive GWG. Systematic Review Registration PROSPERO registration no. CRD42023412098.
Preprint
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Background Overweight or obese before pregnancy can have adverse effects on the health of singleton pregnant women, but its potential impact on twin pregnant mothers and twins is still unclear. Material and methods This study collected clinical data of twin births and their mothers from 22 units in 12 regions of China between January 2018 and December 2020. The study used multiple logistic regression analysis, propensity score matching analysis, inverse probability weighting, and overlap weighting models to control confounding factors, and explored the effects of different prepregnancy body mass index on adverse pregnancy outcomes. Results Compared to prepregnancy normal weight, prepregnancy overweight/obesity increased the incidence of larger and smaller twin infants with 1-min Apgar score ≤ 7 (adjusted OR (95% CI): 1.60 (1.20–2.13) and 1.45 (1.09–1.92), respectively), as well as the incidence of hypertensive disorders of pregnancy and gestational diabetes (adjusted OR (95% CI): 1.85 (1.55–2.21) and 1.49 (1.27–1.74), respectively). These findings were consistent after propensity score matching analysis, inverse probability weighting, and overlapping weighting. Additionally, prepregnancy underweight reduced the rate of twins with 1-min Apgar score ≤ 7 (0.56 (0.32–0.92) and 0.58 (0.34–0.94), respectively). Different prepregnancy BMI did not have a significant impact on 5-minute Apgar score, birth weight discordance in twins, NICU admission, preterm birth or low birth weight. Conclusion Maternal overweight/obesity before pregnancy increases the incidence of hypertensive disorders of pregnancy and gestational diabetes in twin pregnancies, and also elevates the risk of twins having a low Apgar score. Therefore, it is imperative to manage weight before pregnancy and prepare for neonatal resuscitation during delivery.
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Zusammenfassung Körperlicher Aktivität vor als auch während der Schwangerschaft hat zahlreiche positive Effekte auf Mutter und Kind. Allerdings erreichen in Deutschland weniger als die Hälfte der Frauen im Erwachsenenalter die Aktivitätsempfehlungen der Weltgesundheitsorganisation, sich mindestens 150 Minuten in moderater Ausdaueraktivität zu betätigen. In der Schwangerschaft wird die Aktivitätszeit noch weiter reduziert. Kombiniert mit Übergewicht oder Adipositas in der Schwangerschaft hat dies Auswirkungen auf die mütterliche als auch auf die kindliche Gesundheit. Auf Basis der aktuellen Literatur sollen daher beispielhaft die Effekte von Bewegung während der Schwangerschaft auf Mutter und Kind im Kontext Adipositas zusammengestellt sowie die aktuellen Empfehlungen zu Bewegung in dieser Zielgruppe beschrieben werden. Darüber hinaus wird auf die potentiellen zugrundeliegenden Mechanismen eingegangen.
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Today, fewer newborn children in Norway have low Apgar scores than was formerly the case, but it is not clear whether improved obstetrical practices will affect the score's predictive value. This population-based cohort study estimated the risk of adverse outcomes associated with a low Apgar score in approximately 235,000 children born in Norway in the years 1983-1987. All had a birth weight of 2500 g or greater, and none had birth defects (other than congenital hip dislocation) when followed to age 8 to 12 years. A 5-minute Apgar score of 3 or lower was recorded in 0.1% of infants, whereas 0.6% had scores of 4 to 6. The former group had neonatal and infant mortality rates of 16.4 and 19.2%, respectively. Mortality was 3% between ages 1 and 8 years for children with scores of 0 to 3. Of those who lived beyond age 12 months despite a score of 0 to 3, 6.8% were receiving benefits because of cerebral palsy (CP) by age 8 to 12 years. Compared with infants whose 5-minute Apgar scores were 7 to 10, those with scores of 0 to 3 were 386 times likelier to die neonatally, 76 times likelier to die within the first year of life, and 81 times more likely to develop CP. These effects were even more marked when 1- and 5-minute Apgar scores were combined. Neonatal deaths were increased 642-fold when both scores were 3 or lower. Parent reports of CP coincided completely with a discharge diagnosis of CP. Both low Apgar scores and later CP correlated with seizures, feeding problems, and respiratory difficulty in the first week of life. Low Apgar scores were strongly associated with both infant death and CP in this population, in which low scores are relatively infrequent. These findings suggests that the Apgar score still is important for the early detection of infants at increased risk for serious or fatal conditions.
Article
Large population-based epidemiological studies have found that a high prepregnancy body weight or body mass index (BMI) increases the risk of many adverse maternal and perinatal complications including stillbirth. This prospective population-based study, based on the Swedish Birth Register, examined associations between a change in prepregnancy BMI between first and second pregnancies. The study population consisted of 151,025 women having their first two consecutive singleton births from 1992 to 2001. BMI was estimated at the first antenatal visit of each pregnancy. Women in the study gained just over half a BMI unit on average during a mean inter-pregnancy interval of 2 years. After adjusting for potential confounding factors, the risk of adverse outcomes increased linearly with the amount of weight gained between pregnancies. Adjusted odds ratios with 95% confidence intervals for women gaining 3 or more BMI units were 1.78 (1.52–2.08) for preeclampsia; 1.76 (1.39–2.23) for gestational hypertension; 2.09 (1.68–2.61) for gestational diabetes; 1.32 (1.22–1.44) for cesarean delivery; 1.63 (1.20–2.21) for stillbirth; and 1.87 (1.72–2.04) for a large-for-gestational-age birth. Except for stillbirth, similar associations were confirmed in women whose BMI was less than 25 during both pregnancies. BMI status at the start of the first pregnancy did not significantly influence the effects of inter-pregnancy BMI change on the risks of preeclampsia, cesarean delivery, or stillbirth. Inter-pregnancy weight gain correlates strongly with the risk of major maternal and perinatal complications, even in women who are not overweight. The findings implicate some nonmeasured obesity-related factor. The results of this large-scale trial provide a rationale for promoting weight loss in overweight and obese women who are planning to become pregnant. It is even more important for healthy-weight women not to gain weight before pregnancy.
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At term 365 (5.6%) of 6497 pregnant women weighed over 90 kg; in these obese patients there were significantly increased incidences of hypertension (43.6%), hyperglycemia (16.9%), and subnormal urinary estriol excretion (18.6%). Infants weighing 4000 g or more at birth were more than twice as common (20.5%) in this group of patients, but increased fetal size was not due to associated maternal hyperglycemia and did not lead to increased rates of operative delivery although obstructed labor occurred in 5 multiparas. The increased incidence of labor exceeding 24 hours after amniotomy (12.3%) primary postpartum hemorrhage (7.1%), neonatal asphyxia (14.0%), and puerperal pyrexia (9.6%) emphasizes the problems of management of labor in the obese parturient. Perinatal mortality was not increased and there was no maternal death. Obesity is not associated with less favorable maternal or perinatal results when prenatal care includes monitoring of glucose tolerance and fetoplacental function and when cephalopelvic disproportion is considered in every labor.
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Objective: The purpose of this study was to test the hypothesis that increasing body mass index (BMI) is associated with increased time from skin incision to infant delivery and increased neonatal morbidity at cesarean delivery. Study design: We performed a retrospective cohort study of all cesarean deliveries that occurred at 1 institution from 2004-2008. Four comparison groups were defined by BMI of <30 kg/m(2) (n = 668 women), 30-39.9 kg/m(2) (n = 1002 women), 40-49.9 kg/m(2) (n = 403 women), or ≥50 kg/m(2) (n = 193 women). The primary outcome was time from skin incision to infant delivery. Secondary outcomes were a composite measure of neonatal morbidity and its individual components: 5-minute Apgar score <7, umbilical cord arterial pH <7.10 and <7.20, umbilical cord arterial base excess ≤8 mmol/L, special care nursery admission, and neonatal intensive care unit admission. Results: Increasing BMI was associated with significantly increased time from skin incision to infant delivery, which demonstrated a dose-response pattern. Minutes from skin incision to delivery of the infant by BMI strata were 9.4 ± 5.9 for <30 kg/m(2), 11.0 ± 6.8 for 30-39.9 kg/m(2), 13.0 ± 8.0 for 40-49.9 kg/m(2), and 16.0 ± 11.3 for ≥50 kg/m(2) (P < .01). Composite neonatal morbidity was significantly higher with increasing BMI: 23.0% for <30 kg/m(2), 25% for 30-39.9 kg/m(2), 29.8% for 40-49.9 kg/m(2), and 32.1% for ≥50 kg/m(2) (P = .02). Conclusion: Increasing BMI is associated with a significantly increased time from skin incision to infant delivery and neonatal morbidity. Cesarean delivery technique remains to be optimized for obese women.
Article
The increase in overweight and obesity is a worldwide health problem. The first wave of the "German Health Interview and Examination Survey for Adults" (DEGS1), conducted from 2008 through 2011, provides current data about overweight and obesity among adults in Germany. Within DEGS1, a representative sample of the 18- to 79-year-old population was interviewed with regard to health relevant issues and physically examined (n = 7,116). From measurements of body height and weight, the body mass index (BMI) was calculated, which was used to define overweight (BMI ≥ 25 kg/m(2)) and obesity (BMI ≥ 30 kg/m(2)). Results are stratified for gender, age group, socioeconomic status and region and compared with results from the German National Health Interview and Examination Survey 1998 (GNHIES98) and the National Examination Surveys 1990/92. According to DEGS1, 67.1% of men and 53.0% of women are overweight. The prevalence of overweight has not changed compared to GNHIES98. The prevalence of obesity, however, has risen substantially, especially among men: in GNHIES98, 18.9% of men and 22.5% of women were obese, in DEGS1, these figures were 23.3% and 23.9%, respectively. The increase in obesity occurred especially among young adults. An English full-text version of this article is available at SpringerLink as supplemental.