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

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


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

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    • "Excessive GWG is also associated with negative infant outcomes such as perinatal mortality and excessive infant birth weights (March ofDimes, 2007;Siega-Riz, et al., 2009). In the mother, excessive GWG increases the likelihood of delivery complications (DeVader, Neeley, Myles, & Leet, 2007;Rhodes, Schoendorf, & Parker, 2003;Stotland, Hopkins, & Caughey, 2004), postpartum weight retention (Gore, Brown, & West, 2003;Siega-Riz, et al., 2009), and subsequent obesity (Gunderson, Abrams, & Selvin, 2000;Rooney & Schauberger, 2002;Schmitt, Nicholson, & Schmitt, 2007). In the longer term, inadequate and excessive GWG appear to alter the fetal intrauterine environment, resulting in obesity in childhood (Salsberry & Reagan, 2005), adolescence (Salsberry & Reagan, 2007), and in Type 2 diabetes and atherogenic profiles in adulthood (Lau, Rogers, Desai, & Ross, 2011;Rasmussen & Yaktine, 2009). "
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    ABSTRACT: Abstract Background and Significance: Extremes of gestational weight gain (GWG) are associated with newborn and pregnancy complications, postpartum obesity and chronic illnesses. In the United States, Mexican American women are the largest subgroup of Hispanics but have been studied least often. The purpose of the study was to determine the prevalence, characteristics, and predictors of GWG in Mexican American women. Methods: A retrospective, correlational design used data from charts (n=684) in a federally qualified health center in Los Angeles. Prevalence of GWG was inadequate, 22%; adequate, 33%; and excessive, 45%. Risk factors for excessive GWG were hypertension (p = .04), overweight (p = .00), or obese pre-pregnancy BMI (p = .01). Conversely, women who had gestational diabetes (p = .02), ate more snacks (p = .01), were multiparous (p = .03), and less acculturated (p = .03) experienced less excessive gain. Conclusions: Efforts to prevent excessive GWG in Mexican Americans should be targeted to women having their first baby and those with high pre-pregnancy BMI. One strategy may be recommending diet/exercise similar to that used in women with gestational diabetes. For women who are less acculturated and/or who are multiparous, strategies that will minimize inadequate GWG may improve newborn outcomes.
    Full-text · Article · Dec 2015
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    • "Excess GWG has been linked to a number of adverse short- and long-term health outcomes in mothers and their offspring (Cox and Phelan, 2008), and excess weight is currently among the most common high-risk obstetric conditions (Galtier-Dereure et al., 2000). Overweight and obesity are linked to higher rates of cesarean sections and greater cost of obstetric care (Galtier-Dereure et al., 2000; Stotland et al., 2004; Vahratian et al., 2005). Additional complications associated with excess GWG have been described in detail (Rasmussen and Yaktine, 2009) and include increased risk of gestational diabetes, hypertension, preeclampsia, delivery complications, perinatal fatality, neural tube defects, neonatal hypoglycemia, and failure to initiate breastfeeding (Hilson et al., 1997, 2006; Galtier-Dereure et al., 2000; Kaiser et al., 2002, 2008; Thorsdottir et al., 2002). "
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    ABSTRACT: Women in the United States experience an increase in food cravings at two specific times during their life, (1) perimenstrually and (2) prenatally. The prevalence of excess gestational weight gain (GWG) is a growing concern due to its association with adverse health outcomes in both mothers and children. To the extent that prenatal food cravings may be a determinant of energy intake in pregnancy, a better understanding of craving etiology could be crucial in addressing the issue of excessive GWG. This paper reviews the available literature to corroborate and/or dispute some of the most commonly accepted hypotheses regarding the causes of food cravings during pregnancy, including a role of (1) hormonal changes, (2) nutritional deficits, (3) pharmacologically active ingredients in the desired foods, and (4) cultural and psychosocial factors. An existing model of perimenstrual chocolate craving etiology serves to structure the discussion of these hypotheses. The main hypotheses discussed receive little support, with the notable exception of a postulated role of cultural and psychosocial factors. The presence of cravings during pregnancy is a common phenomenon across different cultures, but the types of foods desired and the adverse impact of cravings on health may be culture-specific. Various psychosocial factors appear to correlate with excess GWG, including the presence of restrained eating. Findings strongly suggest that more research be conducted in this area. We propose that future investigations fall into one of the four following categories: (1) validation of food craving and eating-related measures specifically in pregnant populations, (2) use of ecological momentary assessment to obtain real time data on cravings during pregnancy, (3) implementation of longitudinal studies to address causality between eating disorder symptoms, food cravings, and GWG, and (4) development of interventions to ensure proper prenatal nutrition and prevent excess GWG.
    Full-text · Article · Sep 2014 · Frontiers in Psychology
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    • "BMI calculated at time of delivery in our study was significantly higher in the comparison group (G3). G3 patients were more likely to be obese with a BMI ≥30 kg/m2, which might explain their increased rates of gestational diabetes28 and cesarean section deliveries.29,30 "
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    ABSTRACT: In this study, we aimed to assess the rate of adolescent delivery in a Saudi tertiary health care center and to investigate the association between maternal age and fetal, neonatal, and maternal complications where a professional tertiary medical care service is provided. A cross-sectional study was performed between 2005 and 2010 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. All primigravid Saudi women ≥24 weeks gestation, carrying a singleton pregnancy, aged <35 years, and with no chronic medical problems were eligible. Women were divided into three groups based on their age, ie, group 1 (G1) <16 years, group 2 (G2) ≥16 up to 19 years, and group 3 (G3) ≥19 up to 35 years. Data were collected from maternal and neonatal medical records. We calculated the association between the different age groups and maternal characteristics, as well as events and complications during the antenatal period, labor, and delivery. The rates of adolescent delivery were 20.0 and 16.3 per 1,000 births in 2009 and 2010, respectively. Compared with G1 and G2 women, G3 women tended to have a higher body mass index, a longer first and second stage of labor, more blood loss at delivery, and a longer hospital stay. Compared with G1 and G2 women, respectively, G3 women had a 42% and a 67% increased risk of cesarean section, and had a 52% increased risk of instrumental delivery. G3 women were more likely to develop gestational diabetes or anemia, G2 women had a three-fold increased risk of premature delivery (odds ratio 2.81), and G3 neonates had a 50% increased overall risk of neonatal complications (odds ratio 0.51). The adolescent birth rate appears to be low in central Saudi Arabia compared with other parts of the world. Excluding preterm delivery, adolescent delivery cared for in a tertiary health care center is not associated with a significantly increased medical risk to the mother, fetus, or neonate. The psychosocial effect of adolescent pregnancy and delivery needs to be assessed.
    Full-text · Article · Apr 2014 · International Journal of Women's Health
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