Effect of Body Mass Index on pregnancy outcomes in nulliparous women delivering singleton babies

Sohinee Bhattacharya, Doris M Campbell, William A Liston, Siladitya Bhattacharya, Sohinee Bhattacharya, Doris M Campbell, William A Liston, Siladitya Bhattacharya

Abstract

Background: The increasing prevalence of obesity in young women is a major public health concern. These trends have a major impact on pregnancy outcomes in these women, which have been documented by several researchers. In a population based cohort study, using routinely collected data, this paper examines the effect of increasing Body Mass Index (BMI) on pregnancy outcomes in nulliparous women delivering singleton babies.

Methods: This was a retrospective cohort study, based on all nulliparous women delivering singleton babies in Aberdeen between 1976 and 2005. Women were categorized into five groups--underweight (BMI < 20 Kg/m2), normal (BMI 20-24.9 Kg/m2) overweight (BMI 25-29.9 Kg/m2), obese (BMI 30-34.9 Kg/m2) and morbidly obese (BMI > 35 Kg/m2). Obstetric and perinatal outcomes were compared by univariate and multivariate analyses.

Results: In comparison with women of BMI 20-24.9, morbidly obese women faced the highest risk of pre-eclampsia {OR 7.2 (95% CI 4.7, 11.2)} and underweight women the lowest {OR 0.6 (95% CI 0.5, 0.7)}. Induced labour was highest in the morbidly obese {OR 1.8 (95% CI 1.3, 2.5)} and lowest in underweight women {OR 0.8 (95% CI 0.8, 0.9)}. Emergency Caesarean section rates were highest in the morbidly obese {OR 2.8 (95% CI 2.0, 3.9)}, and comparable in women with normal and low BMI. Obese women were more likely to have postpartum haemorrhage {OR 1.5 (95% CI 1.3, 1.7)} and preterm delivery (< 33 weeks) {OR 2.0 (95% CI 1.3, 2.9)}. Birthweights less than 2,500 g were more common in underweight women {OR 1.7 (95% OR 1.2, 2.0)}. The highest risk of birth weights > 4,000 g was in the morbidly obese {OR 2.1 (95% CI 1.3, 3.2)} and the lowest in underweight women {OR 0.5 (95% CI 0.4, 0.6)}.

Conclusion: Increasing BMI is associated with increased incidence of pre-eclampsia, gestational hypertension, macrosomia, induction of labour and caesarean delivery; while underweight women had better pregnancy outcomes than women with normal BMI.

Figures

Figure 1
Figure 1
Trends in mean BMI, Aberdeen city & district 1976–2005.

References

    1. RCOG, 5th October 2006 Press Releases Accessed 11.12.2006.
    1. Garbaciak JA, Richter MD, Miller S, Barton JJ. Maternal weight and pregnancy complications. Am J Obstet Gynecol. 1985;152:238–245.
    1. Abrams BF, Laros RK., Jr Prepregnancy weight, weight gain and body birthweight. Am J Obstet Gynecol. 1986;154:503–509.
    1. Naeye RL. Maternal body weight and pregnancy outcome. Am J Clin Nutr. 1990;52:273–279.
    1. Cogswell ME, Serdula MK, Hungerford DW, Yip R. Gestational weight gain among average-weight and overweight women – what is excessive? Am J Obstet Gynecol. 1995;172:705–712. doi: 10.1016/0002-9378(95)90598-7.
    1. Lewis G, editor. Report of the Confidential Enquiry into Maternal and Child Health Why mothers die 2000–2002. RCOG:London; 2004.
    1. Odell LD. The overweight obstetric patient. JAMA. 1945;128:87–90.
    1. Rode L, Nilas L, Wojdemann K, Tabor A. Obesity-related complications in Danish single cephalic term pregnancies. Obstet Gynecol. 2005;105:537–542.
    1. Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ. Pre-pregnancy weight and the risk of stillbirth and neonatal death. BJOG. 2005;112:403–408. doi: 10.1111/j.1471-0528.2005.00437.x.
    1. Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol. 2004;103:219–224.
    1. Cnattingius S, Berfstrom R, Lipworth L, Kramer MS. Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med. 1998;338:147–152. doi: 10.1056/NEJM199801153380302.
    1. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, Regan L, Robinson S. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J of Obesity. 2001;25:1175–1182. doi: 10.1038/sj.ijo.0801670.
    1. Kiran UTS, Hemmadi S, Bethel J, Evans J. Outcome of pregnancy in a woman with an increased body mass index. BJOG. 2005;112:768–772. doi: 10.1111/j.1471-0528.2004.00546.x.
    1. Smith GCS, Shah I, Pell JP, Crossley JA, Dobbie R. Maternal obesity in early pregnancy and risk of spontaneous and elective preterm deliveries: A retrospective cohort study. Am J Public Health. 2007;97:157–162. doi: 10.2105/AJPH.2005.074294.
    1. Spinillo A, Capuzzo E, Piazzi G, Ferrari A, Morales V, DiMario M. Risk for spontaneous preterm delivery by combined body mass index and gestational weight gain patterns. Acta Obstet Gynecol Scand. 1998;77:32–36. doi: 10.1034/j.1600-0412.1998.770107.x.
    1. Sebire NJ, Jolly M, Harris JP, Regan L, Robinson S. Is maternal underweight really a risk factor for adverse pregnancy outcome? A population based study in London. BJOG. 2001;108:61–66. doi: 10.1016/S0306-5456(00)00021-8.
    1. Samphier M, Thomson B. The Aberdeen Maternity and Neonatal Databank. In: Mednick SA, Baert AE, editor. Prospective longitudinal research: an empirical basis for the primary prevention of psychological disorders. 1. Oxford (UK): Oxford University Press; 1981. pp. 61–65.
    1. Abrams B, Parker J. Overweight and pregnancy complications. Int J Obesity. 1988;12:293–303.
    1. O'Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic review. Epidemiology. 2003;14:368–374. doi: 10.1097/00001648-200305000-00020.
    1. Kabiru W, Raynor BD. Obstetric outcomes associated with increase in BMI category during pregnancy. Am J Obstet Gynecol. 2004;191:928–932. doi: 10.1016/j.ajog.2004.06.051.
    1. Abenheim HA, Kinch RA, Morin L, Benjamin A, Usher R. Effect of prepregnancy body mass index categories on obstetrical and neonatal outcomes. Arch Gynecol Obstet. 2007;275:39–43. doi: 10.1007/s00404-006-0219-y.
    1. Bianco AT, Smilen SW, Davis Y, Lopez S, Lapinski R, Lockwood CJ. Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol. 1998;91:97–102. doi: 10.1016/S0029-7844(97)00578-4.
    1. Baeten JM, Bukusi EA, Lambe M. Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health. 2001;91:436–440.
    1. Weiss JL, Malone FD, Emig D, Ball RH, Nyberg DA, Comstock CH, Saade G, Eddleman K, Carter SM, Craigo SD, Carr SR, D'Alton ME, FASTER Research Consortium Obesity, obstetric complications and caesarean delivery rate – a population based screening study. Am J Obstet Gynecol. 2004;190:1091–1097. doi: 10.1016/j.ajog.2003.09.058.
    1. Yu CKH, Teoh TG, Robinson S. Obesity in pregnancy. BJOG. 2006;113:1117–1125. doi: 10.1111/j.1471-0528.2006.00991.x.
    1. Castro LC, Avina RL. Maternal obesity and pregnancy outcomes. Curr Opin Obstet Gynecol. 2002;14:601–606. doi: 10.1097/00001703-200212000-00005.
    1. Accessed on 01.06.07.
    1. Lederman SA, Paxton A. Maternal reporting of prepregnancy weight and birth outcome: Consistency and completeness compared with the clinical record. Matern Child Health J. 1998;2:123–126. doi: 10.1023/A:1022996924094.
    1. Krishnamoorthy U, Schram CMH, Hill SR. Maternal obesity in pregnancy: is time for meaningful research to inform preventive and management strategies? BJOG. 2006;113:1134–1140. doi: 10.1111/j.1471-0528.2006.01045.x.
    1. Institute of Medicine . Nutrition during pregnancy: part I: Weight gain. Washington DC. The National Academy of Sciences; 1990.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다