Effects of pre-pregnancy body mass index and gestational weight gain on maternal and infant complications

Yin Sun, Zhongzhou Shen, Yongle Zhan, Yawen Wang, Shuai Ma, Suhan Zhang, Juntao Liu, Sansan Wu, Yahui Feng, Yunli Chen, Shuya Cai, Yingjie Shi, Liangkun Ma, Yu Jiang, Yin Sun, Zhongzhou Shen, Yongle Zhan, Yawen Wang, Shuai Ma, Suhan Zhang, Juntao Liu, Sansan Wu, Yahui Feng, Yunli Chen, Shuya Cai, Yingjie Shi, Liangkun Ma, Yu Jiang

Abstract

Background: The potential effects of pre-pregnancy body mass (BMI) and gestational weight gain (GWG) on pregnancy outcomes remain unclear. Thus, we investigated socio-demographic characteristics that affect pre-pregnancy BMIs and GWG and the effects of pre-pregnancy BMI and GWG on Chinese maternal and infant complications.

Methods: 3172 women were enrolled in the Chinese Pregnant Women Cohort Study-Peking Union Medical College from July 25, 2017 to July 24, 2018, whose babies were delivered before December 31, 2018. Regression analysis was employed to evaluate the socio-demographic characteristics affecting pre-pregnancy BMI and GWG values and their effects on adverse maternal and infant complications.

Results: Multivariate logistic regression analysis revealed that age groups < 20 years (OR: 1.97), 25-30 years (OR: 1.66), 30-35 years (OR: 2.24), 35-40 years (OR: 3.90) and ≥ 40 years (OR: 3.33) as well as elementary school or education below (OR: 3.53), middle school (OR: 1.53), high school (OR: 1.40), and living in the north (OR: 1.37) were risk factors in maintaining a normal pre-pregnancy BMI. An age range of 30-35 years (OR: 0.76), living in the north (OR: 1.32) and race of ethnic minorities (OR: 1.51) were factors affecting GWG. Overweight (OR: 2.01) and inadequate GWG (OR: 1.60) were risk factors for gestational diabetes mellitus (GDM). Overweight (OR: 2.80) and obesity (OR: 5.42) were risk factors for gestational hypertension (GHp). Overweight (OR: 1.92), obesity (OR: 2.48) and excessive GWG (OR: 1.95) were risk factors for macrosomia. Overweight and excessive GWG were risk factors for a large gestational age (LGA) and inadequate GWG was a risk factor for low birth weights.

Conclusions: Overweight and obesity before pregnancy and an excessive GWG are associated with a greater risk of developing GDM, GHp, macrosomia and LGA. The control of body weight before and during the course of pregnancy is recommended to decrease adverse pregnancy outcomes, especially in pregnant women aged < 20 or > 25 years old educated below university and college levels, for ethnic minorities and those women who live in the north of China.

Trial registration: Registered at Clinical Trials ( NCT03403543 ), September 29, 2017.

Keywords: Chinese pregnant women; Cohort study; Gestational weight gain; Maternal outcomes; Neonatal outcomes; Pre-pregnancy BMI.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of this study

References

    1. Kim SY, Dietz PM, England L, Morrow B, Callaghan WM. Trends in pre-pregnancy obesity in nine states, 1993-2003. Obesity (Silver Spring) 2007;15(4):986–993.
    1. Ma GS, Li YP, Wu YF, Zhai FY, Cui ZH, Hu XQ, et al. The prevalence of body overweight and obesity and its changes among Chinese people during 1992 to 2002. Zhonghua Yu Fang Yi Xue Za Zhi. 2005;39(5):311–315.
    1. Lai JQ, Yin SA. The impact of experience in bearing child on the body mass index and obesity in women. Zhonghua Yu Fang Yi Xue Za Zhi. 2009;43(2):108–112.
    1. WHO. State of inequality: reproductive, maternal, newborn and child health 2015. Available from: .
    1. Wei Y-M, Yang H-X, Zhu W-W, Liu X-Y, Meng W-Y, Wang Y-Q, et al. Risk of adverse pregnancy outcomes stratified for pre-pregnancy body mass index. J Matern Fetal Neonatal Med. 2016;29(13):2205–2209.
    1. Faucett AM, Metz TD, DeWitt PE, Gibbs RS. Effect of obesity on neonatal outcomes in pregnancies with preterm premature rupture of membranes. Am J Obstet Gynecol. 2016;214(2):287 e1–287 e5.
    1. Sebire NJ, Jolly M, Harris J, Regan L, Robinson S. Is maternal underweight really a risk factor for adverse pregnancy outcome? A population-based study in London. BJOG. 2001;108(1):61–66.
    1. Ronnenberg AG, Wang X, Xing H, Chen C, Chen D, Guang W, et al. Low preconception body mass index is associated with birth outcome in a prospective cohort of Chinese women. J Nutr. 2003;133(11):3449–3455.
    1. Vivatkusol Y, Thavaramara T, Phaloprakarn C. Inappropriate gestational weight gain among teenage pregnancies: prevalence and pregnancy outcomes. Int J Women's Health. 2017;9:347–352.
    1. Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, et al. Association of Gestational Weight Gain with Maternal and Infant Outcomes: a systematic review and meta-analysis. JAMA. 2017;317(21):2207–2225.
    1. Han Z, Lutsiv O, Mulla S, Rosen A, Beyene J, McDonald SD, et al. Low gestational weight gain and the risk of preterm birth and low birthweight: a systematic review and meta-analyses. Acta Obstet Gynecol Scand. 2011;90(9):935–954.
    1. Xu Z, Wen Z, Zhou Y, Li D, Luo Z. Inadequate weight gain in obese women and the risk of small for gestational age (SGA): a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2017;30(3):357–367.
    1. Morisset AS, Tchernof A, Dube MC, Veillette J, Weisnagel SJ, Robitaille J. Weight gain measures in women with gestational diabetes mellitus. J Women's Health (Larchmt) 2011;20(3):375–380.
    1. Macdonald-Wallis C, Tilling K, Fraser A, Nelson SM, Lawlor DA. Gestational weight gain as a risk factor for hypertensive disorders of pregnancy. Am J Obstet Gynecol. 2013;209(4):327 e1–327 17.
    1. Mamun AA, Callaway LK, O'Callaghan MJ, Williams GM, Najman JM, Alati R, et al. Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay. BMC Pregnancy Childbirth. 2011;11:62.
    1. Viswanathan M, Siega-Riz AM, Moos MK, Deierlein A, Mumford S, Knaack J, et al. Outcomes of maternal weight gain. Evid Rep Technol Assess (Full Rep). 2008;(168):1–223.
    1. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.
    1. Chen YH, Fu L, Hao JH, Wang H, Zhang C, Tao FB, et al. Influent factors of gestational vitamin D deficiency and its relation to an increased risk of preterm delivery in Chinese population. Sci Rep. 2018;8(1):3608.
    1. Institute of M, National Research Council Committee to Reexamine IOMPWG. The National Academies Collection . Reports funded by National Institutes of Health. In: Rasmussen KM, Yaktine AL, editors. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington (DC): National Academies Press (US) National Academy of Sciences; 2009.
    1. Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP) Hypertens Pregnancy. 2001;20(1):Ix–xiv.
    1. Organization WH. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva: World Health Organization 2013; Available from: 20diabetes_new.pdf.
    1. Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 188: Prelabor rupture of membranes. Obstet Gynecol. 2018;131(1):e1–e14.
    1. Organization WH . A Guide for Progamme Managers. Geneva: World Health Organization; Iron Deficiency Anemia. Assessment, Prevention and Control; 2001.
    1. McLennan MT, Harris JK, Kariuki B, Meyer S. Family history as a risk factor for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(8):1063–1069.
    1. Tegerstedt G, Miedel A, Maehle-Schmidt M, Nyren O, Hammarstrom M. Obstetric risk factors for symptomatic prolapse: a population-based approach. Am J Obstet Gynecol. 2006;194(1):75–81.
    1. Swift S, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic organ support study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192(3):795–806.
    1. DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 1992;166(6 Pt 1):1717–1724.
    1. Boyd PA, Loane M, Garne E, Khoshnood B, Dolk H. Sex chromosome trisomies in Europe: prevalence, prenatal detection and outcome of pregnancy. Eur J Hum Genet. 2011;19(2):231–234.
    1. Qi QW, Jiang YL, Zhou XY, Liu JT, Yin J, Bian XM. Genetic counseling, prenatal screening and diagnosis of Down syndrome in the second trimester in women of advanced maternal age: a prospective study. Chin Med J. 2013;126(11):2007–2010.
    1. Yu C, Shi Z, Lv J, Du H, Qi L, Guo Y, et al. Major dietary patterns in relation to general and central obesity among Chinese adults. Nutrients. 2015;7(7):5834–5849.
    1. Shi Z, Yuan B, Hu G, Dai Y, Zuo H, Holmboe-Ottesen G. Dietary pattern and weight change in a 5-year follow-up among Chinese adults: results from the Jiangsu nutrition study. Br J Nutr. 2011;105(7):1047–1054.
    1. Xiao L, Ding G, Vinturache A, Xu J, Ding Y, Guo J, et al. Associations of maternal pre-pregnancy body mass index and gestational weight gain with birth outcomes in Shanghai, China. Sci Rep. 2017;7:41073.
    1. Vinturache A, Moledina N, McDonald S, Slater D, Tough S. Pre-pregnancy body mass index (BMI) and delivery outcomes in a Canadian population. BMC Pregnancy Childbirth. 2014;14:422.
    1. Enomoto K, Aoki S, Toma R, Fujiwara K, Sakamaki K, Hirahara F. Pregnancy outcomes based on pre-pregnancy body mass index in Japanese women. PLoS One. 2016;11(6):e0157081.
    1. Li N, Liu E, Guo J, Pan L, Li B, Wang P, et al. Maternal prepregnancy body mass index and gestational weight gain on pregnancy outcomes. PLoS One. 2013;8(12):e82310.
    1. Coustan DR. Gestational diabetes mellitus. Clin Chem. 2013;59(9):1310–1321.
    1. Akbay E, Tiras MB, Yetkin I, Toruner F, Ersoy R, Uysal S, et al. Insulin secretion and insulin sensitivity in normal pregnancy and gestational diabetes mellitus. Gynecol Endocrinol. 2003;17(2):137–142.
    1. Agha M, Agha RA, Sandall J. Interventions to reduce and prevent obesity in pre-conceptual and pregnant women: a systematic review and meta-analysis. PLoS One. 2014;9(5):e95132.
    1. Vrachnis N, Belitsos P, Sifakis S, Dafopoulos K, Siristatidis C, Pappa KI, et al. Role of adipokines and other inflammatory mediators in gestational diabetes mellitus and previous gestational diabetes mellitus. Int J Endocrinol. 2012;2012:549748.
    1. Jin Z, Ma S, Dong L, Li X, Zhu J, Zhang H, et al. Chin J Public Health. 2009;25(4):415–416.
    1. Li B, Kong Y. Research progress on the relationship between BMI and pregnancy outcome in pregnant women. Chin J Family Plann. 2017;25(10):715–717.
    1. Jarvie E, Ramsay JE. Obstetric management of obesity in pregnancy. Semin Fetal Neonatal Med. 2010;15(2):83–88.
    1. Bogaerts A, Ameye L, Martens E, Devlieger R. Weight loss in obese pregnant women and risk for adverse perinatal outcomes. Obstet Gynecol. 2015;125(3):566–575.
    1. Cedergren M. Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Int J Gynaecol Obstet. 2006;93(3):269–274.
    1. Yogev Y, Langer O, Xenakis EM, Rosenn B. The association between glucose challenge test, obesity and pregnancy outcome in 6390 non-diabetic women. J Matern Fetal Neonatal Med. 2005;17(1):29–34.
    1. ZHAO J, HUANG W, QIN B, Ruiqing Z. Associations of pre-pregnancy BMI, pregnancy weight gain and newborn weight. China Med Her. 2018;15(30):84–6.
    1. Zhao R, Xu L, Wu M, Li R, Zhang Z, Cao X. Relationship between pre-pregnancy bodymass index,gestational weight gain and birth weight. Acta Univ Med Anhui. 2017;52(05):709–14.
    1. Hull HR, Thornton JC, Ji Y, Paley C, Rosenn B, Mathews P, et al. Higher infant body fat with excessive gestational weight gain in overweight women. Am J Obstet Gynecol. 2011;205(3):211.e1–211.e7.
    1. Simas TA, Waring ME, Liao X, Garrison A, Sullivan GM, Howard AE, et al. Prepregnancy weight, gestational weight gain, and risk of growth affected neonates. J Women's Health (Larchmt) 2012;21(4):410–417.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅