Abstract
Objective: This study presumed that a high or low body mass index (BMI) might increase the risk of infant mortality. Therefore, a meta-analysis was performed to systematically assess the association between maternal BMI and the risk of infant mortality.Methods: The electronic databases, including Pubmed, Embase database, and Cochrane Library, were systemically searched by two investigators from inception to November 26th, 2020, with no language restriction. In parallel, a dose-response was assessed.Results: Finally, 22 cohort studies involving 13,532,293 participants were included into this paper, which showed that compared with normal BMI, maternal overweight significantly increased the risks of infant mortality [risk ratio (RR), 1.16; 95% confidence interval (CI), 1.13–1.19], neonatal mortality (RR, 1.23; 95% CI, 1.08–1.39), early neonatal mortality (RR, 1.55; 95% CI, 1.26–1.92) and post-neonatal mortality (RR, 1.18; 95% CI, 1.07–1.29). Similarly, maternal obesity significantly increased the risk of infant mortality (RR, 1.55; 95% CI, 1.41–1.70), neonatal mortality (RR, 1.55; 95% CI, 1.28–1.67), early neonatal mortality (RR, 1.37; 95% CI, 1.13–1.67), and post-neonatal mortality (RR, 1.30; 95% CI, 1.03–1.65), whereas maternal underweight potentially decreased the risk of infant mortality (RR, 0.93; 95% CI, 0.88–0.98). In the dose-response analysis, the risk of infant mortality significantly increased when the maternal BMI was >25 kg/m2.Conclusions: Maternal overweight or obesity significantly increases the risks of infant mortality, neonatal mortality, early neonatal mortality, and post-neonatal mortality compared with normal BMI in a dose-dependent manner. Besides, maternal underweight will not increase the risk of infant mortality, neonatal mortality, early neonatal mortality, or postneonatal mortality; instead, it tends to decrease the risk of infant mortality. Early weight management may provide potential benefits to infants, and more large-scale prospective studies are needed to verify this finding in the future.
Highlights
Obesity may lead to poor maternal and neonatal health outcomes [1]
The study inclusion criteria were as follows: [1] studies focused on maternal body mass index (BMI); [2] the study outcomes reported the risk of infant, neonatal, post-neonatal or early neonatal mortality; [3] the study type was restricted to cohort study or randomized controlled trial (RCT); [4] the maximum covariates adjusted hazard ratios (HRs), relative risks (RRs), or odds ratios (ORs) were available, or might be obtained through calculation; [5] if a cohort population was investigated repeatedly, studies containing the longest follow-up period or the largest population were included
Aune et al suggested that even the modest increases in maternal BMI were strongly associated with an increase in infant mortality, while the dose-response analysis showed that low maternal underweight did not significantly increase the risk of infant mortality [44], but only four cohort studies were included
Summary
Obesity may lead to poor maternal and neonatal health outcomes [1]. Obesity is more prevalent in women of reproductive age than in the general population. It has been reported that the prevalence of obesity among women aged 20–39 years increases from 31 to 36% from 2007–2008 to 2015–2016 [2], and such changing demographics represent a new epidemiological trend of particular concern to pregnant women. Obese and pregnant women are more likely to develop intrauterine and fetal complications as well as maternal health problems; obesity during pregnancy may be significantly negatively associated with fetal and maternal health outcomes, including hyperemesis, pre-eclampsia, gestational diabetes, increased incidence of mechanical delivery interventions, and stillbirth [4, 5]. This study presumed that a high or low BMI might increase the risk of infant mortality To this end, a meta-analysis was carried out in this study to systematically assess the association between maternal BMI and the risk of infant mortality
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