Abstract
BackgroundLow or high prepregnancy body mass index (BMI) and inadequate or excess gestational weight gain (GWG) are associated with adverse neonatal outcomes. This study estimates the contribution of these risk factors to preterm births (PTBs), small-for-gestational age (SGA) and large-for-gestational age (LGA) births in Canada compared to the contribution of prenatal smoking, a recognized perinatal risk factor.MethodsWe analyzed data from the Canadian Maternity Experiences Survey. A sample of 5,930 women who had a singleton live birth in 2005-2006 was weighted to a nationally representative population of 71,200 women. From adjusted odds ratios, we calculated population attributable fractions to estimate the contribution of BMI, GWG and prenatal smoking to PTB, SGA and LGA infants overall and across four obstetric groups.ResultsOverall, 6% of women were underweight (<18.5 kg/m2) and 34.4% were overweight or obese (≥25.0 kg/m2). More than half (59.4%) gained above the recommended weight for their BMI, 18.6% gained less than the recommended weight and 10.4% smoked prenatally. Excess GWG contributed more to adverse outcomes than BMI, contributing to 18.2% of PTB and 15.9% of LGA. Although the distribution of BMI and GWG was similar across obstetric groups, their impact was greater among primigravid women and multigravid women without a previous PTB or pregnancy loss. The contributions of BMI and GWG to PTB and SGA exceeded that of prenatal smoking.ConclusionsMaternal weight, and GWG in particular, contributes significantly to the occurrence of adverse neonatal outcomes in Canada. Indeed, this contribution exceeds that of prenatal smoking for PTB and SGA, highlighting its public health importance.
Highlights
Low or high prepregnancy body mass index (BMI) and inadequate or excess gestational weight gain (GWG) are associated with adverse neonatal outcomes
The objective of this study is to examine this hypothesis for Canada, by estimating the contribution of BMI and GWG, as measured by population attributable fraction (PAF), to preterm birth (PTB), small-for-gestational age (SGA) and large-for-gestational age (LGA) and to compare this to the contribution of prenatal smoking, a recognized perinatal risk factor
More than half (59.4%) gained above the recommended weight for their BMI; 18.6% gained less than recommended weight; and smoking was reported by 10.4% of women
Summary
Low or high prepregnancy body mass index (BMI) and inadequate or excess gestational weight gain (GWG) are associated with adverse neonatal outcomes. In Canada, based on measured height and weight, the prevalence of obesity among adult women rose from 16% in 1978 to 23% in 2004 [7], reflecting a global trend in increasing overweight and obesity [8] If this trend continues, as hypothesized by Cnattinguis et al [9], the public health importance of maternal overweight and obesity may rival prenatal smoking as a modifiable risk factor for adverse pregnancy outcomes. The objective of this study is to examine this hypothesis for Canada, by estimating the contribution of BMI and GWG, as measured by PAFs, to PTB, SGA and LGA and to compare this to the contribution of prenatal smoking, a recognized perinatal risk factor
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