Abstract
Obesity rates are increasing in Cameroon. Obstetric literature has recently focused on the rising incidence of complications with increases in weight gain in pregnancy. Some of these complications include gestational diabetes, hypertensive disorders, operative deliveries, genital tract lacerations and fetal birth trauma. Examining the effects of excess weight gain during the course of pregnancy could help identify weight gain limits. The Institute of Medicine (IOM) was recommended by the World Health Organization (WHO) to develop guidelines for weight gain during pregnancy and we designed this study in order to determine delivery outcomes when weight is gained above these guidelines. We also sought to know if these guidelines are applicable in our environment. In this cross-sectional analytic design, pre-pregnancy and intra-partum BMIs were calculated for all the parturients who consented. They were classified into normal weight gain and excessive weight gain based on IOM recommendations. Those in the normal weight gain group were women with BMIs that ranged between 18.5 kg/m2 and 30 kg/m2 and who gained 9 - 16 kgs. Those who gained weight above these range were considered as having gained excessive weight during pregnancy. They were all follow-up in labor using the partogram. We compared prepartum, intra-partum and post-partum outcomes in the two groups by calculating odds ratios (ORs), 95% confidence intervals and p values. One hundred and ten (110) overweight women were matched against the same number of women who had normal weight gain. There was no significant difference between social status, marital status as well as level of educational and weight gain in the two groups. Underweight (BMI p = 0.048). Women who gained weight above the recommended range suffered from preeclampsia 18.2% vs. 6.4% (OR 3.2, 95% CI 1.3 - 8.0, p = 0.014), higher cesarean section rates 27.3% vs. 10% (OR 3.3, 95% CI 1.5 - 7.1, p = 0.002), higher rates of induced labor 19.1% vs. 9.0% (OR 2.4, 95% CI 1.0 - 5.2, p = 0.05), prolonged labor 43.6% vs. 16.4% (OR 4.0, 95% CI 2.1 - 7.4, p = 0.000), postpartum hemorrhage 10% vs. 1.8% (OR 6.2, 95% CI 1.3 - 9.2, p = 0.002). There were also higher rates of fetal mal-presentation, 11.8% vs. 3.6% (OR 4.0, 95% CI 1.31 - 11.9, p = 0.004), macrosomia 30.9% vs. 6.4% (OR 7.0, 95% CI 2.7 - 15.6, p p = 0.0045) and birth trauma 10% vs. 1.8%. (OR 6.2, 95% CI 1.3 - 9.2, p = 0.023). Women who gained weight during pregnancy above the recommended range had increased risk of adverse obstetric and neonatal outcomes.
Highlights
The systematic review of outcomes of maternal weight gain during pregnancy, often referred to as gestational weight gain by health organizations is motivated by several trends in perinatal health that are of public health concern [1]
We sought to know if these guidelines are applicable in our environment. In this cross-sectional analytic design, pre-pregnancy and intra-partum body mass index (BMI) were calculated for all the parturients who consented. They were classified into normal weight gain and excessive weight gain based on Institute of Medicine (IOM) recommendations
Women who gained weight above the recommended range were three times more likely to develop preeclampsia (OR = 3.7, 95% confidence intervals (95% CI) = 1.32 - 8.09, p = 0.014) and had 2 folds the odds of being induced (OR = 2, 95% CI = 1 - 5, p = 0.003)
Summary
The systematic review of outcomes of maternal weight gain during pregnancy, often referred to as gestational weight gain by health organizations is motivated by several trends in perinatal health that are of public health concern [1]. Gestational weight gain includes the products of conception, which comprise the fetus and placenta, increases in maternal fat stores, plasma volume, as well as uterine and breast tissue. The prevalence of overweight and obesity is rapidly increasing in industrialized as well as developing coun- OPEN ACCESS. Studies from urban populations in Cameroon have shown that overweight and obesity are increasingly common among the adult population. The estimated prevalence of obesity, based on body mass index (BMI), was 17.1% in women in urban Cameroon by 2002 [2]. There is an increasing prevalence of obesity in women of child-bearing age [3]. Pregnant women constitute an important subpopulation with elevated risk for developing obesity due to excess weight gain during pregnancy, and obesity-related health problems [4]
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