Gestational body weight gain and risk of low birth weight or macrosomia in women of Japan: a nationwide cohort study

Hiroyuki Uchinuma,Koichi Hashimoto,Yukihiro Ohya,Hidekuni Inadera,Shuichi Ito,Hiroyasu Iso,Kyoichiro Tsuchiya,Yuka Akiyama,Youichi Kurozawa,Reiji Kojima,Tetsuo Sekine,Nobuo Yaegashi,Shin Yamazaki,Chisato Mori,Masayuki Shima,Michihiro Kamijima,Takeo Nsakayama,Megumi Kushima,Sanae Otawa,Zentaro Yamagata,Reiko Kishi,Sayaka Horiuchi,Kunio Miyake,Hiroshi Yokomichi,Ryoji Shinohara,Shuji Hirata,Tadao Ooka,Narufumi Suganuma,Koichi Kusuhara,Takahiko Katoh

doi:10.1038/s41366-021-00947-7

Hiroyuki Uchinuma, Koichi Hashimoto + Show 28 more

Open Access

https://doi.org/10.1038/s41366-021-00947-7

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Abstract

ObjectiveBoth maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) influence maternal and pediatric outcomes. We sought to clarify the impact of prepregnancy BMI-specific GWG and its patterns on the risk of low birth weight (LBW) or macrosomia using data from a large nationwide study in Japan.MethodsThis cohort study (n = 98,052) used data from the Japan Environment and Children’s Study (JECS). The outcome variables in this study were LBW and macrosomia. We stratified the subjects into groups according to prepregnancy BMI.ResultsGWG from pre-pregnancy to the first trimester had a small effect on the risk of LBW and macrosomia. From the first to second trimesters, insufficient GWG was associated with the risk of LBW, and from the second trimester to delivery, a GWG of less than 2 kg was associated with the risk of LBW. These associations were commonly observed in all prepregnancy BMI categories. Irrespective of the GWG from pre-pregnancy to the first trimester, GWG from the first to second trimesters affects LBW and/or macrosomia. Irrespective of the GWG from the first to second trimesters, GWG from the second trimester to delivery affects LBW and/or macrosomia. LBW or macrosomia was associated with the prevalence of a sustained low or high BMI percentile until three years of age, respectively.ConclusionsThe present large national cohort study indicates that the risk of LBW or macrosomia is associated with GWG in women in Japan; the significance of this risk depends on the GWG patterns.

Highlights

Both maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) influence maternal and pediatric outcomes
The outcome variables in this study were low birth weight (LBW), macrosomia, and moderate and severe hypertensive disorders in pregnancy (HDP)
Maternal obesity and excessive GWG appear to have a greater impact on the prevalence of macrosomia than maternal diabetes [17, 21]

Summary

Introduction

Both maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) influence maternal and pediatric outcomes. Several studies have reported that increasing prepregnancy body weight (BW) has a linear relationship with birth weight [1, 2]; an obese gravida is at an increased risk of delivering an infant with macrosomia. There is no global consensus on the recommended amount of GWG, the Institute of Medicine (IOM) guidelines are the most widely used in the world [6]. These guidelines offer specific weekly (kg/wk) and absolute (total kg) GWG gain recommendations based on a woman’s pregravid BMI [7]; they provide specific ranges of weight gain for overweight and obese women, which were previously lacking [8]. The guidelines have been questioned as to whether the strict GWG recommendations have contributed to the increasing rate of LBW infants in the country

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