Maternal Prepregnancy Body Mass Index and Gestational Weight Gain on Pregnancy Outcomes

Nan Li,Lei Pan,Jia Guo,Lifang Hou,Gang Hu,Andrea A Baccarelli,Jin Liu,Enqing Liu,Ping Wang,Yue Wang,Baojuan Li,Gongshu Liu,Vincent W V Jaddoe

doi:10.1371/journal.pone.0082310

Abstract

ObjectiveThe aim of the present study was to evaluate the single and joint associations of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) with pregnancy outcomes in Tianjin, China.MethodsBetween June 2009 and May 2011, health care records of 33,973 pregnant women were collected and their children were measured for birth weight and birth length. The independent and joint associations of prepregnancy BMI and GWG based on the Institute of Medicine (IOM) guidelines with the risks of pregnancy and neonatal outcomes were examined by using Logistic Regression.ResultsAfter adjustment for all confounding factors, maternal prepregnancy BMI was positively associated with risks of gestational diabetes mellitus (GDM), pregnancy-induced hypertension, caesarean delivery, preterm delivery, large-for-gestational age infant (LGA), and macrosomia, and inversely associated with risks of small-for-gestational age infant (SGA) and low birth weight. Maternal excessive GWG was associated with increased risks of pregnancy-induced hypertension, caesarean delivery, LGA, and macrosomia, and decreased risks of preterm delivery, SGA, and low birth weight. Maternal inadequate GWG was associated with increased risks of preterm delivery and SGA, and decreased risks of LGA and macrosomia, compared with maternal adequate GWG. Women with both prepregnancy obesity and excessive GWG had 2.2–5.9 folds higher risks of GDM, pregnancy-induced hypertension, caesarean delivery, LGA, and macrosomia compared with women with normal prepregnancy BMI and adequate GWG.ConclusionsMaternal prepregnancy obesity and excessive GWG were associated with greater risks of pregnancy-induced hypertension, caesarean delivery, and greater infant size at birth. Health care providers should inform women to start the pregnancy with a BMI in the normal weight category and limit their GWG to the range specified for their prepregnancy BMI.

Highlights

Improvements of maternal, fetal, and child health are key public health goals
Several studies have shown that maternal excessive gestational weight gain (GWG) was associated with increased risks of pregnancy-induced hypertension, gestational diabetes mellitus (GDM), caesarean delivery and large for gestational age infant, and maternal inadequate GWG was associated with increased risks of low birth weight and small for gestational age infant [4,5,6]
Maternal excessive GWG was associated with increased risks of pregnancy-induced hypertension and caesarean delivery, and a decreased risk of preterm delivery, and maternal inadequate GWG was associated with an increased risk of preterm delivery, compared with maternal adequate GWG

Summary

Introduction

Improvements of maternal, fetal, and child health are key public health goals. In recent years, maternal prepregnancy body mass index (BMI) has increased among the childbearing age women in developed countries [1]. Women who gain weight excessively or inadequately during pregnancy are at increased risks of poor maternal and child health outcomes [4,5,6]. Several studies have shown that maternal excessive gestational weight gain (GWG) was associated with increased risks of pregnancy-induced hypertension, gestational diabetes mellitus (GDM), caesarean delivery and large for gestational age infant, and maternal inadequate GWG was associated with increased risks of low birth weight and small for gestational age infant [4,5,6]. The Danish National Birth Cohort found that excessive GWG increased risks of caesarean delivery and large for gestational age infant, and inadequate GWG increased the risk of having a small baby [3]

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Results

Conclusion