Abstract
To evaluate and compare the prevalence of structural congenital anomalies (CAs) according to maternal body mass index (BMI). The present cross-sectional study involved pregnant women with fetuses diagnosed with structural CAs through morphological ultrasonography between November 2014 and January 2016. The nutritional status of the pregnant women was classified according to the gross value of the body mass index. The pregnant women were categorized into four groups: low weight, adequate weight, overweight, and obesity. Statistical analysis was performed using Stata/SE version 12.0 (Stata Corporation, College Station, TX), with values of p ≤ 0.05 considered statistically significant. A total of 223 pregnant women had fetuses diagnosed with CAs. The prevalence of structural CAs in pregnant women with low weight was of 20.18%, of 43.50% in pregnant women with adequate weight, of 22.87% in pregnant women with overweight, and of 13.45% in pregnant women with obesity. The prevalence of central nervous system (CNS) anomalies and of genitourinary system anomalies was high for the four groups of pregnant women. A positive association was observed between multiple anomalies in pregnant women with adequate weight (prevalence ratio [PR] = 1.65; p ≤ 0.004) and between anomalies of the lymphatic system in obese pregnant women (PR = 4.04, p ≤ 0.000). The prevalence of CNS and genitourinary system anomalies was high in all of the BMI categories. Obese pregnancies were associated with lymphatic system anomalies. Therefore, screening and identification of the risk factors for CAs are important, regardless of the maternal BMI. Our findings reinforce the importance of discussing with pregnant women maternal nutrition and its effect on fetal development and on neonatal outcome.
Highlights
A significant difference in age was observed in pregnant women with low weight; a greater proportion of women were aged between 19 and 29 years old (25.19%; 33/45; p 1⁄4 0.021; prevalence ratio (PR) 1⁄4 3.02; 95% confidence interval (CI):1.24–7.37), and had a family history of congenital anomaly (CA) (30.00%; 15/45; p 1⁄4 0.049; PR 1⁄4 1.73; 95% CI 1⁄4 1.01–2.95)
Normal weight was not associated with diabetes mellitus (DM) (PR 1⁄4 3.09; 95% CI 1⁄4 1.07–8.88; p 1⁄4 0.008); obesity was positively associated with DM (PR 1⁄4 3.09; 95% CI 1⁄4 1.33–7.20; p 1⁄4 0.003) (►Table 1)
The present study demonstrated that there are differences between the profiles of CAs in the groups of pregnant women according to the maternal body mass index (BMI)
Summary
Nutritional status and adequate maternal weight gain are important aspects for the health and the well-being before, during, and after pregnancy.[1,2] It is known that women with normal gestational weight gain have fewer complications during pregnancy.[3]In contrast, low birthweight and malnutrition in pregnant women have been related to adverse effects during pregnancy, such as spontaneous abortion, hypertensive disorders, and fetal growth restriction and prematurity.[4,5] Maternal weight gain beyond the recommended limit may lead to complications in the pre- and postpartum period, and may represent an obstetric risk factor, with consequences for the mother and for the fetus.[3,6] Risks to pregnant women include gestational diabetes mellitus (DM) and preeclampsia, whereas risks to fetuses include congenital anomalies (CAs), macrosomia, stillbirth, neonatal death, and prematurity.[3,7,8,9]Congenital anomalies result in mortality in approximately 276,000 newborns per year worldwide. Nutritional status and adequate maternal weight gain are important aspects for the health and the well-being before, during, and after pregnancy.[1,2] It is known that women with normal gestational weight gain have fewer complications during pregnancy.[3]. 50% of the CAs have an unexplained etiology; some etiological factors have been reported, including genetic, nutritional, infectious, and/or environmental factors, among which maternal nutritional status is highlighted.[10,11] Despite this, there are few epidemiological studies on the prevalence of CAs and the association between the body mass index (BMI) of pregnant women and the development of CAs.[12,13,14] These studies include only overweight and obese pregnant women
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