Abstract
BackgroundIncreasing rates of overweight have been reported. In Germany, women of childbearing age are especially affected. Those women are at increased risks of several peri- and postnatal complications. The purpose of this study was to carry out Germany’s first study in terms of secular trends of overweight and weight gain during pregnancy related to foetal clinical outcomes (birth weight, Apgar score and umbilical blood pH).MethodsA database maintained by a large regional university hospital in Cologne, Germany was used to evaluate clinical routine data from 1996 to 2012. 11771 women (23.5 ± 5.4 years; 18–48 years), who gave birth to a live singleton child (>2000 gram) were included. Recommended weight gain during pregnancy was based on IOM guidelines: Total weight gain range for underweight (initial BMI < 18.5 kg/m2) is 12.5 - 18 kg/ 28–40 lbs respectively, for normal-weight (initial BMI 18.5 -24.9 kg/m2) is 11.5 - 16 kg/ 25–35 lbs respectively, for overweight (initial BMI 25.0-29.9 kg/m2) is 7–11.5 kg/ 15–25 lbs respectively and for obese (initial BMI ≥ 30.0 kg/m2) is 5–9 kg/ 11–20 lbs respectively.A one-way variance analysis was employed to test for differences in particular factors in various groups. Multiple linear regression analysis was used to model impact factors.ResultsOver the second analysed period (2005–2012), the number of women with high weight gain increased from 33.8% to 42.9% (p <0.001). 54.5% overweight and 57.7% obese women were affected (p <0.001). Women with high weight gain were 54.5% significantly more likely to give birth to an infant ≥ 4000 grams than women with normal (31.7%) or low weight gain (13.8%, p < 0.001). Women with normal weight gain had significantly better foetal outcomes in terms of the Apgar score at 5 min and umbilical cord blood pH.ConclusionThese data confirm an increase in maternal weight gain before and during pregnancy. An excessive weight gain is accompanied by macrosomia, lower Apgar scores and pH-value. Women should therefore be advised about the risks of obesity before and during pregnancy as well as excessive maternal weight gain during pregnancy.
Highlights
Increasing rates of overweight have been reported
Gestational weight gain averaged 13.3 ± 5.6 kg and, when the different years were taken into account, it became evident that women gained less weight in 2000 (12.3 kg; 95% Cl: 11.9, 12.7), in 2001 (12.3 kg; 95% Cl: 11.9, 12.6) and in 2002 (12.5 kg; 95% Cl: 12.0, 12.9) than women in 2010 (13.7 kg; 95%Cl: 13.4, 14.1), 2011 (13.9 kg; 95% Cl: 13.5, 14.2) and 2012 (13.7 kg; 95% Cl: 13.2, 14.2) (p
Relative weight gain Depending on weight before pregnancy [12], 27.4% of the women (n = 2514) gained less weight than the recommended amounts, 36.5% (n = 3347) were within the range and 36.0% (n = 3303) gained more than the recommended amount (p
Summary
Increasing rates of overweight have been reported. In Germany, women of childbearing age are especially affected. The risk of developing gestational diabetes is increased by 2.4% in overweight women and by 5.2% in obese women when compared to normal-weight women [4]. Excessive weight gain during pregnancy is associated with multiple maternal and neonatal complications like gestational hypertension, macrosomia, birth complications, caesarean delivery, stillbirth, low Apgar score at 5 minutes, hypoglycaemia or cardiovascular risk factors [7,8,9,10,11]. Studies have found excessive maternal weight gain [12] in overweight women to be associated with a higher percentage of fat mass in their children compared to children of normal-weight women [13]. A lower Apgar score is associated with lower levels of umbilical cord pH, especially in morbidly obese women (BMI >50 kg/m2) [25]
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