Abstract
BackgroundWeight-change across parities and/or current BMI may influence maternal and fetal morbidity and requires to be differentiated to better inform weight-management guidance.MethodsDirection, pattern and magnitude of weight-change across three consecutive parities and thereby two inter-pregnancy periods was described in 5079 women. The association between inter-pregnancy weight-change versus current BMI and adverse maternal events, SGA-birth and preterm delivery at second and third pregnancy were investigated by logistic regression.ResultsMore women gained weight across the defined childbearing period than lost it, with ~35% of normal and overweight women gaining sufficient weight to move up a BMI-category. Nine patterns of weight-change were defined across two inter-pregnancy periods and 50% of women remained weight-stable throughout (within 2BMI units/period). Women who were overweight/obese at first pregnancy had higher risk of substantial weight-gain and loss (>10kg) during each of two inter-pregnancy periods. Inter-pregnancy weight-gain (> 2BMI units) between first and second pregnancy increased the risk of maternal morbidity (1or more event of hypertensive disease, caesarean-section, thromboembolism) at second pregnancy, while weight-loss (>2BMI units) increased the risk of SGA-birth. Similarly, increased risk of maternal morbidity at the third pregnancy was influenced by weight-gain during both inter-pregnancy periods but not by current BMI-category. Both weight-gain between first and second pregnancy, and being overweight/obese by third pregnancy protected the fetus against SGA-birth whereas weight-loss between second and third pregnancy doubled the SGA risk.ConclusionHalf the women studied exhibited significant weight-fluctuations. This influenced their risk of maternal morbidity and SGA-birth at second and third pregnancy.
Highlights
In an increasingly obesogenic environment the childbearing period is considered a key lifestage when women are vulnerable to excess weight-gain setting the scene for persistent weightretention leading to mid-life obesity and its associated co-morbidities [1,2]
More women gained weight across the defined childbearing period than lost it, with ~35% of normal and overweight women gaining sufficient weight to move up a BMI-category
Inter-pregnancy weight-gain (> 2BMI units) between first and second pregnancy increased the risk of maternal morbidity (1or more event of hypertensive disease, caesarean-section, thromboembolism) at second pregnancy, while weight-loss (>2BMI units) increased the risk of SGA-birth
Summary
In an increasingly obesogenic environment the childbearing period is considered a key lifestage when women are vulnerable to excess weight-gain setting the scene for persistent weightretention leading to mid-life obesity and its associated co-morbidities [1,2] In spite of this assertion there is a relative paucity of longitudinal studies examining the direction and magnitude of weight-change between the start of successive parities in a defined population of women in relation to pre-gravid or early first pregnancy BMI. Irrespective of chronology, weight-gain between the first-trimester of the first-ever and second pregnancy robustly increases the risk of pre-eclampsia, gestational hypertension, gestational diabetes, caesarean-delivery, stillbirth, LGA (large-for-gestational age)birth and infant mortality at the second pregnancy in geographically diverse populations [7,8,9,10,11,12,13]. Weight-change across parities and/or current BMI may influence maternal and fetal morbidity and requires to be differentiated to better inform weight-management guidance
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