Maternal Pregestational Body Mass Index Research Articles

The mutual effect of pre-pregnancy body mass index, waist circumference and gestational weight gain on obesity-related adverse pregnancy outcomes: A birth cohort study.

ObjectiveThe aim of this study was to examine the mutual effect of pre-pregnancy body mass index (BMI), waist circumference (WC) and gestational weight gain (GWG) on obesity-related adverse pregnancy outcomes.MethodsThis birth cohort study was conducted in three Streets in Changsha, China, including a total of 976 mother-child pairs. All data was collected within 15 days after deliveries from a self-administered questionnaire, maternal health manual and perinatal health care information system. Multivariate logistic regression models were conducted to estimate the effects of maternal pre-pregnancy BMI, WC and GWG on obesity-related adverse pregnancy outcomes including gestational diabetes mellitus (GDM), primary cesarean section (P-CS), large for gestational age (LGA) and composite outcome (one or more adverse pregnancy outcomes)ResultsAfter controlling for all confounders, both maternal pre-pregnancy overweight/obesity and central adiposity contributed to increased risks of GDM [ORs 95% CIs = 2.19 (1.02–4.76) and 2.26 (1.11–4.60), respectively], P-CS [ORs 95% CIs = 1.66 (1.05–2.65) and 1.71 (1.11–2.63), respectively], LGA [ORs 95% CIs = 1.93 (1.07–3.50) and 2.14 (1.21–3.75), respectively] and composite outcome [ORs 95% CIs = 1.82 (1.15–2.87) and 1.98 (1.30–3.01), respectively] compared with mothers with normal pre-pregnancy weight and normal WC. Excessive GWG was found to be associated with an increased risk of LGA [OR 95% CI = 1.74 (1.05–2.89)], but was not significantly related to higher risks of GDM, P-CS and composite outcome [ORs 95% CIs = 0.90 (0.47–1.72), 1.08 (0.77–1.52), and 1.30 (0.94–1.79), respectively]. In terms of the joint effect of maternal pregestational BMI and WC on obesity-related composite outcome, mothers with both pre-pregnancy overweight and central adiposity had the highest risk of composite outcome [OR 95% CI = 3.96 (2.40–6.54)], compared with mothers without pre-pregnancy overweight or central adiposity.ConclusionsThe results of this study suggest that maternal pre-pregnancy overweight/obesity and central adiposity may contribute to multiple obesity-related adverse pregnancy outcomes, excessive weight gain during pregnancy is associated with an increased risk of LGA. Healthcare providers should carry out health education, and guide women to keep an ideal BMI and WC prior to pregnancy and help them gain optimal weight during pregnancy based on their pre-pregnancy BMI and WC.

Participant Characteristics in the Kumamoto University Regional Center of Japan Environment and Children's Study (JECS): Association of Pregnancy Outcomes with Pregestational Maternal Body Mass Index and Maternal Weight Gain during Pregnancy.

The purpose of this study was to identify participant characteristics in the Kumamoto University Regional Center of the Japan Environment and Children's Study (K-JECS) and to investigate the association of pregnancy outcomes with pregestational maternal body mass index (BMI) and maternal weight gain during pregnancy (MWG). The subjects were women with singleton birth, who had been recruited by the K-JECS, and were registered in the data systems for the first and second questionnaires and transcripts of medical records. The subjects were categorized by BMI with further classification by MWG. The chi-squared test and one-way analysis of variance were performed to determine the correlations of BMI and MWG with perinatal outcomes. Logistic regression analysis was performed to examine perinatal outcome risks. The subject characteristics were similar to the trends observed in the Japanese general population. The odds ratio for natural delivery was low in the overweight groups (OW) and normal weight groups (NW) with excessive weight gain. On the other hand, the risk of cesarean section was high in the OW, and risk of induced or accelerated delivery was high in the NW with excessive weight gain. The risks of preterm birth and LBW were high in the insufficient weight gain groups regardless of BMI. The risks of pregnancy-induced hypertension and gestational diabetes were high in the OW.

Pregestational body mass index, gestational weight gain, and risks for adverse pregnancy outcomes among Taiwanese women: A retrospective cohort study

ObjectiveTo investigate the associations between maternal pregestational body mass index (BMI), gestational weight gain (GWG), and adverse pregnancy outcomes among Taiwanese women. Materials and MethodsA retrospective cohort study was conducted among all singletons without fetal anomalies delivered to women at Taipei Chang Gung Memorial Hospital between 2009 and 2015. Two study cohorts were selected for analysis: all deliveries after 24 0/7 weeks of gestation (Cohort 1, n=12,064) and all live births after 37 0/7 weeks of gestation excluding maternal overt diabetes mellitus and chronic hypertension (Cohort 2, n=10,973). The associations between pregestational BMI, GWG outside the 2009 Institute of Medicine (IOM) guidelines, and adverse pregnancy outcomes were assessed using multivariable logistic regression analysis. ResultsIn Cohort 1, the prevalence of pregestational underweight, normal weight, overweight, and obesity was 14.0%, 74.8%, 9.0%, and 2.2%, respectively. Compared with the women with normal weight, maternal underweight was associated with increased risk for placental abruption, small-for-gestational age, and low birth weight (<2500 g). In contrast, overweight and obese women were at risk for gestational diabetes mellitus, preeclampsia, dysfunctional labor, cephalopelvic disproportion, large-for-gestational age, and macrosomia (>4000 g). In Cohort 2, GWG below the IOM guidelines were associated with higher rates of gestational diabetes mellitus, small-for-gestational age, and low birth weight, while GWG above the IOM guidelines were with higher rates of primary cesarean delivery, large-for-gestational age, and macrosomia in women with pregestational underweight or normal weight. Normal weight women were more likely to have placental abruption with GWG below the guidelines and to have preeclampsia with GWG above the guidelines. For overweight and obese women, GWG below the guidelines was associated with a higher rate of gestational diabetes mellitus, but GWG above the guidelines was associated with a higher rate of macrosomia. ConclusionsWomen with abnormal pregestational BMI are at risk for adverse maternal and neonatal outcomes. Moreover, GWG has a differential effect on the rates of adverse pregnancy outcomes between women of different pregestational BMI categories.

Breastfeeding Pattern and Duration and Post-Partum Maternal Weight Retention

Background/Aim: The aims were to investigate the association of breastfeeding (BF) duration with maternal postpartum weight retention (PPWR) at 12 months after delivery. Methods: In this prospective cohort study, mothers were interviewed at birth, and at 3, and 12 months after delivery to gather information on socio-demographic and reproductive maternal characteristics, BF initiation, BF pattern at 3 months and BF duration, as well as to measure maternal anthropometric indicators. Results: A negative association between BF intensity at 3-months and maternal PPWR was found at 3-months and 12-months after delivery. In adjusted multivariable linear regression, for each month of EBF increase between birth and 3-months postpartum, there was a mean decrease of 0.21 kg in maternal long-term PPWR; and for each month of any BF increase between birth and 12 months postpartum, there was a mean decrease of 0.11 kg in maternal long-term PPWR. Maternal younger ages weakened the negative long-term effect of BF on PPWR and the greater levels of maternal pre-gestational body mass index annulled the effect of any BF on PPWR. Conclusion: This study supports the evidence that BF improves the reduction of PPWR and suggests that encouraging prolonged EBF and any BF may contribute to decrease PPWR.

Risk factors and placental histopathological findings of term born low birth weight neonates

IntroductionLow birth weight (LBW) is associated with increased neonatal morbidity and mortality. Hence, this condition should be well studied. The aims of this study were to identify the risk factors for term born LBW, as well as the placental histopathological lesions observed. MethodsThis case control study was carried out in the University Teaching Hospital and the Central Maternity, both of Yaoundé, Cameroon, from November 1st, 2013 to April 30th, 2014. Maternal medical records and placentas of term born (≥37 completed weeks) LBW (<2500 g at birth) or normal weight (3000–3500 g) were compared. The main variables recorded included maternal age and parity, maternal height, complications that occurred during pregnancy, maternal pre-gestational body mass index, the number of antenatal visits, the sex and birth weight of the newborn, the umbilical cord length, the placental weight and placental histology. Data were analyzed using Epi info 3.5.4. Fisher exact test, t-test and logistic regression were used for comparison. P < 0.05 was considered statistically significant. Resultsand Discussion: A total of 30 cases of LBW and the same number of controls were examined. Significant risk factors for LBW were primiparity (aOR 14.0, 95%CI 2.1–92.7), hypertensive diseases of pregnancy (aOR 18.1, 95%CI 1.02–322.5) and <4 antenatal visits (aOR 9.5, 95%CI 1.3–67.5). Significant placental lesions were placental infarction (aOR 19.5, 95%CI 2.9–130.1) and chronic villitis (aOR 35.9, 95%CI 1.2–1034.3). Our study showed that primiparous women, those with pregnancy-induced hypertensive diseases and those with <4 antenatal visits were more at risk for LBW. Significant placental lesions observed among LBW were placental infarcts and chronic villitis. Since LBW has the tendency to recur, and given that some causes such as placental infarcts are preventable, we recommend that a histological examination of the placenta should always be carried out in cases of LBW.

The influence of placental perfusion on birthweight in women with gestational diabetes

Objective: To evaluate the influence of both uterine and umbilical arteries Doppler pulsatility indexes (PI) and metabolic control on birthweight in pregnant women with gestational diabetes mellitus.Methods: One hundred sixty-nine women with gestational diabetes were evaluated. Doppler measurements of umbilical artery and mean uterine arteries PI were recorded and the corresponding Z-score values by gestational age calculated. Maternal pregestational body mass index (BMI) and the levels of glycosylated hemoglobin were also recorded. The relationships between these studied variables and customised birthweight centiles according to sex and gestational age were analyzed using Spearman’s correlation coefficient and linear regression.Results: There was a significant correlation between birthweight centiles and Z-score values of the umbilical artery PI (r = −0.25, p = 0.001), but not with the Z-score values of the uterine artery PI (r = −0.12, p = 0.43). Third trimester maternal glycosylated hemoglobin was also positively correlated to birthweight (r = 0.29, p = 0.01). When using stepwise linear regression both maternal glycosylated hemoglobin and the Z-score of umbilical artery PI were included as independent variables in the predictive model of birthweight centile (p = 0.0002, p = 0.001 respectively, R2 = 0.27).Conclusions: Umbilical artery PI predicts birthweight in women with gestational diabetes. However, metabolic control is the only important determinant of fetal macrosomia in these mothers.

Pregestational body mass index is related to neonatal abdominal circumference at birth—a Danish population‐based study

To examine the impact of maternal pregestational body mass index (BMI) and smoking on neonatal abdominal circumference (AC) and weight at birth. To define reference curves for birth AC and weight in offspring of healthy, nonsmoking, normal weight women. Population-based study. Data from the Danish Medical Birth Registry. All live singletons without congenital malformations in Denmark 2004-10. Data on 366,886 singletons at 35(+0) to 41(+6) weeks(+days) of gestation were extracted and analysed using multivariate linear regressions. Birth AC and weight in relation to pregestational maternal BMI, maternal smoking and medical conditions (any). Birth AC and weight increased with increasing pregestational BMI, and decreased with smoking (P < 0.0001). Reference curves were created for offspring of healthy, nonsmoking mothers with normal pregestational BMI. Mean AC ranged from 30.1 cm and 30.2 cm at 35 weeks of gestation to 33.9 cm and 34.1 cm at 41 weeks of gestation, for girls and boys, respectively. Mean birthweight ranged from 2581 and 2666 g at 35 weeks to 3705 and 3852 g at 41 weeks of gestation for girls and boys, respectively. Pregestational BMI correlated more to the Z score of birthweight than to the Z score of AC (P < 0.0001). Birth AC and weight are affected by maternal smoking status and pregestational BMI. Pregestational BMI correlated more to birthweight than to AC. Using data from healthy, nonsmoking mothers with normal pregestational BMI we have provided new reference curves for birth AC and birthweight.

Maternal pre-pregnancy underweight and fetal growth in relation to institute of medicine recommendations for gestational weight gain

PurposeMaternal nutritional status is one of the most important factors of fetal growth and development. Consequently, the currently increasing prevalence of underweight women worldwide has come in the focus of interest of perinatal medicine. The aim of the study was to assess the effect of low pre-pregnancy body mass index (BMI) on fetal growth. Materials and methodsData on 4678 pregnant women and their neonates were retrospectively analyzed. Pre-pregnancy BMI of study women was categorized according to the WHO standards. Fetal growth was assessed by birth weight and birth length, birth weight for gestational age, and ponderal index. ResultsStudy group included 351 (7.6%) women with pregestational BMI<18.5kg/m2, while all women with pregestational BMI 18.5–25kg/m2 (n=3688; 78.8%) served as a control group. The mean birth weight and birth length of neonates born to underweight mothers were by 167g and 0.8cm lower in comparison with the neonates born to mothers of normal nutritional status, respectively (P<0.001 both). The prevalence of small for gestational age (SGA) births was twofold that found in the control group of mothers of normal nutritional status (9.7% vs. 4.9%; P<0.001). The inappropriately low gestational weight gain additionally increased the rate of SGA infants in the group of mothers with low pre-pregnancy BMI (21.4% vs. 10.4%; P=0.02). Pre-pregnancy BMI category did not influence neonatal growth symmetry. ConclusionLow maternal pregestational BMI is associated with fetal growth assessment. Improvement of the maternal nutritional status before pregnancy can increase the likelihood of perinatal outcome.

1318 Smoking and Other Pre-Gestational Risk Factors for Spontaneous Preterm Birth

ObjectivesTo investigate pre-gestational risk factors for spontaneous preterm birth and, the role of smoking and its cumulative effects on prematurity.MethodsA case-control study analyzed all births (2,198) occurring in a tertiary...

Smoking and other pre-gestational risk factors for spontaneous preterm birth

OBJECTIVES: to investigate pre-gestational risk factors for spontaneous preterm birth and, the role of smoking and its cumulative effects on prematurity. METHODS: a case-control study analyzed a data set of all births occurring in a tertiary maternity hospital between April 2002 and July 2004. Spontaneous preterm births of single and live newborns without malformations were selected as cases. Controls were all the term births of live and single newborns without malformations during the same period. Three outcomes were studied: all preterm births (&lt;37 weeks), less than 35 weeks and less than 32 weeks of gestational age. Logistic regression was used to obtain the independent effect of pre-gestational risk factors. RESULTS: maternal age of less than 20 years, low schooling, low maternal pre-gestational body mass index and smoking showed significant, independent association with spontaneous preterm birth for the three outcomes. For all these risk factors, excepting maternal smoking, odds ratios increased with decreasing gestational age at birth and this trend was significant for low maternal age and low pre-gestational body mass index. CONCLUSIONS: the cumulative effects of smoking calls for the need to encourage smoking cessation among pregnant women, especially those who are underweight and in the older age groups, because of the increased risk of delivering premature babies.

Risk factors for fractured clavicle in the newborn

To disclose potential risk factors for sustaining a fractured clavicle in the newborn. A retrospective case-control analysis of women who gave birth to an infant with a fractured clavicle during a four-year period (2003-2006) was performed. A control group of newborns who did not sustain a fractured clavicle was formed (2:1) matched for maternal age, parity and gestational age at delivery. The rate of fractured clavicle was 0.35%. Heavier newborns' birth weight (3632.9 ± 376.1 g vs. 3429.5 ± 513.0 g, P < 0.05) and the use of oxytocin (91.3% vs. 69.5%, P < 0.05) were associated with the occurrence of fractured clavicle during birth. Fractured clavicle was not well correlated with maternal height, maternal pregestational body mass index, maternal body mass index at delivery, maternal weight gain during pregnancy, induction of labor, duration of the second stage of labor, instrumental delivery or newborn birth weight of more than 4000 g. We could not identify significant risk factors that could be dealt with in order to avoid a fractured clavicle being sustained during birth. Most fractured clavicles occur in normal newborns following normal labor and delivery.

Perfil lipídico na adolescência: efeito de exposições intra-uterinas

This study assessed the effects of intrauterine growth restriction and risk factors for intrauterine growth restriction on blood lipids in adolescents from the 1982 birth cohort in Pelotas, Rio Grande do Sul State, Brazil. All male subjects were identified in 2000 when enrolling in the national army; 79% (n = 2,250) were interviewed, and 2,089 provided blood samples. The following outcome variables were studied: total cholesterol and fractions (VLDL, LDL, and HDL), non-HDL cholesterol, LDL/HDL ratio, and serum triglycerides. The explanatory variables were intrauterine growth restriction, maternal pre-gestational body mass index (BMI), and maternal smoking during pregnancy. After adjusting for confounding variables, total, LDL, and non-HDL cholesterol levels were slightly and significantly higher among adolescents whose mothers were in the 3rd and 4th quartiles of pre-gestational BMI. However, these associations disappeared after adjusting for the adolescent's diet, schooling, and BMI. Other associations were not significant (p > 0.05).

Trimester‐specific blood pressure levels in relation to maternal pre‐pregnancy body mass index

We evaluated the influence of maternal pre-pregnancy body mass index (BMI), based on reported pre-pregnancy weight and height, on blood pressure (BP) levels during pregnancy by using information from a prospective cohort of 1733 women recruited before 20 weeks' gestation. Maternal antenatal BP values were abstracted from medical records, and we evaluated the mean BP differences according to BMI group in regression models, using generalised estimating equations to account for repeated BP records within each pregnancy. In each trimester, mean systolic BP (SBP) and diastolic BP (DBP) values were positively associated with maternal pre-gestational BMI. This association persisted after adjustment for maternal age, parity, smoking, education, marital status and physical activity. Overweight women (25-29 kg/m(2)) had first-, second- and third-trimester mean SBPs that were 8.1, 7.7 and 8.2 mmHg, respectively, higher than values observed in lean women (<20 kg/m(2)). Mean DBP values were 4.5, 5.4 and 5.6 mmHg higher for each successive trimester in overweight vs. lean women. Obese (>30 kg/m(2)) women consistently had the highest mean SBP and DBP values. Trimester-specific mean SBP values were 10.7-12.0 mmHg higher among obese women vs. lean women. Corresponding trimester-specific mean DBP values were 6.9-7.4 mmHg higher in obese vs. lean women. Similar patterns were observed when trimester-specific average mean arterial pressures were evaluated. Elevated pregnancy BPs associated with maternal pre-gestational BMI are consistent with a large body of literature that documents increased pre-eclampsia risk among overweight and obese women.