The Effect of Gestational Weight Gain by Body Mass Index on Maternal and Neonatal Outcomes

ObjectiveTo evaluate the effects of gestational weight gain on maternal and neonatal outcomes in different body mass index (BMI) classes.MethodsWe compared maternal and neonatal outcomes based on gestational weight gain in underweight, normal weight, overweight, obese, and morbidly obese (BMI ≥ 40.00) women. The study group was a population-based cohort of women with singleton gestations who delivered between April 1, 2001, and March 31, 2007, drawn from the Newfoundland and Labrador Provincial Perinatal Program Database. Univariate analyses and multivariate logistic regression analyses (controlling for maternal age, parity, smoking status, partnered status, and gestational age) were performed and odds ratios (ORs) were calculated.ResultsOnly 30.6% of women gained the recommended amount of weight during pregnancy; 52.3% of women gained more than recommended, and 17.1% gained less than recommended. In women with normal pre-pregnancy BMI, excess weight gain was associated with increased rates of gestational hypertension (OR 1.27; 95% CI 1.08–1.49), augmentation of labour (OR 1.09; 95% CI 1.01–1.18), and birth weight ≥ 4000 g (OR 1.21; 95% CI 1.10–1.34). In overweight women, excess weight gain was associated with increased rates of gestational hypertension (OR 1.31; 95% CI 1.10–1.55) and birth weight ≥4000 g (OR 1.30; 95% CI 1.15–1.47). In women who were obese or morbidly obese, excess weight gain was associated with increased rates of birth weight ≥4000 g (OR 1.20; 95% CI 1.07–1.34) and neonatal metabolic abnormality (OR 1.31; 95% CI 1.00–1.70). In morbidly obese women, poor weight gain was associated with less use of epidural analgesia (OR 0.34; 95% CI 0.12–0.95). In women who were of normal weight, overweight, or obese, the rate of adverse outcome (Caesarean section, gestational hypertension, birth weight < 2500 g or birth weight ≥4000 g) was lower in women with recommended weight gain than in those with excess weight gain. Adverse outcomes were reduced in nulliparous morbidly obese women who had poor weight gain (OR 0.18; 95% CI 0.04–0.83).ConclusionThe effects of gestational weight gain on pregnancy outcome depend on the woman’s pre-pregnancy BMI. Pregnancy weight gains of 6.7–11.2 kg (15–25lb) in overweight and obese women, and less than 6.7 kg (15lb) in morbidly obese women are associated with a reduction in the risk of adverse outcome.     

Primary preeclampsia in the second pregnancy: effects of changes in prepregnancy body mass index between pregnancies

OBJECTIVE: To examine the association between changes in prepregnancy body mass index (BMI) between a woman's first two pregnancies and incidence of preeclampsia in the second pregnancy. METHODS: We performed a population-based retrospective cohort analysis using data on women's first two singleton pregnancies (n=136,884) in Missouri (1989-1997). The study was restricted to women without preeclampsia in the first pregnancy. Prepregnancy BMI (kg/m(2)) was categorized as underweight (less than 18.5), normal (18.5-24.9), overweight (25-29.9), and obese (30 or greater). Analyses were adjusted for confounders through multivariable logistic regression. RESULTS: The incidence rate of preeclampsia in the second pregnancy was 2.0%. In comparison with women who were of normal BMI in both pregnancies, the risk for preeclampsia increased when BMI changed between the first two pregnancies from underweight to obese (odds ratio [OR] 5.6, 95% confidence interval [CI] 1.7-18.2), normal to overweight (OR 2.0, 95% CI 1.7-2.3), normal to obese (OR 3.2, 95% CI 2.5-4.2), and overweight to obese (OR 3.7, 95% CI 3.1-4.3). Being obese or overweight in both pregnancies was associated with increased risk of preeclampsia in the second pregnancy. Women who increased their BMI from underweight to normal or overweight between pregnancies had risks of preeclampsia comparable with those with normal BMI in both pregnancies. African-American, but not white, women who had a reduction in BMI from obese or overweight to normal between pregnancies remained at increased risk for preeclampsia. CONCLUSION: Increases in prepregnancy BMI from normal weight to overweight or obese between pregnancies are associated with increased risk of preeclampsia in the subsequent pregnancy. LEVEL OF EVIDENCE: II.     

Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index

Objective: To determine the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on large-for-gestational-age (LGA) birth weight (≥90th % ile). Methods: We examined 4321 mother-infant pairs from the Ottawa and Kingston (OaK) birth cohort. Multivariate logistic regression (controlling for gestational and maternal age, pre-pregnancy weight, parity, smoking) were performed and odds ratios (ORs) calculated. Results: Prior to pregnancy, a total of 23.7% of women were overweight and 16.2% obese. Only 29.3% of women met GWG targets recommended by the Institute of Medicine (IOM), whereas 57.7% exceeded the guidelines. Adjusting for smoking, parity, age, maternal height, and achieving the IOM’s recommended GWG, overweight (OR 1.99; 95%CI 1.17–3.37) or obese (OR 2.64; 95% CI 1.59–4.39) pre-pregnancy was associated with a higher rate of LGA compared to women with normal BMI. In the same model, exceeding GWG guidelines was associated with higher rates of LGA (OR 2.86; 95% CI 2.09–3.92), as was parity (OR 1.49; 95% CI 1.22–1.82). Smoking (OR 0.53; 95%CI 0.35–0.79) was associated with decreased rates of LGA. The adjusted association with LGA was also estimated for women who exceeded the GWG guidelines and were overweight (OR 3.59; 95% CI 2.60–4.95) or obese (OR 6.71; 95% CI 4.83–9.31). Conclusion: Pregravid overweight or obesity and gaining in excess of the IOM 2009 GWG guidelines strongly increase a woman’s chance of having a larger baby. Lifestyle interventions that aim to optimize GWG by incorporating healthy eating and exercise strategies during pregnancy should be investigated to determine their effects on LGA neonates and down-stream child obesity.     

Optimal weight gain during twin pregnancy in Japanese women with favorable perinatal outcomes

Objective: We examined the optimal weight gain in the healthy Japanese women with favorable perinatal outcomes of (dichorionic) twin pregnancy.

Methods: We calculated the average weight gain in the women whose height was 150–164?cm with favorable perinatal outcomes of dichorionic twin pregnancy set for this study. The women were categorized to underweight, normal, overweight and obese based on the pre-pregnancy body mass index (BMI) categories according to the Institute of Medicine (IOM) and the World Health Organization (WHO) body mass index (BMI) cutoffs.

Results: The average GWG in the normal-weight women with the favorable perinatal outcomes was 13.9?±?3.6?kg. It was significantly different from that in the underweight, overweight and obese women according to the both 2 BMI cutoffs by Student’s t-test (p?Conclusion: There are optimal ranges of weight gain during twin pregnancy based on the BMI classification.     

Pre-pregnancy weight and the risk of stillbirth and neonatal death

OBJECTIVE: To evaluate the association between maternal pre-pregnancy body mass index (BMI) and the risk of stillbirth and neonatal death and to study the causes of death among the children. DESIGN: Cohort study of pregnant women receiving routine antenatal care in Aarhus, Denmark. SETTING: Aarhus University Hospital, Denmark, 1989-1996. POPULATION: A total of 24,505 singleton pregnancies (112 stillbirths, 75 neonatal deaths) were included in the analyses. METHODS: Information on maternal pre-pregnancy weight, height, lifestyle factors and obstetric risk factors were obtained from self-administered questionnaires and hospital files. We classified the population according to pre-pregnancy BMI as underweight (BMI <18.5 kg/m(2)), normal weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)) and obese (BMI 30.0 kg/m(2) or more). MAIN OUTCOME MEASURES: Stillbirth and neonatal death and causes of death. RESULTS: Maternal obesity was associated with a more than doubled risk of stillbirth (odds ratio = 2.8, 95% confidence interval [CI]: 1.5-5.3) and neonatal death (odds ratio = 2.6, 95% CI: 1.2-5.8) compared with women of normal weight. No statistically significantly increased risk of stillbirth or neonatal death was found among underweight or overweight women. Adjustment for maternal cigarette smoking, alcohol and caffeine intake, maternal age, height, parity, gender of the child, years of schooling, working status and cohabitation with partner did not change the conclusions, nor did exclusion of women with hypertensive disorders or diabetes mellitus. No single cause of death explained the higher mortality in children of obese women, but more stillbirths were caused by unexplained intrauterine death and fetoplacental dysfunction among obese women compared with normal weight women. CONCLUSION: Maternal obesity more than doubled the risk of stillbirth and neonatal death in our study. The present and other studies linking maternal obesity to an increased risk of severe adverse pregnancy outcomes emphasise the need for public interventions to prevent obesity in young women.     

The effect of prepregnancy body mass index on birth weight,preterm birth,cesarean section,and preeclampsia in pregnant women

Objective: The objective of this study is to determine the impact of maternal prepregnancy BMI on birth weight, preterm birth, cesarean section, and preeclampsia among pregnant women delivering singleton life birth.

Methods: A cross-sectional study of 4397 women who gave singleton birth in Tehran, Iran from 6 to 21 July 2015, was conducted. Women were categorized into four groups: underweight (BMI?2), normal (BMI 18.5–25?kg/m²), overweight (BMI 25–30?kg/m²) and obese (BMI >30?kg/m²), and their obstetric and infant outcomes were analyzed using both univariate and multivariate logistic regression.

Results: Prepregnancy BMI of women classified 198 women as underweight (4.5%), 2293 normal (52.1%), 1434 overweight (32.6%), and 472 as obese (10.7%). In comparison with women of normal weight, women who were overweight or obese were at increased risk of preeclampsia (odds ratio (OR)?=?1.47, 95% CI?=?1.06–2.02; OR?=?3.67, 95% CI?=?2.57–5.24, respectively) and cesarean section (OR?=?1.21, 95% CI?=?1.04–1.41; OR?=?1.35, 95% CI?=?1.06–1.72, respectively). Infants of obese women were more likely to be macrosomic (OR?=?2.43, 95% CI?=?1.55–3.82).

Conclusion: Prepregnancy obesity is a risk factor for macrosomia, preeclampsia, and cesarean section and need for resuscitation.     

Gestational Weight Gain and Early Postpartum Weight Retention in a Prospective Cohort of Alberta Women

ObjectiveTo describe gestational weight gain during pregnancy, adherence to Health Canada 2010 Gestational Weight Gain Guidelines, and the effects of weight gain on postpartum weight retention in women with different pre-pregnancy body mass indices.MethodsBody weight data were collected from women during pregnancy and in the early postpartum period as part of this prospective cohort study; analyses are presented for the first 600 women recruited. Multilinear regression was used to assess associations between pre-pregnancy BMI, total gestational weight gain, and postpartum weight retention. Multinomial regression was used to assess adherence to guidelines for total weight gain and rates of weekly weight gain.ResultsWomen who gained above recommendations were more likely to be overweight (OR 5.5; 95% CI 2.7 to 10.9, P < 0.001) or obese (OR 6.5; 95% CI 2.5 to 16.5, P < 0.001) before pregnancy, to have a history of smoking (OR 1.96; 95% CI 1.18 to 3.26, P = 0.01), or to be nulliparous (OR 2.23; 95% CI 0.99 to 5.05, P = 0.054). Women who gained weight above recommendations (P < 0.001) and women with low income (P < 0.01) were more likely to retain higher body weight at three months postpartum. Seventy-one percent of participants exceeded recommended rates of weekly weight gain; average weekly weight gain of these women was 0.65 ± 0.17 kg.ConclusionPre-pregnancy BMI is a significant predictor of excessive weight gain in pregnancy. Higher gestational weight gain predisposes women to higher postpartum weight retention across all BMI categories. Future studies are warranted to design tools and intervention programs to monitor weight gain during pregnancy.     

Placental weight and efficiency in relation to maternal body mass index and the risk of pregnancy complications in women delivering singleton babies

Herein we report placental weight and efficiency in relation to maternal BMI and the risk of pregnancy complications in 55,105 pregnancies. Adjusted placental weight increased with increasing BMI through underweight, normal, overweight, obese and morbidly obese categories and accordingly underweight women were more likely to experience placental growth restriction [OR 1.69 (95% CI 1.46-1.95)], while placental hypertrophy was more common in overweight, obese and morbidly obese groups [OR 1.59 (95% CI 1.50-1.69), OR 1.97 (95% CI 1.81-2.15) and OR 2.34 (95% CI 2.08-2.63), respectively]. In contrast the ratio of fetal to placental weight (a proxy for placental efficiency) was lower (P < 0.001) in overweight, obese and morbidly obese than in both normal and underweight women which were equivalent. Relative to the middle tertile reference group (mean 622 g), placental weight in the lower tertile (mean 484 g) was associated with a higher risk of pre-eclampsia, induced labour, spontaneous preterm delivery, stillbirth and low birth weight (P < 0.001). Conversely placental weight in the upper tertile (mean 788 g) was associated with a higher risk of caesarean section, post-term delivery and high birth weight (P < 0.001). With respect to assumed placental efficiency a ratio in the lower tertile was associated with an increased risk of pre-eclampsia, induced labour, caesarean section and spontaneous preterm delivery (P < 0.001) and a ratio in both the lower and higher tertiles was associated with an increased risk of low birth weight (P < 0.001). Placental efficiency was not related to the risk of stillbirth or high birth weight. No interactions between maternal BMI and placental weight tertile were detected suggesting that both abnormal BMI and placental growth are independent risk factors for a range of pregnancy complications.     

Maternal pre-pregnancy body mass index and the risk for gestational diabetes mellitus in women with twin pregnancy in South Korea

ObjectiveTo investigate the association between maternal pre-pregnancy body mass index (BMI) and the risk for gestational diabetes mellitus (GDM) in women with twin pregnancy in South Korea.Materials and methodsWe performed a single-center, retrospective cohort study involving 1028 women with twin pregnancy from January 2006 to December 2018 in South Korea. Pregnancies with monoamnionic twins, twin–twin transfusion syndrome, fetal death in utero before 24 weeks, pre-gestational diabetes mellitus, and unknown BMI or GDM status were excluded. Subjects were grouped into four groups based on pre-pregnancy BMI: underweight (<18.5 kg/m²), normal (18.5–22.9 kg/m²), overweight (23.0–24.9 kg/m²), and obese (≥25.0 kg/m²).ResultsAmong 1028 women who were included in the analysis, 169 (16.4%), 655 (63.7%), 111 (10.8%), and 93 (9.0%) women were underweight, normal, overweight, and obese, respectively, before pregnancy. The incidence of GDM was 8.9% in the total study population: 4.7%, 8.2%, 11.7%, and 17.2% in the underweight, normal, overweight, and obese group, respectively (p = 0.005). The incidence of GDM significantly increased according to the increase in pre-pregnancy BMI (p < 0.001). Women in the obese group were more likely to be affected by GDM compared to the normal group (adjusted odds ratio = 2.20, 95% confidence interval = 1.19–4.08) after controlling for maternal age, parity, type of conception, and chorionicity.ConclusionIn twin pregnancies in South Korea, the risk of GDM increased as maternal pre-pregnancy BMI increased and obese women before pregnancy were more likely to be affected by GDM.     

To evaluate the effect of pre-pregnancy body mass index on maternal and perinatal outcomes among adolescent pregnant women

Objective: To evaluate the effect of pre-pregnancy body mass index on maternal and perinatal outcomes among adolescent pregnant women.

Methods: We conducted this prospective cross-sectional study on 365 singleton adolescent pregnancies (aged between 16 and 20 years) at a Maternity Hospital, between December 2014 and March 2015. We divided participants into two groups based on pre-pregnancy body mass index (BMI): overweight and obese adolescent (BMI at or above 25.0?kg/m) and normal weight (BMI between 18.5 and 24.99?kg/m) adolescent. We used multivariate analysis to evaluate the association of the risk of adverse pregnancy outcomes and pre-pregnancy BMI.

Results: The prevalence of maternal overweight/obesity and normal weight was 34.6% (n?=?80) and 65.4% (n?=?261) in the study population, respectively. Compared with normal-weight teens (n?=?234), overweight/obese teens (n?=?71) were at higher risk for cesarean delivery (odds ratio [OR] 0.7, 95% confidence interval [CI] 0.4–1.4), preeclampsia (adjusted odds ratio [OR] 0.1, 95% confidence interval [CI] 0.02–0.9) and small of gestational age (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.1–0.9).

Conclusion: BMI increased during pre-pregnancy could be an important preventable risk factor for poor obstetric complications in adolescent pregnancies, and for these patients prevention strategies (e.g., nutritional counseling, weight-loss, regular physical activity) for obesity are recommended before getting pregnant.     

Obesity and adverse pregnancy outcomes in twin pregnancies

Abstract

Objective: To compare pregnancy outcomes in twin pregnancies based on maternal pre-pregnancy body mass index (BMI).

Methods: Historical cohort study of all twin pregnancies >24 weeks managed by one maternal-fetal medicine practice from 2005 to 2012. We compared pregnancy outcomes between pre-pregnancy obese (BMI ≥30?kg/m²) and normal weight women (BMI 18.5–24.99?kg/m²). We also compared pre-pregnancy normal weight women to overweight women (BMI 25–29.99?kg/m²) and underweight women (BMI <18.5?kg/m²). Chi square, Fisher’s exact test, Student’s t-test, and one-way ANOVA were used as appropriate. A p value of <0.05 was considered significant.

Results: Five hundred fourteen patients with twin pregnancies were included. Pre-pregnancy obesity was associated with gestational hypertension (34.1% versus 17.9%, p?=?0.011), preeclampsia (27.3% versus 14.4%, p?=?0.028), and gestational diabetes (22.2% versus 4.7%, p?<?0.001). Pre-pregnancy overweight was associated with gestational diabetes (13.7% versus 4.7%, p?=?0.002). Pre-pregnancy underweight was not associated with any adverse pregnancy outcomes. Comparing outcomes across normal weight, overweight, and obese women, the rates of gestational diabetes and gestational hypertension increased significantly across the three groups.

Conclusion: In patients with twin pregnancy, pre-pregnancy obesity is associated with adverse pregnancy outcomes, including gestational diabetes, gestational hypertension, and preeclampsia.     

Gewichtszunahme Schwangerer und postpartale Gewichtsretention

Overweight and particularly obese women (BMI????30?kg/m²) are at risk for complications in pregnancy. One third of overweight and more than 50% of obese pregnant women gain more weight than generally recommended. Both increased prepregnancy BMI and excessive weight gain during pregnancy are crucial predictors of perinatal outcome (e.g. higher risk for childhood obesity and cardiovascular diseases). Apart from preconceptional weight loss, detailed information and determination of individual weight gain goals (IOM guidelines) as well as diet and exercise recommendations are of particular importance for obstetric care professionals. Overweight and obese women should be encouraged to breastfeed. Detailed advice should be offered regarding postpartum weight retention, lifestyle interventions and physical activity.     

孕前体重指数对糖筛选异常孕妇妊娠结局的影响

目的：探讨孕前体重指数对单纯50g糖筛选阳性的孕妇母儿预后的影响。方法：选取2000年1月至2006年12月在上海第一人民医院行50g糖筛选异常而75g葡萄糖耐量试验结果正常的孕妇655例为研究对象,按孕前体重指数（BMI）分为3组：A：消瘦组（〈18.5kg/m^2）,B：体重正常组（18.5~24.9kg/m^2）,C.超重及肥胖组（〉25kg/m^2）,比较3组孕妇的妊娠结局。结果：655例孕妇中,A组95例（14.5%）,B组483例（73.7%）,C组77例（11.8%）。与B组相比,C组孕妇发生妊娠不良结局的危险度增高,其中子痫前期OR为3.58（95%Cl2.28~9.98）,早产OR3.64（95%Cl1.73~7.67）,巨大儿OR1.49（95%Cl1.23~3.01）,低出生体重儿OR2.55（95%Cl1.03~6.32）,新生儿低血糖OR4.07（95%Cl2.31~12.78）;A组发生低出生体重儿的几率增加,为2.70（95%Cl1.66~4.40）。结论：孕前体重指数是影响妊娠结局的独立因素。     

Inadequate gestational weight gain contributes to increasing rates of low birth weight in Taiwan: 2011–2016 nationwide surveys

ObjectiveLow birth weight (LBW) is associated with adverse health outcomes. Incidence of LBW in Taiwan grew from 5% in 1997 to 8.4% in 2016. This study aims to identify the role of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) in LBW rate changes during 2011–2016.Materials and methodsWe analyzed 66 135 postpartum women from 6 cross-sectional national surveys. Data were collected through telephone interviews with randomly selected mothers. Logistic regression was applied to assess contribution of maternal characteristics to LBW time changes.ResultsLBW increased from 5.3% to 7.0% during 2011–2016 (crude odds ratio (OR) = 1.04/year, p-value for trend = 0.001). Inadequate GWG increased from 27.9% to 41.5% (p-value for trend <0.001). Along with the increase in overweight (9.7%–11.1%) and obese (4.8%–7.4%), prevalence of underweight fluctuated between 16.0% and 17.8%. LBW increased in underweight group from 6.3% to 9.5% (crude OR = 1.09/year, p-value for trend<0.001). Adjustment for GWG attenuated odds ratio per year in total sample (adjusted OR = 1.03, p-value for trend = 0.04) and in underweight (adjusted OR = 1.08, p-value for trend = 0.002).ConclusionsIncreasing percentage of women with inadequate GWG could contribute to LBW increase in Taiwan during 2011–2016, especially for the underweight. Prenatal advice on GWG should be individualized according to pre-pregnancy BMI.     

The association between maternal pre-pregnancy body mass index and pregnancy outcomes of preeclampsia

ObjectiveTo evaluate the effects of pre-pregnancy maternal body mass index (BMI) to pregnancy outcomes in patients diagnosed as preeclampsia.Materials and methodsThis was a retrospectively study on women who had been diagnosed as preeclampsia and delivered at Seoul National University Bundang Hospital between June 2017 and March 2020. Multifetal gestation, major fetal anomaly, and fetal death in utero were excluded. A total of 150 singleton pregnancies were included and divided into four groups according to the pre-pregnancy BMI classification: underweight (<18.5 kg/m², n = 6), normal (18.5–22.9 kg/m², n = 66), overweight (23.0–24.9 kg/m², n = 26), and obese (≥25.0 kg/m², n = 52). Pregnancy outcomes including gestational age at delivery, birthweight, and delivery modes were reviewed.ResultsThe rates of preterm birth before 34 weeks of gestation were 67%, 49%, 35%, and 27% for underweight group, normal BMI group, overweight group, and obese group, respectively (p-trend = 0.006). The birthweight of newborn increased significantly as pre-pregnancy BMI increased (p-trend<0.001). The proportions of small for gestational age (SGA) were highest in underweight group and decreased as pre-pregnancy BMI increased (67%, 41%, 42%, and 10% for each group, respectively, p-trend<0.001).ConclusionThe rates of preterm birth before 34 weeks and SGA increased as pre-pregnancy BMI decreased in patients with preeclampsia.Implications for practiceWomen with underweight before pregnancy are at the highest risk for preterm birth and SGA, therefore they need to be monitored more intensively when diagnosed as preeclampsia.     

Preconception lifestyle changes in women with planned pregnancies

Objectives(1) to study preconception lifestyle changes and associated factors in women with planned pregnancies; (2) to assess the prevalence of risk factors for adverse pregnancy outcomes in women not reporting any preconception lifestyle changes; and (3) to explore the need for and use of preconception-related advice.Designsecondary data analysis of a cross-sectional study about pregnancy planning.Settingsix Flemish Hospitals (Belgium).Participantsfour hundred and thirty women with a planned pregnancy ending in birth.Measurementspreconception lifestyle changes were measured during the first 5 days postpartum using the validated London Measure of Unplanned Pregnancy. The following changes were assessed: folic acid or multivitamin intake, smoking reduction or cessation, alcohol reduction or cessation, caffeine reduction or cessation, eating more healthily, achieving a healthier weight, obtaining medical or health advice, or another self-reported preconception lifestyle change.Findingsmost women (83%) that planned their pregnancy reported ≥1 lifestyle change in preparation for pregnancy. Overall, nulliparous women (OR 2.18, 95% CI 1.23–3.87) and women with a previous miscarriage (OR 2.44, 95% CI 1.14–5.21) were more likely to prepare for pregnancy, while experiencing financial difficulties (OR 0.20, 95% CI 0.04–0.97) or having a lower educational level (OR 0.56, 95% CI 0.32–0.99) decreased the likelihood of preparing for pregnancy. Half of the women (48%) obtained advice about preconception health, and 86% of these women received their advice from a professional caregiver. Three-quarters (77%) of the women who did not improve their lifestyle before conceiving reported one or more risk factors for adverse pregnancy outcomes.Key Conclusions and implications for practicemultiparous women and women of lower socio-economic status were less likely to change their lifestyle before conception. Strategies to promote preconception health in these women need to be tailored to their needs and characteristics to overcome barriers to change. It may be advantageous to reach these women through non-medical channels, such as schools or other community organizations.     

Pre-pregnant body mass index, weight gain and the risk of delivering large babies among non-diabetic mothers.

OBJECTIVE: Pre-pregnancy overweight and excess weight gain during pregnancy have each been associated with an increased risk of delivering large babies. However, previous studies have focused on the separate effects of these two indices of weight in diabetic women. METHOD: This study analyzed both separate and combined effects of pre-pregnant body mass index and weight gain in relation to macrosomia (> or =4000 g) in offspring among 815 non-diabetic women, using data collected from a retrospective study. RESULT: Compared to mothers with normal pre-pregnancy BMI and pregnancy weight gain, risk of macrosomia in offspring was significantly elevated only in overweight women with excess weight gain (adjusted OR=2.6, 95% CI [1.2,5.4]) but not among normal weight mothers with excess gain (adjusted OR=1.1, 95% CI [0.5,2.4]) or overweight mothers with normal or low gain (adjusted OR=1.1, 95% CI [0.4,3.1]). CONCLUSION: Given the complications that are associated with delivering large babies, overweight women may benefit from not gaining excess weight in pregnancy.     

Weight in Pregnancy and Its Implications: What Women Report

ObjectiveMisclassification of body mass index (BMI) by pregnant women could be a significant barrier to minimizing weight-related adverse pregnancy outcomes and improving the short- and long-term health of mother and child. The primary objective in this study was to determine the proportion of a group of pregnant women who were able to correctly classify BMI. Secondary objectives included assessing the direction of BMI misclassification and maternal knowledge of target gestational weight gain and obesity-associated pregnancy complications.MethodsWe designed a cross-sectional survey to assess misclassification of BMI and knowledge of obesity and pregnancy outcomes, and to provide information regarding the participants’ sources of knowledge, their perception of appropriate weight gain in pregnancy, and basic demographic information. The questionnaire was completed by participants awaiting routine ultrasound assessment at between 11 and 24 weeks’ gestation.ResultsOf 117 respondents, 30 (25.6%) were overweight (BMI 25 to 29.9) or obese (BMI ≥ 30.0). Obese or overweight women were significantly more likely to misclassify their BMI. Furthermore, they were significantly more likely to overestimate the minimum and maximum target gestational weight gains for their respective BMI classes. There were no differences between women in the various BMI categories with regard to their awareness of several common obesity-related pregnancy complications.ConclusionMisclassification of pre-pregnancy BMI is common, particularly among women carrying excess weight. Evaluation of pre-pregnancy BMI and education regarding appropriate gestational weight gain are logical initial steps for optimizing weight-related pregnancy outcomes.     

Valores extremos del IMC materno: factores determinantes de peores resultados obstétricos y perinatales

ObjectiveTo study the influence of maternal body mass index (BMI) at the beginning of pregnancy on obstetric-perinatal outcomes.Material and methodsObservational-ambispective study. We recruited 1407 patients with singleton gestations and deliveries of foetuses > 24 weeks between 01/12/2017 and 31/07/2019. The sample was stratified according to their BMI following the WHO classification. Variables on pre-pregnancy, gestational disease, obstetric care, and maternal-perinatal outcomes were analysed and compared between the studied groups. The statistical program has been R Core Team 2020, version 3.6.3. P ≤ .05 was considered significant.ResultsClass II-III (BMI 35-39 and BMI ≥ 40 respectively) obese women have a higher risk of chronic arterial hypertension (OR 53.54, 95% CI 18.21-229.02), gestational diabetes (OR 5.24, 95% CI 2.87-9.51) and preeclampsia (OR 2.38, 95% CI 0.95-5.51 with P = .049). The underweight women had more intrauterine growth restriction diagnoses (OR 3.09, 95% CI 1.46-6.17). Inductions of labour and caesarean sections increase as BMI increases (P = .006). Low weight patients also had a higher risk of caesarean section (OR 2.46, 95% CI 1.06-5.20). Neonatal admissions were more frequent in obese and underweight women (OR 2.68, 95% CI 1.39-5.00 and OR 2.56, 95% CI 1.10-5.44 respectively). Obese women had a higher risk of neonatal weight > 4000 g (OR 3.06, 95% CI 1.57-5.77) and low weight pregnant women had a higher risk of neonatal weight < 2500 g (OR 2.94, 95% CI 1.54-5.41).ConclusionExtreme values of maternal BMI at the beginning of gestation are determining factors for an adverse obstetric-perinatal outcome.     

Prepregnancy body mass index and gestational weight gain with the outcome of pregnancy: a 13-year study of 292,568 cases in China

Purpose

We aimed to investigate the combined associations of prepregnancy body mass index (BMI) and gestational weight gain (GWG) with pregnancy outcomes in Chinese women.

Methods

Data for 292,568 singleton term pregnancies were selected from 1993 to 2005 based on the Perinatal Health Care Surveillance System, with anthropometric measurements being collected prospectively. Prepregnancy BMI was categorized according to the definitions of the World Health Organization (WHO). Total GWG was categorized into four groups. Adjusted associations of prepregnancy BMI and GWG with outcomes of interest were estimated using logistic regression analyses. GWG was categorized as below, within and above the Institute of Medicine (IOM) (2009) recommendations.

Results

Maternal overweight and high GWG or GWG above the IOM recommendation were associated with hypertensive disorders complicating pregnancy, cesarean delivery, macrosomia and large-for-gestational-age (LGA) infants. Maternal underweight and low GWG or GWG below the IOM recommendation were risk factors for low-birth-weight (LBW) and small-for-gestational-age (SGA) infants. Moreover, being overweight [odds ratio (OR) 1.2, 95?% confidence interval (CI) 1.0–1.3) and having a low weight gain (OR 1.1, 95?% CI 1.0–1.1) increased the risk of newborn asphyxia.

Conclusion

Being overweight/obese and having a high weight gain, as well as being underweight and having a low weight gain, were associated with increased risks for adverse pregnancy outcomes in Chinese women.