Impact of pre-gravid body mass index and body mass index change on preeclampsia and gestational diabetes in singleton and twin pregnancies

Abstract

Objective: To examine pre-gravid body mass index (BMI) and gestational BMI change impact on preeclampsia and gestational diabetes mellitus (GDM).

Methods: Retrospective population-based cohort study. Data from Slovenian National Perinatal Information System were analyzed for the period 2002–2011. Three singleton controls were matched by parity and maternal age to each twin pregnancy delivered at >36 weeks. Student’s t test was used to compare pre-gravid BMI and gestational BMI change in different groups (p?<?0.05 significant).

Results: 2046 twin and 6138 singleton pregnancies were included. Twin and singleton patients with preeclampsia or GDM had higher pre-gravid BMI (p?<?0.001). Gestational BMI change was smaller in twins with GDM (p?<?0.001), and not associated with preeclampsia (p?=?0.07). Smaller gestational BMI change in singleton pregnancies was associated with GDM (p?<?0.001), and greater BMI change with preeclampsia (p?=?0.004).

Conclusions: Pre-gravid BMI is more strongly associated with preeclampsia and GDM in twin and singleton pregnancies than gestational BMI change. Smaller gestational BMI change in GDM pregnancies reflect the importance of dietary counseling.     

Linear association between maternal pre-pregnancy body mass index and risk of caesarean section in term deliveries

OBJECTIVE: Maternal obesity is a well-known risk factor for caesarean delivery. The aim of this study is to determine whether all the spectrum of pre-pregnancy maternal corpulence (body mass index [BMI]) is associated with the risk of caesarean delivery. DESIGN: Observational study over 4.5 years (2001-05). SETTING: Groupe Hospitalier Sud-Réunion's maternity (island of La Réunion, French overseas department, Indian Ocean). POPULATION: All consecutive singleton live births having delivered at the maternity. METHODS: Data have been analysed according to different risk factors. Maternal corpulence has been defined as the maternal pre-pregnancy weight. BMIs have been studied by multiples of 5 kg/m2 from 10-14.9 kg/m2 to 40-44.9 kg/m2. MAIN OUTCOME MEASURE: Rate of caesarean section. RESULTS: There were 17 462 singleton live births during the period, of which 16 952 (97.1% of the total) pre-pregnancy BMIs have been determined. There is a linear association (chi 2 for linear trend, P < 0.001) between maternal corpulence and risk of caesarean deliveries, the leanest mothers having the best rate of vaginal delivery. This linear association exists in a model controlling for diagnosis of gestational diabetes, term deliveries (> or =37 weeks), very short maternal height (<1.50 m), primiparity and maternal age > or = 35 years (adjusted chi 2, P < 0.001). CONCLUSION: There is a significant linear association between pre-pregnancy maternal corpulence and risk of caesarean deliveries in pregnancies at term. The authors discuss several interpretations including the adaptability of fetal birthweights to maternal corpulence and the concept of soft-tissue dystocia.     

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.     

The Preterm Prediction Study: association between maternal body mass index and spontaneous and indicated preterm birth

OBJECTIVE: The purpose of this study was to evaluate the relationship between prepregnancy maternal body mass index and spontaneous preterm birth and indicated preterm birth. STUDY DESIGN: This was a secondary analysis of the Maternal-Fetal Medicine Units Network, Preterm Prediction study. Patients were classified into categories that were based on their body mass index. Rates of indicated and spontaneous preterm birth were compared. RESULTS: Five hundred ninety-seven (20.5%) of 2910 women were obese. Obese women had fewer spontaneous preterm births at < 37 weeks of gestation (6.2% vs 11.2%; P < .001) and at < 34 weeks of gestation (1.5% vs 3.5%; P = .012). Women with a body mass index of < 19 kg/m2 had 16.6% spontaneous preterm birth, with a body mass index of 19 to 24.9 kg/m 2 had 11.3% spontaneous preterm birth, with a body mass index of 25 to 29.9 kg/m2 had 8.1% spontaneous preterm birth, with a body mass index of 30 to 34.9 kg/m2 had 7.1% spontaneous preterm birth, and with a body mass index of > or = 35 kg/m2 had 5.2% spontaneous preterm birth (P < .0001). Indicated delivery was responsible for an increasing proportion of preterm births with increasing body mass index (P = .001). Obese women had lower rates of cervical length < 25 mm (5% vs 8%; P = .012). Multivariable regression analysis confirmed a lower rate of spontaneous preterm birth in obese gravid women (odds ratio, 0.57; 95% CI, 0.39-0.83; P = .003). CONCLUSION: Obesity before pregnancy is associated with a lower rate of spontaneous preterm birth.     

The association between vitamin C dietary intake and its serum levels with anthropometric indices: A systematic review and meta-analysis

Backgroundstudies showed inflammatory background of overweight and obesity. Prevalence of weight disorders has dramatically increased over the past few decades. Vitamin C is an antioxidant and may be associated with weight disorders. This study aims to systematically review the relationship between dietary and serum vitamin C levels with anthropometric indices.MethodsA systematic search was conducted in Medline database (PubMed), Scopus, Embase, Web of Science, Cochrane library and Google Scholar up to the end of August 2021. All observational studies that assessed the relationship between dietary or circulating vitamin C levels and body mass index (BMI) and waist circumference (WC) on adults were included. The quality of included studies was assessed using the National Institute of Health quality assessment tool.ResultsAmong 11,689 studies, 47 and 37 articles were included in the systematic review and meta-analysis, respectively. There was an inverse significant correlation between WC and serum vitamin C levels (r = −0.28, 95% CI: −0.35,-0.21, I² = 14.2%) and between BMI and serum vitamin C levels (r = −0.17, 95% CI: −0.25, −0.09, I² = 72.8%). Higher vitamin C consumption was significantly associated with lower BMI. There were no significant differences in serum vitamin C levels between normal-weight and overweight subjects, but serum vitamin C levels were significantly higher in obese subjects in comparison with normal-weight subjects.ConclusionResults showed that both dietary and serum vitamin C levels were inversely associated with BMI and WC. More well-designed clinical trials are needed to assess the effect of vitamin C supplementation in prevention and treatment of obesity.     

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.     

妊娠前BMI与子痫前期发生及临床特征的关系

目的:探讨妊娠前体质指数（BMI）与子痫前期（PE）发生及临床特征的关系。方法:收集2017年7月1日至2019年12月31日于南方医科大学附属深圳妇幼保健院诊断为宫内妊娠,孕周为6~8周 +6,排除有基础性疾病和病历资料不完整者,共计42 427例孕妇,其中诊断为PE者659例。依据孕前BMI分为低体重组...     

The effect of low body mass index on the development of gestational hypertension and preeclampsia

Objectives.?To evaluate the relationship between low maternal body mass index (BMI) as calculated in the first trimester and the risk of preeclampsia and gestational hypertension.

Methods.?Patients enrolled in the First And Second Trimester Evaluation of Risk for aneuploidy (FASTER) trial were grouped into three weight categories: low BMI (BMI <19.8 kg/m²), normal BMI (BMI 19.8 – 26 kg/m²), and overweight BMI (26.1 – 29 kg/m²). The incidences of gestational hypertension and preeclampsia were ascertained for each group. Tests for differences in crude incidence proportions were performed using Chi-square tests. Multiple logistic regression was used to adjust for maternal age, race, parity, obesity, use of assisted reproductive technology (ART), in vitro fertilization (IVF), gestational diabetes, pre-gestational diabetes, cocaine use, and smoking.

Results.?The proportion of patients having gestational hypertension in the low BMI group was 2.0% compared to 3.2% for normal BMI and 6.0% for overweight BMI (p < 0.0001). Women with low BMI were also less likely to develop preeclampsia, 1.1% vs. 1.9% for normal BMI and 2.8% for overweight BMI (p < 0.0001).

Conclusions.?We found that women with low BMI in the first trimester were significantly less likely to develop gestational hypertension or preeclampsia than women with a normal BMI.     

叶酸、体质指数及凝血指标与子痫前期的相关性分析#br#

Objective?To analyze the correlation between folic acid, body mass index (BMI), blood coagulation indexes and preeclampsia. Methods?A total of 86 pregnant women confirmed with preeclampsia from January 2018 to December 2020 were enrolled. According to different severity, they were divided into severe preeclampsia (severe group) and mild preeclampsia (mild group). 55 normal pregnant women during the same period were enrolled as the control group. Predictive effects of pregestational BMI, folic acid in first trimester (11~12 weeks), prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (FIB) for preeclampsia were analyzed. Results?Compared with control group, levels of serum folic acid and coagulation indexes (PT, APTT) in preeclampsia pregnant women decreased, while BMI and FIB increased (P<0.05).The analysis of receiver operating characteristic (ROC) curves showed that area under the curve (AUC) and 95% confidence interval of folic acid combined with BMI and coagulation indexes for predicting preeclampsia were 0.853 and (0.778~0.905) respectively. Compared with mild group, levels of serum folic acid and APTT in the severe group were decreased, while FIB was increased (P<0.05). Pearson correlation analysis showed that levels of serum folic acid and APTT were negatively correlated with severity of preeclampsia (r=-0.483, -0.451, P<0.05), while BMI and FIB were positively correlated with it (r=0.527, 0.420, P<0.05). Conclusion?The combined detection of pregestational BMI, folic acid in early pregnancy and coagulation indexes (PT, APTT, FIB) is of high predictive value for preeclampsia and closely related to disease severity.     

Pre-pregnancy body mass index (BMI) and macrosomia in a Canadian birth cohort

Objective: To compare demographic characteristics and maternal, fetal, neonatal, and pregnancy outcomes of term macrosomic infants of obese and non-obese mothers.

Methods: A sample of 1996 singleton, term deliveries was drawn from the All Our Babies Cohort, a prospective, community-based pregnancy cohort. Maternal self-reported socio-demographic and anthropometric information was linked to the clinical data on pregnancy and birth events abstracted from electronic health records. Demographic, obstetrical characteristics and maternal, fetal, neonatal, and pregnancy outcomes of macrosomic infants in obese, overweight, and normal weight women were compared. Multinomial regression analysis assessed the risk factors of macrosomia in primiparous and multiparous women stratified by maternal pre-pregnancy BMI, controlling for confounding variables.

Results: Macrosomia affected 10% of pregnancies in the study. Mothers whose infants were macrosomic were more likely to be Caucasian, obese, have had previous deliveries, undergo induction of labour and delivery by emergency C-section, particularly for labour abnormalities. Macrosomic infants were more likely to be delivered postdates, have meconium stained liquor and require resuscitation at birth. There were no significant differences in birth and neonatal outcomes of macrosomic pregnancies between obese, overweight and normal weight women. Pre-pregnancy BMI and gestational age at delivery were risk factors for macrosomia in all women. Ethnicity and history of delivery of a macrosomic infant were additional independent risk factors in multiparas.

Conclusions: Obesity in pregnancy increases the risk of delivery of a macrosomic infant in both primiparous and multiparous women. The maternal, fetal and neonatal outcomes of macrosomic pregnancies are similar in obese and normal weight women.     

Risk of adverse pregnancy outcomes stratified for pre-pregnancy body mass index

Objective: To estimate the risk of adverse maternal and perinatal outcomes in women with different pre-pregnancy body mass index (BMI).

Methods: We conducted a cohort study with 14?451 singleton pregnancies in 15 medical centers in Beijing between 20 June 2013 and 30 November 2013 using cluster random sampling. We divided participants into four groups based on pre-pregnancy BMI: Group A (underweight): BMI?<?18.5?kg/m², Group B (normal): 18.5–23.9?kg/m², Group C (overweight): 24–27.9?kg/m², Group D (obesity): ≥28?kg/m². 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 and obesity was 14.82% (2142/14?451) and 4.71% (680/14?451) in the study population, respectively. Higher pre-pregnancy BMI is associated with higher prevalence of gestational diabetes (GDM), macrosomia, Cesarean section (C-section), preeclampsia and postpartum hemorrhage. Pre-pregnancy overweight or obesity increases the risk of adverse pregnancy outcomes, regardless of GDM status.

Conclusions: Pre-pregnancy overweight or obesity is associated with increased risk of adverse pregnancy outcomes. Nutrition counseling is recommended before pregnancy in women who have overweight or obesity.     

Body Mass Index (BMI) in women booking for antenatal care: Comparison between selfreported and digital measurements

Objective

We set out to compare measurement of Body Mass Index (BMI) with selfreporting in women early in pregnancy.

Study design

We studied 100 women booking for antenatal care in the first trimester with a normal ongoing pregnancy. Selfreported maternal weight and height were recorded and the Body Mass Index was calculated. Afterwards maternal weight and height were digitally measured and actual BMI was calculated.

Results

If selfreporting is used for BMI classification, we found that 22% of women were classified incorrectly when BMI was measured. 12% of the women who were classified as having a normal selfreported BMI were overweight and 5% classified as overweight were obese. Similar findings have been reported outside pregnancy.

Conclusions

These findings have implications for clinical practice, and for research studies exploring the relationship between maternal adiposity and pregnancy complications.     

Body mass index influences plasma concentration of neuropeptide Y in healthy female volunteers: a pilot study

Neuropeptide Y (NPY) was measured in plasma obtained from healthy female volunteers twice in the natural menstrual cycle or the hormonal cycle caused by oral contraceptives about 2 weeks apart. The ratio between the NPY plasma concentration in the second sample and the first sample was influenced negatively by body mass index (BMI). There were no differences in NPY plasma concentrations on comparing the first and second samples. Age and the use or non-use of oral contraceptives did not exert any influence. BMI might be a confounding factor when determining NPY in the plasma of healthy women.