Maternal weight gain during pregnancy. Relation to prepregnancy weight

OBJECTIVE: To describe the weight gain during normal pregnancy and to evaluate the relationship between maternal pregravid weight and gestational weight change. MATERIALS AND METHODS: The study population consisted of 1443 healthy women who delivered of singleton, live infants. Pregravid weight was determined on the basis of maternal reporting and categorized into four categories using the following BMI cut points (kg m-2): underweight (< 19.8), normal weight (19.8-26.0), overweight (26.1-29.0), obesity (> 29.0). Length of gestation was first determined from the onset of the last menstrual period. Weight gain by gestational age: the woman's pregravid weight was subtracted from the weight measured at each visit. Total weight gain was calculated from the last weight measured. RESULTS: The mean (+/- SD) total amounts of weight gained by gestational week were 0.9 +/- 0.7 kg by 12 weeks, 7.5 +/- 2.7 kg by 28 weeks, and 12.9 +/- 3.8 kg by 40 weeks. Weight gain curve for this sample of women was linear. Weight curves in groups of women who differed in prepregnancy weight status showed similar linear trends. Compared with normal-weight women, obese and overweight women gained less during pregnancy (13.3 kg vs 11.8 kg, 12.2 kg, respectively). CONCLUSIONS: Total weight gain in study population was similar to weight gain in other populations reported in publications. There was a tendency for overweight and obese women to gain weight at a lower rate, thus result in a overall lower total weight gain.     

Pre-pregnancy body mass, gestational weight gain and birth weight

OBJECTIVE: This study was undertaken to determine the effect of pregravid body weight and weight gain during pregnancy on birth weight of term newborns. MATERIALS AND METHODS: The study population consisted of 1443 healthy women, who delivered of singleton, live infants at or beyond 38 weeks of gestation. Maternal pregravid weight was obtained by recall and categorized into quartiles: < or = 53, < or = 58, < or = 65, > 65 (kg). Women were further divided according to their gestational weight gain into quartiles: < or = 10.5; < or = 12.5; < or = 15.5; > 15.5 (kg). Birth weight was measured and recorded at delivery. Newborns were classified as hypotrophic (SGA; < 10th percentile for the study population) and hypertrophic (LGA; > 90th percentile). RESULTS: The mean birth weight in the study population was 3499 +/- 447 g, 8.5% infants met the criteria for SGA, and 9.4%--for LGA. Studies showed that a progressive increase in maternal pregravid weight as well as gestational weight gain effect independently on increase birthweight, although the effect of weight gain during pregnancy was lessened as weight before gestation increased. For example, increasing gestational weight gain from < or = 10.5 kg to > 15.5 kg increased mean birthweight by 385 g (12.1%) for pregravid weight of 53 kg or less, compared with 142 g (4.0%) for weight of more than 65 kg. They were also associated with decreased frequency of hypotrophic infants and increased frequency of hypertrophic neonates. CONCLUSIONS: Both maternal prepregnancy weight and weight gain during gestation are important factors affecting fetal growth and birth weight. Increasing maternal weight before pregnancy diminishes the influence of weight gain on birthweight. As pregravid weight and prenatal weight gain increase, the incidence of LGA also increase, whereas the frequency of SGA decreases.     

Maternal weight, weight gain during pregnancy and pregnancy outcome.

OBJECTIVE: To evaluate the effects of abnormal maternal weight or weight gain on pregnancy outcome. METHOD: Records for 191 mothers with abnormal prepregnancy weight (> or = 20%) above, or under, ideal body weight for height) or weight gain > or = 20 kg, or < or = 5 kg during pregnancy were reviewed. The control group consisted of 166 mothers with normal prepregnancy weight and normal weight gain during pregnancy. Data on mothers and their infants were analyzed by one-way analysis of variance. RESULTS: Obese women and mothers with excessive weight gain during pregnancy had an increased incidence of induced labor (P < or = 0.05) and tendency for emergency cesarean sections during the delivery. Obese women had more large-for-date babies than controls (P < or = 0.05). Weight gain < or = 5 kg during pregnancy was most common in slightly obese women and did not carry any special obstetric or neonatal risk. Underweight women had a significant risk for delivering a small-for-data baby. CONCLUSION: Obese women and women with excessive weight gain during pregnancy need special follow-up and counseling during pregnancy and delivery. Underweight women may need prepregnancy nutritional counseling to guarantee normal fetal growth. In developed countries suboptimal weight gain (< or = 5 kg) during pregnancy seems not to need any medical intervention.     

妊娠合并糖代谢异常孕妇的体重适宜增长

目的 探讨适合糖代谢异常孕妇妊娠期适宜体重增长范围.方法 对2005年1月至2007年12月在北京大学第一医院分娩的妊娠合并糖代谢异常的足月单胎且病历资料完整的孕产妇661例进行回顾性分析.根据孕前体重指数(BMI)将研究对象分为低体重组(BMI<18.5)40例(Ⅰ组);正常体重组(BMI 18.5～23.9)400例(Ⅱ组);超重组(BMI 24～27.9)162例(Ⅲ组);肥胖组(BMI≥28.0)59例(Ⅳ组).分析孕前不同BMI组正常出生体重儿和巨大儿母亲的孕期增重,并计算出新生儿出生体重在3000～3500 g产妇的孕期平均增重,作为各孕前BMI组孕期适宜的体重增长.结果 孕前不同BMI组分娩巨大儿者孕期增重明显大于分娩正常体重儿者的孕期增重,Ⅱ组孕期平均增重分别为(17.0±5.2)kg和(14.1±4.7)kg,m组孕期平均增重分别为(16.8±7.3)kg和(11.9±5.1)kg,Ⅳ组孕期平均增重分别为(18.3±6.7)kg和(11.2±5.4)kg,差异有统计学意义(P<0.05).各组孕妇孕期平均体重增长和适宜增重范围:Ⅰ组(15.6±3.3)kg,(14.0～18.O)kg,Ⅱ组(13.9±4.6)kg,(11.0～16.5)kg,Ⅲ组(11.5±5.2)kg,(9.0～15.0)ks,Ⅳ组(10.1±2.9)kg,(7.0～12.7)kg.结论 对孕前不同体重的糖代谢异常孕妇进行血糖监测的同时,使其妊娠期体重增长在各自适宜的范围,有助于获得理想出生体重的新生儿.     

Does an obese prepregnancy body mass index influence outcome in pregnancies complicated by mild gestational hypertension remote from term?

OBJECTIVES: This study was undertaken to determine the influence of increased prepregnancy body mass index (BMI) on pregnancy outcome in women with mild gestational hypertension remote from term. STUDY DESIGN: A matched cohort design was used. A total of 365 pregnant women with mild gestational hypertension and a normal prepregnancy BMI (20-25 kg/m2) were matched 1:1 for gestational age at diagnosis, race and parity to 365 women with mild gestational hypertension, but an obese prepregnancy BMI (> or = 30 kg/m2). RESULTS: Matched characteristics were distributed as follows: gestational age at diagnosis 32.2 +/- 2.4 weeks; race 80.8% white; parity 59.7% nulliparous. The rate of progression to preeclampsia was the primary endpoint of the study and was similar between the prepregnancy normal and obese BMI groups (37.8% vs 41.1%, P = .352). Birth weight at delivery (3033 +/- 747 g vs 2833 +/- 659 g, P < .001) and cesarean delivery rate (56.7% vs 40.3%, P < .001) were greater in the obese prepregnancy BMI group. CONCLUSION: In patients with mild gestational hypertension remote from term, an obese prepregnancy BMI was associated with similar rates of progression to preeclampsia. Secondarily, an obese prepregnancy BMI was associated with higher birth weights and an increased incidence of cesarean delivery.     

Patterns of maternal weight gain in pregnancy

Summary. A retrospective study of 1145 pregnant women showed that trends in mean maternal weight gain from the time of booking until delivery were not linear. Statistically significant lower rates of maternal weight gain were seen before 16 weeks, after 36 weeks and between 28 and 32 weeks gestation (   P < 0.05  ). The mean maternal weight gain was 10.71 kg (SD 4.3) and the mean weekly weight gain was 0.38 kg (SD 0.16). A wide variation of maternal weight gain was seen in women with a normal outcome. The mean weight gain in heavy (>68 kg) and light (<55.4 kg) women was less than that in women whose weight was in the third quartile (60–68 kg,   P <0.05  ). The mean maternal weight gain was less in young (<20 years) women than in older women (>25 years;   P <0.05  ), less in parous than in primigravid women from week 37 onwards (   P <0.05  ), less in smokers than in non-smokers from 20 weeks onwards (   P <0.05  ), and greater in hypertensive women (BP> 140/90) than in normotensive women (   P <0.05  ) from week 24 onwards. The mean weight gain in women who had small for gestational age (SGA) infants was not significantly different from that in women who had infants that were of appropriate size for gestational age. After taking into account infant and placental weight using multiple regression analysis, the factors that were associated with statistically significant differences in average weekly weight gain were parity, body mass index, smoking habit and raised blood pressure. Only 9.6% of the variation in average weekly weight gain could be predicted using these variables. It is unlikely that the measurement of maternal weight gain would be useful in detecting women who will have SGA infants or will develop hypertension.     

Inflammatory bowel disease: risk factors for adverse pregnancy outcome and the impact of maternal weight gain

Objective: To identify risk factors for adverse pregnancy outcome in women with inflammatory bowel disease (IBD) and to assess the effect of maternal pre-pregnancy weight and weight gain during pregnancy on pregnancy outcome. Methods: A retrospective, matched control study of all gravid women with IBD treated in a single tertiary center. Data were compared with healthy controls matched to by age, parity and pre-pregnancy BMI in a 3:1 ratio. Results: Overall, 300 women were enrolled, 75 women in the study group (28 with ulcerative colitis and 47 with Crohn’s disease) and 225 in the control group. The rates of preterm delivery and small for gestational age were higher in the study group (13.3 vs. 5.3% p = 0.02 and 6.7 vs. 0.9%, p = 0.004). The rate of cesarean section (36 vs. 19.1%; p = 0.002), NICU admission (10.7 vs. 4.0%, p = 0.03) and low 5-Min Apgar (4.0 vs. 0.4%, p = 0.02) were increased in the study group. Disease activity within 3 months of conception [OR 8.4 (1.3–16.3)] and maternal weight gain of less than 12 kg. [OR 3.6 (1.1–12.2)] were associated with adverse pregnancy outcome. Conclusion: Active disease at conception and inappropriate weight gain during pregnancy are associated with increased adverse pregnancy outcome in patients with IBD.     

Efficacy of an intervention to prevent excessive gestational weight gain

OBJECTIVE: This study was undertaken to evaluate the efficacy of an intervention directed at preventing excessive gestational weight gain. STUDY DESIGN: Healthy pregnant women with normal and overweight early pregnancy body mass index were monitored from early pregnancy until 1-year postpartum. One hundred seventy-nine women in the intervention group had their gestational weight gains monitored by health care providers and also received by-mail patient education. Three hundred eighty-one women formed an historical control group. The proportions in each group gaining more weight in pregnancy than is recommended and retaining more than 2.27 kg at 1-year postpartum were compared using logistic regression analysis. RESULTS: Low-income women who received the intervention had a significantly reduced risk of excessive gestational weight gain (odds ratio [OR]=0.41, 95% CI=0.20-0.81). Overweight women within this income subgroup were at significantly reduced risk of retaining more than 2.27 kg (OR=0.24, 95% CI=0.07-0.89). CONCLUSION: The intervention appeared to reduce the risk of excessive gestational weight gain only in the low-income subgroup.     

Association between maternal weight gain and birth weight

OBJECTIVE: To investigate the association between maternal weight gain and birth weight less than 3,000 g and greater than or equal to 4,000 g in underweight (body mass index [BMI] less than 19.8 kg/m(2)), normal weight (BMI 19.8-26.0 kg/m(2)), overweight (BMI 26.1-29.0 kg/m(2)), and obese (BMI greater than 29.0 kg/m(2)) women, with emphasis on the use of the American Institute of Medicine (IOM) recommendations in Denmark. METHODS: We analyzed data from 2,248 women with singleton, term pregnancies. The relationship between weight gain and risk of birth weight less than 3,000 g and greater than or equal to 4,000 g was examined in the four BMI groups, and use of IOM recommendations was tested by logistic regression analyses. RESULTS: We found an inverse relationship between maternal weight gain and the proportion of infants with a birth weight less than 3,000 g. Birth weight greater than or equal to 4,000 g increased with an increasing weight gain in underweight and normal-weight women, but the association was less apparent in overweight and obese women. Underweight women seemed to benefit from gaining more weight than recommended by the IOM, because the odds ratio (OR) of birth weight less than 3,000 g was 0.3 (95% confidence interval [CI] 0.1-0.9) and the OR was 1.7 for birthweight greater than or equal to 4,000 g (95% CI 0.8-3.6). The normal-weight women had an increased risk of birth weight less than 3,000 g (OR 2.4, 95% CI 1.5-3.7) if weight gain was below the recommended range, and the OR of birth weight greater than or equal to 4,000 g was 1.9 (95% CI 1.5-2.5) when the women gained more than recommended. CONCLUSION: The IOM recommendations may provide a basis for Danish recommendations to pregnant women, although the upper recommended limit for underweight women may have to be increased.     

Effects of gestational weight gain and body mass index on obstetric outcome in Sweden.

OBJECTIVE: The objective of this study was to estimate the effects of low and high gestational weight gain, in different maternal Body Mass Index (BMI) classes, on obstetric and neonatal outcomes. METHOD: A prospective population-based cohort study of 245,526 singleton term pregnancies. Women were grouped in five categories of BMI and in three gestational weight gain categories; < 8 kg (low weight gain), 8-16 kg and >16 kg (high weight gain). Obstetric and neonatal outcomes were evaluated after adjustments for maternal age, parity, smoking, year of birth. RESULT: Obese women with low gestational weight gain had a decreased risk for the following outcomes (adjusted odds ratio; 95% confidence interval): preeclampsia (0.52; 0.42-0.62), cesarean section (0.81; 0.73-0.90), instrumental delivery (0.75; 0.63-0.88), and LGA births (0.66; 0.59-0.75). There was a 2-fold increased risk for preeclampsia and LGA infants among average and overweight women with excessive weight gain. High gestational weight gain increased the risk for cesarean delivery in all maternal BMI classes. CONCLUSION: The effects of high or low gestational weight gain differ depending on maternal BMI and the outcome variable studied. Obese women may benefit from a low weight gain during pregnancy.     

肝素治疗胎儿生长受限的临床观察

目的探讨肝素用于治疗胎儿生长受限(FGR)的临床疗效及安全性.方法将107例FGR患者分为3组,标准肝素治疗组37例,将标准肝素50～75 mg溶于5%葡萄糖氯化钠注射液500 ml中静脉滴注,6～8 h滴完;低分子肝素治疗组31例,给予低分子肝素(商品名速避凝)0.2～0.4 ml皮下注射;对照组39例,给予低分子右旋糖酐500 ml加复方丹参注射液20 ml静脉滴注. 治疗前后及终止妊娠前,行彩色超声(彩超)检查,监测胎儿生长情况和脐血流变化,并进行生物物理评分,同时监测血小板计数(PLT)、凝血酶原时间(PT)、部分凝血活酶时间(APTT);记录新生儿情况并进行随访.结果 (1)标准肝素治疗组、低分子肝素治疗组,平均每周宫高均增长(0.7±0.6) cm,高于对照组的 (0.5±0.4) cm,差异有显著性(P＜0.05);平均每周双顶径分别增长[(2.4±0.7) mm、(2.5±0.8) mm,显著高于对照组的(1.7±0.6) mm,差异也有显著性(P＜0.05).(2)标准肝素治疗组、低分子肝素治疗组、对照组胎儿生物物理评分别为(9.7±0.8) 分、(9.6±0.6) 分、(8.9±0.7)分,差异有显著性(P＜0.05).(3)标准肝素治疗组及低分子肝素治疗组,脐动脉收缩期最大血流速度(S)与舒张末期血流速度(D)的比值(S/D比值)分别为2.5±0.5、2.4±0.5,显著低于对照组的2.9±0.6,差异有显著性(P＜0.05);搏动指数(PI)、阻力指数(RI)也显著低于对照组,差异也有显著性(P＜0.05).(4)标准肝素治疗组、低分子肝素治疗组新生儿出生后1分钟Apgar评分8～10分者分别占86%、87%,显著高于对照组的74%(P＜0.05);新生儿出生体重分别为(3100±256)g、(3080±225)g,显著高于对照组的(2580±304)g,差异有显著性(P＜0.05);胎龄均为(38±4)周,也显著长于对照组的(37±4)周,差异均有显著性(P＜0.05).(5)标准肝素治疗组及低分子肝素治疗组足月小样儿均为2例(分别占5%、6%),显著低于对照组的7例(18%),差异均有显著性(P＜0.05).(6)各组孕妇治疗前后PLT、PT、APTT比较,差异均无显著性(P＞0.05).(7)标准肝素治疗组及低分子肝素治疗组,治疗后孕妇的宫高、胎儿的股骨长度、头围、腹围、脐血流各指标、新生儿出生体重、胎龄等变化比较,差异均无显著性(P＞0.05).结论肝素可改善胎盘血流,使胎儿体重增加,减少足月小样儿的发生率,改善围产儿的预后,且肝素治疗FGR对母、儿都较安全.     

Excess pregnancy weight gain and long-term obesity: one decade later

OBJECTIVE: To estimate the impact of excess pregnancy weight gain and failure to lose weight by 6 months postpartum on excess weight 8-10 years later. METHODS: Seven hundred ninety-five women were observed through pregnancy and 6 months postpartum to examine factors that affect weight loss. Weight was recorded 10 years later through a medical record review to examine the impact of retained weight on long-term obesity. Overall weight change at last follow-up and body mass index (BMI) were examined by pregnancy weight gain appropriateness according to the Institute of Medicine guidelines for weight gain during pregnancy. RESULTS: Of the original cohort, 540 women had a documented weight beyond 5 years (mean = 8.5 years). The average weight gain from prepregnancy to follow-up was 6.3 kg. There was no difference in weight gain by prepregnancy BMI. Women who gained less than the recommended amount during their pregnancy were 4.1 kg heavier at follow-up, those gaining the recommended amount were 6.5 kg heavier, and those gaining more than recommended were 8.4 kg heavier (P =.01). Women who lost all pregnancy weight by 6 months postpartum were 2.4 kg heavier at follow-up than women with retained weight, who weighed 8.3 kg more at follow-up (P =.01). Women who breast-fed and women who participated in aerobic exercise also had significantly lower weight gains. CONCLUSION: Excess weight gain and failure to lose weight after pregnancy are important and identifiable predictors of long-term obesity. Breast-feeding and exercise may be beneficial to control long-term weight.     

Cross-sectional study of weight gain and increase in BMI throughout pregnancy

OBJECTIVE: To generate reliable new reference ranges for weight gain and increase in body mass index (BMI) during pregnancy from a large population. STUDY DESIGN: In a prospective cross-sectional study at the Obstetric outpatient clinic, Zurich University Hospital, weight gain and BMI, before gestation and at the booking visit, were determined in 4034 pregnant women with accurately dateable singleton pregnancies (Caucasian: N = 3242, Asian (predominantly from Sri Lanka, Thailand and the Philippines): N = 578 and Black: N = 214). Women with known insulin-dependent diabetes mellitus before pregnancy were excluded. Fifth, 50th and 95th centiles were presented for Caucasians and corresponding centile curves for Asians and Blacks. Simple and multiple regression analyses were performed for various risk factors. A significance level of P < 0.05 was used in all tests. RESULTS: Mean weight gain was 15.5+/-5.9 kg (34.2+/-13.0 lb) at term with values >25.4 kg (56.0 lb) and <5.7 kg (12.6 lb) for the 95th and the 5th centile, respectively. Mean BMI increased slightly and steadily to 28 kgm(-2) at term. Parity and pre-pregnancy BMI were significant determinants in Caucasians. Weight gain and BMI was slightly lower in Asians and Blacks. CONCLUSIONS: BMI centile curves have the advantage in that they consider height during the whole course of pregnancy. It may be an additional helpful tool in controlling weight gain in pregnancy. Further studies are required to determine the prognostic implications of values > or = 95th centile and < or = 5th centile.     

Patterns of maternal weight gain in pregnancy

A retrospective study of 1145 pregnant women showed that trends in mean maternal weight gain from the time of booking until delivery were not linear. Statistically significant lower rates of maternal weight gain were seen before 16 weeks, after 36 weeks and between 28 and 32 weeks gestation (P less than 0.05). The mean maternal weight gain was 10.71 kg (SD 4.3) and the mean weekly weight gain was 0.38 kg (SD 0.16). A wide variation of maternal weight gain was seen in women with a normal outcome. The mean weight gain in heavy (greater than 68 kg) and light (less than 55.4 kg) women was less than that in women whose weight was in the third quartile (60-68 kg, P less than 0.05). The mean maternal weight gain was less in young (less than 20 years) women than in older women (greater than 25 years; P less than 0.05), less in parous than in primigravid women from week 37 onwards (P less than 0.05), less in smokers than in non-smokers from 20 weeks onwards (P less than 0.05), and greater in hypertensive women (BP less than 140/90) than in normotensive women (P less than 0.05) from week 24 onwards. The mean weight gain in women who had small for gestational age (SGA) infants was not significantly different from that in women who had infants that were of appropriate size for gestational age. After taking into account infant and placental weight using multiple regression analysis, the factors that were associated with statistically significant differences in average weekly weight gain were parity, body mass index, smoking habit and raised blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

双胎妊娠孕期不同阶段体质量增长速度与母婴结局的关系

目的:分析双胎妊娠孕期不同阶段体质量增长情况与母婴结局的关系。方法:对2013年1月至2015年10月在上海交通大学医学院附属国际和平妇幼保健院住院分娩的472例双胎妊娠产妇的临床资料进行回顾性分析,比较不同孕前BMI孕妇孕期体质量增长情况,在校正年龄和孕前BMI后,使用二元Logistic回归分析孕期不同阶段体质量增长速度与孕期并发症、早产、胎膜早破和新生儿出生体质量的关系。结果:(1)孕早中期平均体质量增长速度0.41±0.15 kg/w,孕晚期平均体质量增长速度0.64±0.30 kg/w,整个孕期平均体质量增长速度0.49±0.15 kg/w。(2)孕晚期和整个孕期体质量增长过快是妊娠期高血压疾病和发生早产的高危因素(P0.05),孕早中期、孕晚期及整个孕期体质量增长过快是发生胎膜早破的高危因素(P0.05),孕早中期及整个孕期的体质量增长过慢是新生儿低出生体质量的高危因素(P0.05)。(3)在校正年龄、孕前BMI、孕周等因素后,孕期体质量每增加1 kg,双胎出生体质量之和增加25.21 g(P0.001);孕早中期每增加1 kg,双胎出生体质量之和增加30.89 g(P0.001);孕晚期每增加1 kg,双胎出生体质量之和增加21.46 g(P=0.001)。结论:双胎妊娠孕期体质量增长与母婴不良结局密切相关,妊娠不同阶段的体质量增长速度对母婴结局有一定的预测价值,应进一步探讨适合中国人群的双胎妊娠孕期体质量增长适宜范围。     

Effect of maternal weight gain on infant birth weight

OBJECTIVE: To ascertain whether increased weight gain during pregnancy resulted in higher birth weight infants. METHODS: A database was constructed from valid data of a sample of 159 healthy women between 19 to 37 years of age. The inclusion criteria were: maternal age of 19-37 years, term gestations (37-42 weeks), a baseline weight obtained at 0-15 weeks gestation, and a final weight obtained within 2 weeks of delivery. Weight gain was calculated by subtracting baseline weight from the final weight. A documented height enabled calculation of BMI. A negative screen for gestational diabetes was required. RESULTS: Women with lower first trimester BMI (< 25) had infants of lower birth weight than women of higher BMI (> 25). Women with lower gain (< 35 lbs) delivered smaller infants than women with higher gain (> 35 lbs). Women of higher BMI and higher gain delivered the largest infants (F = 5.37; p = 0.0015). Underweight women (BMI < 19) gained less weight than women of normal weight (BMI 19-25), who gained the most weight. Obese women (BMI > 29) gained the least weight (F = 6.26; p = 0.0005). CONCLUSION: The results confirmed that excessive maternal weight gain in pregnancy (> 35 lbs), does result in higher birth weight infants.     

Human fetal-placental weight ratio in normal singleton near-term pregnancies.

OBJECTIVE: To determine the fetal-placental weight ratio in normal near-term singleton pregnancies. PATIENTS AND METHODS: 431 consecutive singleton near-term live deliveries following uncomplicated pregnancies were included in a prospective study. Mean maternal age was 28.6 years (range 17-50), mean parity was 2.9 (range 1-16). Mean gestation age at delivery was 39.7 weeks (range 33-42). RESULTS: Mean newborn weight was 3,382.1 +/- 486.7 g (range 2,180-4,810). Mean placental weight was 613.0 +/- 123.8 g (range 319-1,266). Mean fetal-placental weight ratio was 5.6 +/- 0.96 (range 2.9-10.6) with kurtosis of 3.6 and skewness of 1.05. The ratio did not differ significantly between male (n = 253) and female (n = 176) infants, 5.7 +/- 0.89 and 5.6 +/- 1.04, respectively. There was a progressive increase in the fetal-placental weight ratio with gestational age (r = 0.87): from 5.3 +/- 0.90 at 33-36 weeks to 5.9 +/- 1.06 at the 41st week and 5.7 +/- 0.71 at the 42nd week (p < 0.05) and with birth weight distribution (r = 0.85) from 5.0 +/- 1. 06 in newborns weighing 2,000-2,499 g to 5.9 +/- 0.94 in newborns weighing >4,000 g (p < 0.05). There was a positive relationship between the fetal-placental weight ratio in teenage and elder parturients (r = 0.98): 5.2 +/- 0.98 (age 17-19), 5.7 +/- 0.88 (age 20-29), 5.6 +/- 1.08 (age 30-39), and 5.7 +/- 0.96 (age 41-50) (p < 0.05). The most contributing variable was birth weight. CONCLUSIONS: The fetal-placental weight ratio tends to be low in teenage women, early near-term gestational age, and low fetal weight. There was a progressive increase in the fetal-placental weight ratio with gestational age and with birth weight distribution.     

Placental weight in diabetic pregnancies

The placenta from 30 women with diabetes mellitus were examined and weighed at delivery. Nineteen of these were from women with overt and eleven from women with gestational diabetes. Eleven placentae from normal pregnancies served as controls. There was no difference between the mean +/- s.d. placental weight for the diabetic group and the control group (609 +/- 148 versus 591 +/- 93 g, NS). The mean placental weight ratios for the diabetic group and the control group were also similar (0.98 +/- 0.23 versus 0.89 +/- 0.15, NS). Moreover, there was no difference between the weights and weight ratios of placentae from women with overt (622 +/- 173 g, 1.02 +/- 0.27) and those with gestational diabetes (586 +/- 90 g, versus 0.90 +/- 0.13). Placental weights correlated with birthweights (r = 0.70, P less than 0.01) and with skinfold thickness measurements fo the infants (r = 0.40, P less than 0.05), but neither with gestational ages (r = 0.15, NS) nor with maternal glycosylated haemoglobin levels in the third trimester (r = 0.24, NS). Among the women with overt diabetes, placental weights were greater in those in White's class B and C than those in class D and R (689 +/- 143 versus 530 +/- 177 g; P less than 0.05). In general, placentae from well controlled diabetic patients were not heavier than those from normal pregnant women, although there was an increase in placental weight in White's class B and C, as compared with those in class D and R.     

Body fat distribution and body composition during GnRH agonist therapy

OBJECTIVE: To identify the effects of GnRH agonist therapy on body composition (lean and fat mass components) and body fat distribution. METHODS: Fifteen women with uterine leiomyomas were given a GnRH agonist (leuprorelin acetate, 3.75 mg) monthly for 4 months. Weight, height, and body mass index (BMI, weight/height) were recorded. Regional and total body composition, trunk-leg fat ratio, bone mineral density of the lumbar spine (L2-L4), and total body were assessed by whole-body scanning with dual-energy x-ray absorptiometry before and after treatment. Uterine volume was measured by transabdominal ultrasonography. RESULTS: The mean (+/- standard deviation [SD]) lean mass of total body, trunk, and leg decreased significantly (36.3 +/- 4.9 to 35.4 +/- 4.4 kg, P <.01; 18.8 +/- 2.8 to 18.1 +/- 2.8 kg, P <.05; and 11.4 +/- 1.8 to 11.1 +/- 1.6 kg, P <.05; respectively), whereas body fat mass, percentage of body fat, and trunk fat mass increased significantly (20.8 +/- 4.8 to 21.8 +/- 4.6 kg, P <.01; 34.9 +/- 5.9 to 36.5 +/- 5.2%, P <.01; and 8.6 +/- 3.0 to 9.3 +/- 3.0 kg, P <.01; respectively). Trunk-leg fat ratio increased significantly (1.03 +/- 0.32 to 1.12 +/- 0.33, P <.05). Weight, BMI, arm tissue composition (lean and fat mass components), and leg fat mass did not change during 4 months of GnRH agonist therapy. Bone mineral density and uterine volume decreased significantly. CONCLUSION: Hypogonadism by GnRH agonist therapy induces lean mass loss, increased adiposity overall, and upper body fat accumulation.     

Maternal low birth weight and gestational hyperglycemia.

We aimed to investigate whether birth weight could predict the subsequent risk of gestational diabetes and impaired glucose tolerance. Consecutive women with a singleton pregnancy and gestational diabetes (n = 50), impaired glucose tolerance (n = 50) and normoglycemia (n = 200) were included in the study. Birth data were collected from original hospital records of the women. Women with gestational hyperglycemia were significantly older and heavier than those with normoglycemia. Maternal birth weights significantly declined for each class of glucose tolerance (3389 +/- 644; 3184 +/- 583 and 3077 +/- 661, respectively for women with normoglycemia, impaired glucose tolerance and gestational diabetes). After adjustment for age, gestational age and weight gain, maternal diabetes, and pre-pregnancy body mass index, maternal birth weight was negatively related to impaired glucose tolerance (OR 0.88, 95% CI 0.81-0.97) and to gestational diabetes (OR 0.82, 95% CI 0.74-0.91) in a multiple logistic regression model. These findings suggest that women with low birth weight constitute a group at increased risk for both gestational impaired glucose tolerance and diabetes.