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Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling.

ABSTRACT: To estimate the absolute risks of adverse maternal and perinatal outcomes based on small differences in prepregnancy body mass (eg, 10% of body mass or 10-20 pounds).This population-based cohort study (N=226,958) was drawn from all singleton pregnancies in British Columbia (Canada) from 2004 to 2012. The relationships between prepregnancy body mass index (BMI) (as a continuous, nonlinear variable) and adverse pregnancy outcomes were examined using logistic regression models. Analyses were adjusted for maternal age, height, parity, and smoking in pregnancy. Adjusted absolute risks of each outcome are reported according to incremental differences in prepregnancy BMI and weight in pounds.A 10% difference in prepregnancy BMI was associated with at least a 10% lower risk of preeclampsia, gestational diabetes, indicated preterm delivery, macrosomia, and stillbirth. In contrast, larger differences in prepregnancy BMI (20-30% differences in BMI) were necessary to meaningfully reduce risks of cesarean delivery, shoulder dystocia, neonatal intensive care unit stay 48 hours or longer, and in-hospital newborn mortality. Prepregnancy BMI was not associated with risk of postpartum hemorrhage requiring intervention, severe maternal morbidity or maternal mortality, or spontaneous preterm delivery before 32 weeks of gestation.These results can inform prepregnancy weight loss counseling by defining achievable weight loss goals for patients that may reduce their risk of poor perinatal outcomes.II.

SUBMITTER: Schummers L

PROVIDER: S-EPMC4285688 | biostudies-literature | 2015 Jan

REPOSITORIES: biostudies-literature

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Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling.

Schummers Laura L Hutcheon Jennifer A JA Bodnar Lisa M LM Lieberman Ellice E Himes Katherine P KP

Obstetrics and gynecology 20150101 1

<h4>Objective</h4>To estimate the absolute risks of adverse maternal and perinatal outcomes based on small differences in prepregnancy body mass (eg, 10% of body mass or 10-20 pounds).<h4>Methods</h4>This population-based cohort study (N=226,958) was drawn from all singleton pregnancies in British Columbia (Canada) from 2004 to 2012. The relationships between prepregnancy body mass index (BMI) (as a continuous, nonlinear variable) and adverse pregnancy outcomes were examined using logistic regre ...[more]

PMID: 25560115

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Project description:ObjectivesThe objective was to investigate the associations of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) trajectories with adverse pregnancy outcomes (APOs).DesignThis was a prospective cohort study.SettingThis study was conducted in Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai, China.Primary and secondary outcome measuresA cohort study involving a total of 2174 pregnant women was conducted. Each participant was followed to record weekly weight gain and pregnancy outcomes. The Institute of Medicine classification was used to categorise prepregnancy BMI, and four GWG trajectories were identified using a latent class growth model.ResultsThe adjusted ORs for the risks of large for gestational age (LGA), macrosomia, gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) were significantly greater for women with prepregnancy overweight/obesity (OR=1.77, 2.13, 1.95 and 4.24; 95% CI 1.3 to 2.42, 1.32 to 3.46, 1.43 to 2.66 and 2.01 to 8.93, respectively) and lower for those who were underweight than for those with normal weight (excluding HDP) (OR=0.35, 0.27 and 0.59; 95% CI 0.22 to 0.53, 0.11 to 0.66 and 0.36 to 0.89, respectively). The risk of small for gestational age (SGA) and low birth weight (LBW) was significantly increased in the underweight group (OR=3.11, 2.20; 95% CI 1.63 to 5.92, 1.10 to 4.41; respectively) compared with the normal-weight group; however, the risk did not decrease in the overweight/obese group (p=0.942, 0.697, respectively). GWG was divided into four trajectories, accounting for 16.6%, 41.4%, 31.7% and 10.3% of the participants, respectively. After adjustment for confounding factors, the risk of LGA was 1.54 times greater for women in the slow GWG trajectory group than for those in the extremely slow GWG trajectory group (95% CI 1.07 to 2.21); the risk of SGA and LBW was 0.37 times and 0.46 times lower for women in the moderate GWG trajectory group and 0.14 times and 0.15 times lower for women in the rapid GWG trajectory group, respectively; the risk of macrosomia and LGA was 2.65 times and 2.70 times greater for women in the moderate GWG trajectory group and 3.53 times and 4.36 times greater for women in the rapid GWG trajectory group, respectively; and the women in the other three trajectory groups had a lower risk of GDM than did those in the extremely slow GWG trajectory group, but there was not much variation in the ORs. Notably, different GWG trajectories did not affect the risk of HDP.ConclusionsAs independent risk factors, excessively high and low prepregnancy BMI and GWG can increase the risk of APOs.

Project description:BackgroundThe prevalence of obesity and excessive gestational weight gain (GWG) has been increasing worldwide. The aims of this study were to evaluate associations of prepregnancy body mass index (BMI) and rate of GWG in the 2nd and 3rd trimesters with pregnancy outcomes in Chinese urban women, and to examine the dose-response relationship between rate of GWG and pregnancy outcomes.MethodsA retrospective analysis included 8926 women who delivered live singletons at ≥28 weeks of gestation between June 2012 and March 2013 among Chinese urban women. BMI was classified into underweight (BMI < 18.5 kg/m2), normal weight (18.5 kg/m2 ≤ BMI < 24 kg/m2), overweight (24 kg/m2 ≤ BMI < 28 kg/m2) and obese (BMI ≥ 28 kg/m2) according to the Chinese standard. Rate of GWG in the 2nd and 3rd trimesters was classified as insufficient, adequate and excessive if it was below, within, or above the 2009 IOM guidelines (0.44-0.58 kg/w [underweight], 0.35-0.50 kg/w [normal], 0.23-0.33 kg/w [overweight], and 0.17-0.27 kg/w [obese]). Logistic regression models and restricted cubic spline analyses were used to assess the association of prepregnancy BMI and rate of GWG with cesarean delivery, preterm birth, small-for-gestational age (SGA) and large-for-gestational age (LGA).Results22.6 and 50.0% of women had insufficient and excessive rate of GWG, respectively. After adjustment for potential confounders, prepregnancy underweight was associated with increased risk of SGA (OR = 1.71, 95% CI: 1.40-2.09), while both overweight and obesity were associated with higher risk of cesarean delivery (overweight: OR [95% CI] = 1.80 [1.56-2.08]; obese: 2.34 [1.69-3.24]) and LGA (overweight: 1.75 [1.44-2.13]; obese: 2.48 [1.71-3.60]). Both insufficient (OR = 1.34, 95% CI: 1.08-1.65) and excessive rates of GWG (OR = 1.44, 95% CI: 1.20-1.73) were associated with higher risk of preterm birth. Insufficient rate of GWG was associated with increased odds of SGA (OR = 1.49, 95% CI: 1.16-1.82), while excessive rate of GWG was associated with higher risk for cesarean delivery (OR = 1.22, 95% CI: 1.10-1.35) and LGA (OR = 1.58, 95% CI: 1.33-1.87). Additionally, there were significant nonlinear associations between rate of GWG and preterm birth (U-shaped, P for nonlinear < 0.001).ConclusionsPrepregnancy overweight, obesity and underweight, and insufficient and excessive rate of GWG were associated with increased risk of pregnancy outcomes in Chinese urban women.

Project description:OBJECTIVE:To study the association of prepregnancy body mass index (BMI) and gestational weight gain with child neurodevelopmental outcomes. METHODS:We performed a secondary analysis of data from two parallel, multicenter, randomized, double-blind, placebo-controlled thyroxine replacement trials in pregnant women with either hypothyroxinemia or subclinical hypothyroidism who delivered at term. Body mass index was categorized as normal (18.5-24.9), overweight (25.0-29.9), or obese (30 or greater). We also evaluated early (20 weeks of gestation or less), late (greater than 20 weeks of gestation), and total gestational weight gain and categorized gestational weight gain as inadequate, adequate, and excessive per 2009 Institute of Medicine guidelines. Neurodevelopmental outcomes included 5-year Wechsler Preschool and Primary Scale of Intelligence and 3-year Differential Ability Scales-II. Linear and logistic regression analyses were performed and adjusted for maternal age, race-ethnicity, education, insurance status, parity, smoking and alcohol use, thyroid status (subclinical hypothyroidism or hypothyroxinemia), treatment group, gestational age at delivery, and neonatal sex. RESULTS:Of the 948 women included, 380 (40%), 305 (32%), and 263 (28%) had normal, overweight, and obese prepregnancy BMI, respectively. A total of 106 (11%), 212 (22%), and 630 (66%) of women had inadequate, adequate, and excessive total rates of gestational weight gain, respectively. Maternal differences among the BMI categories included race-ethnicity, education, insurance type, parity, and thyroid status (all P<.01), whereas the gestational weight gain groups only differed by parity (P<.001). In unadjusted analysis, children of obese (93.2±12.8; 88.5±13.3) and overweight (94.1±15.6; 89.6±16.0) women had lower Wechsler Preschool and Primary Scale of Intelligence and Differential Ability Scales-II scores, respectively, than normal-weight women (97.4±15.4; 93.9±16.0; P<.001 for all comparisons); however, in adjusted analysis, there were no differences in neurodevelopmental outcomes by maternal BMI. The association was primarily accounted for by race-ethnicity and education. In unadjusted and adjusted analyses, there were no differences in neurodevelopmental outcomes by adequacy of early, late, or total gestational weight gain. CONCLUSION:In women with either subclinical hypothyroidism or hypothyroxinemia, neither prepregnancy BMI nor gestational weight gain was associated with neurodevelopmental outcomes among children born at term in adjusted analyses.

Dataset Information

Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling.

Publications

Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling.

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