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Fukui K, Suto M, Kaneko K, Isayama T, Ito Y, Takehara K. Pre-pregnancy body mass index and low birthweight: Secondary data analysis using health insurance claims data in Japan. J Obstet Gynaecol Res 2024. [PMID: 38764381 DOI: 10.1111/jog.15973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Abstract
AIM For women, being underweight increases their susceptibility to osteoporosis, anemia, and other conditions and affects the weight of their infants and the well-being of future generations. This study examined the association between low pre-pregnancy body mass index (BMI) and low birthweight using health insurance claims data and health checkup data, including weight measurements. METHODS We used health insurance claims data and health checkup data (JMDC, Tokyo, Japan) of women and their newborns in Japan between 2006 and 2020. We used checkup data, which included more accurate weight measurements and blood test-based diagnoses of anemia and hyperlipidemia compared to self-reported data. Maternal pre-pregnancy BMI was compared across three groups: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), and overweight (BMI ≥25.0 kg/m2). The primary outcome was low birthweight (<2500 g), and secondary outcome was preterm childbirth. Logistic regression analyses were conducted to compare outcomes in the three groups by BMI. The underweight BMI group was considered as the reference group. A subgroup analysis was performed by maternal age. RESULTS In total, 16 363 mothers (underweight, 3418 [21%], normal weight, 11 493 [70%], and overweight, 1452 [8.9%]) were included. The risk of primary outcome (low birthweight) was significantly lower in the normal weight group than in the underweight group (4.6% vs. 5.7%; adjusted odds ratio 0.78 [95% confidence interval: 0.65-0.96]). In the subgroup analyses, no significant differences were noted in the incidences of low birthweight and preterm childbirth between maternal age groups. CONCLUSIONS Pre-pregnancy BMI was associated with an increased risk of delivering low-birthweight infant. Awareness about the importance of women's pre-pregnancy health and appropriate BMI may reduce the incidence of low birthweight.
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Affiliation(s)
- Kana Fukui
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Maiko Suto
- Division of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Kayoko Kaneko
- Division of Maternal Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Yushi Ito
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Takehara
- Division of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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Aktar S, Nu UT, Rahman M, Pervin J, Rahman SM, El Arifeen S, Persson LÅ, Rahman A. Trends and risk of recurrent preterm birth in pregnancy cohorts in rural Bangladesh, 1990-2019. BMJ Glob Health 2023; 8:e012521. [PMID: 37984897 PMCID: PMC10660812 DOI: 10.1136/bmjgh-2023-012521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/08/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION A history of preterm birth reportedly increases the risk of subsequent preterm birth. This association has primarily been studied in high-income countries and not in low-income settings in transition with rapidly descending preterm birth figures. We evaluated the population-based trends of preterm births and recurrent preterm births and the risk of preterm birth recurrence in the second pregnancy based on prospectively studied pregnancy cohorts over three decades in Matlab, Bangladesh. METHODS A population-based cohort included 72 160 live births from 1990 to 2019. We calculated preterm birth and recurrent preterm birth trends. We assessed the odds of preterm birth recurrence based on a subsample of 14 567 women with live-born singletons in their first and second pregnancies. We used logistic regression and presented the associations by OR with a 95% CI. RESULTS The proportion of preterm births decreased from 25% in 1990 to 13% in 2019. The recurrent preterm births had a similar, falling pattern from 7.4% to 3.1% across the same period, contributing 27% of the total number of preterm births in the population. The odds of second pregnancy preterm birth were doubled (OR 2.18; 95% CI 1.96 to 2.43) in women with preterm birth compared with the women with term birth in their first pregnancies, remaining similar over the study period. The lower the gestational age at the first birth, the higher the odds of preterm birth in the subsequent pregnancy (test for trend p<0.001). CONCLUSION In this rural Bangladeshi setting, recurrent preterm births contributed a sizeable proportion of the total number of preterm births at the population level. The increased risk of recurrence remained similar across three decades when the total proportion of preterm births was reduced from 25% to 13%.
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Affiliation(s)
- Shaki Aktar
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - U Tin Nu
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Monjur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jesmin Pervin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Lars Åke Persson
- Department of Disease Control, Faculty of infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Anisur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Ishitsuka K, Yamamoto-Hanada K, Mezawa H, Saito-Abe M, Sasaki H, Nishizato M, Sato M, Ohya Y. Association between pre-pregnancy weight status and dietary patterns during pregnancy: results from the Japan Environment and Children's Study. Public Health Nutr 2023; 26:1807-1814. [PMID: 37129016 PMCID: PMC10478052 DOI: 10.1017/s1368980023000770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 02/11/2023] [Accepted: 04/04/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Pre-pregnancy weight status is related to offspring health and may influence dietary patterns during pregnancy. We aimed to evaluate the link between pre-pregnancy weight status and dietary patterns during pregnancy. DESIGN Dietary data were collected using a FFQ during middle or late pregnancy. Dietary patterns were identified using principal component analysis. Anthropometric data were extracted from medical charts. Multiple linear regression was used to assess associations between pre-pregnancy weight status (severely or moderately underweight, mildly underweight, normal weight, overweight and obese) and dietary patterns during pregnancy after adjusting for socio-demographic characteristics. SETTING Nationwide Japan. PARTICIPANTS Pregnant Japanese women enrolled in the Japan Environment and Children's Study, a prospective birth cohort study (n 90 765). RESULTS We identified three dietary patterns. Compared with women with pre-pregnancy normal weight, those with pre-pregnancy obesity were less likely to habitually consume 'fruits and vegetables' pattern (coefficient, -0·18; 95 % CI, -0·21, -0·14) and 'confectionery' pattern (coefficient, -0·18; 95 % CI, -0·21, -0·14) and more likely to consume 'white rice and soy products' pattern (coefficient, 0·08; 95 % CI, 0·04, 0·11), and those with severely or moderately pre-pregnancy underweight were more likely to consume 'confectionery' pattern (coefficient, 0·06; 95 % CI, 0·03, 0·09) during pregnancy, after adjusting for confounders. CONCLUSION We found that moderately and severely pre-pregnancy underweight women and those with obesity had unhealthy dietary patterns compared to those with pre-pregnancy normal weight. Our findings suggest that prenatal dietary advice is important and should be based on the pre-pregnancy weight status.
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Affiliation(s)
- Kazue Ishitsuka
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Kiwako Yamamoto-Hanada
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Hidetoshi Mezawa
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Mayako Saito-Abe
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Hatoko Sasaki
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Minaho Nishizato
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Miori Sato
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
| | - Yukihiro Ohya
- Medical Support Center of JECS Study, National Center for Child Health and Development, Tokyo1578535, Japan
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Pani P, Carletti C, Giangreco M, Knowles A, Clagnan E, Gobbato M, Del Zotto S, Cattaneo A, Ronfani L. Monitoring gestational weight gain: setting up a regional surveillance system in Italy. BMC Public Health 2023; 23:132. [PMID: 36653835 PMCID: PMC9850588 DOI: 10.1186/s12889-023-15028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In many countries, including Italy, there are few national data on pre-pregnancy Body Mass Index (BMI) and gestational weight gain (GWG), despite these being important predictors of maternal and neonatal health outcomes. This dearth of information makes it difficult to develop and monitor intervention policies to reduce the burden of disease linked to inadequate BMI status and/or GWG in pregnant women. This study describes the setting up and initial implementation of a regional surveillance system on pre-pregnancy BMI and GWG. METHODS Between 1 January 2017 and 31 December 2018, anthropometric data were collected from all pregnant women accessing public health services in the Friuli Venezia Giulia region (Italy) for first ultrasound check (T1) and at delivery (T2). Anthropometric data collected at T1 (self-reported pre-pregnancy weight and measured weight and height) and T2 (measured weight and self-reported pre-pregnancy weight and height) were compared. RESULTS The system was able to reach 43.8% of all the women who gave birth in the region, and provided complete data for 6400 women of the 7188 who accessed the services at T1. At the beginning of pregnancy 447 (7.0%) women were underweight, 4297 (67.1%) had normal weight, 1131 (17.7%) were overweight and 525 (8.2%) had obesity. At delivery, 2306 (36.0%) women were within the appropriate weight gain range, while for 2021 (31.6%) weight gain was insufficient and for 2073 (32.4%) excessive. Only minor differences were observed between measured and self-reported anthropometric data. CONCLUSIONS The surveillance system offers an overview of the weight status of women during pregnancy. About 1/3 of women entered pregnancy with unsatisfactory BMI and 2/3 did not achieve the recommended weight gain. This surveillance system can be an effective tool to guide public health interventions.
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Affiliation(s)
- Paola Pani
- grid.418712.90000 0004 1760 7415Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Via Dell’Istria 65/1, 34137 Trieste, Italy
| | - Claudia Carletti
- grid.418712.90000 0004 1760 7415Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Via Dell’Istria 65/1, 34137 Trieste, Italy
| | - Manuela Giangreco
- grid.418712.90000 0004 1760 7415Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Via Dell’Istria 65/1, 34137 Trieste, Italy
| | - Alessandra Knowles
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Via Dell'Istria 65/1, 34137, Trieste, Italy.
| | - Elena Clagnan
- SC Pianificazione Programmazione E Controllo Direzionale, ARCS – Azienda Regionale di Coordinamento per la Salute Regione Autonoma Friuli Venezia Giulia, Via Pozzuolo, 330 – 33100, Udine, Italy
| | - Michele Gobbato
- SC Pianificazione Programmazione E Controllo Direzionale, ARCS – Azienda Regionale di Coordinamento per la Salute Regione Autonoma Friuli Venezia Giulia, Via Pozzuolo, 330 – 33100, Udine, Italy
| | - Stefania Del Zotto
- SC Pianificazione Programmazione E Controllo Direzionale, ARCS – Azienda Regionale di Coordinamento per la Salute Regione Autonoma Friuli Venezia Giulia, Via Pozzuolo, 330 – 33100, Udine, Italy
| | | | - Luca Ronfani
- grid.418712.90000 0004 1760 7415Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS “Burlo Garofolo”, Via Dell’Istria 65/1, 34137 Trieste, Italy
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Ishitsuka K, Tsuji M, Yamamoto M, Tanaka R, Suga R, Kuwamura M, Sakuragi T, Shimono M, Kusuhara K. Association between maternal fish consumption during pregnancy and preterm births: the Japan Environment and Children's Study. Environ Health Prev Med 2023; 28:47. [PMID: 37648522 PMCID: PMC10480610 DOI: 10.1265/ehpm.23-00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/30/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Fish are a rich source of essential nutrients that protect against preterm birth. However, as fish can absorb environmental pollutants, their consumption can also increase the risk of preterm birth. This study aimed to assess whether maternal fish consumption during pregnancy is associated with preterm birth in a nationwide large Japanese cohort that consumed relatively high amounts and many types of fish. METHODS This study included 81,428 mother-child pairs enrolled in a nationwide prospective Japanese birth cohort study. Fish consumption was assessed using a validated food frequency questionnaire. Multivariate logistic regression was used to investigate the association of total consumption of fish, fatty fish and lean fish, fish paste, and seafood and clams with preterm birth, adjusted for potential confounders. RESULTS There was no association between overall fish consumption and preterm births. However, the highest quintile of fish paste consumption was significantly associated with an increased risk of preterm birth (odds ratio [OR]: 1.11; 95% confidence interval [CI: 1.04, 1.17]). The consumption of baked fish paste at least three times per week was significantly associated with preterm birth (OR: 1.20; 95% CI: 1.03, 1.40). Consumption of other types of fish, except fish paste, was not significantly associated with preterm birth risk. CONCLUSIONS Fish paste consumption may increase the risk of preterm birth. Further studies are required to confirm this association.
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Affiliation(s)
- Kazue Ishitsuka
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health
- Departiment of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mayumi Tsuji
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health
- Regional Center for Japan Environment and Children’s Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Megumi Yamamoto
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health
- Department of Environment and Public Health, National Institute for Minamata Disease, Minamata, Japan
| | - Rie Tanaka
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health
| | - Reiko Suga
- Regional Center for Japan Environment and Children’s Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Mami Kuwamura
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshihide Sakuragi
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health
| | - Masayuki Shimono
- Regional Center for Japan Environment and Children’s Study, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koichi Kusuhara
- Regional Center for Japan Environment and Children’s Study, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - the Japan Environment and Children’s Study Group
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health
- Departiment of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
- Department of Environment and Public Health, National Institute for Minamata Disease, Minamata, Japan
- Regional Center for Japan Environment and Children’s Study, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Pediatrics, University of Occupational and Environmental Health, Kitakyushu, Japan
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McHale P, Maudsley G, Pennington A, Schlüter DK, Barr B, Paranjothy S, Taylor-Robinson D. Mediators of socioeconomic inequalities in preterm birth: a systematic review. BMC Public Health 2022; 22:1134. [PMID: 35668387 PMCID: PMC9172189 DOI: 10.1186/s12889-022-13438-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Rates of preterm birth are substantial with significant inequalities. Understanding the role of risk factors on the pathway from maternal socioeconomic status (SES) to preterm birth can help inform interventions and policy. This study therefore aimed to identify mediators of the relationship between maternal SES and preterm birth, assess the strength of evidence, and evaluate the quality of methods used to assess mediation. METHODS Using Scopus, Medline OVID, "Medline In Process & Other Non-Indexed Citation", PsycINFO, and Social Science Citation Index (via Web of Science), search terms combined variations on mediation, socioeconomic status, and preterm birth. Citation and advanced Google searches supplemented this. Inclusion criteria guided screening and selection of observational studies Jan-2000 to July-2020. The metric extracted was the proportion of socioeconomic inequality in preterm birth explained by each mediator (e.g. 'proportion eliminated'). Included studies were narratively synthesised. RESULTS Of 22 studies included, over one-half used cohort design. Most studies had potential measurement bias for mediators, and only two studies fully adjusted for key confounders. Eighteen studies found significant socioeconomic inequalities in preterm birth. Studies assessed six groups of potential mediators: maternal smoking; maternal mental health; maternal physical health (including body mass index (BMI)); maternal lifestyle (including alcohol consumption); healthcare; and working and environmental conditions. There was high confidence of smoking during pregnancy (most frequently examined mediator) and maternal physical health mediating inequalities in preterm birth. Significant residual inequalities frequently remained. Difference-of-coefficients between models was the most common mediation analysis approach, only six studies assessed exposure-mediator interaction, and only two considered causal assumptions. CONCLUSIONS The substantial socioeconomic inequalities in preterm birth are only partly explained by six groups of mediators that have been studied, particularly maternal smoking in pregnancy. There is, however, a large residual direct effect of SES evident in most studies. Despite the mediation analysis approaches used limiting our ability to make causal inference, these findings highlight potential ways of intervening to reduce such inequalities. A focus on modifiable socioeconomic determinants, such as reducing poverty and educational inequality, is probably necessary to address inequalities in preterm birth, alongside action on mediating pathways.
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Affiliation(s)
- Philip McHale
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England.
| | - Gillian Maudsley
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
| | - Andy Pennington
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
| | - Daniela K Schlüter
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
| | - Ben Barr
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
| | - Shantini Paranjothy
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Health Data Science Research Centre, University of Aberdeen, Aberdeen, Scotland
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, England
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Hedderson MM, Xu F, Dayo OM, Liu E, Sridhar S, Lee C, Greenberg M. Contribution of maternal cardiometabolic risk factors to racial-ethnicity disparities in preterm birth subtypes. Am J Obstet Gynecol MFM 2022; 4:100608. [PMID: 35257938 DOI: 10.1016/j.ajogmf.2022.100608] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND There are recognized racial-ethnic disparities in preterm birth and in maternal cardiometabolic risk factors likely linked to systemic racism. However, it is unclear the extent to which cardiometabolic risk factors contribute to the higher rates of preterm birth among minoritized populations. OBJECTIVE This study aimed to evaluate racial-ethnic disparities in preterm birth subtypes and the role of maternal cardiometabolic risk factors as mediators of the association between maternal race-ethnicity and preterm birth subtypes. STUDY DESIGN This was a retrospective cohort study of 295,210 singleton live births from 2011 to 2018. Preterm birth subtypes were defined as medically indicated and spontaneous preterm birth. Poisson regression with robust standard errors were used to provide estimates of the relative risks and 95% confidence intervals for preterm birth subtypes. Causal mediation analysis used logistic regression models to estimate the natural direct and natural indirect (mediated) effects of maternal cardiometabolic risk factors. RESULTS Compared with White individuals, Black, Asian, and Hispanic individuals were at increased risk for having both medically indicated preterm birth (1.45, 1.30-1.61; 1.21, 1.12-1.31; and 1.13, 1.05-1.22, respectively) (risk ratios, 95% confidence intervals, respectively) and spontaneous preterm birth (1.20, 1.08-1.34; 1.34, 1.26-1.43; and 1.16, (1.08-1.23), independent of established risk factors. The extent to which cardiometabolic risk factors mediated the associations between race-ethnicity (each group vs White in separate analyses) and preterm birth subtypes varied by race-ethnicity. Hypertensive disorders mediated 30.1% of the association between Black race-ethnicity and medically indicated preterm birth, but it did not mediate the association for other racial-ethnic groups or for spontaneous preterm birth. Any glucose disorder in pregnancy was a mediator of medically indicated preterm birth and spontaneous preterm birth for Asian (65.8% and 13.9%, respectively) and Hispanic (17.3% and 11.9%) race-ethnicity but not for Black race-ethnicity. Overweight or obesity mediated the association between race-ethnicity and medically indicated preterm birth (15.5% among Black individuals and 25.1% among Hispanic individuals) and spontaneous preterm birth (10.7% among Hispanic individuals) but was not a mediator among Asian individuals. CONCLUSION Black, Asian, and Hispanic individuals are at increased risk for preterm birth. Maternal cardiometabolic risk factors partially mediate the associations between race-ethnicity and preterm birth subtypes but the extent varies by race-ethnicity. These findings suggest that strategies that improve and diminish differences in cardiometabolic health between race-ethnicity populations may diminish disparities in preterm birth.
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Affiliation(s)
| | - Fei Xu
- Kaiser Permanente Northern California's Division of Research
| | - Olumayowa M Dayo
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, CA
| | - Emily Liu
- Kaiser Permanente Northern California's Division of Research
| | - Sneha Sridhar
- Kaiser Permanente Northern California's Division of Research
| | - Catherine Lee
- Kaiser Permanente Northern California's Division of Research
| | - Mara Greenberg
- Regional Perinatal Service Center, Kaiser Permanente Northern California, Santa Clara, CA
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Nakanishi K, Saijo Y, Yoshioka E, Sato Y, Kato Y, Nagaya K, Takahashi S, Ito Y, Kobayashi S, Miyashita C, Ikeda-Araki A, Kishi R. Severity of low pre-pregnancy body mass index and perinatal outcomes: the Japan Environment and Children's Study. BMC Pregnancy Childbirth 2022; 22:121. [PMID: 35148693 PMCID: PMC8840606 DOI: 10.1186/s12884-022-04418-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background The extremes of maternal pre-pregnancy body mass index (BMI) are known to be risk factors associated with obstetric and adverse perinatal outcomes. Among Japanese women aged 20 years or older, the prevalence of underweight (BMI < 18.5 kg/m2) was 11.5% in 2019. Maternal thinness is a health problem caused by the desire to become slim. This study aimed to investigate the association between the severity of maternal low pre-pregnancy BMI and adverse perinatal outcomes, including preterm birth (PTB), low birth weight (LBW), and small-for-gestational age (SGA). Methods We conducted a prospective cohort study using data from the Japan Environment and Children’s Study, which recruited pregnant individuals between 2011 and 2014. Pre-pregnancy BMI was categorized as severe-moderate underweight (BMI < 16.9 kg/m2), mild underweight (BMI, 17.0–18.4 kg/m2), low-normal weight (BMI, 18.5–19.9 kg/m2), high-normal weight (BMI, 20.0–22.9 kg/m2), overweight (BMI, 23.0–24.9 kg/m2), and obese (BMI ≥ 25.0 kg/m2). The high-normal weight group was used as the reference for statistical analyses. Adjusted logistic regression was performed to evaluate the association between pre-pregnancy BMI and PTB, LBW, and SGA. Results Of 92,260 singleton pregnant individuals, the prevalence was 2.7% for severe-moderate underweight, 12.9% for mild underweight, and 24.5% for low-normal weight. The prevalence of adverse outcomes was 4.6% for PTB, 8.1% for LBW, and 7.6% for SGA. The adjusted odds ratios (aORs) for PTB were 1.72 (95% confidence interval [CI], 1.46–2.03) for severe-moderate underweight and 1.26 (95% CI, 1.14–1.39) for mild underweight. The aORs of LBW were 2.55 (95% CI, 2.27–2.86) for severe-moderate underweight, 1.64 (95% CI, 1.53–1.76) for mild underweight, and 1.23 (95% CI, 1.16–1.31) for low-normal weight. The aORs of SGA were 2.53 (95% CI, 2.25–2.84) for severe-moderate underweight, 1.66 (95% CI, 1.55–1.79) for mild underweight, and 1.29 (95% CI, 1.21–1.38) for low-normal weight. Conclusions A dose-response relationship was found between the severity of low pre-pregnancy BMI and PTB, LBW, and SGA. Even low-normal BMI (18.5–19.9 kg/m2) increased the risk of LBW and SGA. This study provides useful information for pre-conception counseling in lean individuals. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04418-3.
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Affiliation(s)
- Kentaro Nakanishi
- Department of Obstetrics and Gynecology, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yasuaki Saijo
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Eiji Yoshioka
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yukihiro Sato
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yasuhito Kato
- Department of Obstetrics and Gynecology, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan.,Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan
| | - Ken Nagaya
- Division of Neonatology, Perinatal Medical Center, Asahikawa Medical University Hospital, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan
| | - Satoru Takahashi
- Department of Pediatrics, Asahikawa Medical University, 1-1-1, Midorigaoka higashi2-jo, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yoshiya Ito
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing, 664-1, Akebono-cho, Kitami, Hokkaido, 090-0011, Japan
| | - Sumitaka Kobayashi
- Center for Environmental and Health Sciences, Hokkaido University, Kita12-jo, Nishi7-chome, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Chihiro Miyashita
- Center for Environmental and Health Sciences, Hokkaido University, Kita12-jo, Nishi7-chome, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Atsuko Ikeda-Araki
- Center for Environmental and Health Sciences, Hokkaido University, Kita12-jo, Nishi7-chome, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan.,Faculty of Health Sciences, Hokkaido University, Kita12-jo, Nishi5-chome, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, Kita12-jo, Nishi7-chome, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan
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9
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Lefizelier E, Misbert E, Brooks M, Le Thuaut A, Winer N, Ducarme G. Preterm Birth and Small-for-Gestational Age Neonates among Prepregnancy Underweight Women: A Case-Controlled Study. J Clin Med 2021; 10:jcm10245733. [PMID: 34945028 PMCID: PMC8709329 DOI: 10.3390/jcm10245733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/28/2021] [Accepted: 12/03/2021] [Indexed: 12/27/2022] Open
Abstract
The aim of our study was to investigate whether prepregnancy underweight body mass index (BMI) is associated with preterm birth (PTB) and small-for-gestational age (SGA). This retrospective case-control study included 814 women with live singleton fetuses in vertex presentation that gave birth between January 2016 and November 2016 in two tertiary care hospitals. The study group (n = 407) comprised all women whose prepregnancy BMI was underweight (<18.5 kg/m2) and who delivered during the study period. A control group (n = 407) was established with women whose prepregnancy BMI was normal (18.5–24.9 kg/m2) by matching age and parity. Univariate and multivariate analyses were performed to compare PTB and SGA associated with prepregnancy underweight BMI. Compared with the control group, the study group had higher rates of overall PTB (10.1% vs. 5.7%, p = 0.02), iatrogenic PTB (4.2% vs. 1.5%, p = 0.02), and SGA (22.1% vs. 11.1%, p < 0.001). In a multivariable analysis, prepregnancy underweight BMI was associated with PTB (aOR 2.32, 95% CI 1.12–4.81) and with SGA (aOR 2.38, 95% CI 1.58–3.58). In singleton pregnancies, women’s prepregnancy underweight compared with normal BMI was associated with an increase in PTB and in SGA neonates. Identifying this specific high-risk group is pragmatic and practical for all physicians, and they should be aware about perinatal outcome among underweight women.
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Affiliation(s)
- Emelyne Lefizelier
- Department of Obstetrics and Gynaecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France; (E.L.); (M.B.)
| | - Emilie Misbert
- Department of Obstetrics and Gynaecology, Nantes University Hospital, 44000 Nantes, France; (E.M.); (N.W.)
| | - Marion Brooks
- Department of Obstetrics and Gynaecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France; (E.L.); (M.B.)
| | - Aurélie Le Thuaut
- Plateforme de Méthodologie et Biostatistique, CHU Nantes, 44093 Nantes, France;
| | - Norbert Winer
- Department of Obstetrics and Gynaecology, Nantes University Hospital, 44000 Nantes, France; (E.M.); (N.W.)
| | - Guillaume Ducarme
- Department of Obstetrics and Gynaecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France; (E.L.); (M.B.)
- Correspondence: ; Tel.: +33-2514-46570; Fax: +33-2514-46404
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10
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Qu P, Zhao D, Mi Y, Dang S, Shi J, Shi W. Association between pre-pregnancy BMI and neonatal weight outcomes in twin pregnancies resulting from assisted reproductive technology: a 10-year cohort study. Eur J Clin Nutr 2021; 75:1465-1474. [PMID: 33531637 DOI: 10.1038/s41430-021-00862-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND/OBJECTIVES To examine the effect of pre-pregnancy maternal body mass index (BMI) on neonatal weight outcomes of twin infants who were conceived by assisted reproductive technology (ART). SUBJECTS/METHODS A 10-year (2006-2015) Chinese sample of 3431 mothers and their twin infants conceived by ART from a retrospective cohort were included. The effects of pre-pregnancy maternal BMI on gestational age and birth weight were assessed by generalized linear model and generalized estimating equation model. RESULTS Compared with a normal weight group, pre-pregnancy maternal underweight was associated with lower birth weight and increased risk of small for gestational age (SGA) in twins conceived by ART (birth weight: difference -59.22 g, 95% CI -93.16 to -25.27 g; SGA: RR 1.25, 95% CI 1.09 to 1.43). Pre-pregnancy maternal obesity was associated with higher birth weight and increased risk of preterm birth (birth weight: difference 65.82 g, 95% CI 10.66 to 120.99 g; preterm birth: RR 1.19, 95% CI 1.03-1.37). A nonlinear relationship between pre-pregnancy maternal BMI and SGA was observed. The risk of SGA decreased with the pre-pregnancy maternal BMI up to the turning point (BMI = 21) (RR 0.90, 95% CI 0.86-0.95). CONCLUSIONS Among mothers undergoing ART, pre-pregnancy maternal obesity is associated with higher birth weight and higher risk of preterm birth for twin pregnancy, and pre-pregnancy maternal underweight is associated with lower birth weight and higher risk of SGA. Women preparing for ART should maintain a normal BMI to lower the chances of adverse neonatal outcomes.
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Affiliation(s)
- Pengfei Qu
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, 710061, Shaanxi, People's Republic of China.,Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, 710003, Shaanxi, People's Republic of China.,Departments of Pediatrics and Neonatology, Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Doudou Zhao
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, 710061, Shaanxi, People's Republic of China.,Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, 710003, Shaanxi, People's Republic of China
| | - Yang Mi
- Department of obstetrics, Northwest Women's and Children's Hospital, Xi'an, 710003, Shaanxi, People's Republic of China
| | - Shaonong Dang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Juanzi Shi
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, 710061, Shaanxi, People's Republic of China. .,Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, 710003, Shaanxi, People's Republic of China.
| | - Wenhao Shi
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, 710061, Shaanxi, People's Republic of China. .,Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, 710003, Shaanxi, People's Republic of China.
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11
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Zash R, Caniglia EC, Diseko M, Mayondi G, Mabuta J, Luckett R, Hofmeyr GJ, Morroni C, Ramogola‐Masire D, Williams PL, Zera C, Wylie BJ, Makhema J, Lockman S, Shapiro RL. Maternal weight and birth outcomes among women on antiretroviral treatment from conception in a birth surveillance study in Botswana. J Int AIDS Soc 2021; 24:e25763. [PMID: 34176240 PMCID: PMC8236225 DOI: 10.1002/jia2.25763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/13/2021] [Accepted: 05/25/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Antiretrovirals such as dolutegravir (DTG) and tenofovir alafenamide (TAF) have been associated with excessive weight gain. The objective of this study was to understand the potential impact of ART-associated weight gain on pregnancy outcomes among women living with HIV. METHODS Using data from the Tsepamo birth outcomes surveillance study in Botswana, we evaluated the relationship between maternal weight (and weight gain) and severe birth outcomes (very preterm delivery <32 weeks, very small for gestational age (SGA) <3rd percentile, perinatal death), macrosomia (birthweight > 4000 g) and maternal hypertension. We estimated the relative risk of each outcome by baseline weight (first weight in pregnancy <24 weeks) and second trimester average weekly weight gain (kg/week from 12 ± 2 to 24 ± 2 weeks) using log binomial regression and evaluated effect modification by ART regimen (DTG vs. Efavirenz (EFV)). RESULTS Of 22,828 women on ART at conception with singleton deliveries between August 2014 and April 2020, 16,300 (71.4%) had a weight measured <24 weeks' gestation (baseline weight) and 4437 (19.2%) had weight measured both at 12 (±2) weeks and 24 (±2) weeks, allowing second trimester weight gain calculation. Compared to women with baseline weight 60 to 70 kg, low baseline weight (<50 kg) was associated with increased risk of very preterm delivery (aRR 1.30, 95% CI 1.03, 1.65) and very SGA (aRR1.96, 95% CI 1.69, 2.28). High baseline weight (>90 kg) was associated with increased risk of macrosomia (aRR 3.24, 95% CI 2.36, 4.44) and maternal hypertension (aRR 1.79, 95% CI 1.62, 1.97). Baseline weight was not associated with stillbirth or early neonatal death. For all outcomes, second trimester weight gain showed weaker associations than did baseline weight. Duration of pre-pregnancy ART (years) was associated with higher baseline weight for DTG but not for EFV, and the risk of maternal hypertension by baseline weight category was higher for DTG than EFV for all strata. CONCLUSIONS ART regimens associated with weight gain may reduce the number of women at risk for certain severe adverse pregnancy outcomes associated with low weight but increase the number at risk of macrosomia and maternal hypertension. Further research could determine whether weight-based ART treatment strategies improve maternal and child health.
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Affiliation(s)
- Rebecca Zash
- Beth Israel Deaconess Medical CenterBostonMAUSA
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
- Harvard T.H. Chan School of Public HealthBostonMAUSA
| | | | - Modiegi Diseko
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
| | - Gloria Mayondi
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
| | - Judith Mabuta
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
| | - Rebecca Luckett
- Beth Israel Deaconess Medical CenterBostonMAUSA
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
- University of BotswanaGaboroneBotswana
| | | | - Chelsea Morroni
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
- Liverpool School of Tropical MedicineLiverpoolUK
| | | | | | - Chloe Zera
- Beth Israel Deaconess Medical CenterBostonMAUSA
| | | | - Joseph Makhema
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
| | - Shahin Lockman
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
- Harvard T.H. Chan School of Public HealthBostonMAUSA
- Brigham and Women’s HospitalBostonMAUSA
| | - Roger L Shapiro
- Botswana‐Harvard AIDS Institute PartnershipGaboroneBotswana
- Liverpool School of Tropical MedicineLiverpoolUK
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12
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Salmon C, Thibon P, Prime L, Renouf S, Dreyfus M, Dolley P. Impact of maternal underweight on obstetric and neonatal prognosis: A retrospective study. Eur J Obstet Gynecol Reprod Biol 2020; 260:6-9. [PMID: 33706226 DOI: 10.1016/j.ejogrb.2020.12.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Maternal underweight (BMI < 18.5) is an uncommon situation with potentially serious obstetric consequences, though data in the literature are scarce. OBJECTIVE To compare the obstetrical prognosis of patients with normal BMI and BMI < 18.5. STUDY DESIGN We performed a retrospective study in France (Normandy). RESULTS We included 14,246 patients between January 2011 and November 2017, among whom 12,648 (88.8 %) had normal BMI, 1269 were considered mild underweight (17 ≤ BMI < 18.5 kg/m²) and 329 (2.3 %) were considered severe to moderate underweight (BMI < 17 kg/m²). The risk of preterm birth was all the greater as the thinness was severe (ORa: 1.34 [1.12-1.60] and ORa 1.77 [1.31-2.34]) and the risk of intrauterine growth retardation also increased with severe thinness (ORa: 1.63 [1.35-1.96] and ORa 2.28 [1.69-3.07]). The risk of a caesarean section or scheduled labour was no different. Neonatal parameters were comparable between the groups. CONCLUSION Our study confirms an increased risk of preterm delivery and intrauterine growth retardation with increased thinness after adjusting for confounding factors. This link had only been shown previously in 2 studies Neither the type of prematurity (induced or spontaneous) nor the severity of prematurity is influenced by the severity of thinness; however, the low prevalence of thinness limits the power of these data. It would be interesting to study the medico-economic relevance of a policy of close maternal-foetal surveillance in this target population.
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Affiliation(s)
- Capucine Salmon
- Service de Gynécologie-Obstétrique, CHU de Caen Normandie, Normandie Univ, UNICAEN, 14000 Caen, France.
| | - Pascal Thibon
- Réseau Périnatal, Centre Hospitalo-Universitaire, Caen F-14033, France
| | - Ludovic Prime
- Réseau Périnatal, Centre Hospitalo-Universitaire, Caen F-14033, France
| | - Solène Renouf
- Service de Gynécologie-Obstétrique, Centre Hospitalo-Universitaire, Caen F-14033, France
| | - Michel Dreyfus
- Service de Gynécologie-Obstétrique, Centre Hospitalo-Universitaire, Caen F-14033, France
| | - Patricia Dolley
- Service de Gynécologie-Obstétrique, Centre Hospitalo-Universitaire, Caen F-14033, France.
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13
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Effect of maternal body mass index on neonatal outcomes in women with endometriosis undergoing IVF. Reprod Biomed Online 2020; 40:559-567. [PMID: 32171707 DOI: 10.1016/j.rbmo.2020.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/07/2019] [Accepted: 01/13/2020] [Indexed: 01/24/2023]
Abstract
RESEARCH QUESTION Does preconception body mass index (BMI) affect neonatal outcomes in women with endometriosis who conceive with IVF? DESIGN This retrospective study included 7086 women who delivered a singleton live birth through IVF between December 2006 and December 2017. Of these, 1111 women were diagnosed with endometriosis by laparoscopy or laparotomy, while 5975 women received IVF treatment due to tubal factor or male factor infertility. Women were categorized according to predefined BMI groups (<18.5 kg/m2, BMI 18.5-24.9 kg/m2, ≥25 kg/m2). All comparisons performed were between women undergoing cryopreserved embryo transfer. RESULTS After stratification by BMI, underweight women with endometriosis showed higher preterm birth (PTB) rates compared with controls (14.61% versus 3.28%, P < 0.001), whereas normal weight and overweight/obese endometriotic women had similar PTB rates to controls. There was a significant interactive effect of endometriosis and maternal BMI on preterm delivery (P for interaction <0.05). After adjustment for potential confounding factors, the PTB rate remained consistently higher in the low BMI subgroup of women with endometriosis (adjusted odds ratio 4.66, 95% confidence interval 2.54-8.57), whereas this difference was not observed for the other BMI categories. Additionally, we noted no differences in the rate of early PTB, low birthweight, macrosomia, small for gestational age and large for gestational age between women with endometriosis and controls with respect to any preconception category of BMI. CONCLUSIONS Endometriotic patients who were underweight before conception (BMI <18.5 kg/m2) had a higher rate of PTB than women without endometriosis, but the difference was not observed in the other BMI categories.
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14
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Pigatti Silva F, Souza RT, Cecatti JG, Passini R, Tedesco RP, Lajos GJ, Nomura ML, Rehder PM, Dias TZ, Oliveira PF, Silva CM. Role of Body Mass Index and gestational weight gain on preterm birth and adverse perinatal outcomes. Sci Rep 2019; 9:13093. [PMID: 31511664 PMCID: PMC6739338 DOI: 10.1038/s41598-019-49704-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/29/2019] [Indexed: 12/22/2022] Open
Abstract
The association of body mass index (BMI) and gestational weight gain (GWG) with preterm birth (PTB) remains controversial in the literature. To evaluate different maternal BMI and GWG categories, according to the initial BMI, in relation to different PTB subtypes and perinatal outcomes, we conducted a secondary analysis of a multicentre cross-sectional study, along with a nested case-control study including PTB from 20 centers in Brazil. Pre-pregnancy underweight was associated with a lower risk of provider-initiated PTB, while overweight and obesity were associated with a higher risk of provider-initiated PTB and a lower risk of spontaneous preterm birth. Insufficient gestational weight gain was associated with a higher prevalence of spontaneous PTB and preterm premature rupture of membranes. Excessive GWG correlated with a higher prevalence of provider-initiated PTB or preterm premature rupture of membranes. Irrespective of the initial BMI, the greater the rate of GWG, the higher the predicted probability of all PTB subtypes, except for spontaneous PTB in underweight women and those with normal BMI. On multivariate analysis, the initial BMI was shown to be the only factor associated with pi-PTB. Briefly, further studies evaluating the risk for PTB should consider that GWG may have a different role depending on the initial BMI and PTB subtype.
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Affiliation(s)
- Fabia Pigatti Silva
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Renato T Souza
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil.
| | - Renato Passini
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Ricardo P Tedesco
- Department of Obstetrics and Gynecology, Jundiaí Medical School, Jundiaí, SP, Brazil
| | - Giuliane J Lajos
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Marcelo L Nomura
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Patricia M Rehder
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Tabata Z Dias
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Paulo F Oliveira
- Unit of Statistics, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Cleide M Silva
- Unit of Statistics, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
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Qu P, Liu F, Zhao D, Wang Y, Wang M, Wang L, Dang S, Wang D, Shi J, Shi W. A propensity-matched study of the association between pre-pregnancy maternal underweight and perinatal outcomes of singletons conceived through assisted reproductive technology. Reprod Biomed Online 2019; 39:674-684. [PMID: 31540847 DOI: 10.1016/j.rbmo.2019.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/01/2019] [Accepted: 06/18/2019] [Indexed: 01/06/2023]
Abstract
RESEARCH QUESTION Is pre-pregnancy maternal underweight associated with perinatal outcomes of singletons who were conceived through assisted reproductive technology (ART)? DESIGN A 10-year (2006-2015) Chinese sample of 6538 women and their singleton infants who were conceived through ART was used to examine the association between pre-pregnancy maternal underweight and perinatal outcomes. Propensity scores for underweight were calculated for each participant using multivariable logistic regression, which was used to match 740 (91.36% of 810) underweight women with 740 normal weight women; the effects of underweight on birth weight and gestational age were then assessed by generalized estimating equation model. RESULTS After propensity score matching, the birth weight was lower (difference -136.83 g, 95% CI -184.11 to -89.55 g) in the underweight group than in the normal weight group. The risks of low birth weight (LBW) and small for gestational age (SGA) were increased in the underweight group compared with those in the normal weight group (LBW: RR 1.64, 95% CI 1.01 to 2.67; SGA: RR 1.46, 95% CI 1.06 to 2.02). The risks of fetal macrosomia and being large for gestational age (LGA) were decreased in the underweight group compared with those in the normal weight group (macrosomia: RR 0.39, 95% CI 0.26 to 0.61; LGA: RR 0.36, 95% CI 0.24 to 0.53). The associations between underweight, gestational age and preterm birth were not statistically significant. CONCLUSIONS Among women undergoing ART, pre-pregnancy maternal underweight was associated with lower birth weight, increased LBW and SGA risks, and decreased fetal macrosomia and LGA risks in singleton infants.
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Affiliation(s)
- Pengfei Qu
- Assisted Reproduction Center, Northwest Women's and Children's Hospital of Xi'an Jiaotong University Health Science Center, No.73 Houzaimen, Xi'an Shaanxi 710003, People's Republic of China; Translational Medicine Center, Northwest Women's and Children's Hospital of Xi'an Jiaotong University Health Science Center, No.1616 Yanxiang Road, Xi'an Shaanxi 710061, People's Republic of China
| | - Fangfang Liu
- Department of stomatology, Xi'an Central Hospital, No.161 Xiwu Road, Xi'an Shaanxi 710003, People's Republic of China
| | - Doudou Zhao
- Assisted Reproduction Center, Northwest Women's and Children's Hospital of Xi'an Jiaotong University Health Science Center, No.73 Houzaimen, Xi'an Shaanxi 710003, People's Republic of China; Translational Medicine Center, Northwest Women's and Children's Hospital of Xi'an Jiaotong University Health Science Center, No.1616 Yanxiang Road, Xi'an Shaanxi 710061, People's Republic of China
| | - Yongbo Wang
- Assisted Reproduction Center, Northwest Women's and Children's Hospital of Xi'an Jiaotong University Health Science Center, No.73 Houzaimen, Xi'an Shaanxi 710003, People's Republic of China
| | - Min Wang
- Assisted Reproduction Center, Northwest Women's and Children's Hospital of Xi'an Jiaotong University Health Science Center, No.73 Houzaimen, Xi'an Shaanxi 710003, People's Republic of China
| | - Linyu Wang
- Assisted Reproduction Center, Northwest Women's and Children's Hospital of Xi'an Jiaotong University Health Science Center, No.73 Houzaimen, Xi'an Shaanxi 710003, People's Republic of China; Translational Medicine Center, Northwest Women's and Children's Hospital of Xi'an Jiaotong University Health Science Center, No.1616 Yanxiang Road, Xi'an Shaanxi 710061, People's Republic of China
| | - Shaonong Dang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No.76 Yanta West Road, Xi'an Shaanxi 710061, People's Republic of China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine Pembroke Place, Liverpool, UK
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital of Xi'an Jiaotong University Health Science Center, No.73 Houzaimen, Xi'an Shaanxi 710003, People's Republic of China; Translational Medicine Center, Northwest Women's and Children's Hospital of Xi'an Jiaotong University Health Science Center, No.1616 Yanxiang Road, Xi'an Shaanxi 710061, People's Republic of China.
| | - Wenhao Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital of Xi'an Jiaotong University Health Science Center, No.73 Houzaimen, Xi'an Shaanxi 710003, People's Republic of China; Translational Medicine Center, Northwest Women's and Children's Hospital of Xi'an Jiaotong University Health Science Center, No.1616 Yanxiang Road, Xi'an Shaanxi 710061, People's Republic of China.
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16
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The relationship between maternal body mass index and pregnancy outcomes in twin compared with singleton pregnancies. Int J Obes (Lond) 2019; 44:33-44. [PMID: 30992520 DOI: 10.1038/s41366-019-0362-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/22/2019] [Accepted: 03/10/2019] [Indexed: 11/08/2022]
Abstract
OBJECIVE Women with twins have an a priori increased risk for many of the complications associated with maternal obesity. Thus, the impact of maternal obesity in twins may differ from that reported in singletons. In addition, given the increased metabolic demands in twin pregnancies, the impact of maternal underweight may be greater in twin compared with singleton gestations. Our objective was to test the hypothesis that the relationship between maternal pre-pregnancy body mass index (BMI) and adverse pregnancy outcomes differ between twin and singleton gestations. METHODS This was a retrospective population-based study of all women who had a singleton or twin hospital birth in Ontario, Canada, between April 2012 and March 2016. Data were obtained from the Better Outcomes Registry & Network (BORN) Ontario. The relationship between maternal BMI category and pregnancy complications was assessed separately in twin and singleton gestations. The primary outcome was a composite variable that included any of the following complications: preeclampsia, gestational diabetes, or preterm birth before 320/7 weeks. Relative risk (aRR) and 95% confidence intervals (CI) for adverse outcomes for each BMI category as defined by WHO (using normal weight category as reference) were generated using modified Poisson regression, adjusting for maternal age, nulliparity, smoking, previous preterm birth, and fetal sex. RESULTS A total of 487,870 women with singleton (n = 480,010) and twin (n = 7860) pregnancies met the inclusion criteria. The risk of the composite primary outcome, preeclampsia, gestational diabetes, and cesarean delivery increased with high maternal BMI in both singleton and twin gestations, but these associations were weaker in twin compared with singleton gestations (association of BMI ≥ 40.0 kg/m2 with primary outcome: aRR = 3.10, 95%-CI 2.96-3.24 in singletons compared with aRR = 1.74, 95%-CI 1.37-2.20 in twins). In singleton pregnancies the risk of preterm birth at < 320/7 weeks increased with maternal BMI, mainly due to an increased risk of provider-initiated preterm birth. In twin gestations, however, underweight (but not overweight or obesity) was associated with the greatest risk of preterm birth at < 32 weeks (aRR 1.67, 95%-CI 1.17-2.37), mainly due to an increased risk of spontaneous preterm birth (aRR 2.10, 95%-CI 1.44-3.08). CONCLUSION In healthy women with twin pregnancies, underweight is associated with the greatest risk for preterm birth, while the association of maternal obesity with adverse pregnancy outcomes is weaker than that observed in singletons.
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Gao X, Yan Y, Xiang S, Zeng G, Liu S, Sha T, He Q, Li H, Tan S, Chen C, Li L, Yan Q. 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. PLoS One 2017; 12:e0177418. [PMID: 28575041 PMCID: PMC5456032 DOI: 10.1371/journal.pone.0177418] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/26/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The 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. METHODS This 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). RESULTS After 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. CONCLUSIONS The 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.
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Affiliation(s)
- Xiao Gao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
- * E-mail:
| | - Shiting Xiang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Guangyu Zeng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Shiping Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Tingting Sha
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Qiong He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Hongyan Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Shan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Cheng Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Ling Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Qiang Yan
- Department of Maternal and Child Health, Kaifu District Health Bureau, Changsha, China
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Girsen AI, Mayo JA, Wallenstein MB, Gould JB, Carmichael SL, Stevenson DK, Lyell DJ, Shaw GM. What factors are related to recurrent preterm birth among underweight women? . J Matern Fetal Neonatal Med 2017; 31:560-566. [PMID: 28166677 DOI: 10.1080/14767058.2017.1292243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Our objective was to identify factors associated with recurrent preterm birth among underweight women. METHODS Maternally linked hospital and birth certificate records of deliveries in California between 2007 and 2010 were used. Consecutive singleton pregnancies of women with underweight body mass index (BMI <18.5 kg/m2) in the first pregnancy were analyzed. Pregnancies were categorized based on outcome of the first and second birth as: term-term; term-preterm; preterm-term and preterm-preterm. RESULTS We analyzed 4971 women with underweight BMI in the first pregnancy. Of these, 670 had at least one preterm birth. Among these 670, 86 (21.8%) women experienced a recurrent preterm birth. Odds for first term - second preterm birth were decreased for increases in maternal age (aOR: 0.90, 95%CI: 0.95-0.99) whereas inter-pregnancy interval <6 months was related to both first term - second preterm birth (aOR:1.66, 95%CI: 1.21-2.28) and first preterm birth - second term birth (aOR: 1.43, 95%CI: 1.04-1.96). Factors associated with recurrent preterm birth were: negative or no change in pre-pregnancy weight between pregnancies (aOR: 1.67, 95%CI: 1.07-2.60), inter-pregnancy interval <6 months (aOR: 2.14, 95%CI: 1.29-3.56), and maternal age in the first pregnancy (aOR: 0.93, 95%CI: 0.90-0.97). CONCLUSIONS Recurrent preterm birth among underweight women was associated with younger age, short inter-pregnancy interval, and negative or no weight change between pregnancies.
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Affiliation(s)
- Anna I Girsen
- a Department of Obstetrics & Gynecology , Stanford University School of Medicine , Stanford , CA , USA
| | - Jonathan A Mayo
- b March of Dimes Prematurity Research Center, Division of Developmental & Neonatal Medicine, Department of Pediatrics , Stanford University School of Medicine , Stanford , CA , USA
| | - Matthew B Wallenstein
- b March of Dimes Prematurity Research Center, Division of Developmental & Neonatal Medicine, Department of Pediatrics , Stanford University School of Medicine , Stanford , CA , USA
| | - Jeffrey B Gould
- b March of Dimes Prematurity Research Center, Division of Developmental & Neonatal Medicine, Department of Pediatrics , Stanford University School of Medicine , Stanford , CA , USA
| | - Suzan L Carmichael
- b March of Dimes Prematurity Research Center, Division of Developmental & Neonatal Medicine, Department of Pediatrics , Stanford University School of Medicine , Stanford , CA , USA
| | - David K Stevenson
- b March of Dimes Prematurity Research Center, Division of Developmental & Neonatal Medicine, Department of Pediatrics , Stanford University School of Medicine , Stanford , CA , USA
| | - Deirdre J Lyell
- b March of Dimes Prematurity Research Center, Division of Developmental & Neonatal Medicine, Department of Pediatrics , Stanford University School of Medicine , Stanford , CA , USA
| | - Gary M Shaw
- b March of Dimes Prematurity Research Center, Division of Developmental & Neonatal Medicine, Department of Pediatrics , Stanford University School of Medicine , Stanford , CA , USA
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van Zijl MD, Koullali B, Mol BW, Pajkrt E, Oudijk MA. Prevention of preterm delivery: current challenges and future prospects. Int J Womens Health 2016; 8:633-645. [PMID: 27843353 PMCID: PMC5098751 DOI: 10.2147/ijwh.s89317] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Preterm birth (PTB), defined as delivery at <37 weeks of gestation, is the most important cause of neonatal morbidity and mortality. Therefore, preventing PTB is one of the main goals in obstetric care. In this review, we provide an overview of the current available literature on screening for risk factors for PTB and a summary of preventive strategies in both low-risk and high-risk women with singleton or multiple gestations. Furthermore, current challenges and future prospects on PTB are discussed. For an optimal prevention of PTB, risk stratification should be based on a combination of (maternal) risk factors, obstetric history, and screening tools. Cervical length measurements can help identify women at risk. Thereafter, preventive strategies such as progesterone, pessaries, and cerclage may help prevent PTB. Effective screening and prevention of PTB vary between the different pregnancy populations. In singleton or multiple pregnancies with a short cervix, without previous PTB, a pessary or progesterone might prevent PTB. In women with a (recurrent) PTB in the past, progesterone and a cerclage may prevent recurrence. The effect of a pessary in these high-risk women is currently being studied. A strong collaboration between doctors, patients' organizations, pharmaceutical companies, and (international) governments is needed to reduce the morbidity and mortality as a result of spontaneous PTB.
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Affiliation(s)
- Maud D van Zijl
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands
| | - Bouchra Koullali
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands
| | - Ben Wj Mol
- The Robinson Research Institute, School for Reproductive Health and Pediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, the Netherlands
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Pan Y, Zhang S, Wang Q, Shen H, Zhang Y, Li Y, Yan D, Sun L. Investigating the association between prepregnancy body mass index and adverse pregnancy outcomes: a large cohort study of 536 098 Chinese pregnant women in rural China. BMJ Open 2016; 6:e011227. [PMID: 27439613 PMCID: PMC4964214 DOI: 10.1136/bmjopen-2016-011227] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Unhealthy maternal weight before pregnancy increases the risk of various adverse pregnancy outcomes. We conducted a nutrition survey to provide baseline data on the prepregnant nutritional status of mothers in order to better understand the association between prepregnancy maternal body mass index (BMI) and adverse pregnancy outcomes. DESIGN A large, prospective, population-based cohort study. SETTING Data from the National Free Preconception Health Examination Project (NFPHEP) in China during 2010-2012. PARTICIPANTS 536 098 pregnant women out of 2 120 131 were evaluated. PRIMARY AND SECONDARY OUTCOME MEASURES The primary adverse pregnancy outcomes included preterm birth (PTB), low birth weight (LBW), spontaneous miscarriage (SM), ectopic pregnancy (EP) and stillbirth (SB). A χ(2) test was used to compare the prevalence of each BMI category during 2010-2012. Univariable and multiple logistic regression analyses were performed to assess the association between prepregnancy BMI and various adverse pregnancy outcomes. RESULTS Between 2010 and 2012, the average BMI decreased from 21.31 to 21.16, while underweight prevalence increased from 10.40% to 14.14%. An age-stratified subgroup analysis indicated that the underweight prevalence increased from 13.52% to 17.02% among women aged 21-24 and from 10.72% to 13.71% among women aged 25-34. Overweight prevalence increased from 9.84% to 10.75% (25-34 years) and from 17.10% to 19.20% (35-49 years). Obesity prevalence increased from 2.17% to 2.42% and from 4% to 4.2% among women aged 25-34 and 35-49 respectively. Prepregnancy underweight was associated with PTB, LBW and SM; overweight women had an increased risk of LBW; obese women had a higher risk of LBW, SM, EP and SB. CONCLUSIONS While the average prepregnancy BMI decreased, the prevalence of underweight individuals in a very large population significantly increased. The abnormal prepregnancy BMIs were associated with increased risks of adverse pregnancy outcomes. Most notably, underweight prepregnant women appeared to be at a greater risk of developing adverse pregnancy outcomes in China's rural areas.
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Affiliation(s)
- Yi Pan
- Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shikun Zhang
- Department of Maternal & Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Qiaomei Wang
- Department of Maternal & Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Haiping Shen
- Department of Maternal & Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Yiping Zhang
- Department of Maternal & Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Yuanyuan Li
- National Research Institute for Family Planning, Beijing, China
| | - Donghai Yan
- Department of Maternal & Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Lizhou Sun
- Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Sharma AJ, Vesco KK, Bulkley J, Callaghan WM, Bruce FC, Staab J, Hornbrook MC, Berg CJ. Rate of Second and Third Trimester Weight Gain and Preterm Delivery Among Underweight and Normal Weight Women. Matern Child Health J 2016; 20:2030-6. [PMID: 27329188 DOI: 10.1007/s10995-016-2032-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives Low gestational weight gain (GWG) in the second and third trimesters has been associated with increased risk of preterm delivery (PTD) among women with a body mass index (BMI) < 25 mg/m(2). However, few studies have examined whether this association differs by the assumptions made for first trimester gain or by the reason for PTD. Methods We examined singleton pregnancies during 2000-2008 among women with a BMI < 25 kg/m(2) who delivered a live-birth ≥28 weeks gestation (n = 12,526). Women received care within one integrated health care delivery system and began prenatal care ≤13 weeks. Using antenatal weights measured during clinic visits, we interpolated GWG at 13 weeks gestation then estimated rate of GWG (GWGrate) during the second and third trimesters of pregnancy. We also estimated GWGrate using the common assumption of a 2-kg gain for all women by 13 weeks. We examined the covariate-adjusted association between quartiles of GWGrate and PTD (28-36 weeks gestation) using logistic regression. We also examined associations by reason for PTD [premature rupture of membranes (PROM), spontaneous labor, or medically indicated]. Results Mean GWGrate did not differ among term and preterm pregnancies regardless of interpolated or assumed GWG at 13 weeks. However, only with GWGrate estimated from interpolated GWG at 13 weeks, we observed a U-shaped relationship where odds of PTD increased with GWGrate in the lowest (OR 1.36, 95 % CI 1.10, 1.69) or highest quartile (OR 1.49, 95 % CI 1.20, 1.85) compared to GWGrate within the second quartile. Further stratifying by reason, GWGrate in the lowest quartile was positively associated with spontaneous PTD while GWGrate in the highest quartile was positively associated with PROM and medically indicated PTD. Conclusions Accurate estimates of first trimester GWG are needed. Common assumptions applied to all pregnancies may obscure the association between GWGrate and PTD. Further research is needed to fully understand whether these associations are causal or related to common antecedents.
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Affiliation(s)
- Andrea J Sharma
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-74, Atlanta, GA, 30341, USA. .,U.S. Public Health Service Commissioned Corps, Atlanta, GA, USA.
| | - Kimberly K Vesco
- The Center for Health Research, Northwest/Hawai'i/Southeast, Kaiser Permanente Northwest, Portland, OR, USA
| | - Joanna Bulkley
- The Center for Health Research, Northwest/Hawai'i/Southeast, Kaiser Permanente Northwest, Portland, OR, USA
| | - William M Callaghan
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-74, Atlanta, GA, 30341, USA
| | - F Carol Bruce
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-74, Atlanta, GA, 30341, USA
| | - Jenny Staab
- The Center for Health Research, Northwest/Hawai'i/Southeast, Kaiser Permanente Northwest, Portland, OR, USA
| | - Mark C Hornbrook
- The Center for Health Research, Northwest/Hawai'i/Southeast, Kaiser Permanente Northwest, Portland, OR, USA
| | - Cynthia J Berg
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-74, Atlanta, GA, 30341, USA
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Girsen AI, Mayo JA, Carmichael SL, Phibbs CS, Shachar BZ, Stevenson DK, Lyell DJ, Shaw GM, Gould JB. Women's prepregnancy underweight as a risk factor for preterm birth: a retrospective study. BJOG 2016; 123:2001-2007. [PMID: 27172996 DOI: 10.1111/1471-0528.14027] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the distribution of known factors for preterm birth (PTB) by severity of maternal underweight; to investigate the risk-adjusted relation between severity of underweight and PTB, and to assess whether the relation differed by gestational age. DESIGN Retrospective cohort study. SETTING State of California, USA. METHODS Maternally linked hospital and birth certificate records of 950 356 California deliveries in 2007-2010 were analysed. Singleton live births of women whose prepregnancy body mass index (BMI) was underweight (<18.5 kg/m2 ) or normal (18.50-24.99 kg/m2 ) were analysed. Underweight BMI was further categorised as: severe (<16.00), moderate (16.00-16.99) or mild (17.00-18.49). PTB was grouped as 22-27, 28-31, 32-36 or <37 weeks (compared with 37-41 weeks). Adjusted multivariable Poisson regression modeling was used to estimate relative risk for PTB. MAIN OUTCOME MEASURES Risk of PTB. RESULTS About 72 686 (7.6%) women were underweight. Increasing severity of underweight was associated with increasing percent PTB: 7.8% (n = 4421) in mild, 9.0% (n = 1001) in moderate and 10.2% (475) in severe underweight. The adjusted relative risk of PTB also significantly increased: adjusted relative risk (aRR) = 1.22 (95% CI 1.19-1.26) in mild, aRR = 1.41 (95% CI 1.32-1.50) in moderate and aRR = 1.61 (95% CI 1.47-1.76) in severe underweight. These findings were similar in spontaneous PTB, medically indicated PTB, and the gestational age groupings. CONCLUSION Increasing severity of maternal prepregnancy underweight BMI was associated with increasing risk-adjusted PTB at <37 weeks. This increasing risk was of similar magnitude in spontaneous and medically indicated births and in preterm delivery at 28-31 and at 32-36 weeks of gestation. TWEETABLE ABSTRACT Increasing severity of maternal underweight BMI was associated with increasing risk of preterm birth.
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Affiliation(s)
- A I Girsen
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
| | - J A Mayo
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - S L Carmichael
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - C S Phibbs
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Health Economics Resource Center, Veterans Affairs Palo Alto Healthcare System, Menlo Park, CA, USA
| | - B Z Shachar
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - D K Stevenson
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - D J Lyell
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - G M Shaw
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - J B Gould
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Knight AK, Smith AK. Epigenetic Biomarkers of Preterm Birth and Its Risk Factors. Genes (Basel) 2016; 7:E15. [PMID: 27089367 PMCID: PMC4846845 DOI: 10.3390/genes7040015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/28/2016] [Accepted: 04/08/2016] [Indexed: 01/21/2023] Open
Abstract
A biomarker is a biological measure predictive of a normal or pathogenic process or response. Biomarkers are often useful for making clinical decisions and determining treatment course. One area where such biomarkers would be particularly useful is in identifying women at risk for preterm delivery and related pregnancy complications. Neonates born preterm have significant morbidity and mortality, both in the perinatal period and throughout the life course, and identifying women at risk of delivering preterm may allow for targeted interventions to prevent or delay preterm birth (PTB). In addition to identifying those at increased risk for preterm birth, biomarkers may be able to distinguish neonates at particular risk for future complications due to modifiable environmental factors, such as maternal smoking or alcohol use during pregnancy. Currently, there are no such biomarkers available, though candidate gene and epigenome-wide association studies have identified DNA methylation differences associated with PTB, its risk factors and its long-term outcomes. Further biomarker development is crucial to reducing the health burden associated with adverse intrauterine conditions and preterm birth, and the results of recent DNA methylation studies may advance that goal.
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Affiliation(s)
- Anna K Knight
- Genetics and Molecular Biology Program, Emory University, Atlanta, GA 30322, USA.
| | - Alicia K Smith
- Genetics and Molecular Biology Program, Emory University, Atlanta, GA 30322, USA.
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA.
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Dunlop AL, Mulle JG, Ferranti EP, Edwards S, Dunn AB, Corwin EJ. Maternal Microbiome and Pregnancy Outcomes That Impact Infant Health: A Review. Adv Neonatal Care 2015; 15:377-85. [PMID: 26317856 PMCID: PMC4658310 DOI: 10.1097/anc.0000000000000218] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The maternal microbiome is recognized as a key determinant of a range of important maternal and child health outcomes, and together with perinatal factors influences the infant microbiome. This article provides a summary review of research investigating (1) the role of the maternal microbiome in pregnancy outcomes known to adversely influence neonatal and infant health, including preterm birth, cardiometabolic complications of pregnancy such as preeclampsia and gestational diabetes, and excessive gestational weight gain; (2) factors with an established link to adverse pregnancy outcomes that are known to influence the composition of the maternal microbiome; and (3) strategies for promoting a healthy maternal microbiome, recognizing that much more research is needed in this area.
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Affiliation(s)
- Anne L. Dunlop
- Emory University School of Nursing, 1520 Clifton Road NE, Atlanta, GA 30322, 404-712-8520 (phone); 404-727-6945 (fax)
| | - Jennifer G. Mulle
- Rollins School of Public Health & School of Medicine, Department of Human Genetics, Emory University Atlanta, GA 30322
| | - Erin P. Ferranti
- Nell Hodgson Woodruff School of Nursing, Emory University,Atlanta, GA 30322
| | - Sara Edwards
- Nell Hodgson Woodruff School of Nursing, Emory University,Atlanta, GA 30322
| | - Alexis B. Dunn
- Nell Hodgson Woodruff School of Nursing, Emory University,Atlanta, GA 30322
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Yang S, Peng A, Wei S, Wu J, Zhao J, Zhang Y, Wang J, Lu Y, Yu Y, Zhang B. Pre-Pregnancy Body Mass Index, Gestational Weight Gain, and Birth Weight: A Cohort Study in China. PLoS One 2015; 10:e0130101. [PMID: 26115015 PMCID: PMC4482572 DOI: 10.1371/journal.pone.0130101] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 05/15/2015] [Indexed: 12/02/2022] Open
Abstract
Objective To assess whether pre-pregnancy body mass index (BMI) modify the relationship between gestational weight gain (GWG) and child birth weight (specifically, presence or absence of low birth weight (LBW) or presence of absence of macrosomia), and estimates of the relative risk of macrosomia and LBW based on pre-pregnancy BMI were controlled in Wuhan, China. Methods From June 30, 2011 to June 30, 2013. All data was collected and available from the perinatal health care system. Logistic regression models were used to estimate the independent association among pregnancy weight gain, LBW, normal birth weight, and macrosomia within different pre-pregnancy BMI groups. We built different logistic models for the 2009 Institute of Medicine (IOM) Guidelines and Chinese-recommended GWG which was made from this sample. The Chinese-recommended GWG was derived from the quartile values (25th-75th percentiles) of weight gain at the time of delivery in the subjects which comprised our sample. Results For LBW children, using the recommended weight gain of the IOM and Chinese women as a reference, the OR for a pregnancy weight gain below recommendations resulted in a positive relationship for lean and normal weight women, but not for overweight and obese women. For macrosomia, considering the IOM’s recommended weight gain as a reference, the OR magnitude for pregnancy weight gain above recommendations resulted in a positive correlation for all women. The OR for a pregnancy weight gain below recommendations resulted in a negative relationship for normal BMI and lean women, but not for overweight and obese women based on the IOM recommendations, significant based on the recommended pregnancy weight gain for Chinese women. Of normal weight children, 56.6% were above the GWG based on IOM recommendations, but 26.97% of normal weight children were above the GWG based on Chinese recommendations. Conclusions A GWG above IOM recommendations might not be helpful for Chinese women. We need unified criteria to classify adult BMI and to expand the sample size to improve representation and to elucidate the relationship between GWG and related outcomes for developing a Chinese GWG recommendation.
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Affiliation(s)
- Shaoping Yang
- Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, 430015, China
| | - Anna Peng
- Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, 430015, China
| | - Sheng Wei
- Key Laboratory of Environment and Health, Ministry of Education & Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wu
- Key Laboratory of Environment and Health, Ministry of Education & Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinzhu Zhao
- Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, 430015, China
| | - Yiming Zhang
- Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, 430015, China
| | - Jing Wang
- Maternal and Children Health Care Department of Districts of Wuhan, Wuhan, China
| | - Yuan Lu
- Maternal and Children Health Care Department of Districts of Wuhan, Wuhan, China
| | - Yuzhen Yu
- Maternal and Children Health Care Department of Districts of Wuhan, Wuhan, China
| | - Bin Zhang
- Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, 430015, China
- * E-mail:
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van der Ven AJ, van Os MA, Kleinrouweler CE, de Groot CJM, Haak MC, Mol BWJ, Pajkrt E, Kazemier BM. Is cervical length associated with maternal characteristics? Eur J Obstet Gynecol Reprod Biol 2015; 188:12-6. [PMID: 25770842 DOI: 10.1016/j.ejogrb.2015.02.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/24/2014] [Accepted: 02/19/2015] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Women with a mid-trimester short cervical length (CL) are at increased risk for preterm delivery. Consequently, CL measurement is a potential screening tool to identify women at risk for preterm birth. Our objective was to assess possible associations between CL and maternal characteristics. STUDY DESIGN A nationwide screening study was performed in which CL was measured during the standard anomaly scan among low risk women with a singleton pregnancy. Data on maternal height, pre-pregnancy weight, ethnicity, parity and gestational age at the time of the CL measurement were collected from January 2010 to December 2012. Univariable and multivariable linear regression analyses were performed to assess the relationship between CL and maternal characteristics. RESULTS We included 5092 women. The mean CL was 44.3mm. No association was found between CL and maternal height or gestational age of the measurement. Maternal weight was associated with CL (p=0.007, adjusted R(2) 0.03). Separate analysis for BMI did not change these results. Ethnicity, known in 2702 out of 5092 women, was associated with CL (mean CL in Caucasian women 45.0mm, Asian 43.9mm, Mediterranean 43.1mm, and African 41.8mm, p=0.003), as well as parity (mean CL multiparous 45.3mm, nulliparous 43.5mm, p<0.0001). CONCLUSION Shorter mid-trimester cervical length is associated with higher maternal weight, younger maternal age, nulliparity and non-Caucasian ethnicity, but not with maternal height.
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Affiliation(s)
- A J van der Ven
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - M A van Os
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
| | - C E Kleinrouweler
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - C J M de Groot
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
| | - M C Haak
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands.
| | - B W J Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 5000 SA, Australia.
| | - E Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
| | - B M Kazemier
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
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Sharifzadeh F, Kashanian M, Jouhari S, Sheikhansari N. Relationship between pre-pregnancy maternal BMI with spontaneous preterm delivery and birth weight. J OBSTET GYNAECOL 2014; 35:354-7. [PMID: 25383975 DOI: 10.3109/01443615.2014.968101] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of the present study was to find the relationship between pre-pregnancy maternal body mass index (BMI) with spontaneous preterm delivery and birth weight. A prospective cohort study was performed on 576 pregnant women. Maternal BMI was determined at the first prenatal visit between 8-12 weeks' gestation and considered as the pre-pregnancy maternal weight. The women were then monitored up to delivery. Out of 576 women, 396 completed the study. The demographics of the women in all BMI groups did not differ with regard to age, height, history of abortion and employment. A total of 21 women (5.3%) were underweight; 198 women (50%) were normal weight; 117 women (29.5%) were overweight and 60 (15.2%) were obese. There were no cases of morbidly obese (BMI > 40 kg/m(2)) women. Obesity in women had a positive correlation with higher gestational age at the time of delivery (r = 0.213, p = 0.015) and a heavier birth weight (r = 0.361, p = 0.008). Low birth weight had a correlation with low maternal BMI (r = 0.157, p = 0.041). Macrosomia was greater in obese women (p = 0.022) and BMI had a positive correlation with macrosomia (r = 0.224, p = 0.034). Preterm delivery showed a negative correlation with maternal BMI (r = -0.124, p = 0.004) and the women with a lower BMI had a greater number of preterm deliveries (p = 0.035).
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Affiliation(s)
- F Sharifzadeh
- Department of Obstetrics and Gynecology, Akbarabadi Teaching Hospital, Iran University of Medical Sciences , Tehran , Iran
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Premru-Srsen T, Verdenik I, Steblovnik L, Ban-Frangez H. Early prediction of spontaneous twin very preterm birth: a population based study 2002-2012. J Matern Fetal Neonatal Med 2014; 28:1784-9. [PMID: 25245228 DOI: 10.3109/14767058.2014.968774] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to establish early pregnancy risk indicators for spontaneous twin very preterm birth. METHODS We conducted a retrospective observational population-based study. Twenty-one potential early pregnancy risk factors were analyzed using multivariable logistic regression to determine which of them was independently associated with spontaneous twin very preterm birth. RESULTS Of 1815 spontaneous twin births 15.3% (277) occurred before 32 weeks. Previous preterm delivery (aOR 3.73; 95% CI, 2.52-5.52), nulliparity (aOR 2.94; 95% CI, 2.09-4.14), body mass index <18.5 (aOR 1.86; 95% CI, 1.12-3.10), body mass index ≥30 (aOR 1.87; 95% CI, 1.21-2.89), hysteroscopic metroplasty (aOR 1.63; 1.07-2.49), conization (aOR 2.05; 95% CI, 1.07-3.94) and monochorionicity (aOR 1.83; 95% CI, 1.28-2.63) were significantly associated with twin very preterm birth. CONCLUSIONS Pending verification in other populations, twin pregnancies at significant risk for spontaneous very preterm birth can be identified in early pregnancy using several risk indicators.
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Abstract
INTRODUCTION There is increasingly a double burden of under-nutrition and obesity in women of reproductive age. Preconception underweight or overweight, short stature and micronutrient deficiencies all contribute to excess maternal and fetal complications during pregnancy. METHODS A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on maternal, newborn and child health (MNCH) outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. RESULTS Maternal pre-pregnancy weight is a significant factor in the preconception period with underweight contributing to a 32% higher risk of preterm birth, and obesity more than doubling the risk for preeclampsia, gestational diabetes. Overweight women are more likely to undergo a Cesarean delivery, and their newborns have higher chances of being born with a neural tube or congenital heart defect. Among nutrition-specific interventions, preconception folic acid supplementation has the strongest evidence of effect, preventing 69% of recurrent neural tube defects. Multiple micronutrient supplementation shows promise to reduce the rates of congenital anomalies and risk of preeclampsia. Although over 40% of women worldwide are anemic in the preconception period, only one study has shown a risk for low birth weight. CONCLUSION All women, but especially those who become pregnant in adolescence or have closely-spaced pregnancies (inter-pregnancy interval less than six months), require nutritional assessment and appropriate intervention in the preconception period with an emphasis on optimizing maternal body mass index and micronutrient reserves. Increasing coverage of nutrition-specific and nutrition-sensitive strategies (such as food fortification; integration of nutrition initiatives with other maternal and child health interventions; and community based platforms) is necessary among adolescent girls and women of reproductive age. The effectiveness of interventions will need to be simultaneously monitored, and form the basis for the development of improved delivery strategies and new nutritional interventions.
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Affiliation(s)
- Sohni V Dean
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Ayesha M Imam
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
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Abstract
The notion of preconception care aims to target the existing risks before pregnancy, whereby resources may be used to improve reproductive health and optimize knowledge before conceiving. The preconception period provides an opportunity to intervene earlier to optimize the health of potential mothers (and fathers) and to prevent harmful exposures from affecting the developing fetus. These interventions include birth spacing and preventing teenage pregnancy, promotion of contraceptive use, optimization of weight and micronutrient status, prevention and management of infectious diseases, and screening for and managing chronic conditions. Given existing interventions and the need to organize services to optimize delivery of care in a logical and effective manner, interventions are frequently co-packaged or bundled together. This paper highlights packages of preconception interventions that can be combined and co-delivered to women through various delivery channels and provides a logical framework for development of such packages in varying contexts.
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Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Sohni V Dean
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Dania Mallick
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
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Sharashova EE, Anda EE, Grjibovski AM. Early pregnancy body mass index and spontaneous preterm birth in Northwest Russia: a registry-based study. BMC Pregnancy Childbirth 2014; 14:303. [PMID: 25192943 PMCID: PMC4162961 DOI: 10.1186/1471-2393-14-303] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/01/2014] [Indexed: 11/25/2022] Open
Abstract
Background International studies on the association between maternal body mass index (BMI) and spontaneous preterm birth (PTB) yield controversial results warranting large studies from other settings. The aim of this article was to study association between maternal early pregnancy BMI and the risk of spontaneous PTB in Murmansk County (MC), Northwest Russia. Methods This is a registry-based cohort study. All women with singleton pregnancies registered at antenatal clinics during the first 12 weeks of gestation and who delivered in MC between January, 1st 2006 and December, 31st 2011 comprised the study base (n = 29,709). All women were categorized by BMI into four groups: underweight (<18.5 kg/m2), normal (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30.0 kg/m2). Multivariable logistic regression was used to study associations between maternal BMI and PTB (<37 weeks) and very preterm birth (VPTB) (<32 weeks) adjusted for socio-economic factors, biological and lifestyle characteristics. Results The prevalence of underweight, overweight and obesity were 7.1% (95% CI: 6.8-7.4), 18.3% (95% CI: 17.8-18.7) and 7.1% (95% CI: 6.8-7.4), respectively. Altogether, 5.5% (95% CI: 5.3-5.8) of the births were PTB and 0.8% (95% CI: 0.7-0.9) were VPTB. After adjustment, both underweight (OR = 1.25, 95% CI: 1.03-1.50), overweight (OR = 1.10, 95% CI: 0.97-1.26) and obese (OR = 1.31, 95% CI: 1.08-1.57) women were more likely to deliver preterm. VPTB was associated with overweight (OR = 1.47, 95% CI: 1.056-2.03) and obesity (OR = 1.63, 95% CI: 1.02-2.60). Conclusion The findings demonstrate a J-shaped association between first trimester maternal BMI and spontaneous PTB and VPTB with increased risk among underweight, overweight and obese women.
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Affiliation(s)
- Ekaterina E Sharashova
- Department of Community Medicine, UiT The Arctic University of Norway, N-9037 Tromsø, Norway.
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Association of extremes of prepregnancy BMI with the clinical presentations of preterm birth. Am J Obstet Gynecol 2014; 210:428.e1-9. [PMID: 24321446 DOI: 10.1016/j.ajog.2013.12.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/25/2013] [Accepted: 12/05/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to examine associations between the prepregnancy maternal body mass index (BMI) across the 3 clinical presentations of preterm birth (PTB). STUDY DESIGN We conducted a retrospective cohort study of the records of 11,726 women. The World Health Organization International Classification was used to categorize BMI. The primary outcome of the study was PTB (<37 weeks' gestation) presenting as spontaneous preterm labor, preterm premature rupture of the membranes, or a medical indication. We used univariable and multivariable logistic regression analysis to analyze the data (P < .05). RESULTS We found (1) a significant increase in the overall incidence of PTB at the extremes of BMI, (2) a higher risk for PTB from spontaneous preterm labor at the lower extremes (low plus moderate thinness) of BMI (adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.4-4.2; P = .003), (3) a higher risk for preterm premature rupture of the membranes at the upper extremes (obese class II plus III) of BMI (aOR, 1.6; 95% CI, 1.1-2.3; P = .02), and (4) a higher risk for a medically indicated PTB at the lower (aOR, 2.8; 95% CI, 1.4-5.6; P = .004) and upper (aOR, 1.5; 95% CI, 1.1-2.2; P = .02) extreme of BMI. CONCLUSION Women at the extremes of prepregnancy BMI are at risk for PTB.
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Fujiwara K, Aoki S, Kurasawa K, Okuda M, Takahashi T, Hirahara F. Associations of maternal pre-pregnancy underweight with small-for-gestational-age and spontaneous preterm birth, and optimal gestational weight gain in Japanese women. J Obstet Gynaecol Res 2014; 40:988-94. [PMID: 24428432 DOI: 10.1111/jog.12283] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/15/2013] [Indexed: 10/25/2022]
Abstract
AIM To determine associations of maternal pre-pregnancy underweight with poor outcomes and evaluate how gestational weight gain affects risks for such outcomes in pre-pregnancy underweight Japanese women. METHODS By analyzing the January 2001-December 2012 hospital database, we retrospectively identified 6954 women with pre-pregnancy normal weights (body mass index, 18.5-24.9 kg/m²) and 1057 pre-pregnancy underweight women (body mass index, <18.5 kg/m²) who delivered at the Perinatal Maternity and Neonatal Center of Yokohama City University. These women were stratified by weekly weight gain during the second/third trimesters to investigate associations of gestational weight gain with spontaneous preterm birth and small for gestational age (SGA). Spontaneous preterm birth and SGA incidences were compared with those of women meeting Institute of Medicine (IO M) guidelines to determine optimal weight gain in Japanese women. RESULTS Preterm birth and SGA incidences were significantly higher in pre-pregnancy underweight than in pre-pregnancy normal weight women (4.6% vs 2.4% [P=0.005] and 13.9% vs 9.7% [P = 0.003], respectively). For pre-pregnancy normal weight women, preterm birth incidence was significantly higher in those with weight gain of less than 0.2 kg/week than in those IOM guidelines. For pre-pregnancy underweight women, preterm birth and SGA incidences were significantly higher in those with weight gain of less than 0.3 kg/week than in those meeting IOM guidelines. CONCLUSION Preterm birth and SGA incidences did not differ significantly between pre-pregnancy normal weight women with weight gain of 0.2 kg/week or more and pre-pregnancy underweight women with weight gain of 0.3 kg/week or more, as compared to women meeting IOM guidelines. These results suggest that IOM guidelines for gestational weight gain may lack external validity in Japanese women.
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Affiliation(s)
- Kana Fujiwara
- Perinatal Center for Maternity and Neonatal, Yokohama City University Medical Center, Yokohama, Japan
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Kuklina EV, Shilkrut A. Spontaneous preterm labor and cardiovascular disease risk: one step closer to a better understanding. J Womens Health (Larchmt) 2012; 21:619-20. [PMID: 22582721 DOI: 10.1089/jwh.2012.3678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Preterm birth (delivery before 37 completed weeks of gestation) is common and rates are increasing. In the past, medical efforts focused on ameliorating the consequences of prematurity rather than preventing its occurrence. This approach resulted in improved neonatal outcomes, but it remains costly in terms of both the suffering of infants and their families and the economic burden on society. Increased understanding of the pathophysiology of preterm labor has altered the approach to this problem, with increased focus on preventive strategies. Primary prevention is a limited strategy which involves public education, smoking cessation, improved nutritional status and avoidance of late preterm births. Secondary prevention focuses on recurrent preterm birth which is the most recognisable risk factor. Widely accepted strategies include cervical cerclage, progesterone and dedicated clinics. However, more research is needed to explore the role of antibiotics and anti-inflammatory treatments in the prevention of this complex problem.
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Affiliation(s)
- Karen Flood
- Royal College of Surgeons in Ireland, Department of Obstetrics and Gynaecology, Dublin, Ireland
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Kosa JL, Guendelman S, Pearl M, Graham S, Abrams B, Kharrazi M. The association between pre-pregnancy BMI and preterm delivery in a diverse southern California population of working women. Matern Child Health J 2011; 15:772-81. [PMID: 20602159 PMCID: PMC3131509 DOI: 10.1007/s10995-010-0633-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Whereas preterm birth has consistently been associated with low maternal pre-pregnancy weight, the relationship with high pre-pregnancy weight has been inconsistent. We quantified the pre-pregnancy BMI-preterm delivery (PTD) relationship using traditional BMI categories (underweight, normal weight, overweight and obese) as well as continuous BMI. Eligible women participated in California's statewide prenatal screening program, worked during pregnancy, and delivered a live singleton birth in Southern California in 2002-2003. The final analytic sample included 354 cases delivering at <37 weeks, as identified by clinical estimate of gestational age from screening records, and 710 term normal-birthweight controls. Multivariable logistic regression models using categorical BMI levels and continuous BMI were compared. In categorical analyses, PTD was significantly associated with pre-pregnancy underweight only. Nonparametric local regression revealed a V-shaped relationship between continuous BMI and PTD, with minimum risk at the high end of normal, around 24 kg/m2. The odds ratio (OR) for PTD associated with low BMI within the normal range (19 kg/m2) was 2.84 (95% CI = 1.61-5.01); ORs for higher BMI in the overweight (29 kg/m2) and obese (34 kg/m2) ranges were 1.42 (95% CI = 1.10-1.84) and 2.01 (95% CI = 1.20-3.39) respectively, relative to 24 kg/m2). BMI categories obscured the preterm delivery risk associated with low-normal, overweight, and obese BMI. We found that higher BMI up to around 24 kg/m2 is increasingly protective of preterm delivery, beyond which a higher body mass index becomes detrimental. Current NHLBI/WHO BMI categories may be inadequate for identifying women at higher risk for PTD.
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Affiliation(s)
- Jessica Lang Kosa
- Maternal and Child Health Program, School of Public Health, University of California, 207 J University Hall, Berkeley, CA 94720-7360 USA
| | - Sylvia Guendelman
- Maternal and Child Health Program, School of Public Health, University of California, 207 J University Hall, Berkeley, CA 94720-7360 USA
| | | | | | - Barbara Abrams
- Maternal and Child Health Program, School of Public Health, University of California, 207 J University Hall, Berkeley, CA 94720-7360 USA
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Gungor I, Oskay U, Beji NK. Biopsychosocial risk factors for preterm birth and postpartum emotional well-being: a case-control study on Turkish women without chronic illnesses. J Clin Nurs 2011; 20:653-65. [PMID: 21320194 DOI: 10.1111/j.1365-2702.2010.03532.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS AND OBJECTIVES The study aimed to determine bio-psycho-social risk factors for preterm birth in a sample of Turkish women without chronic illnesses and evaluate their anxiety and depression in early postpartum period. BACKGROUND Preterm birth is a devastating event with long-term health and social implications. Studies have identified several risk factors; however, the contribution of these causes differs by ethnic groups. DESIGN This case-control study was conducted in a tertiary hospital in Istanbul over one year. In total, 149 preterm mothers were included in the case group and 150 term mothers who delivered in the same day with a case group woman were included in the control group. Chronic illnesses and anomalies were excluded. METHOD Data were gathered using a form that addressed risk factors for preterm birth. Multidimensional Scale of Perceived Social Support, Beck Depression Inventory and Spielberger's State-Trait Anxiety Inventory were administered within 24-72 hours after birth. RESULTS Logistic regression analysis revealed that partner's lower education (≤ 8 years), history of preterm birth, antenatal hospitalisation, genitourinary infection and irregular prenatal care were significant risk factors. Perceived social support from family and friends were significantly lower in preterm group. Preterm mothers experienced significantly more anxiety and depressive symptoms in early postpartum. CONCLUSION Many of the socio-economical and obstetric causes of preterm births were similar to other countries with higher preterm birth rates. Preterm births were associated with lower social support along with more anxiety and depressive symptoms in early postpartum. RELEVANCE TO CLINICAL PRACTICE Women who have established risk factors can be targeted for more intensive antenatal care for the prevention of preterm birth. Increased maternal anxiety and depression reveal the necessity of emotional support immediately after birth.
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Affiliation(s)
- Ilkay Gungor
- Department of Obstetric and Gynecologic Nursing, Istanbul University Florence Nightingale School of Nursing, Istanbul, Turkey.
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Sebastián Manzanares G, Angel Santalla H, Irene Vico Z, López Criado MS, Alicia Pineda L, José Luis Gallo V. Abnormal maternal body mass index and obstetric and neonatal outcome. J Matern Fetal Neonatal Med 2011; 25:308-12. [PMID: 21615231 DOI: 10.3109/14767058.2011.575905] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study is to examine the effects of abnormal maternal body mass index (BMI), either underweight or severe or morbid obesity (BMI >35), on obstetrical and neonatal outcomes. METHODS A three-year period (2.007-2.009) observational retrospective study was carried out in Granada (Spain). Women were categorized by first ten weeks of pregnancy BMI, according to World Health Organization (WHO) into three groups: underweight (<18.5), normal (20-24.9), and severe or morbid obese (>35). Obstetrical and neonatal outcomes were evaluated using normal group as reference after suitable adjustments for confounding factors. RESULTS 3.016 patients out of 12.781 single births were included. Maternal BMI classified 168 women (5.5 %) as underweight, 2.597 (86.1%) as normal, and 251 (8.3%) as severe or morbidly obese. As compared to normal women, underweight women were younger, and class II or III obese showed higher parity and higher incidence of hypertension disorders and Diabetes Mellitus. After controlling for these confounders, underweight women showed increased adjusted risk of oligohydramnios and low birth weight babies, and severe or morbidly obese women had an increased adjusted risk of Streptococcus Group B colonization, induction of labour, elective and emergency cesarean section, fetal macrosomia, fetal acidosis at birth, and perinatal mortality. CONCLUSIONS Severe or morbid obesity were associated with an increased risk of adverse perinatal outcome and mortality and should be managed as high-risk pregnancies.
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Affiliation(s)
- Galán Sebastián Manzanares
- Department of Obstetrics & Gynecology, Virgen de las Nieves University Hospital , Fuerzas Armadas Av 2, 18014, Granada, Spain.
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Intakes and breast-milk concentrations of essential fatty acids are low among Bangladeshi women with 24–48-month-old children. Br J Nutr 2011; 105:1660-70. [DOI: 10.1017/s0007114510004964] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Maternal fat intake and adipose reserves are major sources of PUFA during lactation. The present study examined the cross-sectional relationship between prolonged breast-feeding and maternal BMI, assessed adequacy of fat intake among lactating and non-lactating mothers of children 24–48 months of age and determined breast-milk fatty acid composition. Multi-stage sampling was used to select a representative sample of mothers from two rural districts in Bangladesh (n474). Dietary data were collected during two non-consecutive 24 h periods via 12 h in-home daytime observations and recall. The National Cancer Institute method for episodically consumed foods was used to estimate usual intake distributions. Breast milk samples were collected from ninety-eight women, and breast-milk fatty acid methyl esters were quantified using GC. Approximately 42 % of lactatingv.26 % of non-lactating mothers were underweight (BMI < 18·5 kg/m2;P = 0·0003). The maternal diet was low in total fat (approximately 8 % of mean total energy) and food sources of PUFA, including oil and animal source foods, resulting in a low estimated mean total consumption of PUFA (5·1 g/d). Almost all women were estimated to consume less than the recommended intake levels for total fat, total PUFA, α-linolenic acid (ALA) and DHA. Median breast-milk linoleic acid (8·5 % weight) and ALA (0·2 %) concentrations were among the lowest reported in the literature, in contrast with arachidonic acid (0·5 %) and DHA (0·3 %) concentrations, which were mid-range. Bangladeshi women in general, and especially those who practise prolonged breast-feeding, may benefit from increased consumption of food sources of PUFA.
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Maternal early pregnancy body mass index and risk of preterm birth. Arch Gynecol Obstet 2010; 284:813-9. [DOI: 10.1007/s00404-010-1740-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 10/18/2010] [Indexed: 10/18/2022]
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Nishida T, Sakakibara H. Association Between Underweight and Low Lymphocyte Count as an Indicator of Malnutrition in Japanese Women. J Womens Health (Larchmt) 2010; 19:1377-83. [DOI: 10.1089/jwh.2009.1857] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Tomoko Nishida
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hisataka Sakakibara
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Mbah AK, Kornosky JL, Kristensen S, August EM, Alio AP, Marty PJ, Belogolovkin V, Bruder K, Salihu HM. Super-obesity and risk for early and late pre-eclampsia. BJOG 2010; 117:997-1004. [PMID: 20482533 DOI: 10.1111/j.1471-0528.2010.02593.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the association between obesity subtypes and risk of early and late pre-eclampsia. DESIGN Population-based retrospective study. SETTING State of Missouri maternally linked birth cohort files. POPULATION All singleton live births in the state of Missouri from 1989 to 2005. METHODS The body mass index (BMI) was used to classify women as normal weight (BMI = 18.5-24.9 kg/m(2)), class I obesity (BMI = 30-34.9 kg/m(2)), class II obesity (BMI = 35-39.9 kg/m(2)), class III obesity (BMI = 40-49.9 kg/m(2)) or super-obesity (BMI > or = 50 kg/m(2)). Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between obesity and the risk of pre-eclampsia were obtained from logistic regression models with adjustment for intracluster correlation. RESULTS The rate of pre-eclampsia increased with increasing BMI, with super-obese women having the highest incidence (13.4%). Compared with normal weight women, obese women (BMI > or = 30 kg/m(2)) had a higher risk for pre-eclampsia (OR = 2.59, 95% CI = 2.87-3.01). This risk remained approximately the same for late-onset pre-eclampsia (pre-eclampsia occurring at 34 weeks or more of gestation) and was slightly reduced for early-onset pre-eclampsia (pre-eclampsia occurring at 34 weeks or less of gestation). Within each BMI category, the risk of pre-eclampsia increased with the rate of weight gain. Compared with normal weight mothers with moderate weight gain, super-obese women with a high rate of weight gain had the greatest risk for pre-eclampsia (OR = 7.52, 95% CI = 2.70-21.0). CONCLUSION BMI and rate of weight gain are synergistic risk factors that amplify the burden of pre-eclampsia among super-obese women.
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Affiliation(s)
- A K Mbah
- Center for Research and Evaluation, The Chiles Center, University of South Florida, 3111 E. Fletcher Avenue, Tampa, FL 33613, USA
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