Body Mass Index Change Between Pregnancies and Small for Gestational Age Births

Clinical risk factors for vasculo-placental disorders: results from a prospective case-control study nested in HEMOTHEPP French cohort study

OBJECTIVE

Determine clinical risk factors for vasculo-placental disorders in singleton pregnancies.

DESIGN

Prospective case-control study nested in HEMOTHEPP French cohort.

SETTING

Women delivered between June, 2015 and January, 2019 in any maternity ward of Finistère.

POPULATION

Cases were women with vasculo-placental disorders (pre-eclampsia, intrauterine growth restriction (IUGR), placental abruption or stillbirth). Controls were women matched for age at delivery and parity.

METHODS

Clinical data were collected by obstetricians or midwives during antenatal care visits and delivery, and recorded by trained research assistants.

MAIN OUTCOME MEASURES

Occurrence of a vasculo-placental disorder.

RESULTS

505 women with vasculo-placental disorder (299 pre-eclampsia, 253 IUGR, 44 placental abruptions, 11 stillbirths) and 1515 matched controls were selected out of 20,075 participants. In multivariable analysis, four clinical parameters were associated with pre-eclampsia: obesity (Odd ratio (OR) = 3.11, 95%CI 2.11-4.58), French overseas origin (OR = 4.41, 95%CI 1.87-10.42), previous vasculo-placental disorder (OR = 5.14, 95%CI 2.72-9.70), aspirin during pregnancy (OR = 10.10, 95%CI 1.99-51.08). Three clinical parameters were associated with IUGR: auto-immune/inflammatory disorder (OR = 3.75, 95%CI 1.83-7.68), previous vasculo-placental disorder (OR = 3.63, 95%CI 2.06-6.41), smoking during pregnancy (OR = 2.66, 95%CI 1.91- 3.71). A previous venous thromboembolism (VTE) was associated with IUGR in univariable but not in multivariable analysis (OR = 3.72, 95%CI 0.82-17.00, p = 0.09).

CONCLUSIONS

Clinical risk factors differ between IUGR and pre-eclampsia, the later, but not the former, being associated with cardiovascular risk factors.

Does prepregnancy weight change have an effect on subsequent pregnancy health outcomes? A systematic review and meta-analysis

International guidelines recommend women with an overweight or obese body mass index (BMI) aim to reduce their body weight prior to conception to minimize the risk of adverse perinatal outcomes. Recent systematic reviews have demonstrated that interpregnancy weight gain increases women's risk of developing adverse pregnancy outcomes in their subsequent pregnancy. Interpregnancy weight change studies exclude nulliparous women. This systematic review and meta-analysis was conducted following MOOSE guidelines and summarizes the evidence of the impact of preconception and interpregnancy weight change on perinatal outcomes for women regardless of parity. Sixty one studies met the inclusion criteria for this review and reported 34 different outcomes. We identified a significantly increased risk of gestational diabetes (OR 1.88, 95% CI 1.66, 2.14, I²  = 87.8%), hypertensive disorders (OR 1.46 95% CI 1.12, 1.91, I²  = 94.9%), preeclampsia (OR 1.92 95% CI 1.55, 2.37, I²  = 93.6%), and large-for-gestational-age (OR 1.36, 95% CI 1.25, 1.49, I²  = 92.2%) with preconception and interpregnancy weight gain. Interpregnancy weight loss only was significantly associated with increased risk for small-for-gestational-age (OR 1.29 95% CI 1.11, 1.50, I²  = 89.9%) and preterm birth (OR 1.06 95% CI 1.00, 1.13, I²  = 22.4%). Our findings illustrate the need for effective preconception and interpregnancy weight management support to improve pregnancy outcomes in subsequent pregnancies.

Maternal weight change between successive pregnancies: an opportunity for lifecourse obesity prevention

Maternal obesity is a major risk factor for adverse health outcomes for both the mother and the child, including the serious public health problem of childhood obesity which is globally on the rise. Given the relatively intensive contact with health/care professionals following birth, the interpregnancy period provides a golden opportunity to focus on preconception and family health, and to introduce interventions that support mothers to achieve or maintain a healthy weight in preparation for their next pregnancy. In this review, we summarise the evidence on the association between interpregnancy weight gain with birth and obesity outcomes in the offspring. Gaining weight between pregnancies is associated with an increased risk of large-for-gestational age (LGA) birth, a predictor of childhood obesity, and weight loss between pregnancies in women with overweight or obesity seems protective against recurrent LGA. Interpregnancy weight loss seems to be negatively associated with birthweight. There is some suggestion that interpregnancy weight change may be associated with preterm birth, but the mechanisms are unclear and the direction depends if it is spontaneous or indicated. There is limited evidence on the direct positive link between maternal interpregnancy weight gain with gestational diabetes, pre-eclampsia, gestational hypertension and obesity or overweight in childhood, with no studies using adult offspring adiposity outcomes. Improving preconception health and optimising weight before pregnancy could contribute to tackling the rise in childhood obesity. Research testing the feasibility, acceptability and effectiveness of interventions to optimise maternal weight and health during this period is needed, particularly in high-risk and disadvantaged groups.

The impact of interpregnancy weight change on perinatal outcomes in women and their children: A systematic review and meta-analysis

Prepregnancy overweight and obesity are associated with higher risk of perinatal complications. However, the effect of weight change prior to pregnancy on perinatal outcome is largely unknown. Therefore, it is aimed to examine the impact on perinatal outcomes of interpregnancy BMI change in women of different BMI categories. The MEDLINE, EMBASE, LILACS, and CINAHL databases were searched (1990-August 2019). Observational studies on interpregnancy BMI change were selected. Outcomes evaluated were gestational diabetes mellitus (GDM), preeclampsia, gestational hypertension (GH), cesarean section, preterm birth, and newborns being large (LGA) or small (SGA) for gestational age. Meta-analyses and meta-regression analyses were executed. Thirty studies were included (n > 1 million). Interpregnancy BMI gain was associated with a higher risk of GDM (for BMI gain ≥3 kg/m² : OR 2.21; [95%CI 1.53-3.19]), preeclampsia (1.77 [1.53-2.04]), GH (1.78 [1.61-1.97]), cesarean section (1.32 [1.24-1.39]), and LGA (1.54 [1.28-1.86]). The effects of BMI gain were most pronounced in women with BMI <25 kg/m² before the first pregnancy regarding GDM, GH, and cesarean section. Except for LGA, interpregnancy BMI loss did not result in a decreased risk of perinatal complications. In this study, women of normal weight who gain weight before pregnancy were identified as a high-risk population for perinatal complications. This emphasizes that weight management is important for women of all BMI categories and a pregnancy wish.

Effect of interpregnancy weight change on perinatal outcomes: systematic review and meta-analysis

Background

Although obesity is a well-known risk factor for adverse pregnancy outcomes, evidence is sparse about the effects of interpregnancy weight change on the risk of adverse perinatal complications in a subsequent pregnancy. The current study aims to assess the effect of interpregnancy weight change on the risk of developing gestational diabetes, pre-eclampsia, pregnancy induced hypertension, preterm birth, or delivering a large- or small-for-gestational age neonate.

Methods

Pubmed, Ovid Embase, ClinicalTrial.gov and the Cochrane library were systematically searched up until July 24th, 2019. Interpregnancy weight change was defined as the difference between pre-pregnancy weight of an index pregnancy and a consecutive pregnancy. Inclusion criteria included full text original articles reporting quantitative data about interpregnancy weight change in multiparous women with any time interval between consecutive births and the risk of any perinatal complication of interest. Studies reporting adjusted odds ratios and a reference group of − 1 to + 1 BMI unit change between pregnancies were harmonised by meta-analysis.

Results

Twenty-three cohort studies identified a total of 671,906 women with two or more consecutive pregnancies. Seven of these studies were included in the meta-analysis (280,672 women). Interpregnancy weight gain was consistently associated with a higher risk of gestational diabetes, pre-eclampsia, pregnancy induced hypertension and large-for-gestational age births. In contrast, interpregnancy weight loss was associated with a lower risk of delivering a large-for-gestational age neonate. The effect magnitude (relative risk) of interpregnancy weight gain on pregnancy induced hypertension or delivering a large-for-gestational age neonate was greater among women with a normal BMI in the index pregnancy compared to women with a starting BMI ≥25 kg/m².

Conclusion

These findings confirm that interpregnancy weight change impacts the risk of developing perinatal complications in a subsequent pregnancy. This provides evidence in support of guidelines encouraging women to achieve post-partum weight loss, as their risk of perinatal complications might be minimised if they return to their pre-pregnancy weight before conceiving again.

Prospectively registered with PROSPERO (CRD42017067326).

Interpregnancy weight change and perinatal outcomes: A protocol for a systematic review and meta-analysis

BACKGROUND

Growing evidence suggests that interpregnancy weight change (IPWC) is a risk factor for perinatal outcomes, since it may increase the probability of gestational complications including gestational diabetes or cesarean delivery. Additionally, IPWC may affect neonatal outcomes increasing the prevalence of newborns small for gestational age or preterm birth. However, the association between IPWC and perinatal outcomes has not systematically synthesized thus far. This study protocol aims to provide a clear, transparent and standardized procedure for systematically reviewing the association between IPWC and perinatal outcomes.

METHODS AND ANALYSIS

This systematic review and meta-analyses protocol is based on the preferred reporting items for systematic review and meta-analysis protocols and the Cochrane Collaboration Handbook. MEDLINE, EMBASE, the Cochrane Library, and Web of Science will be systematically searched from their inception. No limits will be defined by study design, as such different tools to assess risk of bias will be used:Odd ratios and their corresponding 95% confidence intervals will be reported to evaluate associations between IPWC and perinatal outcomes.

RESULTS

The results of this study will be published in a peer-reviewed journal.

CONCLUSION

This systematic review and meta-analysis will systematically synthesize the evidence regarding the association between IPWC and perinatal outcomes. Data will be extracted from published articles and findings will be published in peer-reviewed journals. Ethical approval and informed consent will not be required due to the nature of the study.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018100449.

Interpregnancy Body Mass Index Changes: Distribution and Impact on Adverse Pregnancy Outcomes in the Subsequent Pregnancy

OBJECTIVE

To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes.

STUDY DESIGN

We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category.

RESULTS

In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1-32.7; p = 0.003).

CONCLUSION

Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM.

Interpregnancy weight change and adverse pregnancy outcomes: a systematic review and meta-analysis

OBJECTIVES

To evaluate the effect of interpregnancy body mass index (BMI) change on pregnancy outcomes, including large-for-gestational-age babies (LGA), small-for-gestational-age babies (SGA), macrosomia, gestational diabetes mellitus (GDM) and caesarean section (CS).

DESIGN

Systematic review and meta-analysis of observational cohort studies.

DATA SOURCES

Literature searches were performed across Cochrane, MEDLINE, EMBASE, CINAHL, Global Health and MIDIRS databases.

STUDY SELECTION

Observational cohort studies with participants parity from 0 to 1.

MAIN OUTCOME MEASURES

Adjusted ORs (aORs) with 95% CIs were used to evaluate the association between interpregnancy BMI change on five outcomes.

RESULTS

925 065 women with singleton births from parity 0 to 1 were included in the meta-analysis of 11 studies selected from 924 identified studies. A substantial increase in interpregnancy BMI (>3 BMI units) was associated with an increased risk of LGA (aOR 1.85, 95% CI 1.71 to 2.00, p<0.001), GDM (aOR 2.28, 95% CI 1.97 to 2.63, p<0.001), macrosomia (aOR 1.54, 95% CI 0.939 to 2.505) and CS (aOR 1.72, 95% CI 1.32 to 2.24, p<0.001) compared with the reference category, and a decreased risk of SGA (aOR 0.83, 95% CI 0.70 to 0.99, p=0.044). An interpregnancy BMI decrease was associated with a decreased risk of LGA births (aOR 0.70, 95% CI 0.55 to 0.90, p<0.001) and GDM (aOR 0.80, 95% CI 0.62 to 1.03), and an increased risk of SGA (aOR 1.31, 95% CI 1.06 to 1.63, p=0.014). Women with a normal BMI (<25kg/m2) at first pregnancy who have a substantial increase in BMI between pregnancies had a higher risk of LGA (aOR 2.10, 95% CI 1.93 to 2.29) and GDM (aOR 3.10, 95% CI 2.74 to 3.50) when compared with a reference than women with a BMI ≥25 kg/m2 at first pregnancy.

CONCLUSIONS

Gaining weight between pregnancies increases risk of developing GDM, CS and LGA, and reduces risk of SGA in the subsequent pregnancy. Losing weight between pregnancies reduces risk of GDM and LGA and increases risk of SGA. Weight stability between first and second pregnancy is advised in order to reduce risk of adverse outcomes.

TRIAL REGISTRATION NUMBER

CRD42016041299.

Predicting fetal growth deviation in parous women: combining the birth weight of the previous pregnancy and third trimester ultrasound scan

AIM

To investigate the value of the birth weight of the previous pregnancy (BW1) alone and combined with the third trimester ultrasonographically estimated fetal weight (EFW) and Doppler studies in the prediction of small (SGA) and large for gestational age (LGA) neonates in the index pregnancy (BW2).

METHOD

Some 1298 parous women with uncomplicated singleton pregnancies who had a third trimester ultrasound scan were considered as samples in this retrospective cohort study. Maternal and pregnancy characteristics, BW1, EFW, umbilical artery, and middle cerebral artery pulsatility indices were investigated as predictors of SGA and LGA.

RESULTS

BW1, maternal weight, mode of conception, and smoking status were associated with BW2 (R2=0.39) with BW1 being the strongest predictor (R2=0.37). The addition of EFW conferred significant improvement (R2=0.63), whereas the addition of the Doppler indices did not. The sensitivity of BW1 alone in the prediction of SGA was 75% for 25% screen positive rate and increased to 92% with the addition of EFW. The equivalent figures for LGA were 68% and 93%, respectively.

CONCLUSIONS

BW1 used as a continuous variable is predictive of growth deviations in the index pregnancy. Incorporating EFW enhanced the sensitivity for the detection of both conditions.

Differential levels of amino acid transporters System L and ASCT2, and the mTOR protein in placenta of preeclampsia and IUGR

Background

Sufficient amino acid transport activity (AAT) is indispensable for appropriate fetal growth. Studies suggest that placental nutrient uptake activity is responsive to both maternal and fetal nutrient demands. We hypothesize that under conditions of limited nutrient availability to the fetus, as often present in preeclampsia, intrauterine growth restriction (IUGR), and insufficient weight-gain during pregnancy, a general adaptive response aimed to increase amino acid transport activity may be observed in the placenta.

Method

A total of 40 placentas from full-term (n = 10) and pre-term (average gestational period = 34.8 weeks, n = 10) normal pregnancies, IUGR (n = 10), and preeclampsia (n = 10) associated pregnancies were looked at by immunohistochemistry followed by relative qualitative scoring to compare expression levels and localization of System L, ASCT2, and mTOR proteins.

Result

Microvillous syncytiotrophoblast (ST) in placenta of pregnancies complicated by IUGR or preeclampsia (PE) showed significant increases in the levels of System L amino acid transport proteins 4F2hc and LAT1 compared to both full-term control and pre-term (early gestation control) pregnancies seperately (p < 0.05). Elevated mTOR protein was uniquely higher in IUGR placentas compared to full-term controls (P = 0.0026). Total cellular ASCT2 transporter protein levels were similar in all groups, however, levels of ASCT2 protein localized to the ST microvillous membrane (MVM) were significantly lower in IUGR compared to both full-term and pre-term pregnancies (P = 0.0006, 0.03, respectively). Additionally, ASCT2 and mTOR protein levels were positively associated with maternal pre-pregnancy BMI (P = 0.046, 0.048, respectively).

Conclusion

There are three important findings based upon the present study. First, in conditions of limited nutrient availability, such as PE or IUGR, there is an overall increase in the level of System L and mTOR protein expression in the ST, suggestive of an adaptive response. Second, a decrease in ASCT2 protein at the ST MVM suggests a post-translational event that may decrease AAT activity in IUGR placentas. Third, a physiological link between transporter expression and pre-pregnancy BMI is suggested based upon a positive association observed with ASCT2 and mTOR expression values.

Maternal pre-pregnancy underweight and fetal growth in relation to institute of medicine recommendations for gestational weight gain

PURPOSE

Maternal nutritional status is one of the most important factors of fetal growth and development. Consequently, the currently increasing prevalence of underweight women worldwide has come in the focus of interest of perinatal medicine. The aim of the study was to assess the effect of low pre-pregnancy body mass index (BMI) on fetal growth.

MATERIALS AND METHODS

Data on 4678 pregnant women and their neonates were retrospectively analyzed. Pre-pregnancy BMI of study women was categorized according to the WHO standards. Fetal growth was assessed by birth weight and birth length, birth weight for gestational age, and ponderal index.

RESULTS

Study group included 351 (7.6%) women with pregestational BMI<18.5kg/m(2), while all women with pregestational BMI 18.5-25kg/m(2) (n=3688; 78.8%) served as a control group. The mean birth weight and birth length of neonates born to underweight mothers were by 167g and 0.8cm lower in comparison with the neonates born to mothers of normal nutritional status, respectively (P<0.001 both). The prevalence of small for gestational age (SGA) births was twofold that found in the control group of mothers of normal nutritional status (9.7% vs. 4.9%; P<0.001). The inappropriately low gestational weight gain additionally increased the rate of SGA infants in the group of mothers with low pre-pregnancy BMI (21.4% vs. 10.4%; P=0.02). Pre-pregnancy BMI category did not influence neonatal growth symmetry.

CONCLUSION

Low maternal pregestational BMI is associated with fetal growth assessment. Improvement of the maternal nutritional status before pregnancy can increase the likelihood of perinatal outcome.

Relationship between interpregnancy interval and birth defects in Washington State

OBJECTIVE

Interpregnancy interval (IPI) influences numerous adverse perinatal outcomes. IPI's impact on birth defects is unclear.

STUDY DESIGN

We conducted a population-based case-control study, using 1998 to 2008 administrative data from Washington State. A total of 10, 772 cases, women whose second of two births resulted in an infant with a birth defect, were compared with 32 ,310 controls, women whose second of two births did not result in an infant with a birth defect.

RESULT

Compared with mothers with an IPI between 18 to 23 months, those with an IPI <6 months or ≥60 months had elevated risks of delivering an infant with a birth defect (odds ratio=1.15, 95% confidence interval: 1.03 to 1.28, and odds ratio=1.15, 95% confidence interval: 1.04 to 1.26, respectively).

CONCLUSION

We observed a J-shaped relationship between IPI and risk of having an infant with a birth defect. As this is one of the first studies to evaluate this association, confirmatory studies are needed.

Immigrants' duration of residence and adverse birth outcomes: a population-based study

OBJECTIVE

This study aimed to examine preterm and small-for-gestational-age (SGA) births among immigrants, by duration of residence, and to compare them with the Canadian-born population.

DESIGN

Population-based cross-sectional study with retrospective assessment of immigration.

SETTING

Metropolitan areas of Ontario, Canada.

POPULATION

A total of 83 233 singleton newborns born to immigrant mothers and 314 237 newborns born to non-immigrant mothers.

METHODS

We linked a database of immigrants acquiring permanent residence in Ontario, Canada, in the period 1985-2000 with mother-infant hospital records (2002-2007). Duration of residence was measured as completed years from arrival to Canada to delivery/birth. Logistic regression models were used to estimate the effects of duration of residence with adjusted odds ratios and 95% confidence intervals. In analyses restricted to immigrants only, hierarchical models were used to account for the clustering of births into maternal countries of birth.

MAIN OUTCOME MEASURES

Preterm birth (PTB) and SGA birth.

RESULTS

Recent immigrants (<5 years) had a lower risk of PTB (4.7%) than non-immigrants (6.2%), but those with > or =15 years of stay were at higher risk (7.4%). Among immigrants, a 5-year increase in Canadian residence was associated with an increase in PTB (AOR 1.14, 95% CI 1.10-1.19), but not in SGA birth (AOR 0.99, 95% CI 0.96-1.02).

CONCLUSIONS

Time since migration was associated with increases in the risk of PTB, but was not associated with an increase in SGA births. Ignoring duration of residence may mask important disparities in preterm delivery between immigrants and non-immigrants, and between immigrant subgroups categorised by their duration of residence.

Pre-pregnancy overweight status between successive pregnancies and pregnancy outcomes

OBJECTIVE

The two objectives of this study were to (1) examine factors associated with changes in pre-pregnancy overweight to pre-pregnancy normal/underweight or obese Body Mass Index (BMI) in the subsequent pregnancy, and (2) assess select pregnancy and newborn outcomes associated with changes in pre-pregnancy BMI.

METHODS

Birth certificates from 1995-2004 for residents of Kansas City, Missouri, were used to identify overweight nulliparous women who had a singleton birth and subsequently a second singleton birth. Maternal factors associated with changes in BMI between pregnancies were determined. Hypertension in pregnancy, preterm birth, emergency cesarean section, small-for-gestational age, and large-for-gestational age outcomes were examined.

RESULTS

At second pregnancy, 55% of the women remained overweight, 33% were obese, and 12% had normal/underweight BMIs. The upward shift in BMI was associated with being unmarried and having a birth interval of 18 or more months, while the downward shift was associated with gestational weight gain. Of the five outcomes variables, only emergency cesarean section was significantly associated with an upward shift in BMI.

CONCLUSIONS

Clinical interventions for pre-pregnancy overweight women should focus on appropriate weight gain during pregnancy and motivators for loss of pregnancy-related weight during the postpartum period.

Pre-pregnancy body mass index change between pregnancies and preterm birth in the following pregnancy

Maternal pre-pregnancy body mass index (BMI) may affect the risk of preterm birth. However, it is unclear how changes in BMI between pregnancies modify the risk of preterm birth in the following pregnancy. We studied this effect in the Collaborative Perinatal Project, when obesity was uncommon and the prevalence of induction of labour was low. This analysis included 1892 primiparae whose first enrolled (index) pregnancy was a singleton livebirth and the second enrolled (outcome) pregnancy was a consecutive singleton pregnancy (both pregnancies within 20-51 weeks of gestation). We used the Cox regression model to calculate the hazard ratio (HR) of preterm birth at the outcome pregnancy as a function of reduced BMI (<25(th) percentile of change) and increased BMI (>75(th) percentile), compared with stable BMI (25(th)-75(th) percentile), adjusted for pre-pregnancy BMI at the index pregnancy and other covariates. Body mass index reduction was associated with a non-significant increased risk of preterm birth, adjusted HR 1.17 [95% confidence interval 0.90, 1.53]; BMI increase had effects close to null (adjusted HR 1.08 [0.83, 1.41]). In the model with linear BMI change, each 1 kg/m(2) increase was associated with an HR of 0.96 [0.89, 1.03]. The estimates associated with a BMI reduction were higher in women whose index pregnancy ended preterm (HR 1.49 [0.90, 2.44]) and in those with BMI < 25 kg/m(2) at the index pregnancy (HR 1.30 [0.98, 1.71]). This study involved mainly low-to-normal weight women with spontaneous deliveries, and might suffer from type II error owing to small sample size. The effect of BMI change in overweight and obese women needs to be studied using contemporary data.

The effect of body mass index value during labor on pregnancy outcomes in Turkish population (obesity and pregnancy outcomes)

PURPOSE

We investigated the relation between body mass index (BMI) value during labor and pregnancy outcomes in a group of Turkish population.

METHODS

The data on 9,112 singleton pregnancies were reviewed retrospectively. Patients were classified into three groups according to their BMI values: normal (BMI 20-25 kg/m(2), n = 5,685, 62.4%), overweight (BMI 20-25 kg/m(2), n = 2,214, 24.3%) and obese (BMI >30 kg/m(2), n = 1,213, 33.3%).

RESULTS

Gestational diabetes mellitus (P = 0.000), risk of delivering a baby >90th percentile (P = 0.000) and preeclampsia (P = 0.000) were increased in parallel with increased BMI. A statically significant difference was observed between the normal and obese groups in terms of the abdominal cesarean rates (P = 0.020). However, a significant difference was not observed in terms of preterm delivery (P = 0.846), birthweight <10th percentile (P = 0.484), placenta previa (P = 0.880), ablatio placenta (P = 0.499) and intrauterine death (P = 0.175) between the groups.

CONCLUSIONS

Regardless of the gestation, BMI is a factor that affects the fetal and maternal outcomes. The obese and overweight women should be followed up carefully during the labor and delivery.

Fetal growth restriction and subsequent pregnancy risks

Fetal growth restriction can result from a variety of intrinsic or extrinsic insults, resulting from maternal, fetal, and placental factors. Determining the underlying cause of poor fetal growth can be difficult but is essential for assessing potential risks for future pregnancies. Importantly, recurrence risks greatly depend on these underlying conditions. Understanding these risks can allow more appropriate patient counseling and may influence management strategies to optimize future pregnancies.

Maternal obesity and complications during pregnancy

Obesity has become a major health problem all over the world and during pregnancy is associated with an increased risk of complications, including gestational diabetes, preeclampsia, and delivery complications such as macrosomia, shoulder dystocia and higher rates of cesarean sections and infections. Maternal obesity may also be an independent risk factor for neural tube defects and fetal mortality. This review focuses on the consequences of maternal obesity during pregnancy.