Maternal body mass index and risk of birth and maternal health outcomes in low- and middle-income countries: a systematic review and meta-analysis

Obstetric and neonatal outcomes of extremely obese pregnant women after late preterm gestation

OBJECTIVE

To determine the obstetric and neonatal outcomes of pregnant women with extreme obesity at birth after late preterm gestation.

METHODS

This was a retrospective study on extremely obese pregnant women with body mass index (BMI) ≥ 40.0 kg/m2 (obesity stage III according to the BMI classification of the World Health Organization) who had delivered at Seoul National University Bundang Hospital between September 2003 and February 2023. Fetal death in utero and preterm births before 34 weeks of gestation were excluded. Obstetric and neonatal outcomes were reviewed.

RESULTS

A total of 94 extremely obese pregnant women were included and the median value of BMI at delivery was 42.4 kg/m2. When analyzed according to the obesity II category of pre-pregnancy BMI, the rate of chronic hypertension was higher in the alleged extreme obese women than those with lower pre-pregnancy BMI (34% vs. 10%, p = 0.012). However, preterm labor with tocolytics was higher in the group with lower BMI than 35.0 kg/m2 (26% vs. 5%, p = 0.007). The proportion of adverse neonatal outcomes such as neonatal intensive care unit admission, the use of respiratory support (including positive pressure ventilation, continuous positive airway pressure, and mechanical ventilator), and jaundice were higher in the group with pre-pregnancy BMI < 35.0 kg/m2 than that with BMI ≥ 35.0 kg/m2 group (all p-value < 0.05). The use of neonatal respiratory support increased as the category of pre-pregnancy BMI was lower and as the degree of weight gain during pregnancy was higher.

CONCLUSIONS

In extremely obese women (stage III) at delivery in late preterm gestation, the obstetric outcomes such as use of tocolytics for preterm labor and adverse neonatal respiratory outcomes seemed to be higher for the women who were not that much obese before pregnancy than those who were already extremely obese. Therefore, weight gain during pregnancy needs to be closely monitored for pregnant women especially when obese.

Impacts of Ramadan fasting during pregnancy on pregnancy and birth outcomes: An umbrella review

BACKGROUND

Despite a large number of primary research studies, and systematic and narrative reviews, there is no consensus on the impact of fasting during Ramadan while pregnant on pregnancy and birth outcomes. Currently, there is no evidence-based guideline for Muslim women regarding Ramadan fasting during pregnancy and clinicians cannot provide firm recommendations.

OBJECTIVES

To review the current evidence regarding the impact of Ramadan fasting during pregnancy on pregnancy and birth outcomes.

SEARCH STRATEGY

We conducted an umbrella review of all systematic and narrative reviews examining the impacts of fasting during Ramadan while pregnant on pregnancy and birth outcomes by searching PubMed, CINAHL, and Cochrane Registry of Systematic Reviews databases between November 2023 and February 2024.

SELECTION CRITERIA

We included all systematic and narrative reviews examining the impacts of Ramadan fasting on pregnancy and birth outcomes. The primary outcome was the change in birth weight, gestational age at birth, fetal growth indices, and Apgar score as well as the risk of delivery by cesarean section and the risks of gestational diabetes and pre-eclampsia.

DATA COLLECTION AND ANALYSIS

We summarized the data using narrative synthesis and descriptive statistics as appropriate. This study was registered with PROSPERO, ID: CRD42023478819.

MAIN RESULTS

Out of 943 published reports identified across all database searches, 13 systematic and narrative reviews were included, of which three were systematic reviews with meta-analysis, six were systematic reviews without meta-analysis, and the remaining four were narrative reviews. There is no sufficient evidence that Ramadan fasting during pregnancy may reduce gestational age at birth or increase the risk of preterm birth (PTB). There is little evidence to support the hypothesis that maternal Ramadan fasting may reduce birth weight or increase the risk of low birth weight (LBW). Systematic reviews showed pooled estimates of odds ratios ranging between 0.93 (95% confidence interval [CI] 0.60-1.44) and 0.99 (95% CI 0.72-1.37) for PTB, and between 1.05 (95% CI 0.87-1.26) and 1.37 (95% CI 0.74-2.53) for LBW. There is no sufficient evidence that Ramadan fasting during pregnancy may increase the risk of delivery by cesarean section, gestational diabetes, or the risk of pre-eclampsia. None of the reviews reported evidence regarding the impacts of fasting during pregnancy on rare but clinically significant pregnancy and birth outcomes such as stillbirth, miscarriage, congenital anomalies, or neonatal deaths.

CONCLUSION

There is little evidence that Ramadan fasting during pregnancy can negatively impact pregnancy and birth outcomes. Primary research studies on this issue suffered from significant methodologic limitations and systematic reviews showed significant heterogeneity for several pregnancy and birth outcomes. High-quality primary research studies that collect data on multiple confounders and effect modifiers are needed to investigate this issue and help reaching evidence-based recommendations.

Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India

OBJECTIVE

To investigate whether induction/augmentation of labor in pregnant women with anemia increases the risk of postpartum hemorrhage (PPH) and whether this risk varied by indications for labor induction/augmentation and by anemia severity in pregnancy.

METHODS

In a prospective cohort study of 9420 pregnant women from 13 hospitals across India, we measured hemoglobin concentrations at recruitment (≥28 weeks of gestation) and blood loss after childbirth during follow-up and collected clinical information about PPH. Clinical obstetric and childbirth information at both visits were extracted from medical records. Anemia severity in the third trimester was categorized using hemoglobin concentrations (no/mild anemia: hemoglobin ≥10 g/dL; moderate: hemoglobin 7 to 9.9 g/dL; severe: hemoglobin <7 g/dL), while PPH was defined based on blood loss volume (vaginal births: ≥500 mL or cesarean sections: ≥1000 mL) and clinical diagnosis. Indications for labor induction/augmentation were classified as clinically indicated and elective as per guidelines. We performed multivariable modified Poisson regression analyses to investigate the associations of anemia severity and indications for labor induction/augmentation, including their interaction, with PPH, adjusted for potential confounders.

RESULTS

PPH was associated with anemia but not with indications for labor induction/augmentation. However, there was a significant interaction between the two factors in relation to PPH (P = 0.003). Among pregnant women with severe anemia, a higher risk of PPH was associated with elective (adjusted risk ratio, 3.44 [95% confidence interval, 1.29-9.18]) but not with clinically indicated (adjusted risk ratio, 1.22 [95% confidence interval, 0.42-3.55]) labor induction/augmentation. No associations were observed among pregnant women with no/mild and moderate anemia.

CONCLUSION

The risk of PPH is higher in women who have moderate-severe anemia in late pregnancy. Induction/augmentation of labor is generally safe for women with anemia, but it can increase the risk of PPH in women with severe anemia if performed electively.

Gestational weight gain and obstetric outcomes in women with obesity in an inner-city population

OBJECTIVES

To describe maternal and perinatal outcomes in patients with BMI ≥30 kg/m2 by BMI class and gestational weight gain.

METHODS

Retrospective review of singleton pregnancies with pre-pregnancy BMI ≥30 kg/m2 who received care at our institution between January 1, 2016 and December 31, 2021. Patients were divided into three categories based on BMI (kg/m2): Class I (BMI 30.0-34.9), Class II (BMI 35-39.9), and Class III (BMI≥40) obesity. For gestational weight gain analysis, pregnancies were stratified into three groups: <11 pounds, 11-20 pounds, and >20 pounds. Maternal demographics and outcomes were compared using chi-square analysis, analysis of variance, nonparametric tests, and multivariable regression analysis.

RESULTS

Of 641 patients included, 299 (46.6 %) were in Class I, 209 (32.6 %) in Class II, and 133 (20.7 %) in Class III. Readmission within 6 weeks postpartum, the only outcome found to have a significant difference between BMI categories, was higher in the Class III group (p=0.01). One hundred sixty-two (25.3 %) patients gained <11 pounds, 164 (25.6 %) gained 11-20 pounds, and 313 (48.8 %) gained ≥20 pounds. Greater gestational weight gain was associated with increased rates of cesarean delivery (p<0.001), higher quantitative blood loss (p=0.006), longer length of hospitalization (p=0.03), and higher birthweights (p<0.001).

CONCLUSIONS

This represents a unique and actionable opportunity for clinicians to counsel and support their patients in adhering to optimal weight gain targets throughout their pregnancy. Future studies are needed to determine the optimal gestational weight gain recommendations for obese patients.

Impact of pre-pregnancy body mass index on preeclampsia

Background

It remains unclear how pre-pregnancy body mass index (BMI) affects preeclampsia in the Chinese population, primarily due to insufficient large-scale research on this topic.

Objective

The study aimed to determine the relationship between pre-pregnancy BMI and (severe) preeclampsia in the Chinese population, providing a detailed description of the findings.

Methods

The retrospective study included a total of 75,773 pregnant women registered between 2016 and 2020. These participants were categorized into four groups based on their pre-pregnancy BMI: underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5-<24 kg/m2), overweight (BMI 24-<28 kg/m2), and obese (BMI ≥ 28 kg/m2). The relationship between risks of preeclampsia or severe preeclampsia and pre-pregnancy BMI were further explored, with an evaluation of potential modification by maternal age.

Results

A lower risk of developing preeclampsia was observed in the underweight population, with an OR of 0.604 (95%CI, 0.507-0.719). In contrast, women who were overweight or obese during the pre-pregnancy period demonstrated a significantly higher risk of preeclampsia, with ORs of 2.211 (95%CI, 1.967-2.486) and 3.662 (95%CI, 3.026-4.431), respectively. After adjusting for confounding factors, the elevated risk of preeclampsia persisted, showing ORs of 2.152(95%CI, 1.911-2.425) for the overweight population and 3.493 (95%CI, 2.874-4.245) for those who were obese, while the risk for underweight women remained lower, with an OR of 0.609(95%CI, 0.511-0.727). For severe preeclampsia, the risk was also higher in the overweight and obese participants after adjusting for confounders, demonstrating ORs of 1.652(95%CI, 1.364-2.001) and 2.762(95%CI, 2.014-3.788), respectively. The underweight population exhibited a lower risk of severe preeclampsia, with an OR of 0.720(95%CI, 0.565-0.919). In addition, these risks were not significantly associated with maternal age.

Conclusion

Regardless of adjustment for confounders, underweight women demonstrated a lower risk of preeclampsia, whereas the overweight/obese population exhibited a higher occurrence of both preeclampsia and severe preeclampsia. These associations were not influenced by maternal age.

Mapping neonatal vulnerability using the Small Vulnerable Newborn (SVN) framework-secondary analysis of PRISMA Pakistan study

Background

Despite progress in global neonatal mortality, South Asia continues to lag behind in reducing neonatal deaths. The Small Vulnerable Newborn (SVN) framework has been proposed to integrate preterm birth (PT), small for gestational age (SGA), and low birth weight. However, there is lack of data on the burden and risk factors of SVN in Pakistan, a country which has one of the highest neonatal deaths globally. This study aimed to estimate the incidence of SVN, and identify risk factors among pregnant women in Pakistan.

Methods

This secondary analysis leverages data from PRISMA (Pregnancy Risk Infant Surveillance, and Measurement Alliance)-Pakistan. Women presenting ≤20 weeks gestation and, with birth weights recorded within 72 h post-delivery were analysed. Newborns were classified into categories of SVN. Multinomial and binomial regression models were used to examine associations between maternal characteristics and SVN categories, as well as neonatal mortality.

Findings

The overall incidence of SVN was 46% (n = 771) with Term + SGA being the most common category (n = 461, 27.5%), followed by PT + AGA (n = 210, 12.5%) and PT + SGA (n = 41, 2.5%). Maternal undernutrition (MUAC <23 cm) increased the risk of SVN by 17% (aRR 1.17, 95% CI 1.05-1.31). SVN also emerged as a significant predictor of neonatal mortality, quadrupling the risk (aRR 4.52, 95% CI 2.42-8.46).

Interpretation

This study adds to the growing body of evidence on Pakistan's alarming burden of SVN, with every second newborn at risk. Identification and targeted interventions are imperative to mitigate adverse birth outcomes and optimize child growth and development.

Funding

No funding was received for this secondary data analysis.

Spatio-temporal distribution and socioeconomic inequality of low birthweight rate in China from 1992 to 2021 and its predictions to 2030

This paper aims to investigate the trend, spatio-temporal distribution, and socioeconomic inequality of the low birthweight rate (LBWR) in China from 1992 to 2021 and to project the LBWR to 2030. We performed a secondary analysis of data from the China Health Statistics Yearbook. LBWR refers to the ratio of the number of infants born with a birth weight less than 2,500 grams to the number of live births in a given year. We used joinpoint regression models to estimate LBWR trends from 1992 to 2021 for the whole country and from 2002 to 2021 for the three regions (eastern, central, and western regions) and each province. The slope index of inequality (SII) and relative index of inequality (RII) were calculated for each year from 2002 to 2021 based on provincial data. LBWR increased from 2.52% (1992) to 3.70% (2021), and the average annual percentage change (AAPC) (95% confidence interval [CI]) was 1.35% (0.22%, 2.49%) in China. The overall LBWR from 2002 to 2021 was greatest in the Eastern region, but LBWR had the fastest increase in the Western region, with an AAPC (95% CI) of 3.15% (2.59%, 3.12%). There were spatio-temporal differences in the LBWR and trends between provinces. The SII and RII increased linearly from -0.15 and 0.94 to 0.53 (B = 0.035%, p < 0.001) and 1.16 (B = 0.011, p < 0.01), respectively, over the past 20 years. The results of the ARIAM model showed that the National LBWR will be increasedfrom 3.70% in 2021 to 5.28% in 2030. The LBWRs in the eastern, central and western regions in 2030 will be 4.93%, 6.02% and 5.82%, respectively. National and local governments must prioritize disadvantaged groups to mitigate the rapid prevalence of LBWR, reduce regional disparities, and improve perinatal and infant health and health equity in China.

Maternal Prepregnancy Body Mass Index and Risk of Preterm Birth: The Role of Weight Gain during Pregnancy, Race, and Ethnicity

OBJECTIVE

 Preterm birth (PTB) is one of the leading causes of infant and neonatal mortality. Prepregnancy body mass index (BMI; kg/m2) has been linked to PTB but the evidence of this association by weight gain during pregnancy, race, and ethnicity is limited. This study aimed to assess the association between maternal prepregnancy BMI and PTB stratified by weight gain during pregnancy, race, and ethnicity.

STUDY DESIGN

 The U.S. natality data from 2017 to 2021 were used. In this analysis, we included mothers who had a live singleton birth and available data for prepregnancy BMI, gestational age at birth, weight gain during pregnancy, race, and ethnicity. Logistic regression models were used to assess the association between prepregnancy BMI categories and PTB stratified by weight gain during pregnancy, race, and ethnicity.

RESULTS

 A total of 17,311,509 singleton live births were included of which 1,393,889 (8.05 %) were PTBs. After adjusting for confounders, compared with normal prepregnancy BMI mothers (18.5-24.9), those with underweight BMI (<18.5) were at increased odds of PTB regardless of weight gain during pregnancy, race, and ethnicity. However, for mothers with a prepregnancy BMI above the normal weight (≥25), the association between prepregnancy BMI and PTB differs by weight gain during pregnancy, race, and ethnicity. Asian mothers with obesity II (35.0-39.9) had 93% (odds ratio [OR] = 1.93, 95% confidence interval [CI]: 1.62-2.30) increased odds of PTB for weight gain during pregnancy of 31 to 40 pounds. Their White, Hispanic, and Black counterparts experienced lower odds of PTB for similar weight gain during pregnancy (White: OR = 1.56, 95% CI: 1.51-1.60; Hispanic: OR = 1.48, 95% CI: 1.41, 1.54; and Black: OR = 1.22, 95% CI: 1.17-1.27).

CONCLUSION

 Mothers with underweight BMI were at increased risk of PTB regardless of weight gain during pregnancy, race, and ethnicity. However, the association between high prepregnancy BMI and PTB varied by weight gain during pregnancy, race, and ethnicity.

KEY POINTS

· The association between prepregnancy BMI categories and PTB had a "J" shape, with lower odds in the normal weight group.. · Low prepregnancy BMI was associated with increased risk of PTB regardless of weight gain during pregnancy, race, and ethnicity.. · The association between high prepregnancy BMI and PTB varies by weight gain during pregnancy, race, and ethnicity..

Association between maternal gestation weight gain and preterm birth according to pre-pregnancy body mass index and HbA1c

BACKGROUND

To investigate the association between gestational weight gain (GWG) and preterm birth (PTB) according to pre-pregnancy body mass index (pp-BMI) and glycated haemoglobin (HbA1c) within the normal range.

METHODS

We conducted a population-based retrospective cohort study between July 2017 and January 2020 at Women's Hospital, Zhejiang University School of Medicine. Women were classified into three groups (inadequate GWG, appropriate GWG, and excessive GWG). In addition, women were divided into different subgroups according to pp-BMI and HbA1c. We estimated the odds ratios (OR) with 95% confidence intervals (CI) to assess the associations between GWG and the risk of PTB. Meanwhile, we adjusted for possible confounding factors, including maternal age, infant sex, family history of diabetes, education, pregnancy mode, delivery mode, parity, and gravidity.

RESULTS

The study involved 23,699 pregnant women, of which 1124 (4.70%) were PTB. Women who had inadequate GWG were found to have a significantly higher risk of PTB compared to women with appropriate GWG. In contrast, women with excessive GWG had a reduced risk of PTB. Similarly, GWG and PTB had similar risk associations in the HbA1c and pp-BMI subgroups. Among women with pp-BMI <18.5 kg/m2, women with inadequate GWG had a significantly increased risk of PTB compared with women in the control group (HbA1c 4.6-5.0%, appropriate GWG), and the risk increased with increasing HbA1c levels. Similar results were observed in women with normal pp-BMI.

CONCLUSIONS

There was a significant association between GWG and the risk of PTB, but the risk varied by pp-BMI and HbA1c levels. Reasonable weight gain during pregnancy is essential to prevent PTB. Furthermore, while HbA1c is within the normal range, the higher levels should be noticed.

Early Growth and Impacts on Long-Term Neurodevelopment and Human Capital

BACKGROUND

Growth trajectories during the first 1,000 days from conception to 2 years influence human capital, predicting intelligence, skills and health in adults.

SUMMARY

This review describes current evidence on the impacts of adverse pregnancy outcomes such as low birth weight, preterm birth, small for gestational age, and infant nutrition on long-term neurodevelopment and summarizes interventions that have proven to be effective in improving child development and further impact human capital. To date, no globally standardized measurements of child development in low-medium-income countries exist, and comparisons among studies using different developmental scales are challenging. In the perinatal period, birth weight, gestational age at delivery and elevated placental blood flow resistance have been identified as the main risk factors for global neurological delay, poor neurosensory development and cerebral palsy. Although these adverse neurological outcomes have decreased in developed settings, it is still a problem in low-resource populations. Nutritional deficiencies are the main drivers of developmental impairment, notably iron, iodine and folate deficiencies, and environmental stressors during pregnancy such as air pollution, exposure to chemicals, substance abuse, smoking, and maternal/parental psychiatric disorders can affect the developing brain. Interventions aiming to improve maternal macro- and micronutrient status, delayed cord clamping, exclusive breastfeeding and nurturing care have demonstrated to be effective strategies to prevent perinatal complications known to affect child development.

Impact of Low Maternal Weight on Pregnancy and Neonatal Outcomes

Objective

To examine the effect of underweight maternal body mass index (BMI) on pregnancy complications and neonatal outcomes.

Design

Cohort study.

Setting

Tertiary academic center.

Patients

A total of 16 361 mothers who delivered a singleton between 2015-2021 with either a BMI <18.5 kg/m2 (n = 732) or normal BMI (18.5 ≥ BMI <23 or 25 kg/m2, n = 15 629) at the initial prenatal visit or within 6 months of the initial visit.

Main Outcome Measures

Birthweight, gestational age, neonatal intensive care unit admission, preterm birth, and fetal death; obstetrical complications including preeclampsia/eclampsia, premature rupture of membranes, preterm premature rupture of membranes, and postpartum hemorrhage.

Results

Underweight women were younger and less likely to have private insurance (P < .01 for both) than normal-weight women. Approximately 23% of infants born to underweight mothers were small for gestational age and 15% were low birth weight vs 13.5% and 9% of infants of normal-weight mothers, respectively (P < .01 for both). These differences remained significant after adjusting for potential confounders. In adjusted logistic regression models, underweight women had a decreased risk of premature rupture of membranes and postpartum hemorrhage compared to normal-weight women.

Conclusion

Underweight BMI during pregnancy is associated with an increased risk of small for gestational age and low birth weight infants and a decreased risk of premature rupture of membranes and postpartum hemorrhage. These findings suggest underweight BMI during pregnancy increases the risk of adverse neonatal outcomes, while maternal-related pregnancy outcomes are less affected.

Implementation of Postpartum Nutritional Interventions in Healthcare, Community and eHealth: A Systematic Review

OBJECTIVES

The efficacy of interventions targeting lifestyle habits, particularly dietary habits, among postpartum women is well established. However, whether these results can be translated into tangible changes in the care and services provided to this population remains unclear. Therefore, the aim is to examine the implementation outcomes of postpartum nutritional interventions delivered in healthcare, community, or eHealth settings.

METHODS

A search was conducted in the MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Library databases in July 2024, to identify all relevant studies. Included studies had to report at least 1 of the 8 implementation outcomes studied: acceptability, adoption, appropriateness, implementation cost, feasibility, fidelity, penetration, and sustainability. Study selection and data extraction were performed by two independent reviewers. Descriptive analysis of reported outcomes was performed.

PROSPERO ID

CRD42022351411.

RESULTS

Of the 8907 unique studies identified, 26 interventions (24 publications) were included.There was a great heterogeneity among interventions studied and implementation outcomes reported. Acceptability, feasibility, and fidelity were the most studied implementation outcomes. Overall, postpartum nutritional interventions were found to be acceptable and useful, but improvements were suggested by participants, such as more frequent contacts and longer programs. Recruitment, retention, participation, and penetration rates widely varied across studies. Challenges hindering the delivery of nutritional interventions were reported by participants, such as lack of time and the presence of medical conditions following delivery. CONCLUSIONS FOR PRACTICE: This review demonstrates the potential for the delivery and implementation of nutritional interventions in real-world settings during the postpartum period.

Associations of Maternal Nutritional Status and Supplementation with Fetal, Newborn, and Infant Outcomes in Low-Income and Middle-Income Settings: An Overview of Reviews

BACKGROUND/OBJECTIVES

Despite advances in maternal nutritional knowledge, the effect of maternal diet, micronutrient status and undernutrition, and the effect of maternal supplementation on fetal, neonatal and infant outcomes still have gaps in the literature. This overview of reviews is intended to assess the available information on these issues and identify the main maternal nutritional factors associated with offspring outcomes in low- and middle-income countries as possible targets for public health interventions.

METHODS

The literature search was performed in Medline (PubMed) and Cochrane Library datasets in June 2024. Pre-specified outcomes in offspring were pooled using standard meta-analytical methods.

RESULTS

We found consistent evidence on the impact of maternal undernutrition indicated by low body mass index (BMI), mid-upper arm circumference (MUAC), and stature, but not of individual micronutrient status, on intrauterine-growth retardation, preterm birth, low birth weight, and small for gestational age, with research showing a possible effect of maternal undernutrition in later child nutritional status. Studies on micronutrient supplementation showed possible beneficial effects of iron, vitamin D, and multiple micronutrients on birthweight and/or decreasing small for gestational age, as well as a possible effect of calcium on preterm birth reduction. Interventions showing more consistent beneficial outcomes were balanced protein-energy and lipid base supplements, which demonstrated improved weight in newborns from supplemented mothers and a decreased risk of adverse neonatal outcomes.

CONCLUSIONS

Further research is needed to identify the benefits and risks of maternal individual micronutrient supplementation on neonatal and further child outcomes.

Effects of Metabolic Syndrome on Pregnancy Outcomes in Women Without Polycystic Ovary Syndrome

Context

Metabolic syndrome (MetS) is a cluster of metabolic risk factors that predict cardiovascular disease. Previous studies suggested that MetS impaired clinical outcomes in women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF).

Objective

To evaluate the effects of MetS on IVF/intracytoplasmic sperm injection (ICSI) outcomes in women without PCOS.

Methods

This retrospective study collected 8539 eligible women without PCOS who came for their first cycle of IVF/ICSI to the Institute of Women, Children and Reproductive Health, Shandong University, from 2017 to 2020, including 1147 subjects in the MetS group and 7392 in the control group. The primary outcome was live birth. Secondary outcomes included other pregnancy outcomes and the risk of maternal and neonatal complications.

Results

Women in the MetS group had a lower live birth rate (50.6% vs 54.9%, adjusted odds ratio [aOR] 0.87, 95% CI 0.75-1.00, P = .045) and higher risks of late miscarriage (5.8% vs 3.3%, aOR 1.52, 95% CI 1.02-2.27, P = .041), gestational diabetes mellitus (13.7% vs 7.0%, aOR 1.84, 95% CI 1.30-2.60, P = .001), hypertensive disorder of pregnancy (7.8% vs 3.5%, aOR 1.79, 95% CI 1.14-2.83, P = .012), and preterm birth (9.0% vs 4.4%, aOR 2.03, 95% CI 1.33-3.08, P = .001). Singleton newborns in the MetS group were at higher risk of large for gestational age (33.3% vs 20.5%, aOR 1.66, 95% CI (1.31-2.13), P < .001) but at lower risk of small for gestational age (2.7% vs 6.2%, aOR 0.48, 95% CI 0.25-0.90, P = .023).

Conclusion

MetS was associated with adverse IVF/ICSI outcomes in women without PCOS.

The Roles of Obesity and ASB4 in Preeclampsia Pathogenesis

Preeclampsia is a complex pregnancy-related hypertensive disorder which poses significant risks for both maternal and fetal health. Preeclampsia affects 5-8% of pregnancies in the United States, causing a significant public health and economic burden. Despite extensive research, the etiology and pathogenesis of preeclampsia remain elusive, but have been correlated with maternal conditions such as obesity. In recent decades, the incidence of preeclampsia increased along with the prevalence of obesity among women of reproductive age. Maternal obesity has been shown to negatively affect pregnancy in almost all aspects. However, the precise mechanisms by which obesity influences preeclampsia are unclear. Ankyrin repeat and SOCS Box Containing protein 4 (ASB4) is an E3 ubiquitin ligase that can promote the degradation of a wide range of target proteins. ASB4-null mice display a full spectrum of preeclampsia-like phenotypes during pregnancy including hypertension, proteinuria, and decreased litter size. Furthermore, maternal obesity induced by a high-fat diet aggravates preeclampsia-like phenotypes in pregnant mice lacking ASB4. Variants in the ASB4 gene have been associated with obesity in humans, and a functional connection between the ASB4 gene and obesity has been established in mice. This review discusses the connections between preeclampsia, obesity, and ASB4.

The association between maternal fruit consumption before and during pregnancy and fetal growth: The Lanzhou birth cohort study

Background

The association between maternal fruit consumption and fetal growth remains inconsistent. The current study aimed to determine whether maternal fruit consumption was associated with low birth weight (LBW) or small for gestational age (SGA) babies.

Methods

A large birth cohort study was conducted in Lanzhou, China, from 2010 to 2012 and included 10,076 pregnant women at the 1st, 2nd, and 3rd trimester of pregnancy for analysis. Fruit consumption in the 1st, 2nd, and 3rd trimester of pregnancy was measured by a self-designed food frequency questionnaire (FFQ) and divided into three groups: 1) inadequate fruit consumption: <200 g/d for the1st, 2nd, and 3rd trimester; 2) adequate fruit consumption: 200-350 g/d for the 1st trimester or 200-400 g/d for the 2nd and 3rd trimester; 3) excessive fruit consumption: >350 g/d for the 1st trimester or > 400 g/d for the 2nd and 3rd trimester. A case-control study was used to analyze the association between fruit intake during pregnancy and low birth weight infants.

Results

Compared to adequate fruit consumption, excessive fruit consumption throughout each trimester of pregnancy was associated with a lower risk of LBW, with an odds ratio (OR) ranging from 0.70 to 0.79 (95 % confidence interval, CI: 0.57-0.98); while inadequate fruit consumption was associated with a higher risk of infant LBW, with an OR ranging from 1.26 to 1.36 (95%CI: 1.04-1.66). After stratifying by mother's pre-pregnancy body mass index (BMI), the results were similar among women with underweight BMI. No significance was found between fruit consumption and SGA in the general population. Still, stratified analyses showed that inadequate fruit consumption was associated with an increased risk of SGA in underweight mothers, with an OR ranging from 1.66 to 1.79 (95%CI: 1.13-2.64).

Conclusions

Fruit consumption during pregnancy reduces the risk of LBW in Chinese women, especially in women with low pre-pregnancy BMI.

Association between Perinatal Outcomes and Maternal Risk Factors: A Cohort Study

Background and Objectives: The aim of this study was to analyze the association between maternal risk factors, such as age, body mass index (BMI), and cigarette smoking, and perinatal outcomes. Materials and Methods: We conducted a retrospective analysis based on prospectively collected data at Hospital Universitario de Torrejón (Madrid, Spain) between September 2017 and December 2019. All pregnant women with singleton pregnancies and non-malformed live fetuses attending their routine ultrasound examination at 11+0 to 13+6 weeks' gestation were invited to participate. The association between preeclampsia, preterm birth, gestational diabetes mellitus (GDM), small-for-gestational-age (SGA) or fetal-growth-restricted (FGR) neonates, and type of delivery and maternal age, BMI, and cigarette smoking was studied. Logistic mixed models were used to analyze the data. Results: A total of 1921 patients were included in the analysis. Women who were ≥40 years old had a significantly higher risk of having GDM (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.08 to 2.36) and SGA neonates (OR 1.54, 95% CI 1.00 to 2.37). Women with a BMI < 18 had an increased rate of giving birth to SGA and FGR neonates (OR 3.28, 95% CI 1.51 to 7.05, and OR 3.73, 95% CI 1.54 to 8.37, respectively), whereas women with a BMI ≥ 35 had a higher risk of GDM (OR 3.10, 95% CI 1.95 to 4.89). Smoking increased the risk of having SGA and FGR neonates (OR 1.83, 95% CI 1.36 to 2.46, and OR 1.91, 95% CI 1.29 to 2.78). Conclusions: Advanced maternal age, low or high BMI, and smoking status are significant risk factors for pregnancy complications. Both clinicians and society should concentrate their efforts on addressing these factors to enhance reproductive health.

Influence of maternal body mass index on pregnancy complications and outcomes: a systematic review and meta-analysis

Background

The prevalence of obesity among women of reproductive age is increasing worldwide, with implications for serious pregnancy complications.

Methods

Following PRISMA guidelines, a systematic search was conducted in both Chinese and English databases up to December 30, 2020. Pregnancy complications and outcomes including gestational diabetes mellitus (GDM), gestational hypertension (GHTN), pre-eclampsia, cesarean section (CS), induction of labor (IOL), and postpartum hemorrhage (PPH) were analyzed. Random-effects or fixed-effects models were utilized to calculate the odds ratio (OR) with 95% confidence intervals (CIs).

Results

Women with overweight and obesity issues exhibited significantly higher risks of GDM (OR, 2.92, 95%CI, 2.18-2.40 and 3.46, 95%CI, 3.05-3.94, respectively) and GHTN (OR, 2.08, 95%CI, 1.72-2.53 and 3.36, 95%CI, 2.81-4.00, respectively) compared to women of normal weight. Pre-eclampsia was also significantly higher in women with overweight or obesity, with ORs of 1.70 (95%CI, 1.44-2.01) and 2.82 (95%CI, 2.66-3.00), respectively. Additionally, mothers with overweight or obesity issues had significantly higher risks of CS (OR, 1.44, 95%CI, 1.41-1.47, and 2.23, 95%CI, 2.08-2.40), IOL (OR, 1.33, 95%CI, 1.30-1.35 and 1.96, 95%CI, 1.85-2.07), and PPH (OR, 1.67, 95%CI, 1.42-1.96 and 1.88, 95%CI, 1.55-2.29).

Conclusion

Women with overweight or obesity issues face increased risks of pregnancy complications and adverse outcomes, indicating dose-dependent effects.

The maternal factors associated with infant low birth weight: an umbrella review

BACKGROUND

In this umbrella review, we systematically evaluated the evidence from meta-analyses and systematic reviews of maternal factors associated with low birth weight.

METHODS

PubMed, Scopus, and Web of Science were searched to identify all relevant published studies up to August 2023. We included all meta-analysis studies (based on cohort, case-control, cross-sectional studies) that examined the association between maternal factors (15 risk factors) and risk of LBW, regardless of publication date. A random-effects meta-analysis was conducted to estimate the summary effect size along with the 95% confidence interval (CI), 95% prediction interval, and heterogeneity (I2) in all meta-analyses. Hedges' g was used as the effect size metric. The effects of small studies and excess significance biases were assessed using funnel plots and the Egger's test, respectively. The methodological quality of the included studies was assessed using the AMSTAR 2 tool.

RESULTS

We included 13 systematic Review with 15 meta-analysis studies in our study based on the inclusion criteria. The following 13 maternal factors were identified as risk factors for low birth weight: crack/cocaine (odds ratio [OR] 2.82, 95% confidence interval [CI] 2.26-3.52), infertility (OR 1.34, 95% CI 1.2-1.48), smoking (OR 2.00, 95% CI 1.76-2.28), periodontal disease (OR 2.41, 95% CI 1.67-3.47), depression (OR 1.84, 95% CI 1.34-2.53), anemia (OR 1.32, 95% CI 1.13-1.55), caffeine/coffee (OR 1.34, 95% CI 1.14-1.57), heavy physical workload (OR 1.87, 95% CI 1.00-3.47), lifting ≥ 11 kg (OR 1.59, 95% CI 1.02-2.48), underweight (OR 1.79, 95% CI 1.20-2.67), alcohol (OR 1.23, 95% CI 1.04-1.46), hypertension (OR 3.90, 95% CI 2.73-5.58), and hypothyroidism (OR 1.40, 95% CI 1.01-1.94). A significant negative association was also reported between antenatal care and low birth weight.

CONCLUSIONS

This umbrella review identified drug use (such as crack/cocaine), infertility, smoking, periodontal disease, depression, caffeine and anemia as risk factors for low birth weight in pregnant women. These findings suggest that pregnant women can reduce the risk of low birth weight by maintaining good oral health, eating a healthy diet, managing stress and mental health, and avoiding smoking and drug use.

How does gestational weight gain influence short- and long-term postpartum weight retention? An updated systematic review and meta-analysis

This systematic review and meta-analysis provide an update of an earlier meta-analysis examining the impact of gestational weight gain (GWG) on postpartum weight retention (PPWR). Thirty-four observational studies were included, and results from 18 studies were combined in meta-analyses. We found that women with excessive GWG retained an additional 2.98 kg (95% CI: 0.59, 5.37 kg, I2  = 91%) at 0.5 years, 1.89 kg (95% CI: 0.90, 2.88 kg, I2  = 61%) at > 0.5-1 year and 2.89 kg (95% CI: 1.74, 4.04 kg, I 2  = 0%) at 2-4 years, compared to women who met the National Academy of Medicine GWG recommendations. Moreover, synthesis of confounder-adjusted regression coefficients showed that each 1 kg increase of GWG corresponded to 0.62 kg (95% CI: 0.22, 1.02 kg, I2  = 96%) additional PPWR at 6-9 months, 0.48 kg (95% CI: 0.14, 0.81 kg, I2  = 93%) at 1-3 years, and 0.31 kg (95% CI: -0.24, 0.86 kg, I2  = 89%) at 5-7 years postpartum. Findings suggest that higher GWG contributes to increased maternal body weight in the short- and long-term after childbirth, independent of prepregnancy body mass index. The heterogeneity of reported data and methodological differences across studies complicate the ability to synthesize data and interpret findings.

Association of maternal nutritional status and small for gestational age neonates in peri-urban communities of Karachi, Pakistan: findings from the PRISMA study

BACKGROUND

Early pregnancy nutritional status can be associated with adverse birth outcomes such as small-for-gestational age (SGA) and low birth weight (LBW). BMI (Body Mass Index) and MUAC (Mid-upper arm circumference) are easy to use assessments and are indicative of the pre-pregnancy nutritional status if obtained in the first trimester. This study primarily assesses the association of maternal nutritional status using BMI and MUAC with SGA in a community-based cohort of Pakistani women. It also aims to determine the predictive ability of MUAC and BMI in predicting SGA. Secondarily, we assessed the association between maternal nutrition and large for gestational age (LGA) and LBW.

METHODS

This study is a secondary analysis of an ongoing pregnancy cohort "Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA)"in Ibrahim Hyderi and Rehri Goth, Karachi. PRISMA participants who were enrolled between January 2021 to August 2022 were included given they had a gestational age < 14 weeks confirmed via ultrasound, MUAC and BMI measurements were available and birth weight was captured within 72 hours. Multivariable logistic regression was used to determine an association between maternal nutritional status and SGA. The PRISMA study was approved by the Aga Khan University Ethics Review Committee (2021-5920-15,518).

RESULTS

Of 926 women included in the analysis, 26.6% (n = 247) had a low MUAC (< 23 cm) while 18.4% (n = 171) were underweight (BMI < 18.5 kg/m2). Nearly one third of low MUAC and underweight women delivered SGA infants (34.4 and 35.1% respectively). Underweight women and women with low MUAC had a statistically significant association with SGA (Underweight: OR 1.49, 95% CI 1.1,2.4; Low MUAC-OR 1.64, 95% CI 1.2,2.3) as well as LBW (Underweight: OR-1.63, 95% CI 1.1,2.4; Low MUAC-OR-1.63, 95% CI 1.2,2.3). ROC curves showed that MUAC and BMI had modest predictability for SGA (AUC < 0.7).

CONCLUSION

Maternal nutritional status as indicated by BMI and MUAC are strongly associated with adverse pregnancy outcomes including SGA, LGA and LBW. Although MUAC and BMI are widely used to determine maternal nutritional status, they have poor predictive ability for newborn size. Further research is needed to identify other tools or a combination of tools to better predict adverse birth outcomes in resource-limited settings and plan interventions.

Periodontitis links to concurrent metabolic disorders and abnormal liver function in pregnant women

OBJECTIVE

This cross-sectional study investigated the association of periodontitis with the metabolic status and hepatic function in pregnant women.

MATERIALS AND METHODS

Full-mouth periodontal conditions, metabolic profiles, and hepatic function were assessed in 219 self-reported healthy pregnant females. The association of periodontal status with the systemic parameters was evaluated by parametric and non-parametric tests, and multivariate logistic regression analysis.

RESULTS

Overall, periodontal status was positively associated with the metabolic profiles and hepatic function test results. The subjects with periodontitis exhibited higher levels of body mass index (BMI) (p < 0.01) and serum aspartate transaminase (AST) (p < 0.05), elevated diastolic blood pressure (DBP) (p < 0.05), and lower levels of high-density lipoprotein cholesterol (p < 0.05) than those of the counterparts. The periodontitis severity was strongly correlated with BMI and AST levels, and the extent of periodontal inflammation was related to DBP (p < 0.01). The periodontitis patients at 34-36 gestational weeks showed higher blood pressure and AST levels than those of non-periodontitis subjects (p < 0.05).

CONCLUSION

Our findings on the notable links of periodontitis to concurrent metabolic disorders and abnormal liver function in pregnant women highlight the need of proactive integration of regular periodontal screening and healthcare in maternal programs for promoting optimal health and wellbeing of mothers-to-be and newborns.

Gestational diabetes mellitus early prediction by maternal body fat index: A cohort study

OBJECTIVES

To compare the performance of maternal body fat index (BFI) assessed during the first 20+6 weeks among 138 pregnant women in an ultrasound outpatient clinic as a predictor of gestational diabetes mellitus (GDM) later in pregnancy.

METHOD

Maternal visceral and subcutaneous fat was measured with a convex ultrasound probe placed in two locations on the maternal abdominal surface: the first in the mid-sagittal epigastric region, visualising epigastric fat, and the second 2cm above the maternal umbilical scar, visualising periumbilical fat. Ultrasound callipers measured the distance from dermal edge to the linea alba and after from the linea alba to the anterior hepatic surface (epigastric fat). Periumbilical fat was measured from the dermal edge to the linea alba and after from the linea alba to the anterior aortic surface. The BFI formula was [visceral adipose tissue (mm)×subcutaneous adipose tissue (mm)]/maternal height (cm).

RESULTS

The best thresholds for predicting GDM outcome for epigastric and periumbilical BFI were 1.2 and 4.8, respectively. Odds ratio, sensitivity and specificity were 5.88 (95% CI 1.86-18.6), 80.9%, 58.0% for the epigastric site and 6.31 (95% CI 1.73-22.94), 84.2%, 54.2% for the periumbilical site. Pre-pregnancy body mass index compatible with adult obesity shows inadequate predictive performance for GDM outcome. Only epigastric BFI above 1.2 maintained statistical significance for GDM in the logistic regression analysis, when compared to periumbilical BFI above 4.8.

CONCLUSION

Epigastric BFI above 1.2 during the first half of pregnancy may help identify women at risk of developing GDM later in pregnancy.

The relationship between incidence of cesarean section and physical activity during pregnancy among pregnant women of diverse age groups: Dose-response meta-analysis

BACKGROUND

There is a lack of evidence related to physical activity and risk of cesarean section (CS) by age and/or weight in pregnant women.

OBJECTIVES

To evaluate the effect of physical activity on the incidence of CS and explore the relationship of age and body mass index (BMI) with incidence of CS.

SEARCH STRATEGY

A systematic search was conducted in CNKI, WANGFANG, Web of Science, and PubMed from inception to 31 August 2021.

SELECTION CRITERIA

Experimental studies were included if the participants were pregnant, if intervention included physical activity and controls received routine prenatal care only, and if primary outcome was CS.

DATA COLLECTION AND ANALYSIS

Meta-analysis included a heterogeneity test, data combination, subgroup analysis, forest plot, sensitivity analysis, and dose-response regression analysis.

MAIN RESULTS

Sixty-two studies were included. Physical activity during pregnancy decreased the incidence of CS (relative risk [RR] 0.81, 95% confidence interval [CI] 0.74-0.88, P < 0.001). The incidence of CS was lower among the overweight/obese group (RR 0.78, 95% CI 0.65-0.93) compared with the normal weight group (RR 0.82, 95% CI 0.74-0.90). The incidence of CS was lowest among the young age group (RR 0.61, 95% CI 0.46-0.80) compared with the middle age group (RR 0.74, 95% CI 0.64-0.85) and the older age group (RR 0.90, 95% CI 0.82-1.00). The critical value, when age becomes a risk factor for CS, was 31.7 years in the intervention group and 28.5 years in the control group.

CONCLUSIONS

Physical activity during pregnancy can reduce the incidence of CS, especially among obese people, and prolong the gestational age span.

Maternal pre-pregnancy body mass index and risk of preterm birth: a collaboration using large routine health datasets

BACKGROUND

Preterm birth (PTB) is a leading cause of child morbidity and mortality. Evidence suggests an increased risk with both maternal underweight and obesity, with some studies suggesting underweight might be a greater factor in spontaneous PTB (SPTB) and that the relationship might vary by parity. Previous studies have largely explored established body mass index (BMI) categories. Our aim was to compare associations of maternal pre-pregnancy BMI with any PTB, SPTB and medically indicated PTB (MPTB) among nulliparous and parous women across populations with differing characteristics, and to identify the optimal BMI with lowest risk for these outcomes.

METHODS

We used three UK datasets, two USA datasets and one each from South Australia, Norway and Denmark, together including just under 29 million pregnancies resulting in a live birth or stillbirth after 24 completed weeks gestation. Fractional polynomial multivariable logistic regression was used to examine the relationship of maternal BMI with any PTB, SPTB and MPTB, among nulliparous and parous women separately. The results were combined using a random effects meta-analysis. The estimated BMI at which risk was lowest was calculated via differentiation and a 95% confidence interval (CI) obtained using bootstrapping.

RESULTS

We found non-linear associations between BMI and all three outcomes, across all datasets. The adjusted risk of any PTB and MPTB was elevated at both low and high BMIs, whereas the risk of SPTB was increased at lower levels of BMI but remained low or increased only slightly with higher BMI. In the meta-analysed data, the lowest risk of any PTB was at a BMI of 22.5 kg/m2 (95% CI 21.5, 23.5) among nulliparous women and 25.9 kg/m2 (95% CI 24.1, 31.7) among multiparous women, with values of 20.4 kg/m2 (20.0, 21.1) and 22.2 kg/m2 (21.1, 24.3), respectively, for MPTB; for SPTB, the risk remained roughly largely constant above a BMI of around 25-30 kg/m2 regardless of parity.

CONCLUSIONS

Consistency of findings across different populations, despite differences between them in terms of the time period covered, the BMI distribution, missing data and control for key confounders, suggests that severe under- and overweight may play a role in PTB risk.

Maternal Dietary Diversity and Small for Gestational Age: The Effect Modification by Pre-Pregnancy Body Mass Index and Gestational Weight Gain in a Prospective Study within Rural Sichuan, China (2021-2022)

Infants born small for gestational age (SGA) remains a significant global public health concern, with potential interconnections among maternal diet, pre-pregnancy BMI, gestational weight gain (GWG), and SGA. This prospective study investigated the association between dietary diversity (DD) during pregnancy and the risk of SGA, as well as the synergistic effect of DD with pre-pregnancy BMI and GWG on SGA. Maternal dietary intake during pregnancy was assessed using 24 h dietary recalls, and dietary diversity scores (DDS) were calculated based on the FAO's Minimum Dietary Diversity for Women index. Infant information was followed up. The Poisson regression model was employed to determine the association between maternal DD and SGA. Interactions between DD and pre-pregnancy BMI or GWG were evaluated under additive and multiplicative models. Among the 560 singleton live births, 62 (11.07%) were classified as SGA. After adjusting for potential confounders, the DDS exhibited a protective effect against SGA (aRR: 0.76; 95% CI: 0.62-0.95). DD modified the association between being underweight prior to pregnancy and SGA on the additive scale (interaction contrast ratio = 7.39; 95% CI: 5.84, 8.94). These findings suggest that improving dietary diversity during pregnancy, particularly among women with a low pre-pregnancy BMI, may be a feasible strategy to reduce the risk of SGA newborns.

Vitamins and minerals, education, and self-care need during preconception to 1000 days of life in Southeast Asia: An expert panel opinion

Addressing maternal malnutrition and its drivers is paramount in Southeast Asia. This article summarizes the key clinical learnings and evidence-based opinions from the experts to understand the need for vitamins and minerals supplementation, education, and self-care from preconception to the first 1000 days of life, which warranted further attention since COVID-19 pandemic. Evidence describing the importance of vitamins and minerals during preconception, pregnancy, and lactation stages was identified using literature databases. A pre-meeting survey was conducted to determine the current practices and challenges in Southeast Asia. Based on the literature review and clinical experience, experts defined the topics, and an online meeting was held on 13th July 2021. During the meeting, nine experts from Southeast Asia provided evidence-based opinion on the vitamins and minerals supplementation, education, and self-care need during preconception, pregnancy, and lactation stages. The expert opinions underpin maternal malnutrition as a prevalent issue and discuss appropriate interventions and prevention strategies for women in Southeast Asia. The recent pandemic further impacted nutrition status, pregnancy, and neonatal health outcomes. The expert panel emphasized a need to improve existing inadequacies in education, self-care, and social support, and discussed the role of policymakers in addressing the barriers to dietary changes. As inadequacies in regular vitamins and minerals supplementation, education, and self-care for women of reproductive age implicate maternal and child health outcomes, there is an urgent need for addressing malnutrition concerns in this population. Thus, a strong partnership between policymakers, healthcare professionals, and other relevant sectors is required.

Association of Pre-Pregnancy Obesity and COVID-19 with Poor Pregnancy Outcome

BACKGROUND AND OBJECTIVES

During the COVID-19 pandemic, a possible overlap of obesity and COVID-19 infection has raised concerns among patients and healthcare professionals about protecting pregnant women from developing a severe infection and unwanted pregnancy outcomes. The aim of this study was to evaluate the associations of body mass index with clinical, laboratory, and radiology diagnostic parameters as well as pregnancy complications and maternal outcomes in pregnant patients with COVID-19.

MATERIALS AND METHODS

Clinical status, laboratory, and radiology diagnostic parameters and pregnancy outcomes were analyzed for pregnant women hospitalized between March 2020 and November 2021 in one tertiary-level university clinic in Belgrade, Serbia, due to infection with SARS-CoV-2. Pregnant women were divided into the three sub-groups according to their pre-pregnancy body mass index. For testing the differences between groups, a two-sided p-value <0.05 (the Kruskal-Wallis and ANOVA tests) was considered statistically significant.

RESULTS

Out of 192 hospitalized pregnant women, obese pregnant women had extended hospitalizations, including ICU duration, and they were more likely to develop multi-organ failure, pulmonary embolism, and drug-resistant nosocomial infection. Higher maternal mortality rates, as well as poor pregnancy outcomes, were also more likely to occur in the obese group of pregnant women. Overweight and obese pregnant women were more likely to develop gestational hypertension, and they had a higher grade of placental maturity.

CONCLUSIONS

Obese pregnant women hospitalized due to COVID-19 infection were more likely to develop severe complications.

ABCB1 expression is increased in human first trimester placenta from pregnant women classified as overweight or obese

Obesity has become a global health challenge also affecting reproductive health. In pregnant women, obesity increases the risk of complications such as preterm birth, macrosomia, gestational diabetes, and preeclampsia. Moreover, obesity is associated with long-term adverse effects for the offspring, including increased risk of cardiovascular and metabolic diseases and neurodevelopmental difficulties. The underlying mechanisms are far from understood, but placental function is essential for pregnancy outcome. Transporter proteins P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP) are important for trans-placental transport of endogenous substances like lipids and cortisol, a key hormone in tissue maturation. They also hold a protective function protecting the fetus from xenobiotics (e.g. pharmaceuticals). Animal studies suggest that maternal nutritional status can affect expression of placental transporters, but little is known about the effect on the human placenta, especially in early pregnancy. Here, we investigated if overweight and obesity in pregnant women altered mRNA expression of ABCB1 encoding P-gp or ABCG2 encoding BCRP in first trimester human placenta. With informed consent, 75 first trimester placental samples were obtained from women voluntarily seeking surgical abortion (< gestational week 12) (approval no.: 20060063). Villous samples (average gestational age 9.35 weeks) were used for qPCR analysis. For a subset (n = 38), additional villi were snap-frozen for protein analysis. Maternal BMI was defined at the time of termination of pregnancy. Compared to women with BMI 18.5-24.9 kg/m² (n = 34), ABCB1 mRNA expression was significantly increased in placenta samples from women classified as overweight (BMI 25-29.9 kg/m², n = 18) (p = 0.040) and women classified as obese (BMI ≥ 30 kg/m², n = 23) (p = 0.003). Albeit P-gp expression did not show statistically significant difference between groups, the effect of increasing BMI was the same in male and female pregnancies. To investigate if the P-gp increase was compensated, we determined the expression of ABCG2 which was unaffected by maternal obesity (p = 0.291). Maternal BMI affects ABCB1 but not ABCG2 mRNA expression in first trimester human placenta. Further studies of early placental function are needed to understand how the expression of placental transport proteins is regulated by maternal factors such as nutritional status and determine the potential consequences for placental-fetal interaction.

Identifying the critical windows and joint effects of temperature and PM2.5 exposure on small for gestational age

The potential critical windows for extreme ambient temperature, air pollution exposure and small for gestational age (SGA) are still unclear, and no study has explored their joint effects on SGA. In a national multi-center prospective cohort, we included 179,761 pairs of mother-infant from 16 counties of 8 provinces in China during 2014-2018. Daily averaged temperature and PM2.5 concentration were matched to the maternal residential address to estimate personal exposure. Extreme temperature exposures were categorized by a series of percentile in each meteorological and geographic division for the entire pregnancy, each trimester and gestational week (GA-week). Generalized linear mixed models (GLMMs) and distributed lag nonlinear models (DLNMs) were used to estimate the whole pregnancy-, trimester-specific, and weekly-specific associations of extreme temperature and PM2.5 exposures with SGA. Combined effects were evaluated with the relative excess risk due to interaction (RERI) and proportion attributable to interaction (AP). We observed that by referring to temperature at the 41st - 50th percentile, heat (>90th percentile) exposure during 13th - 29th GA-weeks was associated with SGA; odds ratio (OR) and 95 % confidence intervals (CI) was 1.16 (1.06, 1.28). For cold (<=10th percentile), inverse associations were observed during the 1st - 8th GA-weeks. PM2.5 exposure during the 2nd - 5th and 19th - 27th GA-weeks was associated with SGA, with the strongest association in the 2nd GA-week (OR = 1.0017, 95 %CI: 1.0001, 1.0034, for a 10 μg/m3 increase). No interactive effects between ambient temperature and PM2.5 on SGA were observed. Our findings suggest the weekly susceptibility windows for heat and PM2.5 exposure were primarily the gestational weeks within the 2nd trimester, therefore, corresponding protective measures should be conveyed to pregnant women during routine prenatal visits to reduce exposures.

Early pregnancy serum levels of folate and vitamin B12 in overweight and obese women in Khartoum, Sudan

BACKGROUND

This study was conducted to assess serum levels of folate and vitamin B12 in overweight and obese pregnant women.

METHODS

A cross-sectional study was conducted at Saad Abualila Hospital, Sudan. Clinical data were collected through questionnaires and body mass index (BMI) was computed from weight and height. The serum folate and vitamin B12 levels were analyzed by immunofluorescence.

RESULTS

Of 300 enrolled women, 44.7% were of normal weight, 32.3% were overweight and 3.0% were obese. The folate level was significantly lower in overweight women (median 4.79 ng/ml [IQR 2.70‒7.70]) than in normal-weight women (median 6.650 ng/ml [IQR 3.30‒10.55]; p=0.022). There was no significant difference in the prevalence of marginal and severe folate deficiencies in women in different BMI groups. Compared with normal-weight women (median 197.5 pg/ml [IQR 150.0‒263.0]), obese women (median 173.0 pg/ml [IQR 150.0‒213.0]; p=0.038) had significantly lower vitamin B12 levels and had a higher prevalence of vitamin B12 insufficiency. Fair negative correlations (p<0.01) were observed between folate and BMI (r = -0.157) and between vitamin B12 and BMI (r = -0.173).

CONCLUSIONS

Overweight and obese pregnant Sudanese women had lower levels of serum folate and vitamin B12.

Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis

OBJECTIVE

This sequential, prospective meta-analysis sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to disease severity, maternal morbidities, neonatal mortality and morbidity, and adverse birth outcomes.

DATA SOURCES

We prospectively invited study investigators to join the sequential, prospective meta-analysis via professional research networks beginning in March 2020.

STUDY ELIGIBILITY CRITERIA

Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area.

METHODS

We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a 2-stage meta-analysis.

RESULTS

We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (preexisting diabetes mellitus, hypertension, cardiovascular disease) vs those without were at higher risk for COVID-19 severity and adverse pregnancy outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% confidence interval, 1.12-2.71) more likely to be admitted to the intensive care unit. Pregnant women who were underweight before pregnancy were at higher risk of intensive care unit admission (relative risk, 5.53; 95% confidence interval, 2.27-13.44), ventilation (relative risk, 9.36; 95% confidence interval, 3.87-22.63), and pregnancy-related death (relative risk, 14.10; 95% confidence interval, 2.83-70.36). Prepregnancy obesity was also a risk factor for severe COVID-19 outcomes including intensive care unit admission (relative risk, 1.81; 95% confidence interval, 1.26-2.60), ventilation (relative risk, 2.05; 95% confidence interval, 1.20-3.51), any critical care (relative risk, 1.89; 95% confidence interval, 1.28-2.77), and pneumonia (relative risk, 1.66; 95% confidence interval, 1.18-2.33). Anemic pregnant women with COVID-19 also had increased risk of intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.25-2.11) and death (relative risk, 2.36; 95% confidence interval, 1.15-4.81).

CONCLUSION

We found that pregnant women with comorbidities including diabetes mellitus, hypertension, and cardiovascular disease were at increased risk for severe COVID-19-related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly known risk factors, including HIV infection, prepregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.

Systematic Review and Critical Evaluation of Quality of Clinical Practice Guidelines on Nutrition in Pregnancy

Objective: To report the quality and clinical heterogeneity of the published clinical practice guidelines (CPGs) on nutrition in pregnancy. Methods: MEDLINE, Embase, Scopus, and ISI Web of Science databases were searched. The following aspects related to nutrition in pregnancy were addressed: specific requirements during pregnancy, description of a balanced diet, weight gain, prevention of food-borne, nutrition in peculiar sub-groups of women, and maternal or perinatal outcomes. The assessment of the risk of bias and quality assessment of the included CPGs were performed using “The Appraisal of Guidelines for REsearch and Evaluation (AGREE II)” tool divided in six quality domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence. Mean ± standard deviation (SD) was used to summarize the scores across all the guidelines per domain. The quality of each guideline was computed using the scoring system proposed by Amer et al. A cut-off of >60% was sued to define a CGP as recommended. Results: Eighteen CPGs were included. There was a substantial heterogeneity in the recommended dose for vitamins, folic acid, and micronutrient intake during pregnancy among the different published CPGs. 27.8% (5/18) of the CPGs recommended a daily intake of folic acid of 200 mcg, 38.8% (7/18) 400 mcg, 16.7% (3/18) 600 mcg while the remaining CPGs suggested dose between 400 and 600−800 mc per day. Adequate maternal hydration was advocated in the large majority of included CPGs, but a specific amount of water intake was not reported in 83.3% (15/18) cases. There was also significant heterogeneity in various other aspects of nutrition recommendation among the different CPGs, including gestational weight gain (55.5%), prevention of food-borne diseases in pregnancy (72.2%), nutrition in particular groups of pregnant women (83.3%), maternal and perinatal outcomes (72.2%). The AGREE II standardized domain scores for the first overall assessment (OA1) had a mean of 65% but only half scored more than 60%. Conclusion: The published CPGs on nutrition in pregnancy show an overall good methodology, but also a substantial heterogeneity as regard as different major aspects on nutrition in pregnancy.

Maternal obesity in pregnancy and children's cardiac function and structure: A systematic review and meta-analysis of evidence from human studies

The prevalence of obesity is increasing worldwide. Experimental animal studies demonstrate that maternal obesity during pregnancy directly affects cardiac structure and function in their offspring, which could contribute to their increased cardiovascular disease (CVD) risk. Currently, a systematic overview of the available evidence regarding maternal obesity and alterations in cardiac structure and function in human offspring is lacking. We systematically searched the electronic databases Embase, MEDLINE and NARCIS from inception to June 29, 2022 including human studies comparing cardiac structure and function from fetal life onwards in offspring of women with and without obesity. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews (identifier: CRD42019125071). Risk of bias was assessed using a modified Newcastle-Ottawa scale. Results were expressed using standardized mean differences (SMD). The search yielded 1589 unique publications, of which thirteen articles were included. Compared to offspring of women without obesity, fetuses of women with obesity had lower left ventricular strain, indicative of reduced systolic function, that persisted in infancy (SMD -2.4, 95% confidence interval (CI) -4.4 standard deviation (SD) to -0.4 SD during fetal life and SMD -1.0, 95% CI -1.6 SD to -0.3 SD in infancy). Furthermore, infants born to women with obesity had a thicker interventricular septum (SMD 0.6 SD, 95% CI 0.0 to 1.2 SD) than children born to women without obesity. In conclusion, cardiac structure and function differs between fetuses and children of women with and without obesity. Some of these differences were present in fetal life, persisted in childhood and are consistent with increased CVD risk. Long-term follow-up research is warranted, as studies in offspring of older age are lacking.

Impact of prepregnancy body mass index on adverse pregnancy outcomes: analysis from the Longitudinal Indian Family hEalth cohort study

BACKGROUND

Both high and low maternal prepregnancy body mass index can lead to suboptimal fetal growth and risk of pregnancy complications. In developed countries, nearly half of all women of childbearing age are either overweight or obese, and most data linking maternal body mass index and adverse pregnancy complications are limited to these populations.

OBJECTIVE

This study aimed to prospectively evaluate the relationships between prepregnancy body mass index and adverse pregnancy outcomes using the Longitudinal Indian Family hEalth (LIFE) study.

STUDY DESIGN

We modeled the relationships between prepregnancy body mass index and adverse pregnancy outcomes such as low birthweight, preterm birth, cesarean delivery, intrauterine growth restriction, miscarriage, and fetal death among 675 women aged 15 to 35 years with singleton pregnancies in the Longitudinal Indian Family hEalth study, a population-based prospective pregnancy cohort study conducted in Telangana, India. Prepregnancy body mass index was calculated as weight in kilograms divided by height in meters squared and was classified into 4 categories using the World Health Organization recommendations for Asian adults. Prepregnancy body mass index was assessed at a mean of 12.3 months before pregnancy. Odds ratios and 95% confidence intervals of adverse pregnancy outcomes were modeled and adjusted for confounders.

RESULTS

Obese women had a 3-fold increased risk of cesarean delivery (odds ratio, 3.13; 95% confidence interval, 1.56-6.29) compared with normal-weight women. Those who were overweight also had a marginally increased risk of cesarean delivery, albeit not statistically significant (odds ratio, 1.17; 95% confidence interval, 0.61-2.24). Underweight women had a modestly increased risk of low birthweight, compared with normal-weight women (odds ratio, 1.12; 95% confidence interval, 0.71-1.77), although results were not significant. Conversely, obese (odds ratio, 0.71; 95% confidence interval, 0.28-1.77) and overweight (odds ratio, 0.61; 95% confidence interval, 0.24-1.51) women had a marginally decreased risk of low birthweight.

CONCLUSION

Our data suggest that women with elevated prepregnancy body mass index may have a higher risk of adverse pregnancy outcomes, especially cesarean delivery. Although this study has limited generalizability, our findings are generalizable to rural to periurban regions of India. Further studies exploring the translatability of these findings to other populations are needed. In addition, targeted prepregnancy intervention studies and programs that include counseling on optimization of preconception health and lifestyle modification for improvement of subsequent pregnancy outcomes among overweight and obese women are needed.

Weight gain trajectories patterns from pregnancy to early postpartum: identifying women at risk and timing to prevent weight regain

BACKGROUND

Woman's weight changes during pregnancy and postpartum contribute to obesity and health outcomes later in life. This study aimed to identify and characterize weight change trajectories from pregnancy to one year postpartum among adult women.

METHODS

We used data from an ongoing cohort of healthy adult women (n = 819) with singleton pregnancies from 2007 - 2011. Sociodemographic data, pre-pregnancy body weight, and sedentary and breastfeeding practices were collected using questionaries applied by trained professionals. We applied a group-based trajectory modeling to distinguish weight change measured in the second and third trimesters of pregnancy and at one month, six, and 12 months postpartum. Multinomial regression models were run to characterize each trajectory.

RESULTS

We identified six weight change trajectories with the main difference in the patterns followed after one month of delivery. One in three women (36.7%) was classified in some of the three postpartum weight gain trajectories and regained weight from the second trimester of the first year postpartum. Women who followed some of these trajectories were more likely to have higher age, obesity before pregnancy, < 10 years of schooling, and partner, compared with women (10.7%, n = 87) in a postpartum sustained-fast-lost-weight trajectory (p < 0.05).

CONCLUSIONS

Women with obesity before pregnancy have higher odds of regaining gestational weight after delivery without reaching their pre-pregnancy weight. The first six months postpartum are crucial to establishing obesity prevention strategies. Further research is needed to evaluate the effect of the interventions that prevent substantial weight gain through reproductive years in high-risk women.

Associations of maternal age at marriage and pregnancy with infant undernutrition: Evidence from first‐time mothers in rural lowland Nepal

Objectives

Maternal factors shape the risk of infant undernutrition, however the contributions of age at marriage versus age at pregnancy are rarely disentangled. We explore these issues in a population from lowland rural Nepal, where median ages at marriage and first pregnancy are 15 and 17 years respectively and marriage almost always precedes pregnancy.

Methods

We analyzed data on first‐time mothers (n = 3002) from a cluster‐randomized trial (2012–2015). Exposures were ages at marriage and pregnancy, categorized into groups. Outcomes were z‐scores for weight (WAZ), length (LAZ), head circumference (HCAZ), and weight‐for‐length (WLZ), and prevalence of wasting and stunting, for neonates (<8 days) and infants (6–12 months). Mixed linear and logistic regression models tested associations of marriage and pregnancy ages with outcomes, adjusting for parental education, household assets, caste, landholding, seasonality, child sex, intervention arm, randomization strata and cluster.

Results

For neonates, pregnancy <18 years predicted lower LAZ, and <19 years predicted lower WAZ and HCAZ. Results were largely null for marriage age, however early pregnancy and marriage at 10–13 years independently predicted neonatal stunting. For infants, earlier pregnancy was associated with lower LAZ and HCAZ, with a trend to lower WAZ for marriage 10–13 years. Early pregnancy, but not early marriage, predicted infant stunting.

Conclusions

Early marriage and pregnancy were associated with poorer growth, mainly in terms of LAZ and HCAZ. Associations were stronger for neonatal than infant outcomes, suggesting pregnancy is more susceptible to these stresses. Early marriage and pregnancy may index different social and biological factors predicting child undernutrition.

The risk factors of preterm birth: A multicentre case-control survey in China in 2018

OBJECTIVES

To investigate the risk profile of preterm birth (PTB) in 2018 in China.

METHOD

A prospective multicentre case-control study was conducted in 15 hospitals located in seven provinces throughout three geographical areas (the Eastern, South-Central and North-Western regions) in China. A total of 3147 preterm (<37⁺⁰ weeks) and 3147 term (37⁺⁰ to 41⁺⁶ weeks) live-birth mothers were included. Designed questionnaires were used to investigate maternal and fetal information. We calculated multivariable logistic regression and population attributable risk (PAR).

RESULTS

Iatrogenic PTB accounted for 48.1% of preterm mothers. Multivariable analysis showed PTB was significantly associated with six categories of maternal and fetal factors, adverse life-style and psychological conditions (adjusted odds ratio (aOR) 2.063, 95% confidence interval (CI) 1.601-2.657) had the highest PAR% (60.1%). High school and below education level (PAR% = 25.8%), living in town or village (PAR% = 24.4%), low pregnant weight gain (PAR% = 16.8%), hypertensive disorders in pregnancy (aOR: 5.010, 95% CI: 4.039-6.216, PAR% = 15.3%), placental abnormality (aOR: 4.242, 95% CI: 3.454-5.211, PAR% = 14.1%) and multiple pregnancy (aOR: 10.990, 95% CI: 7.743-15.599, PAR% = 11.8%) were significantly associated with PTB with high PAR% value.

CONCLUSION

The main risk factors for PTB in China were placental abnormality, hypertensive disorders in pregnancy and multiple pregnancy. Adverse life-style and psychological conditions and socio-economic disadvantage had high public health significance.

Association between Pre-Pregnancy Overweightness/Obesity and Pregnancy Outcomes in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Polycystic ovary syndrome (PCOS) is a common metabolic problem in women of reproductive age. Evidence suggests pregnant women with PCOS may have a higher risk of the development of adverse pregnancy outcomes; however, the relationship between pre-pregnancy overweight/obesity and pregnancy outcomes in women with PCOS remains uncertain. We try to clarify the relationship between pre-pregnancy overweight/obesity and subsequent pregnancy outcomes. Therefore, we conducted this systematic review and meta-analysis. We used the databases obtained from the PubMed, Embase, Web of Science, and Cochrane databases, plus hand-searching, to examine the association between pre-pregnancy overweightness/obesity and pregnancy outcomes in women with PCOS from inception to 4 February 2022. A total of 16 cohort studies, including 14 retrospective cohort studies (n = 10,496) and another two prospective cohort studies (n = 818), contributed to a total of 11,314 women for analysis. The meta-analysis showed significantly increased odds of miscarriage rate in PCOS women whose pre-pregnancy body mass index (BMI) is above overweight (OR 1.71 [95% CI 1.38–2.11]) or obese (OR 2.00 [95% CI 1.38–2.90]) under a random effect model. The tests for subgroup difference indicated the increased risk was consistent, regardless which body mass index cut-off for overweight (24 or 25 kg/m²) or obesity (28 and 30 kg/m²) was used. With the same strategies, we found that pregnant women in the control group significantly increased live birth rate compared with those pregnant women with PCOS as well as pre-pregnancy overweight/obesity (OR 0.79 [95% CI 0.71–0.89], OR 0.78 [95% CI 0.67–0.91]). By contrast, we did not find any association between PCOS women with pre-pregnancy overweight/obesity and preterm birth. Based on the aforementioned findings, the main critical factor contributing to a worse pregnancy outcome may be an early fetal loss in these PCOS women with pre-pregnancy overweight/obesity. Since PCOS women with pre-pregnancy overweightness/obesity were associated with worse pregnancy outcomes, we supposed that weight reduction before attempting pregnancy in the PCOS women with pre-pregnancy overweightness/obesity may improve the subsequent pregnancy outcomes.

Acceptability of 11 fortified balanced energy-protein supplements for pregnant women in Nepal

Evidence suggests that multiple micronutrient and balanced energy protein (BEP) supplementation during pregnancy can decrease the risk of stillbirth and small-for-gestational-age births and increase birth weight. We conducted a mixed-methods formative research study to identify the most acceptable among a range of 11 candidates fortified BEP supplements for use in pregnancy and lactation in a rural district in Nepal. Forty pregnant women aged 15-40 years participated in a test meal tasting of 11 different sweet and savoury candidate BEP supplements. Each participant rated the products on organoleptic properties using a 7-point hedonic scale (1 = Dislike it very much to 7 = Like it very much), ranked her 'top 3' most liked supplements, and subsequently discussed each product with peers in focus group discussions (FGDs). Five supplements (sweet lipid-based nutrient supplement (LNS), savoury LNS, sweet vanilla biscuits, vanilla instant drinks and seasoned pillows) achieved the maximum overall median hedonic score of 7, with sweet LNS and seasoned pillows ranking as the top 2. This was consistent with the assessments in FGDs. Women in the FGDs expressed dislike of the smell and taste of the cocoa drink, savoury masala bar, sweet mango bar and savoury curry biscuit, which was consistent with the hedonic scale scores. This study provides valuable insights into our understanding of women's acceptance of different BEP supplements during pregnancy in rural Nepal and has helped identify the two most accepted BEP supplements to be used in a two-month home trial to assess utilisation and compliance in this setting.

Association of maternal pre-pregnancy body mass index with birth weight and preterm birth among singletons conceived after frozen-thawed embryo transfer

BACKGROUND

To explore the effect of pre-pregnancy body mass index (BMI) on neonatal outcomes among singletons born after frozen embryo transfer (FET).

METHODS

This large retrospective cohort study included 18,683 singleton infants born after FET during the period from Jan 1, 2007 to Dec 31, 2019. The main outcomes were large for gestational age (LGA) and preterm birth. Logistic regression models with generalized estimating equations for clustering by patients to estimate odds ratios of LGA and preterm birth.

RESULTS

Overweight was positively associated with LGA overall (adjusted OR 1.78 [95%CI 1.60-1.98]), and this association was consistent across age categories. The underweight was inversely associated with LGA among mothers younger than 35 years (adjusted OR 0.49 [95%CI 0.39-0.62] among mothers younger than 30 years; adjusted OR 0.47 [95%CI 0.37-0.60] among mothers aged 30-34 years), but this association was no significant among mothers 35 years or older. Overweight was positively and significantly associated with preterm birth overall (adjusted OR 1.52 [95%CI 1.30-1.77]) and consistently across age categories. The underweight mothers younger than 30 years had a decreased risk of preterm birth (adjusted OR 0.70 [95%CI 0.51-0.97]), but the underweight was no significantly associated with preterm birth among women aged 30 years of older.

CONCLUSIONS

The risks of LGA and preterm birth were increased in singletons born to overweight mothers, regardless of the maternal age. Underweight decreased the risk of LGA and preterm birth for younger mothers. These findings are important for providing preconceptional counseling to specifically targeted women at high risk of LGA and preterm birth.

The Edmonton Obesity Staging System and pregnancy outcomes in women with overweight or obesity: A secondary analysis of a randomized controlled trial

The Edmonton Obesity Staging System (EOSS) is a proposed clinical practice tool to determine obesity severity. In a secondary analysis of the Pregnancy Exercise and Research Study (PEARS) (a mobile-health-supported lifestyle intervention among pregnant women with body mass index [BMI] ≥25 kg/m² ), we apply the EOSS and explore relationships with pregnancy outcomes. In early (14-16 weeks) and late (28 weeks) pregnancy, fasting lipids and glucose were measured, blood pressure was extracted from medical records and maternal well-being was assessed using the WHO-5 Well-being Index. Pearson's correlations, chi-square statistics and multiple logistic regression were used to identify relationships. One-way analysis of variance was used to compare groups. Pregnant women (n = 348) were mean (SD) age 32.44 (4.39) years and median (interquartile range) BMI 28.0 (26.57, 29.88) kg/m² . Using metabolic criteria only, 81.9% and 98.9% had raised EOSS scores in early and late pregnancy. From early to late pregnancy, EOSS scores increased by 60.1%. Of these, 10.5% experienced a 2-point increase, moving from stage 0 to stage 2. There was a potential relationship between early EOSS and large for gestational age (χ²  = 6.42, df (2), p = .04), although significance was lost when controlled for confounders (p = .223) and multiple testing. Most women with BMI ≥25 kg/m² had raised EOSS scores, limiting the clinical utility of the tool.

Determinants of excessive gestational weight gain: a systematic review and meta-analysis

Background

The prevalence of excessive gestational weight gain (EGWG) during pregnancy is increasing, and it is extremely harmful to pregnant women and newborns. Previous studies have suggested that EGWG is associated with various factors. We conducted a systematic review and meta-analysis to identify, quantify and analyze determinants of EGWG and evaluate the effect of these determinants on EGWG.

Methods

We searched for articles, from January 2009 to November 2020, related to the determinants of EGWG during pregnancy using four Chinese and four English databases. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was utilized to guide the systematic review and meta-analysis process.

Results

Seventy studies, which identified EGWG factors in pregnant women (58 factors, 3 themes: individual [7 aspects, 37 factors]; family [4 aspects, 8 factors]; and social [4 aspects, 13 factors]), were included and analyzed in the systematic review. A meta-analysis was conducted for 13 factors (including 10 individual factors, 2 family factors, and 1 social factor) and revealed that pre-pregnancy overweight (including obesity), younger age (≤ 30 years old), unemployed, primiparity, smoking, and being unmarried (including divorced) were risk factors for EGWG, while prepregnancy underweight and inadequate antenatal care were protective factors for EGWG. There was no significant correlation between EGWG and education level, alcohol consumption, planning pregnancy, food security, and whether access to nutrition guidance during pregnancy.

Conclusions

EGWG was prevalent in pregnant women, and its prevalence seemed to be high and similar in many countries. Based on observational studies with medium-level and high-level evidence, some individual, family, and social factors were found to be associated with EGWG using qualitative and quantitative methods. In the future, exposure of pregnant women to risk factors for EGWG should be avoided, and interventions should be developed around the identified factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00864-9.

Effect of gestational weight gain on preeclampsia among underweight women: A single tertiary referral center study in Japanese women

AIM

To examine the effect of weight gain during pregnancy on preeclampsia among women with a prepregnancy body mass index < 18.5 kg/m2 .

METHODS

This retrospective cohort study included 479 Japanese women with singleton pregnancies and a prepregnancy body mass index < 18.5 kg/m2 , who gave birth between 2013 and 2019 at Ohta Nishinouchi Hospital. The study included 22 (18 with preeclampsia and four with gestational hypertension) and 457 patients with and without hypertensive disorders of pregnancy, respectively.

RESULTS

The prevalence of hypertensive disorders of pregnancy and preeclampsia was 4.6% and 3.8%, respectively. With weight gain during pregnancy (continuous variable) set as a reference, multiple logistic regression revealed that excessive weight gain during pregnancy increased the risk of preeclampsia (adjusted odds ratio: 1.13, 95% confidence interval: 1.00-1.28, p < 0.05) and hypertensive disorders of pregnancy (adjusted odds ratio: 1.15, 95% confidence interval: 1.03-1.29, p < 0.05). Based on receiver operating characteristic curve analyses (area under the curve 0.65, 95% confidence interval: 0.50-0.80; p < 0.05), we determined the cutoff value of weight gain during pregnancy for the occurrence of preeclampsia among women with body mass index < 18.5 kg/m2 to be 13.0 kg, with sensitivity and specificity of 0.50 and 0.78, respectively.

CONCLUSION

This study indicates that excessive weight gain during pregnancy increases preeclampsia risk among underweight women and provides new recommendations for weight gain during pregnancy for such women. Further research regarding the pathogenesis of preeclampsia for underweight women is warranted.

Factors Predicting Successful Vaginal Delivery Following Induction of Labor in Term Pregnancy

PURPOSE

This study was proposed to evaluate factors predicting a successful vaginal delivery following labor induction and develop induction prediction model in term pregnancy among Thai pregnant women.

PATIENTS AND METHODS

We conducted a retrospective cohort study using electronic medical records of 23,833 deliveries from April 2010 to July 2021 at tertiary care university hospital in Bangkok, Thailand. Univariate regression was performed to identify the association of individual parameters to successful vaginal delivery. Multiple logistic regression analysis of all possible variables from univariate analysis was performed to develop a prediction model with statistically significant of p value <0.05.

RESULTS

Of the total 809 labor-induced pregnancies, the vaginal delivery rate was 56.6%. Among predicting variables, history of previous vaginal delivery (aOR 5.75, 95% CI 3.701-8.961), maternal delivery BMI <25 kg/m² (aOR 2.010, 95% CI 1.303-3.286), estimated fetal weight <3500 g (aOR 2.193, 95% CI 1.246-3.860), and gestational age ≤39 weeks (aOR 1.501, 95% CI 1.038-2.173) significantly increased the probability of a successful vaginal delivery following labor induction. The final prediction model has been internally validated. Model calibration and discrimination were satisfactory with Hosmer-Lemeshow test P = 0.21 and with AUC of 0.756 (95% CI 0.695-0.816).

CONCLUSION

This study determined the pragmatic predictors for successful vaginal delivery following labor induction comprised history of previous vaginal delivery, maternal delivery BMI <25 kg/m², estimated fetal weight <3500 g, and gestational age ≤39 weeks. The final induction prediction model was well-performing internally validated prediction model to estimate individual probability when undergoing induction of labor. Despite restricted population, the predicting factors and model could be useful for further prospective study and clinical practice to improve induction outcomes.

Preconception exposures and adverse pregnancy, birth and postpartum outcomes: Umbrella review of systematic reviews

BACKGROUND

Preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, the reports, statements and guidelines of national and international health organisations vary in what they recommend individuals should monitor, avoid, reduce or practise in the preconception period.

OBJECTIVES

To synthesise and evaluate the evidence across systematic reviews for associations between exposures before conception and adverse pregnancy, birth and postpartum outcomes.

DATA SOURCES

MEDLINE, Embase, Epistemonikos (to May 2020) and reference lists of included reviews, without language or date restrictions.

STUDY SELECTION, DATA EXTRACTION AND SYNTHESIS

Systematic literature reviews of observational and/or interventional studies reporting associations between preconception exposures in women and/or men of reproductive age and pregnancy, birth or postpartum health outcomes were included. The methodological quality of reviews and the certainty of the evidence underlying each exposure-outcome association were assessed using AMSTAR 2 and the GRADE approach.

RESULTS

We identified 53 eligible reviews reporting 205 unique exposure-outcome associations. Methodological quality was generally low with only two reviews rated as 'high' quality and two as 'moderate'. We found high-certainty, randomised trial evidence that maternal folate supplementation reduces the risk of neural tube defects and anomaly-related terminations. Moderate-certainty, observational evidence was found that maternal physical activity is associated with reduced risk of pre-eclampsia and gestational diabetes, and that paternal age of ≥40 years and maternal body mass index (BMI) and interpregnancy weight gain are associated with increased risk of various adverse pregnancy and birth outcomes. Low- and very low-certainty evidence was found for other associations.

CONCLUSIONS

Clinicians and policymakers can be confident that maternal folate supplementation should be encouraged during the preconception period. There is moderate certainty in the evidence base that maternal physical activity, BMI and interpregnancy weight gain and advanced paternal age are important preconception considerations. High-quality research is required to better understand other exposure-outcome associations.

Independent effect of gestational weight gain and prepregnancy obesity on pregnancy outcomes among Saudi women: A sub-cohort analysis from Riyadh mother and baby cohort study (RAHMA)

Background

Gestational weight gain (GWG) and prepregnancy obesity are garnering more attention as determining factors of pregnancy outcomes when it comes to the wellbeing of both the mother and her baby. This study was conducted to describe the pattern of GWG among participants of Riyadh Mother and Baby Multicenter Cohort Study (RAHMA) and to investigate the detrimental effects of excessive GWG and prepregnancy obesity on pregnancy outcomes.

Methods

RAHMA is a multicentre cohort study conducted in three hospitals in Riyadh, Saudi Arabia. Participants were categorized according to the Institute of Medicine into inadequate, adequate, and excessive GWG, and stratified by body mass index (BMI) into under/normal weight, overweight, and obese. To examine the independent effect of maternal prepregnancy obesity and GWG, a multivariate regression model was used and adjusted odds ratio (AOR) and 95% Confidence Interval (CI) for each outcome were calculated.

Results

A total of 7029 participants were included in this study; 31.8% had adequate GWG, 25.9% had excessive GWG and 42.3% had inadequate GWG, while 29.7% had normal BMI, 33.3% were overweight, 34.8% were obese, and 2.2% were underweight. Excessive GWG was independently associated with increased risk of hypertensive events, (AOR = 1.77, 95% CI 1.20–2.63). Obesity was associated with higher risk of gestational diabetes (AOR 2.11, 95% CI 1.76–2.53), hypertensive events (AOR 2.06, 95% CI 1.48–3.01), and delivery by emergency caesarean section (AOR = 1.63, 95% CI 1.35–1.97). Infants of obese women had increased odds of macrosomia (AOR 3.11, 95% CI 1.94–4.99) and lower odds of low birth weight (AOR = 0.68, 95% CI 0.53–0.88).

Conclusion

In comparison to excessive GWG, which increases the risk of hypertensive events during pregnancy, prepregnancy obesity is associated with more adverse outcomes including GDM, hypertensive events in pregnancy and emergency CS.

Maternal Pre-pregnancy Body Mass Index Categories and Infant Birth Outcomes: A Population-Based Study of 9 Million Mother–Infant Pairs

Background and Aims

Infant adverse birth outcomes have been suggested to contribute to neonatal morbidity and mortality and may cause long-term health consequences. Although evidence suggests maternal prepregnancy body mass index (BMI) categories associate with some birth outcomes, there is no consensus on these associations. We aimed to examine the associations of maternal prepregnancy BMI categories with a wide range of adverse birth outcomes.

Methods

Data were from a population-based retrospective cohort study of 9,282,486 eligible mother–infant pairs in the U.S. between 2016 and 2018. Maternal prepregnancy BMI was classified as: underweight (<18.5 kg/m²); normal weight (18.5–24.9 kg/m²); overweight (25.0–29.9 kg/m²); obesity grade 1 (30–34.9 kg/m²); obesity grade 2 (35.0–39.9 kg/m²); and obesity grade 3 (≥40 kg/m²). A total of six birth outcomes of the newborn included preterm birth, low birthweight, macrosomia, small for gestational age (SGA), large for gestational age (LGA), and low Apgar score (5-min score <7).

Results

Maternal prepregnancy overweight and obesity increased the likelihood of infant preterm birth, with odds ratios (ORs) (95% CIs) of 1.04 (1.04–1.05) for overweight, 1.18 (1.17–1.19) for obesity grade 1, 1.31 (1.29–1.32) for obesity grade 2, and 1.47 (1.45–1.48) for obesity grade 3, and also for prepregnancy underweight (OR = 1.32, 95% CI = 1.30–1.34) after adjusting for all potential covariates. Prepregnancy overweight and obesity were associated with higher odds of macrosomia, with ORs (95% CIs) of 1.53 (1.52–1.54) for overweight, 1.92 (1.90–1.93) for obesity grade 1, 2.33 (2.31–2.35) for obesity grade 2, and 2.87 (2.84–2.90) for obesity grade 3. Prepregnancy overweight and obesity was associated with higher odds of LGA, with ORs (95% CIs) of 1.58 (1.57–1.59) for overweight, 2.05 (2.03–2.06) for obesity grade 1, 2.54 (2.52–2.56) for obesity grade 2, and 3.17 (3.14–3.21) for obesity grade 3. Prepregnancy overweight and obesity were also associated with higher odds of low Apgar score, with ORs (95% CIs) of 1.12 (1.11–1.14) for overweight, 1.21 (1.19–1.23) for obesity grade 1, 1.34 (1.31–1.36) for obesity grade 2, and 1.55 (1.51–1.58) for obesity grade 3.

Conclusion

Our findings suggest maintaining or obtaining a healthy body weight for prepregnancy women could substantially reduce the likelihood of important infant adverse birth outcomes.

Associations Between Gestational Weight Gain and Adverse Birth Outcomes: A Population-Based Retrospective Cohort Study of 9 Million Mother-Infant Pairs

Background

Gestational weight gain (GWG) reflects maternal nutrition during pregnancy. However, the associations between maternal GWG and adverse birth outcomes are inconclusive.

Objective

We aimed to examine the associations between maternal GWG and adverse birth outcomes according to maternal pre-pregnancy body mass index (BMI) categories in a large, multiethnic and diverse population in the U.S.

Study Design

We used nationwide birth certificate data from the National Vital Statistics System to examine the association of GWG (below, within and above the Institute of Medicine [IOM] guidelines) with six adverse birth outcomes (preterm birth, low birthweight, macrosomia, small for gestational age [SGA], large for gestational age [LGA], and low Apgar score) according to the pre-pregnancy BMI categories (underweight to obesity grade 3). Multivariable logistic regression analyses were performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 9,191,842 women aged 18–49 years at delivery with live singleton births were included. Among them, 24.5% of women had GWG below IOM guidelines, 27.6% within the guidelines, and 47.9% above the guidelines. Compared with maternal GWG within guidelines, GWG below guidelines was associated with higher odds of preterm birth (OR = 1.52, 95%CI = 1.51–1.53), low birthweight (OR = 1.46, 95%CI = 1.45–1.47) and SGA (OR = 1.44, 95%CI = 1.43–1.45). In contrast, maternal GWG above guidelines was associated with higher odds of macrosomia (OR = 2.12, 95%CI = 2.11–2.14) and LGA (OR = 2.12, 95%CI = 2.11–2.14). In addition, maternal GWG below or above guidelines had slightly higher odds of low Apgar score (below guidelines: OR = 1.04, 95%CI = 1.03–1.06, above guidelines: OR = 1.17, 95%CI = 1.15–1.18). The results were largely similar among women with GWG below or above guidelines across pre-pregnancy BMI categories of underweight, overweight, and obesity grade 1 to grade 3.

Conclusion

Pregnant women with GWG below or above the IOM guidelines have increased odds of selected adverse infant birth outcomes. Monitoring maternal GWG could enable physicians to provide tailored nutrition and exercise advice as well as prenatal care to pregnant women to reduce the likelihood of adverse birth outcomes.