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Huang Z, Tan X, Wang J, Zhang A. Maternal pre-pregnancy body mass index and gestational weight gain on adverse birth outcomes in Chinese newborns: a retrospective study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:165. [PMID: 39438934 PMCID: PMC11515635 DOI: 10.1186/s41043-024-00652-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 10/04/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND Maternal and child health is an important measure of national well-being. This study further explored the individual and combined effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on adverse birth weight-related outcomes. METHODS A retrospective study was carried out at a maternal and child health hospital from 2018 to 2021, and a total of 17,506 eligible women were invited to participate. The associations of pre-pregnancy BMI and GWG with adverse birth outcomes were examined by using restricted cubic spline regression and binary logistic regression. RESULTS Pre-pregnancy BMI and GWG had non-linear associations with low birth weight and macrosomia. They were associated with an increased risk of macrosomia (Pre-pregnancy BMI for OR = 1.170, 95%CI:1.144 to 1.197, P < 0.001, and GWG for OR = 1.071, 95%CI:1.054 to 1.089, P < 0.001) and large for gestational age infant (LGA) (Pre-pregnancy BMI for OR = 1.125, 95%CI:1.111 to 1.141, P < 0.001, and GWG for OR = 1.045, 95%CI:1.036 to 1.054, P < 0.001). The high risk of low birth weight and preterm birth was observed among the group of women with inadequate GWG. The risks of macrosomia and LGA increased with pre-pregnancy BMI from low weight to overweight and obesity, and GWG from inadequate to overabundance, while small for gestational age infant was more prevalent in the low pre-pregnancy BMI group. CONCLUSIONS Pre-pregnancy BMI and GWG exhibited non-linear associations with low birth weight and macrosomia. The various combinations of pre-pregnancy BMI and GWG had different effects on adverse birth weight-related outcomes.
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Affiliation(s)
- Zhi Huang
- School of Public Health and Laboratory, Hunan University of Medicine, Jinxi Road No.492, Huaihua, 418000, China
| | - Xia Tan
- Department of Child Healthcare, Changsha City Maternal and Child Health Care Hospital, Chengnan East Road No.416, Yuhua District, Changsha, 410007, China
| | - Jinlian Wang
- Department of Child Healthcare, Changsha City Maternal and Child Health Care Hospital, Chengnan East Road No.416, Yuhua District, Changsha, 410007, China
| | - Aiping Zhang
- Department of Child Healthcare, Changsha City Maternal and Child Health Care Hospital, Chengnan East Road No.416, Yuhua District, Changsha, 410007, China.
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Er YT, Chan YM, Mohd Shariff Z, Abdul Hamid H, Mat Daud Z'A, Yong HY. Dietitian-led cluster randomised controlled trial on the effectiveness of mHealth education on health outcomes among pregnant women: a protocol paper. BMJ Open 2023; 13:e075937. [PMID: 37989361 PMCID: PMC10660825 DOI: 10.1136/bmjopen-2023-075937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Nutrition education is the cornerstone to maintain optimal pregnancy outcomes including gestational weight gain (GWG). Nevertheless, default for appointments is common and often lead to suboptimal achievement of GWG, accompanied with unfavourable maternal and child health outcomes. While mobile health (mHealth) usage is increasing and helps minimising barriers to clinic appointments among pregnant mothers, its effectiveness on health outcomes has been inconclusive. Therefore, this study aimed to address the gap between current knowledge and clinical care, by exploring the effectiveness of mHealth on GWG as the primary outcome, hoping to serve as a fundamental work to achieve optimal health outcomes with the improvement of secondary outcomes such as physical activity, psychosocial well-being, dietary intake, quality of life and sleep quality among pregnant mothers. METHODS AND ANALYSIS A total of 294 eligible participants will be recruited and allocated into 3 groups comprising of mHealth intervention alone, mHealth intervention integrated with personal medical nutrition therapy and a control group. Pretested structured questionnaires are used to obtain the respondents' personal information, anthropometry data, prenatal knowledge, physical activity, psychosocial well-being, dietary intake, quality of life, sleep quality and GWG. There will be at least three time points of data collection, with all participants recruited during their first or second trimester will be followed up prospectively (after 3 months or/and after 6 months) until delivery. Generalised linear mixed models will be used to compare the mean changes of outcome measures over the entire study period between the three groups. ETHICS AND DISSEMINATION Ethical approvals were obtained from the ethics committee of human subjects research of Universiti Putra Malaysia (JKEUPM-2022-072) and medical research & ethics committee, Ministry of Health Malaysia: NMRR ID-22-00622-EPU(IIR). The results will be disseminated through journals and conferences targeting stakeholders involved in nutrition research. TRIAL REGISTRATION NUMBER Clinicaltrial.gov ID: NCT05377151.
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Affiliation(s)
- Ying Ting Er
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Yoke Mun Chan
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Research Centre of Excellence Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Zalilah Mohd Shariff
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Habibah Abdul Hamid
- Department of Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Zulfitri 'Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Research Centre of Excellence Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Heng Yaw Yong
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Wilayah Persekutuan, Malaysia
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Coelho S, Canha M, Leite AR, Neves JS, Oliveira AI, Carvalho D. Relation between weight gain during pregnancy and postpartum reclassification in gestational diabetes. Endocrine 2023; 82:296-302. [PMID: 37668927 DOI: 10.1007/s12020-023-03441-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/22/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Gestational diabetes mellitus (GDM) is the most common metabolic disease in pregnancy. It is known that GDM is a precursor to type 2 diabetes (T2D). There is evidence that excessive gestational weight variation (GWV) increases the risk of GDM. So, in this study, we aimed to evaluate the association between GWV and the persistence of diabetes in postpartum reclassification. METHODS A retrospective observational study including pregnant women based on data from the Portuguese National Registry of Gestational Diabetes. Six-to-eight weeks after delivery, all women included underwent a reclassification test. We performed unadjusted and adjusted logistic regression models to evaluate the associations between GWV and diabetes diagnosis at the reclassification test. A subgroup analysis according to the pre-gestational BMI was also performed. RESULTS We included 10,389 pregnant women, of which 19.6% had GDM in a previous pregnancy. The median of GWV was 10.0 [6.4, 14.0] kg and was found to be higher for those with a normal BMI. At the DM reclassification test, 1% of the women were diagnosed with T2D. We found a negative association between GWV and postpartum diabetes mellitus (DM). We also present a subgroup analysis, and these associations were only significant for the group with a normal pre-gestational BMI. CONCLUSION Our results showed that women with normal pre-gestational BMI and lower GWV were more likely to have a diagnosis of DM in the postpartum reclassification test. This study helps to fill the gap in the effect of GWG on the persistence of diabetes in postpartum reclassification.
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Affiliation(s)
- Sofia Coelho
- Department of Biomedicins, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - Marta Canha
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Ana Rita Leite
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | | | - Davide Carvalho
- Instituto de Investigação e Inovação em Saúde (i3s), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
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Perumal N, Wang D, Darling AM, Liu E, Wang M, Ahmed T, Christian P, Dewey KG, Kac G, Kennedy SH, Subramoney V, Briggs B, Fawzi WW. Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis. BMJ 2023; 382:e072249. [PMID: 37734757 PMCID: PMC10512803 DOI: 10.1136/bmj-2022-072249] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries. DESIGN Individual participant data meta-analysis. SETTING Prospective pregnancy studies from 24 low and middle income countries. MAIN OUTCOME MEASURES Nine neonatal outcomes related to timing (preterm birth) and anthropometry (weight, length, and head circumference) at birth, stillbirths, and neonatal death. ANALYSIS METHODS A systematic search was conducted in PubMed, Embase, and Web of Science which identified 53 prospective pregnancy studies published after the year 2000 with data on GWG, timing and anthropometry at birth, and neonatal mortality. GWG adequacy was defined as the ratio of the observed maternal weight gain over the recommended weight gain based on the Institute of Medicine body mass index specific guidelines, which are derived from data in high income settings, and the INTERGROWTH-21st GWG standards. Study specific estimates, adjusted for confounders, were generated and then pooled using random effects meta-analysis models. Maternal age and body mass index before pregnancy were examined as potential modifiers of the associations between GWG adequacy and neonatal outcomes. RESULTS Overall, 55% of participants had severely inadequate (<70%) or moderately inadequate (70% to <90%) GWG, 22% had adequate GWG (90-125%), and 23% had excessive GWG (≥125%). Severely inadequate GWG was associated with a higher risk of low birthweight (adjusted relative risk 1.62, 95% confidence interval 1.51 to 1.72; 48 studies, 93 337 participants; τ2=0.006), small for gestational age (1.44, 1.36 to 1.54; 51 studies, 93 191 participants; τ2=0.016), short for gestational age (1.47, 1.29 to 1.69; 40 studies, 83 827 participants; τ2=0.074), and microcephaly (1.57, 1.31 to 1.88; 31 studies, 80 046 participants; τ2=0.145) compared with adequate GWG. Excessive GWG was associated with a higher risk of preterm birth (1.22, 1.13 to 1.31; 48 studies, 103 762 participants; τ2=0.008), large for gestational age (1.44, 1.33 to 1.57; 47 studies, 90 044 participants; τ2=0.009), and macrosomia (1.52, 1.33 to 1.73; 29 studies, 68 138 participants; τ2=0) compared with adequate GWG. The direction and magnitude of the associations between GWG adequacy and several neonatal outcomes were modified by maternal age and body mass index before pregnancy. CONCLUSIONS Inadequate and excessive GWG are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes, however further research is needed to assess optimal ranges of GWG based on data from low and middle income countries.
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Affiliation(s)
- Nandita Perumal
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Tahmeed Ahmed
- Nutrition & Clinical Services, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, CA, USA
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | | | - Brittany Briggs
- Certara USA, on behalf of the Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
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Deshpande M, Miriam D, Shah N, Kajale N, Angom J, Bhawra J, Gondhalekar K, Khadilkar A, Katapally TR. Influence of parental anthropometry and gestational weight gain on intrauterine growth and neonatal outcomes: Findings from the MAI cohort study in rural India. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001858. [PMID: 37639449 PMCID: PMC10461821 DOI: 10.1371/journal.pgph.0001858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023]
Abstract
Poor foetal growth and subsequent low birth weight are associated with an increased risk for disease later in life. Identifying parental factors that determine foetal growth are important to curbing intergenerational malnutrition, especially among disadvantaged populations in the global south where undernutrition rates are high. The objective of this study was to assess the relationships between parental biometry, intrauterine growth and neonatal outcomes, while factoring in socioeconomic status of historically disadvantaged households in rural India. Using data from the prospective longitudinal cohort, pregnant women from rural Pune, India (n = 134) were assessed between August 2020 and November 2022. Data on socio-demography, ultrasound measurements, parental and foetal anthropometry were collected. Multiple linear regression models were run to predict determinants of foetal intrauterine and neonatal growth (p value<0.05). The dependent variables were ultrasound measurements and neonatal biometry, and independent variables were gestational weight gain, parental and mid-parental height. Mean(±SD) maternal age, maternal height, paternal height and mid-parental height were 22.8±3.7 years, 153.6±5.5cm, 165.9±6.5cm and 159.1±8.7cm, respectively. Pre-pregnancy body mass index and gestational weight gain was 20.5±4.0 kg/m2 and 9.8±3.7kg respectively. Mid-parental height and gestational weight gain were strongly correlated with neonatal growth and foetal intrauterine growth (p<0.05); however, the correlation peaked at 28 weeks of gestation (p<0.05). Gestational weight gain (B = 28.7, p = 0.001) and mid-parental height (B = 14.3, p = 0.001) were identified as strong determinants of foetal-intrauterine growth and neonatal anthropometry at birth. Maternal height was found to influence length of male neonate (B = 0.18, p = 0.001), whereas, paternal height influenced length of the female neonate (B = 0.11, p = 0.01). Parental socio-economic status, biometry and maternal gestational weight gain influence growth of the child starting from the intrauterine period. Our study underlines the need for interventions during pre-pregnancy, as well as during pregnancy, for optimal weight gain and improved foetal and neonatal outcomes.
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Affiliation(s)
- Mugdha Deshpande
- Department of Growth and Paediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, Maharashtra, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Demi Miriam
- Department of Growth and Paediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, Maharashtra, India
| | - Nikhil Shah
- Department of Growth and Paediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, Maharashtra, India
| | - Neha Kajale
- Department of Growth and Paediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, Maharashtra, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Jyotsna Angom
- Jehangir Hospital, Pune, Maharashtra, India
- Jupiter Hospital, Pune, Maharashtra, India
| | - Jasmin Bhawra
- Department of Growth and Paediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, Maharashtra, India
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Ketan Gondhalekar
- Department of Growth and Paediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Department of Growth and Paediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, Maharashtra, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Tarun Reddy Katapally
- Department of Growth and Paediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Pune, Maharashtra, India
- DEPtH Lab, School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Children’s Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
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Darling AM, Wang D, Perumal N, Liu E, Wang M, Ahmed T, Christian P, Dewey KG, Kac G, Kennedy SH, Subramoney V, Briggs B, Fawzi WW. Risk factors for inadequate and excessive gestational weight gain in 25 low- and middle-income countries: An individual-level participant meta-analysis. PLoS Med 2023; 20:e1004236. [PMID: 37486938 PMCID: PMC10406332 DOI: 10.1371/journal.pmed.1004236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/07/2023] [Accepted: 04/21/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Many women experience suboptimal gestational weight gain (GWG) in low- and middle-income countries (LMICs), but our understanding of risk factors associated with GWG in these settings is limited. We investigated the relationships between demographic, anthropometric, lifestyle, and clinical factors and GWG in prospectively collected data from LMICs. METHODS AND FINDINGS We conducted an individual participant-level meta-analysis of risk factors for GWG outcomes among 138,286 pregnant women with singleton pregnancies in 55 studies (27 randomized controlled trials and 28 prospective cohorts from 25 LMICs). Data sources were identified through PubMed, Embase, and Web of Science searches for articles published from January 2000 to March 2019. Titles and abstracts of articles identified in all databases were independently screened by 2 team members according to the following eligibility criteria: following inclusion criteria: (1) GWG data collection took place in an LMIC; (2) the study was a prospective cohort or randomized trial; (3) study participants were pregnant; and (4) the study was not conducted exclusively among human immunodeficiency virus (HIV)-infected women or women with other health conditions that could limit the generalizability of the results. The Institute of Medicine (IOM) body mass index (BMI)-specific guidelines were used to determine the adequacy of GWG, which we calculated as the ratio of the total observed weight gain over the mean recommended weight gain. Study outcomes included severely inadequate GWG (percent adequacy of GWG <70), inadequate GWG (percent adequacy of GWG <90, inclusive of severely inadequate), and excessive GWG (percent adequacy of GWG >125). Multivariable estimates from each study were pooled using fixed-effects meta-analysis. Study-specific regression models for each risk factor included all other demographic risk factors measured in a particular study as potential confounders, as well as BMI, maternal height, pre-pregnancy smoking, and chronic hypertension. Risk factors occurring during pregnancy were further adjusted for receipt of study intervention (if any) and 3-month calendar period. The INTERGROWTH-21st standard was used to define high and low GWG among normal weight women in a sensitivity analysis. The prevalence of inadequate GWG was 54%, while the prevalence of excessive weight gain was 22%. In multivariable models, factors that were associated with a higher risk of inadequate GWG included short maternal stature (<145 cm), tobacco smoking, and HIV infection. A mid-upper arm circumference (MUAC) of ≥28.1 cm was associated with the largest increase in risk for excessive GWG (risk ratio (RR) 3.02, 95% confidence interval (CI) [2.86, 3.19]). The estimated pooled difference in absolute risk between those with MUAC of ≥28.1 cm compared to those with a MUAC of 24 to 28.09 cm was 5.8% (95% CI 3.1% to 8.4%). Higher levels of education and age <20 years were also associated with an increased risk of excessive GWG. Results using the INTERGROWTH-21st standard among normal weight women were similar but attenuated compared to the results using the IOM guidelines among normal weight women. Limitations of the study's methodology include differences in the availability of risk factors and potential confounders measured in each individual dataset; not all risk factors or potential confounders of interest were available across datasets and data on potential confounders collected across studies. CONCLUSIONS Inadequate GWG is a significant public health concern in LMICs. We identified diverse nutritional, behavioral, and clinical risk factors for inadequate GWG, highlighting the need for integrated approaches to optimizing GWG in LMICs. The prevalence of excessive GWG suggests that attention to the emerging burden of excessive GWG in LMICs is also warranted.
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Affiliation(s)
- Anne Marie Darling
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Dongqing Wang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia, United States of America
| | - Nandita Perumal
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Tahmeed Ahmed
- Nutrition & Clinical Services, International Centre for Diarrheal Disease Research, Bangladesh
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kathryn G. Dewey
- Department of Nutrition, University of California, Davis, Davis, California, United States of America
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stephen H. Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | | | - Brittany Briggs
- Certara USA, Inc. on behalf of the Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
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Daida Y, Pedula K. Prevalence of Overweight and Obese Prepregnancy BMI and Excessive Gestational Weight Gain Using Asian-Specific Cutoffs Among Asian and Mixed-Asian Women Living in Hawaii: A Retrospective Cohort Study. Matern Child Health J 2023; 27:728-736. [PMID: 36214801 PMCID: PMC10023603 DOI: 10.1007/s10995-022-03560-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The use of Asian-specific Body Mass Index (aBMI) cutoffs may be more appropriate than general World Health Organization BMI (gBMI) cutoffs in determining recommended gestational weight gain (GWG) for Asian women. Since aBMI cutoffs are lower than gBMI, more Asian women will be reclassified into higher aBMI categories from gBMI. The prevalence of reclassification and its impact on GWG are not known. METHODS We utilized the electronic health records of 8886 Kaiser Permanente Hawaii members aged ≥ 18 with a singleton live birth. Prepregnancy BMI was first classified using gBMI criteria, then aBMI criteria. BMI categories were "underweight", "normal", "overweight" and "obese"; GWG was classified into lower ("lGWG"), met ("mGWG"), and exceed ("eGWG") GWG per WHO recommendations. Self-reported race/ethnicity include Asian, Asian + Pacific Islander, and Asian + white. Multiple logistic regression was used to estimate adjusted odds of reclassification. The Cochran-Mantel-Haenszel test was used to evaluate associations between race/ethnicity and GWG. RESULTS > 40% of women in each racial/ethnic group were reclassified. Asian + Pacific Islander women had significantly higher odds of being reclassified (p < .0001). In the normal gBMI and aBMI category, Asian + Pacific Islander women had the largest eGWG group. In the overweight gBMI category, Asian + Pacific Islander women had the largest eGWG group; in the overweight aBMI category, Asian + white women had the largest eGWG group. DISCUSSION A sizable percent of women were reclassified into higher BMI categories when aBMI was applied. Mixed-race Asian women were more likely to exceed GWG recommendations than Asian women.
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Affiliation(s)
- Y Daida
- Center for Integrated Healthcare Research, Kaiser Permanente Hawai'i, 501 Alakawa St Suite 201, Honolulu, HI, 96817, USA.
| | - K Pedula
- Center for Integrated Healthcare Research, Kaiser Permanente Hawai'i, 501 Alakawa St Suite 201, Honolulu, HI, 96817, USA
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Does emigration by itself improve birth weight? Study in European newborns of Indo-Pakistan origin. J Migr Health 2023; 7:100165. [PMID: 36760495 PMCID: PMC9905657 DOI: 10.1016/j.jmh.2023.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
Objective Our aim was to evaluate the effect of emigration on fetal birth weight (BW) in a group of pregnant women coming from the Indian subcontinent. Methods This was a retrospective study in a mixed population of pregnant women from the Indian subcontinent that either moved to Europe or stayed in their original countries. The influence of emigration along with several pregnancy characteristics: GA at delivery, fetal gender, maternal age, height, weight, body mass index (BMI) and parity on BW was evaluated by means of multivariable linear regression analysis. Results According to European standards, babies born to Indo-Pakistan emigrants and babies born to women staying in the Indian subcontinent were similarly small (BW centile 30± 29 and 30.1 ± 28, p<0.68). Multivariable regression demonstrated that emigration by itself did not exert a direct influence on BW (p = 0.27), being BMI and gestational age at delivery the true determinants of BW (p<0.0001). Conclusions Maternal BMI is the most relevant parameter affecting fetal growth regardless of the place of residence.
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Liu E, Wang D, Darling AM, Perumal N, Wang M, Ahmed T, Christian P, Dewey KG, Kac G, Kennedy S, Subramoney V, Briggs B, Fawzi WW. Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data. Am J Clin Nutr 2022; 116:1864-1876. [PMID: 36130877 PMCID: PMC10843965 DOI: 10.1093/ajcn/nqac259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/29/2022] [Accepted: 09/13/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). OBJECTIVES We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs. METHODS A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy <70%), inadequate (<90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I2, stratified analysis, and meta-regression. RESULTS MMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P < 0.01] and higher GWG at delivery (WMD: 209 g; 95% CI: 139, 280 g; P < 0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P < 0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: -0.38%, 3.40%; P = 0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG. CONCLUSIONS Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.
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Affiliation(s)
- Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Dongqing Wang
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Anne M Darling
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Nandita Perumal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Tahmeed Ahmed
- Nutrition & Clinical Services, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stephen Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | | | - Brittany Briggs
- Certara USA, Inc. on behalf of the Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - members of the GWG Pooling Project Consortium
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Nutrition & Clinical Services, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Nutrition, University of California, Davis, Davis, CA, USA
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Certara Canada, Montreal, Quebec, Canada
- DVPL Tech
- Certara USA, Inc. on behalf of the Bill & Melinda Gates Foundation, Seattle, WA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
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Preconception health behaviours of women planning a Pregnancy: A scale development study. Eur J Obstet Gynecol Reprod Biol 2022; 279:19-26. [DOI: 10.1016/j.ejogrb.2022.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 09/15/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022]
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11
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Impact of prepregnancy body mass index on adverse pregnancy outcomes: analysis from the Longitudinal Indian Family hEalth cohort study. AJOG GLOBAL REPORTS 2022; 3:100134. [PMID: 36691397 PMCID: PMC9860159 DOI: 10.1016/j.xagr.2022.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
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.
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12
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Aji AS, Lipoeto NI, Yusrawati Y, Malik SG, Kusmayanti NA, Susanto I, Majidah NM, Nurunniyah S, Alfiana RD, Wahyuningsih W, Vimaleswaran KS. Association between pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes: a cohort study in Indonesian pregnant women. BMC Pregnancy Childbirth 2022; 22:492. [PMID: 35705902 PMCID: PMC9202216 DOI: 10.1186/s12884-022-04815-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/08/2022] [Indexed: 11/27/2022] Open
Abstract
Background Pre-pregnancy BMI (PP BMI) and gestational weight gain (GWG) are prominent anthropometric indicators for maternal nutritional status and are related to an increased risk of adverse pregnancy outcomes. This study aimed to determine the factors affecting total GWG, PP BMI and pregnancy outcomes among pregnant women in West Sumatra, Indonesia. Methods This observational analysis was conducted among healthy women in the Vitamin D Pregnant Mother (VDPM) cohort study. A total of 195 pregnant women and their newborn babies were enrolled, and information regarding their socio-demographic characteristics, obstetric history, dietary intake and anthropometric data were assessed through direct interviews. Furthermore, the Institute of Medicine (IOM) 2009 guidelines were used to obtain the total GWG. Results PP BMI was used to categorise the 195 pregnant women as overweight/obese (43.1%), normal (46.7%) and underweight (10.2%). There were 53.3%, 34.4% and 12.3% of women who had inadequate, adequate and excessive GWG, respectively. The multinomial logistic regression model indicated that overweight or obese women at the pre-pregnancy stage were 4.09 times more likely to have an excessive rate of GWG (AOR = 4.09, 95% CI: 1.38–12.12, p = 0.011) than those whose weight was normal. Furthermore, women with excessive GWG were 27.11 times more likely to have a baby with macrosomia (AOR = 27.11, 95% CI: 2.99–245.14) (p = 0.001) and those with inadequate GWG were 9.6 times more likely to give birth to a baby with low birth weight (LBW) (AOR = 9.60, 95% CI; 0.88–105.2) (p = 0.002). Conclusions This study demonstrates that the malnutrition status prior to pregnancy and inadequate or excessive GWG status during pregnancy as significant risk factors for developing adverse pregnancy outcomes. These findings highlight the importance of providing information, preconception counselling and health education on weight management for healthy pregnancies. Supplementary information The online version contains supplementary material available at 10.1186/s12884-022-04815-8.
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Affiliation(s)
- Arif Sabta Aji
- Graduate School of Public Health Department, Faculty of Health Sciences, Alma Ata University, Yogyakarta, 55183, Indonesia. .,Department of Nutrition, Faculty of Health Sciences, Alma Ata University, Yogyakarta, 55183, Indonesia. .,Alma Ata Graduate School of Public Health, Alma Ata University, Jl Brawijaya 99, Kasihan, Bantul, Yogyakarta, 552813, Indonesia.
| | - Nur Indrawaty Lipoeto
- Department of Nutrition, Faculty of Medicine, Andalas University, Padang, 25127, Indonesia
| | - Yusrawati Yusrawati
- Department of Obstetrics and Gynaecology Department, Faculty of Medicine, Andalas University, Padang, 25127, Indonesia
| | - Safarina G Malik
- Eijkman Institute for Molecular Biology, Jakarta, 10430, Indonesia
| | | | - Isman Susanto
- Graduate School of Public Health Department, Faculty of Health Sciences, Alma Ata University, Yogyakarta, 55183, Indonesia
| | - Nur Mukhlishoh Majidah
- Graduate School of Public Health Department, Faculty of Health Sciences, Alma Ata University, Yogyakarta, 55183, Indonesia
| | - Siti Nurunniyah
- Graduate School of Public Health Department, Faculty of Health Sciences, Alma Ata University, Yogyakarta, 55183, Indonesia.,Department of Midwifery, Faculty of Health Sciences, Alma Ata University, Bantul, 55183, Indonesia
| | - Ratih Devi Alfiana
- Department of Midwifery, Faculty of Health Sciences, Alma Ata University, Bantul, 55183, Indonesia
| | - Wahyuningsih Wahyuningsih
- Graduate School of Public Health Department, Faculty of Health Sciences, Alma Ata University, Yogyakarta, 55183, Indonesia.,Department of Nursing, Faculty of Health Sciences, Alma Ata University, Bantul, 55183, Indonesia
| | - Karani S Vimaleswaran
- Department of Food and Nutritional Sciences, Hugh Sinclair Unit of Human Nutrition, University of Reading, Reading, UK.,The Institute for Food, Nutrition, and Health (IFNH), University of Reading, Reading, UK
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13
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Relationship between caesarean section delivery and risk of overweight/obesity among children aged 6–23 months in the Tamale Metropolis of Ghana. J Nutr Sci 2022; 11:e43. [PMID: 35754984 PMCID: PMC9201873 DOI: 10.1017/jns.2022.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
The recent exponential increase in caesarean section (CS) rates in many countries including Ghana requires an understanding of the potential long-term consequences on child health. The present study investigated the relationship between CS delivery and risk of childhood overweight/obesity. A retrospective cohort study was conducted from October 2019 to March 2020 in Ghana. Using multi-stage sampling, 553 mother–child pairs aged 6–23 months were selected from ten health facilities during child welfare clinic (CWC) services. We assessed the association between delivery mode (caesarean v. vaginal) and subsequent body mass index for age (BMI/age Z-score) using hierarchical multivariable linear regression analysis. The prevalence of overweight/obesity (BMI/age Z-score > +2 sd) in children was 3⋅6 %. After adjusting for maternal gestational weight gain, macrosomia and child feeding practices, children who were born through CS had mean BAZ which was 0⋅105 standard units significantly higher than their colleagues who were delivered through normal vaginal [beta coefficient (β) 0⋅105, (95 % CI 0⋅03, 0⋅55)]. CS birth was also associated with 3⋅2 times higher odds of overweight/obesity than vaginal delivery (AOR 3⋅23; 95 % CI 1⋅14, 9⋅13). Consequently, CS delivery was associated positively with increased body mass (adiposity) in the study sample. The association between CS delivery and risk of childhood obesity was attenuated after adjusting for macrosomia. These results would be important for informing clinicians and expectant mothers in considering CS delivery.
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14
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He S, Allen JC, Razali NS, Chern BSM, Tan KH. Association between gestational weight gain and pregnancy outcomes in a Singaporean population: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2022; 272:160-165. [PMID: 35325689 DOI: 10.1016/j.ejogrb.2022.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Inadequate or excessive gestational weight gain (GWG) is associated with adverse pregnancy outcomes. We aimed to study GWG in a Singaporean population and its association with pregnancy outcomes, including small for gestational age (SGA), macrosomia, and caesarean section secondary to failure to progress (FTP) or cephalopelvic disproportion (CPD). STUDY DESIGN 926 women with low-risk singleton pregnancy were enrolled in a prospective cohort study from 2010 to 2014 in a Singapore tertiary maternity hospital. 704 patients without pre-existing diabetes or hypertension and had maternal weight information till term pregnancy were included in analyses. Participants were categorized according to their first antenatal visit body mass index (BMI) as underweight, normal weight, overweight and obese. Total GWG for each BMI group was calculated and compared to Institute of Medicine (IOM) 2009 GWG guidelines. Logistic regression analyses were performed to assess the association of GWG below or above IOM guidelines with pregnancy outcomes. RESULTS GWG below IOM guidelines was associated with an increased risk of SGA (adjusted OR: 2.97 [1.71, 5.15]; p < 0.0001). GWG above IOM guidelines significantly increased the risk of caesarean section due to FTP or CPD (adjusted OR: 2.10 [1.09, 4.01]; p = 0.0275). GWG above IOM guidelines was associated with an increased risk of macrosomia (adjusted odds ratio: 2.27 [1.43, 3.63]; p = 0.0006), while GWG below IOM guidelines was associated with a reduced risk of macrosomia (adjusted odds ratio: 0.18 [0.08, 0.39]; p < 0.0001). CONCLUSIONS GWG not achieving the IOM recommendations has been found to be associated with adverse pregnancy outcomes in Singaporean women. Inadequate GWG is associated with an increased risk of SGA whereas excessive GWG is associated with increased risks of macrosomia and caesarean section due to failure to progress or CPD. Results of the current study add to our understanding on the association of GWG with pregnancy outcomes in the South-East Asia and suggest that appropriate weight management during pregnancy is important.
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Affiliation(s)
- Song He
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - John Carson Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Nurul Syaza Razali
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Bernard Su Min Chern
- Division of Obstetrics and Gynaecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
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15
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Rosinha PMO, Dantas RAB, Alves MIP, Azevedo TCMF, Inácio IMR, Ferreira SGE, Pedrosa CAV, Ferreira MS, Sousa IMA, da Costa JGM. Body mass index and gestational weight gain: relevance in gestational diabetes and outcomes - A retrospective cohort study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:261-268. [PMID: 35420269 PMCID: PMC9832902 DOI: 10.20945/2359-3997000000463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective To evaluate the influence of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on blood glucose levels at diagnosis of gestational diabetes mellitus (GDM) and obstetric/neonatal outcomes. Methods Retrospective cohort study including 462 women with GDM and singleton pregnancy delivered in our institution between January 2015 and June 2018 and grouped according to BMI/GWG. Results The diagnosis of GDM was more likely to be established in the 1st trimester (T) in women with obesity than in normal-weight (55.8% vs 53.7%, p = 0.008). BMI positively and significantly correlated with fasting plasma glucose (FPG) levels in the 1stT (rs = 0.213, p = 0.001) and 2ndT (rs = 0.210, p = 0.001). Excessive GWG occurred in 44.9% women with overweight and in 40.2% with obesity (p < 0.001). From women with obesity, 65.1% required pharmacological treatment (p < 0.001). Gestational hypertension (GH) was more frequent in women with obesity (p = 0.016). During follow-up, 132 cesareans were performed, the majority in mothers with obesity (p = 0.008). Of the 17 large-for-gestational-age (LGA) birthweight delivered, respectively 6 and 9 were offsprings of women with overweight and obesity (p = 0.019). Maternal BMI had a predictive value only for macrosomia [aOR 1.177 (1.006-1.376), p = 0.041]. BMI and GWG positively correlated with birthweight (rs = 0.132, p = 0.005; rs = 0.188, p = 0.005). Conclusion Maternal obesity is related with a major probability of diagnosis of GDM in 1stT, fasting hyperglycemia in 2ndT and a more frequent need for pharmacological therapy. Pre-gestational obesity is associated with GH, cesarean delivery and fetal macrosomia.
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16
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Unhealthy gestational weight gain: are we neglecting inadequate gestational weight gain? Midwifery 2022; 107:103277. [DOI: 10.1016/j.midw.2022.103277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 01/19/2022] [Accepted: 02/06/2022] [Indexed: 11/23/2022]
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Impact of maternal pre-pregnancy body mass index on maternal, fetal and neonatal adverse outcomes in the worldwide populations: A systematic review and meta-analysis. Obes Res Clin Pract 2021; 15:536-545. [PMID: 34782256 DOI: 10.1016/j.orcp.2021.10.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Systematic review and meta-analysis conducted to investigate the effect of stratified pre-pregnancy maternal body mass index on twenty maternal and fetal/neonatal adverse outcomes. METHODS PubMed, Google Scholar, Medline, Embase, Web of Science databases were searched from inception till July 11, 2020. Cohort studies were included. The pooled odds ratio with 95% confidence interval was reported considering the random effect and the quality effect model. The sub-group analysis and meta-regression were conducted for BMI cut-offs, geographical region, source of BMI, and sample size. RESULTS Overall, 86 studies representing 20,328,777 pregnant women were included in this meta-analysis. Our study reveals that overweight and obese mothers are at increased odds of cesarean delivery, elective cesarean delivery, emergency cesarean delivery, gestational diabetes, gestational hypertension, induction of labor, postpartum hemorrhage, pre-eclampsia, pre-term premature rupture of membrane, and the fetuses/neonates of overweight and obese mothers are at increased risk of admission in the newborn intensive care unit, APGAR scores less than 7 at 5 min, large for gestational age, macrosomia, extreme pre-term birth in pregnant mothers compared with standard BMI mothers. However, the underweight mothers showed increased odds for small for gestational age infant and pre-term birth, whereas obese mothers were at higher risk for post-term birth and stillbirths. The subgroup and meta-regression analyses have shown the impact of BMI cut-offs, geographical region, source of BMI, and sample size on several maternal, fetal/neonatal adverse outcomes. CONCLUSION The meta-analysis confirmed the association of elevated pre-pregnancy maternal BMI with higher odds of adverse maternal and fetal/neonatal outcomes.
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18
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Koren R, Idan C, Elkan M, Koren S, Wiener Y. The risk of small and large for gestational age newborns in women with gestational diabetes according to pre-gestational body mass index and weight gain. J Matern Fetal Neonatal Med 2021; 35:8382-8387. [PMID: 34544322 DOI: 10.1080/14767058.2021.1974390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To explore the effects of pregestational body mass index (BMI) and gestational weight gain (GWG) on maternal and neonatal outcomes of women with gestational diabetes mellitus (GDM). METHODS We conducted retrospective cohort analyses of outcomes among women with GDM who delivered at Shamir Medical Center, Israel (2017-2018). RESULTS We included 673 women with GDM in our analysis, 217 (32.24%) with appropriate GWG (aGWG), 247 (36.7%) with excessive GWG (eGWG), and 209 (31%) with insufficient GWG (iGWG). Cesarean section (CS) was less prevalent among women with iGWG (19.6%), compared with women with eGWG (31.2%) and aGWG (31.1%) (p = .008). Small for gestational weight (SGA) newborns were more prevalent in women with iGWG 9.1%, compared with 2% and 0.9% for women with eGWG and aGWG, respectively (p<.001). Large for gestational age (LGA) newborns were significantly more prevalent in women with eGWG 17.4% compared with 4.8% and 9.7% in patients with iGWG and aGWG women, respectively (p<.001). SGA and LGA newborns were more prevalent in women with iGWG and e-GWG across all pre-gestational BMI groups >18.5 kg/m2. CONCLUSIONS A complex interplay exists between pregestational weight, GWG, and GDM and pregnancy outcomes, specifically SGA and LGA newborns. A strict follow-up considering the pregestational BMI, GWG, blood glucose levels, treatment modality, and fetal abdominal circumference could assist in managing the complex interplay of patients with GDM for better neonatal outcomes.
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Affiliation(s)
- Ronit Koren
- Department of Internal Medicine A, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Chen Idan
- Department of Internal Medicine A, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Matan Elkan
- Department of Internal Medicine A, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Shlomit Koren
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Diabetes Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Yifat Wiener
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Alebachew M, Doyo A, Admasu D, Sisay K, Shimels T. Knowledge, Perception and Practice towards the Risks of Excessive Weight Gain during Pregnancy among Pregnant Mothers at Myung Sung Christian Medical General Hospital, Addis Ababa, Ethiopia. Ethiop J Health Sci 2021; 31:371-380. [PMID: 34158789 PMCID: PMC8188074 DOI: 10.4314/ejhs.v31i2.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Being overweight and obese represents a severe public health deterioration affecting all population in general and vulnerable groups, such as pregnant women in particular. This study aimed to assess the knowledge, perception and practice towards the risks of excessive weight gain during pregnancy among pregnant mothers at Myung Sung Christian Medical General Hospital. Methods An institution based cross-sectional study was conducted from July to August, 2019. A systematic random sampling technique was employed to select participants. A total of 176 respondents were included in the study. Data was collected using interviewer administered questionnaire, observation checklist, and measurements of weight and height. Statistical product and service solution version 20.0 was employed for analysis. Descriptive statistics, using tables and charts, was used to present results. Results Gestational diabetes mellitus (83.5%) and high blood pressure (80.7%) were the major known risks associated with excessive weight gain during pregnancy. Based on the mean score, 96(54.5%) had poor knowledge while 80(45.5%) had good knowledge about the risks of excessive weight gain. The majority (92.0%) overweight and all obese pregnant mothers did not know their actual weight status. Similarly, 134(76.1%) of the study participants were not engaged in regular physical exercise during the current pregnancy. Conclusion This study revealed that pregnant mothers attending in Korean General Hospital were generally poorly knowledgeable on the risks of excessive weight gain during pregnancy, had poor perception on current weight status and poor practices on their weight gain management. Facility based education and community awareness creation should accompany antenatal care services.
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Affiliation(s)
| | | | | | - Kokeb Sisay
- Kea Med Medical College, Department of Nursing
| | - Tariku Shimels
- St. Paul's Hospital Millennium Medical College, Research Directorate
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20
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Loh HH, Taipin H, Said A. The effect of obesity in pregnancy and gestational weight gain on neonatal outcome in glucose-tolerant mothers. Obes Sci Pract 2021; 7:425-431. [PMID: 34401200 PMCID: PMC8346371 DOI: 10.1002/osp4.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most studies showing association between mothers with obesity in pregnancy or excessive gestational weight gain (GWG) and adverse neonatal outcome were cross-sectional or retrospective. Many included patients are with gestational diabetes mellitus (GDM), which is a strong risk factor for this adverse outcome. There are no prospective studies on this topic in Malaysia. This study aimed to examine prospectively the effects of obesity in pregnancy and GWG, independent of GDM, on neonatal outcome. METHODS Pregnant mothers in the first trimester, who presented to health clinics in Kuching, were screened. Mothers with existing diabetes mellitus or GDM were excluded using 75-g oral glucose tolerance test during the first and second trimesters. Participants with the first trimester BMI ≥ 23 kg/m2 were recruited as overweight/obese group, whereas those with BMI 18.5-22.9 kg/m2 were taken as the comparison group. At every trimester visit, mothers' weights were recorded. Babies' birth weight and occurrence of adverse neonatal outcome were documented. RESULTS There were 123 mothers recruited as overweight/obese group (mean BMI 29.0 kg/m2 ± 4.45) and 102 mothers as comparison group (mean BMI 20.4 kg/m2 ± 1.48). The number of low birth weight was similar between groups: 9.8% in overweight/obese group, 6.9% in the comparison group (p = 0.416). More than half of these babies were born to mothers with inadequate GWG (58.3% in obese group vs. 57.1% in control group, p = 0.077). There was no significant difference in the mean birth weight (3000 g ± 454.5 vs. 3038 g ± 340.8, p = 0.471), preterm delivery (8.13% vs. 3.92%, p = 0.193), and admission rate to neonatal intensive care unit (8.13% vs. 7.85%, p = 0.937) between groups. There was a positive correlation between the total GWG in overweight/obese group on baby's weight (r = 0.222, p = 0.013). Inadequate GWG was not correlated with lower birth weight (p = 0.052). CONCLUSIONS Obesity in pregnancy was not associated with poor neonatal outcome in this small sample of women in Malaysia. Total GWG showed a weak correlation with baby's birth weight in overweight/obese group.
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Affiliation(s)
- Huai Heng Loh
- Faculty of Medicine and Health SciencesUniversiti Malaysia SarawakMalaysia
| | - Haslinda Taipin
- Malaysia Ministry of Health Training InstituteKota KinabaluSabahMalaysia
| | - Asri Said
- Faculty of Medicine and Health SciencesUniversiti Malaysia SarawakMalaysia
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Huang L, Chen Y, Dai Y, Xiao L, Zhao P, Ben X. Prepregnancy body mass index and gestational weight gain affect the offspring neurobehavioral development at one year of age. J Matern Fetal Neonatal Med 2021; 35:6140-6149. [PMID: 33832396 DOI: 10.1080/14767058.2021.1907336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Recent data show that maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) are associated with offspring neurobehavior in childhood. However, little is known about the effect on infants that less than 20 months of age, and whether this association has sex differences. METHODS In this birth cohort study, a total of 661 mother-infant pairs were enrolled in Shanghai, China, between February 2017 and April 2019. Maternal prepregnancy BMI was categorized according to the Chinese classification and GWG according to the 2009 Institute of Medicine (IOM). Neurobehavioral development for infants of 12 months of age was assessed by Gesell Developmental Scale (GDS), which contained five subscales of gross motor, fine motor, adaptive behavior, language, and social behavior. RESULTS Abnormal maternal prepregnancy BMI and excessive GWG were associated with infant birth weight and/or birth length (p < .05), while no influence was found on yearling weight or length. Women who were overweight/obese prior to pregnancy or excessive GWG during pregnancy had infants who were more deficient in neurobehavioral developmental including language (p < .01) and/or social behavior (p < .05). Specifically, excessive GWG was associated with lower language ability in girls but not boys (p < .05). CONCLUSIONS Aberrant prepregnancy BMI and excessive GWG not only affect the body size of newborn infants, but also impair their neurobehavioral development, suggesting that general guidance to the women should be advised to attain optimal prepregnancy BMI and GWG.
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Affiliation(s)
- Liping Huang
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yongfen Chen
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yunjia Dai
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Lingli Xiao
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Pu Zhao
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xiaoming Ben
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
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Associations of maternal diet quality with weight gain during pregnancy and obesity at three-year postpartum in Jakarta. PLoS One 2020; 15:e0244449. [PMID: 33382776 PMCID: PMC7775051 DOI: 10.1371/journal.pone.0244449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 12/10/2020] [Indexed: 11/24/2022] Open
Abstract
Dietary changes during pregnancy (DP) and post-partum are essential for women’s nutrition status and the health of their offspring. We compared the diet quality DP and at 3-year post-partum (3YPP) and assessed the relationship between maternal diet quality and nutritional status using a prospective cohort design among women in East Jakarta. In total, 107 women were recruited from the study in 2014 and followed up at 3YPP in 2018. The mid-upper arm circumference (MUAC), weight, and height were evaluated. Food consumption data were collected from repeated 24-h recalls. The validated US Diet Quality Index-Pregnancy (DQI-P) scores with eight components were calculated using the food consumption data and compared between DP and 3YPP. Associations of the DQI-P score with the MUAC and weight gain DP and body mass index (BMI) at 3YPP were analyzed using multivariable linear and logistic regression. The median of the DQI-P score DP was significantly higher than at 3YPP [35 (27; 42) versus 27 (19; 30); p-value <0.001, respectively]. The higher DQI-P score was associated with increased weight gain DP of 3.3 kg (adjusted β = 3.30, 95% confidence interval = 1.06–5.54) after adjusting for the mother's age and household income. The DQI-P score was not associated with an increased risk of chronic energy deficiency DP and overweight–obesity at 3YPP. Thus, the diet adequacy was associated with weight gain DP but did not affect the MUAC DP and BMI at 3YPP. The DQI-P score DP was slightly better than the diet at 3YPP; however, the overall diet quality was inadequate. In conclusion, a higher DQI-P score was associated with increased weight gain DP of 3.3 kg but was not associated with other nutritional status indices in DP and 3YPP. Innovative dietary quality improvement programs are required to reduce malnutrition risk in pregnant and reproductive-age women.
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Trombe KSD, Rodrigues LS, Nascente LMP, Simões VMF, Batista RFL, Cavalli RC, Grandi C, Cardoso VC. Is birth weight associated with pregestational maternal BMI? BRISA Cohort, Ribeirão Preto, Brazil. ACTA ACUST UNITED AC 2020; 54:e10037. [PMID: 33295534 PMCID: PMC7727099 DOI: 10.1590/1414-431x202010037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 10/09/2020] [Indexed: 01/01/2023]
Abstract
Given the increase of women with excess weight or obesity and its possible effects on birth weight, the present study aimed to investigate the association between pregestational maternal body mass index (BMI) and birth weight in a birth cohort from Ribeirão Preto, SP, Brazil. This was a prospective study conducted on 1362 mother-child pairs involving singleton births. The women were evaluated using standardized questionnaires during the second trimester of pregnancy and at the time of childbirth. Information about the newborns was obtained from their medical records. The dependent variable was birth weight, categorized as low, adequate, or high. The independent variable was pregestational maternal BMI, categorized as malnutrition, adequate weight, overweight, and obesity. A multinomial regression model was used to estimate the crude and adjusted relative risk (RR) of low and high birth weight. A high frequency of pregestational excess weight (39.6%) was detected and found to be independently associated with high birth weight (RR=2.13, 95%CI: 1.19-3.80 for overweight and RR=3.34, 95%CI: 1.80-6.19 for obese pregnant women). There was no association between pregestational malnutrition and low birth weight (RR=1.70; 95%CI: 0.81-3.55). The present data showed a high rate of women with excess pregestational weight, supporting the hypothesis that pregestational BMI may contribute to high birth weight babies and indicating the need for actions aiming to prevent excessive weight in women at reproductive age.
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Affiliation(s)
- K S D Trombe
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L S Rodrigues
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L M P Nascente
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - V M F Simões
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - R F L Batista
- Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - R C Cavalli
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C Grandi
- Research Committee, Argentine Society of Pediatrics, Buenos Aires, Argentina
| | - V C Cardoso
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Martínez-Hortelano JA, Cavero-Redondo I, Álvarez-Bueno C, Garrido-Miguel M, Soriano-Cano A, Martínez-Vizcaíno V. Monitoring gestational weight gain and prepregnancy BMI using the 2009 IOM guidelines in the global population: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20:649. [PMID: 33109112 PMCID: PMC7590483 DOI: 10.1186/s12884-020-03335-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 10/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies have reported a high prevalence of excessive gestational weight gain (GWG) in women with prepregnancy BMI classified as overweight and obese. However, the joint evidence regarding GWG and prepregnancy BMI in the worldwide population has not been synthesized. Thus, this systematic review and meta-analysis aimed to estimate global and regional mean GWG and the prevalence of GWG above, within and below 2009 Institute of Medicine (IOM) guidelines. Second, we aimed to estimate global and regional prepregnancy BMI and the prevalence of BMI categories according to World Health Organization (WHO) classification. METHODS We searched Medline, Embase, the Cochrane Library and Web of Science to identify observational studies until 9 May 2018. We included studies published from 2009 that used 2009 IOM guidelines, reporting data from women in general population with singleton pregnancies. The 2009 IOM categories for GWG and the WHO categories for prepregnancy BMI were used. DerSimonian and Laird random effects methods were used to estimate the pooled and their respective 95% confidence intervals (95% CIs) of the mean and by category rates of GWG and prepregnancy BMI, calculated by global and regions. RESULTS Sixty-three published studies from 29 countries with a total sample size of 1,416,915 women were included. The global prevalence of GWG above and below the 2009 IOM guidelines, was 27.8% (95% CI; 26.5, 29.1) and 39.4% (95% CI; 37.1, 41.7), respectively. Furthermore, meta-regression analyses showed that the mean GWG and the prevalence of GWG above guidelines have increased. The global prevalence of overweight and obesity, was 23.0% (95% CI; 22.3, 23.7) and 16.3% (95% CI; 15.4, 17.4), respectively. The highest mean GWG and prepregnancy BMI were in North America and the lowest were in Asia. CONCLUSIONS Considering the high prevalence of GWG above the 2009 IOM guidelines and women with overweight/obesity and their continuously increasing trend in most regions, clinicians should recommend lifestyle interventions to improve women's weight during reproductive age. Due to regional variability, these interventions should be adapted to each cultural context. TRIAL REGISTRATION Prospectively registered with PROSPERO ( CRD42018093562 ).
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Affiliation(s)
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain.
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay.
| | - Miriam Garrido-Miguel
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain
| | - Alba Soriano-Cano
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Social and Health Care Research Center, Santa Teresa Jornet s/n, 16071, Cuenca, Spain
- Faculty of Health Sciences, Universidad Autónoma de Chile, Talca, Chile
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First Trimester Ferritin Is Superior over Soluble Transferrin Receptor and Hepcidin in Predicting Anemia in the Third Trimester: Result from a Cohort Study in Indonesia. Anemia 2020; 2020:8880045. [PMID: 33101731 PMCID: PMC7568146 DOI: 10.1155/2020/8880045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Anemia in the third trimester has been identified as a risk factor for maternal and fetal morbidity that might lead to mortality. Due to its high cost, finding the best marker to predict anemia became more important to allow early prevention. Only one of ferritin, hepcidin, or soluble transferrin receptors can be picked for the prediction of anemia in the third trimester especially in low-resource setting. Objective This study aimed at defining the best marker among ferritin, hepcidin, or soluble transferrin receptor (sTfR) in the first trimester for prediction of anemia in the third trimester. Materials, Methods, and Setting. This diagnostic study was nested on the cohort study of vitamin D and its impact during pregnancy in Indonesia. Singleton pregnant mothers with normal fetus were recruited in the first trimester from four cities in West Java, Indonesia. The 304 pregnant women were screened for hepcidin, ferritin, and sTfR level in the sera. All biomarkers were measured by ELISA. Complete blood count (CBC) was done by impedance method measurement (SysmexR). Only subjects with complete data were included in analysis for diagnostic study to compare the three markers by finding the best receiver operating curve (RoC), likelihood ratio (LR), and risk estimate (RR). Result One-hundred and eighty-one pregnant women were eligible for analysis. The result of this study showed that the serum ferritin level in the first trimester was the best marker to predict anemia in the third trimester of pregnancy. Hepcidin and sTfR performed poorly. A new cutoff point of ferritin level ≤27.23 ng/ml yielded the best ROC with 67% area under curve (95% CI 60%-75%, p < 0.0001, Youden index J 0.28), specificity 86.29% (95% CI 79.0%-91.8%), LR (+) 3.07 (95% CI 1.8-5.3), and RR 2.48 (95% CI 1.67-3.68). These last figures were better than the previously used cutoff point of ferritin level below 30 ng/ml. Conclusion This study provided evidence that the serum ferritin level ≤27.23 ng/ml in the first trimester was the best marker to predict anemia in the third trimester. It was valuably useful for secondary screening of anemia in pregnancy, targeting subjects who may need rigorous approach for iron deficiency treatment in the prevention of anemia in pregnancy.
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Cox C, Potterton J, Rosie S. Developmental status of human immunodeficiency virus-exposed uninfected premature infants compared with premature infants who are human immunodeficiency virus unexposed and uninfected. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1401. [PMID: 32671275 PMCID: PMC7343939 DOI: 10.4102/sajp.v76i1.1401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/20/2020] [Indexed: 11/21/2022] Open
Abstract
Background There is growing concern about the developmental outcome of infants exposed to HIV in utero. HIV-infected women are at greater risk of premature delivery which poses a further developmental risk factor. Objectives To determine whether there is a difference between the development of premature infants born at 28–37 weeks gestational age that are HIV exposed but uninfected (HEU) compared with HIV-unexposed uninfected infants (HUU). Method A cross-sectional study was conducted in a Johannesburg state hospital. Thirty HEU and 30 HUU infants, aged between 16 days and six months, were assessed using the Bayley Scales of Infant and Toddler Development III. Results The two groups were well matched for gestational age and birth weight; however, more HUU infants presented with neonatal complications. HUU infants had lower developmental scores than HEU infants in the language (p = 0.003) and motor (p = 0.037) subscales. Expressive language was more affected in the HUU infants (p = 0.001), and fine (p = 0.001) and gross motor (p = 0.03) were affected as well. HUU infants with neonatal complications such as meningitis (p = 0.02) and neonatal jaundice (NNJ) (p = 0.01) are more likely to present with language and motor delay. Conclusion Meningitis and NNJ have more impact on infant development than in-utero HIV and ARV exposure. Clinical implications It is important for all premature infants to be screened regularly in order to diagnose developmental delays early so as to ensure early intervention and improved quality of life.
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Affiliation(s)
- Charne Cox
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanne Potterton
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Samantha Rosie
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Factors affecting maternal nutrition and health: A qualitative study in a matrilineal community in Indonesia. PLoS One 2020; 15:e0234545. [PMID: 32544180 PMCID: PMC7297355 DOI: 10.1371/journal.pone.0234545] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/27/2020] [Indexed: 12/01/2022] Open
Abstract
The Minangkabau people of West Sumatra in Indonesia are renowned for their matrilineal culture with property and land passing down from mother to daughter. Despite there being a fairly balanced social status for women in the community, the impact of health inequalities is uneven. This study was therefore carried out to explore the relationship between the social, cultural and economic contexts in such a distinctive community with maternal nutrition and pregnancy-related health outcomes, from the perspectives of the mothers, fathers and care providers. Qualitative methods were used to undertake this study in collaboration with partners from the University of Andalas in a suburban area of Padang district. The data collection method was qualitative, semi-structured interviews (n = 19) with women, men, midwives and community health workers. The data were recorded with informed consent, transcribed in the local language and then translated into English prior to being thematically analysed. The major themes which emerged from the data included ‘Minangkabau matrilineality and role of women’; ‘culture and supportive attitude towards pregnant women’; ‘dietary patterns, attitude and access to food’; and ‘limited access to information about food and nutrition’. The findings showed healthy dietary patterns such as regular consumption of vegetables and fruit among the participants. However, the issues of poverty, access to food, dietary taboos and inadequate nutritional information remained major challenges for the mothers and the families who participated in the study. The evidence from this study suggests that the matrilineal culture of the Minangkabau promotes the empowerment of women and offers an encouraging environment for enhancing reproductive health. This lends itself to co-developing locally sensitive and sustainable complex interventions incorporating professional support and building on family and community back-up, enhancing knowledge and demystifying dietary misinformation to improve maternal health and nutrition.
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Qu P, Mi Y, Zhao D, Wang M, Dang S, Shi W, Shi J. Effect of the Interaction Between Pre-pregnancy Body Mass Index and Fresh/Frozen Embryo Transfer on Perinatal Outcomes of Assisted Reproductive Technology-Conceived Singletons: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2020; 11:560103. [PMID: 33101197 PMCID: PMC7546789 DOI: 10.3389/fendo.2020.560103] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/20/2020] [Indexed: 01/22/2023] Open
Abstract
Objective: To demonstrate the association between pre-pregnancy maternal overweight, obesity, and perinatal outcomes of singletons conceived by assisted reproductive technology (ART). Design: Retrospective cohort study from 2006 to 2015 data from a single ART center. Setting: Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, Northwestern China. Patients: We included 7,818 women undergoing ART and their singleton infants. Interventions: None. Main Outcome Measure: The primary outcome measures were preterm birth (PTB), macrosomia, low birth weight, small for gestational age, and large for gestational age (LGA). Results: We experienced an increase in the risk of PTB, macrosomia, and LGA in overweight and obese groups compared with that in normal-weight groups [PTB: overweight vs. normal weight: odds ratio [OR] = 1.44, 95% CI: 1.18-1.75; obesity vs. normal weight: OR = 1.53, 95% CI: 1.04-2.25; macrosomia: overweight vs. normal weight: OR = 1.78, 95% CI: 1.48-2.14; obesity vs. normal weight: OR = 2.16, 95% CI: 1.52-3.06; LGA: overweight vs. normal weight: OR = 1.63, 95% CI: 1.39-1.90; obesity vs. normal weight: OR = 2.11, 95% CI: 1.57-2.83]. We observed a significant interaction between maternal BMI and fresh/frozen embryo transfer on PTB and LGA (P = 0.030; P = 0.030). Fresh embryo transfer significantly increased the effect of maternal BMI on LGA (fresh: OR = 1.14, 95% CI: 1.10-1.18; frozen: OR = 1.09, 95% CI: 1.04-1.13), and frozen embryo transfer increased the effect of maternal BMI on PTB (fresh: OR = 1.03, 95% CI: 0.99-1.08; frozen: OR = 1.09, 95% CI: 1.04-1.15). Conclusions: Pre-pregnancy maternal overweight and obesity were associated with higher risks of PTB, macrosomia, and LGA in ART-conceived singletons. These associations were affected by the timing of embryo transfer (fresh/frozen embryo transfer). Therefore, we recommend women before ART to maintain a normal BMI for the prevention of adverse perinatal outcomes.
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Affiliation(s)
- Pengfei Qu
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, China
- Departments of Pediatrics and Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Yang Mi
- Department of Obstetrics, Northwest Women's and Children's Hospital, Xi'an, China
| | - Doudou Zhao
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Min Wang
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Shaonong Dang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Wenhao Shi
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, China
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
- *Correspondence: Wenhao Shi
| | - Juanzi Shi
- Translational Medicine Center, Northwest Women's and Children's Hospital, Xi'an, China
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
- Juanzi Shi
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Ozdilek R, Aba YA, Aksoy SD, Sik BA, Akpak YK. The relationship between body mass index before pregnancy and the amount of weight that should be gained during pregnancy: A cross-sectional study. Pak J Med Sci 2019; 35:1204-1209. [PMID: 31488979 PMCID: PMC6717442 DOI: 10.12669/pjms.35.5.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: To investigate the adaptation of pregnant women to the recommended weight gain range according to body mass index (BMI) and to determine the factors affecting them. Methods: This cross-sectional study was performed in a university hospital’s obstetrics and gynecology unit (tertiary center) in Turkey. This study was conducted between March 2018 and August 2018 (6 months) in pregnant women. Pregnant women with chronic disease and receiving treatment during antenatal follow-up, with twin pregnancy, with a fetus with a congenital abnormality, and nutritional disturbance were excluded from the study. Eight hundred twelve pregnant women with normal antenatal follow-up and who volunteered to participate were included in the study. Results: The mean age of the participants was 27.66 ± 5.05 years. The mean weight and BMI before pregnancy were near standard in all participants. The group with the highest rate of recommended weight gain according to BMI before pregnancy was the group with low weight pregnant women. The ideal weight gain rate in all groups was 32%. Conclusions: The groups with overweight and obese pregnant women according to BMI before pregnancy had the highest rates of weight gain, above the recommended limits. BMI before pregnancy directly affects weight gain during pregnancy and the importance of pre-pregnancy counseling and weight loss is emphasized once again.
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Affiliation(s)
- Resmiye Ozdilek
- Resmiye Ozdilek, Department of Midwifery, Faculty of Health Science, Kocaeli University, Izmit, Turkey
| | - Yilda Arzu Aba
- Yilda Arzu Aba, Department of Nursing, Faculty of Health Science, Bandirma Onyedi Eylül University, Balikesir, Turkey
| | - Sena Dilek Aksoy
- Sena Dilek Aksoy, Department of Midwifery, Faculty of Health Science, Kocaeli University, Izmit, Turkey
| | - Bulat Aytek Sik
- Bulat Aytek Sik, Department of Gynecology and Obstetrics, Istanbul Aydin University, Istanbul, Turkey
| | - Yasam Kemal Akpak
- Yasam Kemal Akpak, Department of Gynecology and Obstetrics, Sudan Nyala-Turkey Education and Research Hospital, Sudan
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Sha T, Gao X, Chen C, Li L, He Q, Wu X, Cheng G, Tian Q, Yang F, Yan Y. Associations of Pre-Pregnancy BMI, Gestational Weight Gain and Maternal Parity with the Trajectory of Weight in Early Childhood: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071110. [PMID: 30925697 PMCID: PMC6480263 DOI: 10.3390/ijerph16071110] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 01/20/2023]
Abstract
Background: The association of maternal parity, pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with childhood weight status has been well studied; however, little is known about these factors with respect to the rate of weight changes in early childhood. Methods: This study was based on a prospective longitudinal study. The follow-up surveys were conducted at the ages of 1, 3, 6, 8, 12, and 18 months. Child weight was investigated twice at each wave. Data on maternal parity, pre-pregnancy weight and height were collected at baseline. The latent growth curve model was used to examine the effects of interested predictors on the trajectory of weight in early childhood. Results: Finally, 893 eligible mother-child pairs were drawn from the cohort. In adjusted models, multiparas were associated with higher birth weight (β = 0.103) and slower weight change rate of children (β = −0.028). Pre-conception BMI (β = 0.034) and GWG (β = 0.014) played important roles in the initial status of child weight but did not have effects on the rate of weight changes of the child. Conclusions: Multiparous pregnancy is associated with both higher mean birth weight and slower weight-growth velocity in early childhood, while pregravid maternal BMI and GWG are only related to the birth weight.
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Affiliation(s)
- Tingting Sha
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha 410078, China.
| | - Xiao Gao
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha 410078, China.
| | - Cheng Chen
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha 410078, China.
| | - Ling Li
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha 410078, China.
| | - Qiong He
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha 410078, China.
| | - Xialing Wu
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha 410078, China.
| | - Gang Cheng
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha 410078, China.
| | - Qianling Tian
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha 410078, China.
| | - Fan Yang
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha 410078, China.
| | - Yan Yan
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Xiangya Road 110, Changsha 410078, China.
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Ng CM, Badon SE, Dhivyalosini M, Hamid JJM, Rohana AJ, Teoh AN, Satvinder K. Associations of pre-pregnancy body mass index, middle-upper arm circumference, and gestational weight gain. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 20:60-65. [PMID: 31084820 DOI: 10.1016/j.srhc.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/01/2019] [Accepted: 03/18/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES An optimal gestational weight gain is essential for maternal health and to reduce adverse birth outcomes. Current guidelines to monitor gestational weight gain are based on pre-pregnancy body mass index (BMI). However, middle-upper arm circumference (MUAC) is increasingly used as an alternative nutritional status measure for pregnant women. Hence, this study aimed to determine associations of MUAC and pre-pregnancy BMI with gestational weight gain rate among Malaysian pregnant women. STUDY DESIGN A cross-sectional study was conducted among 444 pregnant women (≥20 weeks gestation). MAIN OUTCOMES MEASURES Women completed questionnaires on sociodemographic data, maternal characteristics and pre-pregnancy weight. Height, current weight and MUAC were measured at study visit (from 1st February 2016 to 31st January 2017). RESULTS About a third (34.24%) of pregnant women were overweight or obese prior to pregnancy. MUAC was inversely associated with an inadequate rate of gestational weight gain (OR = 0.77; 95% CI: 0.68, 0.87) as compared to normal gestational weight gain. In contrast, a higher MUAC was associated with a higher odds ratio (OR = 1.28; 95% CI: 1.11, 1.49) of having excessive rate of gestational weight. No associations were found for pre-pregnancy BMI categories for gestational weight gain rate. CONCLUSION Our findings revealed that women with low MUAC were more likely to have an inadequate gestational weight gain rate during pregnancy whereas higher MUAC was associated with an excessive gestational weight gain rate. MUAC may be a useful indicator of nutritional status associated with GWG. Routine measurement of MUAC in pregnant women may help health professionals, particularly in middle-income countries, to counsel women about gestational weight gain.
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Affiliation(s)
- C M Ng
- Faculty of Applied Sciences, UCSI University, 1, Jalan Puncak Menara Gading, Taman Connaught, 56000 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - S E Badon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, United States.
| | - M Dhivyalosini
- Faculty of Applied Sciences, UCSI University, 1, Jalan Puncak Menara Gading, Taman Connaught, 56000 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - J J M Hamid
- School of Health Sciences, Universiti Sains Malaysia, USM Health Campus, Kubang Kerian, 15200 Kubang Kerian, Kelantan, Malaysia.
| | - A J Rohana
- School of Medical Sciences, Universiti Sains Malaysia, USM Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
| | - A N Teoh
- Faculty of Applied Sciences, UCSI University, 1, Jalan Puncak Menara Gading, Taman Connaught, 56000 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - K Satvinder
- Faculty of Applied Sciences, UCSI University, 1, Jalan Puncak Menara Gading, Taman Connaught, 56000 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
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Hua XG, Jiang W, Hu R, Hu CY, Huang K, Li FL, Zhang XJ. Large for gestational age and macrosomia in pregnancies without gestational diabetes mellitus. J Matern Fetal Neonatal Med 2019; 33:3549-3558. [PMID: 30714441 DOI: 10.1080/14767058.2019.1578746] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objective: This study aims to estimate the prevalence and risk factors of macrosomia and LGA (large for gestational age) in non-GDM (gestational diabetes mellitus) pregnant women in Fuyang, Anhui Province of China.Methods: A large population-based cohort study was conducted among non-GDM pregnant women aged 18-45 years. Maternal sociodemographic data prior to pregnancy were collected using interviewer-administered standardized questionnaire. Maternal obstetrical delivery records and newborn hospital records were extracted from antenatal care booklets and hospital discharge abstracts. Logistic regression analysis was used to identify the predictors of macrosomia and LGA.Results: The incidence of macrosomia and LGA was 9.2 and 15.9%, respectively. Mothers ≥35 years of age (aOR 2.75, 95% CI 1.98, 3.80), male neonates (aOR 1.68, 95% CI 1.51, 1.89), overweight and obese (aOR 1.61, 95% CI 1.34, 1.92 and aOR 3.05, 95% CI 2.05, 4.56, respectively) were associated with increased risk of macrosomia. Compared with the less educated mothers, the educated mothers were more likely to have increased risk of macrosomia. IFA (iron and folic acid) supplements intake during pregnancy was more likely to deliver macrosomia or LGA (aOR1.32, 95% CI 1.08, 1.49 and aOR1.42, 95% CI 1.24, 1.61, respectively) as compared with no IFA supplements intake. SCr (serum creatinine concentration) >80 µmol/L was related to decreased risk of macrosomia (aOR 0.73, 95% CI 0.61, 0.86) and LGA (aOR 0.67, 95% CI 0.59, 0.77) as compared with normal range (44-80 µmol/L).Conclusions: There was a high prevalence of macrosomia and LGA in non-GDM pregnant women in China. Healthcare educations and reasonable body weight are necessary for pregnant women to prevent macrosomia and LGA. Pregnant women should be checked regularly and have the first prenatal visit as soon as possible.
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Affiliation(s)
- Xiao-Guo Hua
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Wen Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Rui Hu
- School of Health Services Management, Anhui Medical University, Hefei, China
| | - Cheng-Yang Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Kai Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Feng-Li Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Xiu-Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
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Shen J, Zhang Z, Chen K, Lu M, Qian Q, Liu P, Gao Q, Zhang C. Prepregnancy obesity status and risks on pregnancy outcomes in Shanghai: A prospective cohort study. Medicine (Baltimore) 2018; 97:e12670. [PMID: 30290653 PMCID: PMC6200484 DOI: 10.1097/md.0000000000012670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Obesity in women of reproductive age is not only associated with numerous adverse maternal and fetal effects prenatally but also exerts a negative influence on female fertility. The aim of this study was to investigate the situation of prepregnant obesity in Shanghai and explore the impact of prepregnant obesity on gestational weight gain as well as other pregnancy outcomes. A prospective hospital-based pregnant women cohort was established in Shanghai since January 2015. All pregnant women who were registered and expected to deliver in this hospital were included in the cohort. Nearly one fourth of pregnant women in Shanghai were overweight/obese and the prevalence of overweight/obesity was more common among women with advancing age (P < .001). Women prepregnancy overweight/obesity was associated with 3.5-fold higher risk of excessive gestational weight gain (odds ratio, OR 3.58; 95% confidence interval, CI, 2.82-4.55; P < .001). Women prepregnancy BMI was statistically related to pregnancy outcomes as macrosomia (OR 2.24; 95% CI, 1.55-3.23; P < .001), cesarean delivery (OR 2.04; 95% CI, 1.60-2.62; P < .001), maternal complications (OR 1.53; 95% CI, 1.18-1.98; P < .001). Prepregnancy obesity is associated with a much higher risk of excessive gestational weight gain and pregnancy outcomes in Shanghai. Further interventions targeting maternal obesity, especially prepregnancy obesity are required.
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Affiliation(s)
- Jie Shen
- Department of Cancer Prevention, Fudan University Shanghai Cancer Center
| | - Zhiping Zhang
- Department of Obstetrics and Gynecology, Shanghai Pudong New Area Healthcare hospital for Women and Children
| | - Ke Chen
- Department of Cancer Prevention, Fudan University Shanghai Cancer Center
| | - Mei Lu
- Key Lab of Reproduction Regulation of NPFPC-Shanghai Institute of Planned Parenthood Research, Fudan University Reproduction and Development Institution
| | - Qiao Qian
- Department of Obstetrics and Gynecology, Shanghai Pudong New Area Healthcare hospital for Women and Children
| | - Pengfei Liu
- Department of Obstetrics and Gynecology, Shanghai Pudong New Area Healthcare hospital for Women and Children
| | - Qingyun Gao
- Department of Obstetrics and Gynecology, Shanghai Pudong New Area Healthcare hospital for Women and Children
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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Zhang D, Zhang L, Wang Z. The relationship between maternal weight gain in pregnancy and newborn weight. Women Birth 2018; 32:270-275. [PMID: 30274878 DOI: 10.1016/j.wombi.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 12/27/2022]
Abstract
AIM This study investigated the impacts of different pre-pregnancy body mass indexes and gestational weight gain on the risk of delivering a high birth weight infant in China. METHODS A retrospective cohort study was conducted from 2013 to 2014 in the Maternal and Child Health Care Hospital of Jinan City, Shandong Province and 2415 women who had a singleton birth were included in the study. A logistic regression model and restricted cubic spline regression were used to analyse the association. FINDINGS The risk of delivering a high birth weight infant increases when the mother's pre-pregnancy body mass index exceeds 24kg/m2. Compared with women whose pre-pregnancy body mass index was 21kg/m2, the adjusted risk of delivering a high birth weight infant doubled when the mother's pre-pregnancy body mass index was 29kg/m2, and nearly tripled when the mother's pre-pregnancy body mass index was 31kg/m2. Compared with women who had a gestational weight gain of 12.0kg, women having a gestational weight gain of 20.0kg, 22.0kg, and 26.0kg had a 1.7-, 2.2-, and 3.5-fold increased risk of delivering a high birth weight infant. When the mother experiences a gestational weight gain greater than 27kg, the risk of delivering a high birth weight infant is at least 4-fold greater than that for a mother who has a gestational weight gain of 12.0kg. CONCLUSIONS Proposed strategies to raise public awareness of the risks to infants posed by high maternal pre-pregnancy body mass index and gestational weight gain are required. All clinical recommendations and measures are for all pregnant women, not just overweight and obese pregnant women.
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Affiliation(s)
- Danhua Zhang
- Departments of Public Health, Shandong University, Jinan, PR China; Shandong University, 44 Wenhua Xi Road, Jinan, Shandong 250012, PR China
| | - Longfei Zhang
- Departments of Public Health, Shandong University, Jinan, PR China; Shandong University, 44 Wenhua Xi Road, Jinan, Shandong 250012, PR China
| | - Zhiping Wang
- Departments of Public Health, Shandong University, Jinan, PR China; Shandong University, 44 Wenhua Xi Road, Jinan, Shandong 250012, PR China.
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