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Hu D, Zhou Z, Ge Y, Su X, Tan J. Effect modification of pre-pregnancy body mass index on association of gestational weight gain with birth weight. Heliyon 2024; 10:e38478. [PMID: 39416842 PMCID: PMC11481622 DOI: 10.1016/j.heliyon.2024.e38478] [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: 03/04/2024] [Revised: 09/24/2024] [Accepted: 09/25/2024] [Indexed: 10/19/2024] Open
Abstract
Background Maternal weight status, before or during pregnancy, is a significant determinant of fetus development, birth weight, and the short-term and long-term health outcomes of the offspring. Objective This study aimed to evaluate the effect modification of pre-pregnancy body mass index (BMI) on the associations of gestational weight gain (GWG) and birth weight, as per the latest guidelines from the Chinese Nutrition Society. Methods This is a retrospective cohort study performed in a tertiary hospital with the largest deliveries in Shanghai, China. This study included all women who had singleton live births from 2021 to 2022 (n = 50,391). Data on pre-pregnancy weight, GWG, and birth weight were extracted from the medical register system. Logistic regression models were used to estimate the associations of pre-pregnancy BMI and GWG with the risks of being small for gestational age (SGA) and large for gestational age (LGA). The potential for effect modification by BMI on the associations of GWG and birth weight was assessed using both additive and multiplicative scales. Results Pre-pregnancy BMI and GWG were consistently associated with birth weight. We observed a positive effect modification by underweight on the relationships between insufficient GWG and SGA both in multiplicative (adjusted odds ratio (OR), 2.49, 95 % confidence interval (CI): 2.06-2.99), and additive (relative excess risk due to interaction (RERI), 3.04, 95 % CI: 1.70-4.37) scales. Similarly, obesity was found to modify the effect of excessive GWG on the risk of LGA (adjusted OR, 3.82, 95 % CI, 3.14-4.63; RERI, 14.67, 95 % CI: 7.92-21.41). Conclusion Our findings indicate that increased GWG is associated with a higher risk of abnormal birth weight in singleton pregnancies. Additionally, there is evidence of an additive interaction between pre-pregnancy BMI and GWG on the risk of small for gestational age or large for gestational age.
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Affiliation(s)
- Dan Hu
- Department of Medical Affairs, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Number 2699 West Gaoke Road, Shanghai, China
| | - Zheying Zhou
- Department of Outpatient Medical Records, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Number 2699 West Gaoke Road, Shanghai, China
| | - Yingjie Ge
- Department of Medical Affairs, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Number 2699 West Gaoke Road, Shanghai, China
| | - Xiujuan Su
- Clinical Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Number 2699 West Gaoke Road, Shanghai, China
| | - Jing Tan
- Department of Medical Affairs, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Number 2699 West Gaoke Road, Shanghai, China
- Department of Nutrition, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Number 2699 West Gaoke Road, Shanghai, China
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Zhu Y, Wang L, Qi Q, Cheng Y, Zhu Z, Zeng L. Associations between gestational weight gain under different guidelines and adverse birth outcomes: A secondary analysis of a randomized controlled trial in rural western China. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002691. [PMID: 38190379 PMCID: PMC10773947 DOI: 10.1371/journal.pgph.0002691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/10/2023] [Indexed: 01/10/2024]
Abstract
Several gestational weight gain (GWG) guidelines have been established based on monocenter or multicenter researches. We aimed to examine the associations between categories of GWG under the Institute of Medicine (IOM) recommendation guideline, the Chinese National Health Commission (NHC) guideline, and weight-gain-for-gestational-age z-scores derived from the INTERGROWTH-21st Project and adverse birth outcomes. We used data from an antenatal micronutrient supplementation trial in rural western China between 2002 and 2006. Maternal weekly average GWG during the second and third trimesters was calculated and classified into inadequate, adequate and excessive GWG according to the IOM and NHC, respectively. Weight-gain-for-gestational-age z-scores derived from the INTERGROWTH-21st Project were grouped into three subgroups using two approaches: z-score percentile<25th, 25th to 75th, >75th and z-score <-1, -1 to 1, >1 SD. Infant birth weight and gestational age were measured using standard approaches. Generalized linear model with binomial family and logit link was applied to estimate the odds ratio (OR) and 95% confidential intervals (CI) for GWG categories and adverse birth outcomes. Among 1,239 women with normal weight (18.5 kg/m2 to 23.9 kg/m2) during early pregnancy, 18.0% and 34.2% were classified as adequate GWG according to IOM and NHC, respectively. Less than half of Chinese women reached optimal GWG by any recommendation guideline. According to NHC, excessive GWG showed a significant association with macrosomia (OR 3.75, 95% CI 1.03, 13.74), large-for-gestation-age (LGA) (OR 2.12, 95% CI 1.01, 4.45), and inadequate GWG was associated with post-term birth (OR 2.25, 95% CI 1.21, 4.16), compared with adequate GWG. Inappropriate GWG was associated with adverse birth outcomes even among women with normal weight during early pregnancy. The monitoring and interventions of weight status during pregnancy, especially for the second and third trimesters, are of great public health importance for optimal birth outcomes. Additionally, developing guideline of appropriate GWG ranges should account for the traits of regional population.
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Affiliation(s)
- Yingze Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, P.R. China
| | - Liang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, P.R. China
| | - Qi Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, P.R. China
| | - Yue Cheng
- Department of Nutrition and Food Safety Research, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, P.R. China
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, P.R. China
- Center for Chronic Disease Control and Prevention, Global Health Institution, Xi’an Jiaotong University, Xi’an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, P.R. China
- Center for Chronic Disease Control and Prevention, Global Health Institution, Xi’an Jiaotong University, Xi’an, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi’an, China
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3
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Carrilho TRB, Hutcheon JA, Rasmussen KM, Reichenheim ME, Farias DR, Freitas-Costa NC, Kac G. Gestational weight gain according to the Brazilian charts and its association with maternal and infant adverse outcomes. Am J Clin Nutr 2023; 117:414-425. [PMID: 36811564 DOI: 10.1016/j.ajcnut.2022.11.021] [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: 08/10/2022] [Revised: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The lack of gestational weight gain (GWG) recommendations for low- and middle-income countries is a significant concern. OBJECTIVES To identify the ranges on the Brazilian GWG charts associated with lowest risks of selected adverse maternal and infant outcomes. METHODS Data from 3 large Brazilian datasets were used. Pregnant individuals aged ≥18, without hypertensive disorders or gestational diabetes were included. Total GWG was standardized to gestational age-specific z-scores according to Brazilian GWG charts. A composite infant outcome was defined as the occurrence of any of small-for-gestationa lage (SGA), large-forgestationa lage (LGA), or preterm birth. In a separate sample, postpartum weight retention (PPWR) was measured at 6 and/or 12 mo postpartum. Multiple logistic and Poisson regressions were performed with GWG z-scores as the exposure and individual and composite outcomes. GWG ranges associated with the lowest risk of the composite infant outcome were identified using noninferiority margins. RESULTS For the neonatal outcomes, 9500 individuals were included in the sample. For PPWR, 2602 and 7859 individuals were included at 6 and 12 mo postpartum, respectively. Overall, 7.5% of the neonates were SGA, 17.6% LGA, and 10.5% were preterm. Higher GWG z-scores were positively associated with LGA birth, whereas lower z-scores were positively associated with SGA births. The risk of the selected adverse neonatal outcomes were lowest (within 10% of lowest observed risk) when individuals with underweight, normal weight, overweight, or obesity gained between 8.8-12.6; 8.7-12.4; 7.0-8.9; and 5.0-7.2 kg, respectively. These gains correspond to probabilities of PPWR ≥5 kg at 12 mo of 30% for individuals with under and normal weight, and <20% for overweight and obesity. CONCLUSIONS This study provided evidence to inform new GWG recommendations in Brazil.
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Affiliation(s)
- Thais Rangel Bousquet Carrilho
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | | | - Michael E Reichenheim
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Dayana Rodrigues Farias
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nathalia Cristina Freitas-Costa
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Gong Y, Xu Y, Wan K, Wang Y, Zeng L, Zou K, Chen Y, Yang D, Xiong J, Zhao L, Zhang L, Shimokawa T, Cheng G. A prospective analysis of optimal total weight gain ranges and trimester-specific weight gain rates for Chinese pregnant women. BMC Pregnancy Childbirth 2023; 23:60. [PMID: 36694176 PMCID: PMC9872325 DOI: 10.1186/s12884-023-05398-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Gestational weight gain (GWG) criteria recommended by the Institute of Medicine may not be appropriate for Asians. Our aims are to investigate the association between GWG and adverse pregnancy outcomes, and to propose optimal total GWG and rates of GWG for Chinese women. METHODS Prospective data of 51,125 mother-child pairs from 27 hospitals and community health care centers from Guizhou, Yunnan and Sichuan provinces in China between 2014 and 2018 were analyzed. Generalized Additive Models were performed to determine the associations of GWG with the risk of aggregated adverse outcomes (gestational diabetes mellitus, preeclampsia, cesarean delivery, stillbirth, preterm birth, macrosomia, large for gestational age, and small for gestational age). The range that did not exceed a 2.5% increase from the lowest risk of aggregated adverse outcomes was defined as the optimal GWG range. RESULTS Among all participants, U-shaped prospective association was found between GWG and the risk of aggregated adverse pregnancy outcomes. The optimal GWG range of 8.2-13.0 kg was proposed for underweight, 7.3-12.5 kg for normal weight, and 2.0-9.4 kg for overweight/obese women. Meanwhile, a higher GWG rate in the first two trimesters than that in the last trimester was suggested, except for overweight/obese women. After stratified by maternal age, mothers ≥35 years were suggested to gain less weight compared to younger mothers. CONCLUSIONS To keep a balance between maternal health and neonatal growth, optimal GWG ranges based on Asia-specific BMI categories was suggested for Chinese women with different pre-gravid BMIs and maternal ages.
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Affiliation(s)
- Yunhui Gong
- grid.13291.380000 0001 0807 1581Department of Gynaecology, West China Women’s and Children’s Hospital, Sichuan University, Chengdu, China
| | - Yujie Xu
- grid.13291.380000 0001 0807 1581Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Women’s and Children’s Hospital, Sichuan University, Chengdu, China
| | - Ke Wan
- grid.412857.d0000 0004 1763 1087Department of Medical Data-science, Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yidi Wang
- grid.13291.380000 0001 0807 1581West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Linan Zeng
- grid.13291.380000 0001 0807 1581Department of Pharmacy, Evidence-Based Pharmacy Center, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), West China Women’s and Children’s Hospital, Sichuan University, Chengdu, China
| | - Kun Zou
- grid.13291.380000 0001 0807 1581Department of Pharmacy, Evidence-Based Pharmacy Center, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), West China Women’s and Children’s Hospital, Sichuan University, Chengdu, China
| | - Yue Chen
- grid.410578.f0000 0001 1114 4286School of Public Health, Southwest Medical University, Luzhou, China
| | - Dagang Yang
- grid.452244.1Department of Clinical Nutrition, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jingyuan Xiong
- grid.13291.380000 0001 0807 1581West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Li Zhao
- grid.13291.380000 0001 0807 1581West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Lingli Zhang
- grid.13291.380000 0001 0807 1581Department of Pharmacy, Evidence-Based Pharmacy Center, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), West China Women’s and Children’s Hospital, Sichuan University, Chengdu, China
| | - Toshio Shimokawa
- grid.412857.d0000 0004 1763 1087Department of Medical Data-science, Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Guo Cheng
- grid.13291.380000 0001 0807 1581Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Women’s and Children’s Hospital, Sichuan University, Chengdu, China
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Fan X, Dai J, He J, Tian R, Xu J, Song J, Bai J, Liu Y, Zou Z, Chen X. Optimal gestational weight gain in Chinese pregnant women with gestational diabetes mellitus: A large retrospective cohort study. J Obstet Gynaecol Res 2023; 49:182-193. [PMID: 36184564 DOI: 10.1111/jog.15448] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/11/2022] [Accepted: 09/16/2022] [Indexed: 01/19/2023]
Abstract
AIM To examine the optimal gestational weight gain (GWG) for Chinese pregnant women with gestational diabetes mellitus (GDM) based on the Chinese-specific body mass index (BMI) classification. METHODS A retrospective cohort study was conducted using the 2017-2020 data from pregnant women with GDM in a tertiary hospital. A quadratic function model and the total predicted probability of adverse pregnancy outcomes were developed to obtain the optimal GWG. Differences in the incidence of adverse pregnancy outcomes between our optimal GWG recommendations and the Institute of Medicine (IOM) 2009 GWG guidelines were also analyzed. RESULTS A total of 8103 pregnant women with GDM were analyzed. Based on the Chinese-specific BMI classification, the optimal GWG range was 11.0-17.5 kg for underweight women, 3.7-9.7 kg for normal-weight women, -0.6 to 4.8 kg for overweight women, and - 9.8 to 4.2 kg for obese women. Excessive GWG had a higher risk of large for gestational age (LGA) (OR: 2.99, 95% CI: 2.42-3.70), macrosomia (OR: 2.35, 95% CI: 1.77-3.12), pre-eclampsia (OR: 1.91, 95% CI: 1.37-2.65), gestational hypertension (OR: 1.65, 95% CI: 1.24-2.19), cesarean section (OR: 1.29, 95% CI: 1.15-1.44), postpartum hemorrhage (OR: 1.29, 95% CI: 1.02-1.64); insufficient GWG had a higher risk of small for gestational age (OR: 1.82, 95% CI: 1.20-2.75). Compared to the IOM 2009 GWG guidelines, the prevalence of macrosomia, LGA, and postpartum hemorrhage were significantly lower in pregnant women following the implementation of our recommended GWG range (p < 0.05). CONCLUSIONS Compared to the IOM 2009 GWG recommendations, our optimal GWG recommendations for Chinese pregnant women were more sensitive.
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Affiliation(s)
- Xiaoxiao Fan
- Wuhan University School of Nursing, Wuhan University, Wuhan, China
| | - Jiamiao Dai
- Wuhan University School of Nursing, Wuhan University, Wuhan, China
| | - Jing He
- Wuhan University School of Nursing, Wuhan University, Wuhan, China
| | - Ruixue Tian
- Wuhan University School of Nursing, Wuhan University, Wuhan, China
| | - Jingqi Xu
- Wuhan University School of Nursing, Wuhan University, Wuhan, China
| | - Jiayang Song
- Wuhan University School of Nursing, Wuhan University, Wuhan, China
| | - Jinbing Bai
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA
| | - Yanqun Liu
- Wuhan University School of Nursing, Wuhan University, Wuhan, China
| | - Zhijie Zou
- Wuhan University School of Nursing, Wuhan University, Wuhan, China
| | - Xiaoli Chen
- Wuhan University School of Nursing, Wuhan University, Wuhan, China
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Lyu J, Sun Y, Ji Y, Liu N, Zhang S, Lin H, Wang Y, Yang X, Ma S, Han N, Mi Y, Zheng D, Yang Z, Zhang H, Jiang Y, Ma L, Wang H. Optimal Gestational Weight Gain for Women with Gestational Diabetes Mellitus — China, 2011–2021. China CDC Wkly 2023; 5:189-193. [PMID: 37007862 PMCID: PMC10061829 DOI: 10.46234/ccdcw2023.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
What is already known about this topic? Joint effects of gestational weight gain (GWG) and hyperglycemia on adverse pregnancy outcomes suggest that lower optimal GWG is optimal for women with gestational diabetes mellitus (GDM). However, there is still a lack of guidelines. What is added by this report? Optimal weekly GWG range after diagnosis of GDM for underweight, normal-weight, overweight, and obese women was 0.37-0.56 kg/week, 0.26-0.48 kg/week, 0.19-0.32 kg/week, and 0.12-0.23 kg/week, respectively. What are the implications for public health practice? The findings may be used to inform prenatal counseling regarding optimal gestational weight gain for women with gestational diabetes mellitus, and suggest the need for weight gain management.
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Affiliation(s)
- Jinlang Lyu
- School of Public Health, Peking University, Beijing Municipality, China
| | - Yin Sun
- Peking Union Medical College Hospital, Beijing Municipality, China
| | - Yuelong Ji
- School of Public Health, Peking University, Beijing Municipality, China
| | - Nana Liu
- Peking Union Medical College Hospital, Beijing Municipality, China
| | - Suhan Zhang
- Peking Union Medical College Hospital, Beijing Municipality, China
| | - Hang Lin
- Peking Union Medical College Hospital, Beijing Municipality, China
| | - Yaxin Wang
- Peking Union Medical College Hospital, Beijing Municipality, China
| | - Xuanjin Yang
- Peking Union Medical College Hospital, Beijing Municipality, China
| | - Shuai Ma
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Municipality, China
| | - Na Han
- Tongzhou Maternal and Child Health Hospital, Beijing Municipality, China
| | - Yang Mi
- Northwest Women’s and Children’s Hospital, Xi'an City, Shaanxi Province, China
| | - Dan Zheng
- Guiyang Maternal and Child Health Hospital, Guiyang City, Guizhou Province, China
| | - Zhifen Yang
- The Fourth Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | - Hongping Zhang
- Wenzhou People’s Hospital, Wenzhou City, Zhejiang Province, China
| | - Yan Jiang
- People’s Hospital of Dong’e County, Liaocheng City, Shandong Province, China
| | - Liangkun Ma
- Peking Union Medical College Hospital, Beijing Municipality, China
- Liangkun Ma,
| | - Haijun Wang
- School of Public Health, Peking University, Beijing Municipality, China
- Haijun Wang,
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