Pre-pregnancy body mass index and caesarean section in Andean women in Peru: a prospective cohort study

BACKGROUND

During the last two decades, Caesarean section rates (C-sections), overweight and obesity rates increased in rural Peru. We examined the association between pre-pregnancy body mass index (BMI) and C-section in the province of San Marcos, Northern Andes-Peru.

METHODS

This is a prospective cohort study. Participants were women receiving antenatal care in public health establishments from February 2020 to January 2022, who were recruited and interviewed during pregnancy or shortly after childbirth. They answered a questionnaire, underwent a physical examination and gave access to their antenatal care card information. BMI was calculated using maternal height, measured by the study team and self-reported pre-pregnancy weight measured at the first antenatal care visit. For 348/965 (36%) women, weight information was completed using self-reported data collected during the cohort baseline. Information about birth was obtained from the health centre's pregnancy surveillance system. Regression models were used to assess associations between C-section and BMI. Covariates that changed BMI estimates by at least 5% were included in the multivariable model.

RESULTS

This study found that 121/965 (12.5%) women gave birth by C-section. Out of 495 women with pre-pregnancy normal weight, 46 (9.3%) had C-sections. Among the 335 women with pre-pregnancy overweight, 53 (15.5%) underwent C-sections, while 23 (18.5%) of the 124 with pre-pregnancy obesity had C-sections. After adjusting for age, parity, altitude, food and participation in a cash transfer programme pre-pregnancy overweight and obesity increased the odds of C-section by more than 80% (aOR 1.82; 95% CI 1.16-2.87 and aOR 1.85; 95% CI 1.02-3.38) compared to women with a normal BMI.

CONCLUSIONS

High pre-pregnancy BMI is associated with an increased odds of having a C-section. Furthermore, our results suggest that high BMI is a major risk factor for C-section in this population. The effect of obesity on C-section was partially mediated by the development of preeclampsia, suggesting that C-sections are being performed due to medical reasons.

Association of prenatal exposure to PM2.5 and NO2 with gestational diabetes in Western New York

BACKGROUND

Although many studies have examined the association between prenatal air pollution exposure and gestational diabetes (GDM), the relevant exposure windows remain inconclusive. We aim to examine the association between preconception and trimester-specific exposure to PM2.5 and NO2 and GDM risk and explore modifying effects of maternal age, pre-pregnancy body mass index (BMI), smoking, exercise during pregnancy, race and ethnicity, and neighborhood disadvantage.

METHODS

Analyses included 192,508 birth records of singletons born to women without pre-existing diabetes in Western New York, 2004-2016. Daily PM2.5 and NO2 at 1-km2 grids were estimated from ensemble-based models. We assigned each birth with exposures averaged in preconception and each trimester based on residential zip-codes. We used logistic regression to examine the associations and distributed lag models (DLMs) to explore the sensitive windows by month. Relative excess risk due to interaction (RERI) and multiplicative interaction terms were calculated.

RESULTS

GDM was associated with PM2.5 averaged in the first two trimesters (per 2.5 μg/m3: OR = 1.08, 95% CI: 1.01, 1.14) or from preconception to the second trimester (per 2.5 μg/m3: OR = 1.10, 95% CI: 1.03, 1.18). NO2 exposure during each averaging period was associated with GDM risk (per 10 ppb, preconception: OR = 1.10, 95% CI: 1.06, 1.14; first trimester: OR = 1.12, 95% CI: 1.08, 1.16; second trimester: OR = 1.10, 95% CI: 1.06, 1.14). In DLMs, sensitive windows were identified in the 5th and 6th gestational months for PM2.5 and one month before and three months after conception for NO2. Evidence of interaction was identified for pre-pregnancy BMI with PM2.5 (P-for-interaction = 0.023; RERI = 0.21, 95% CI: 0.10, 0.33) and with NO2 (P-for-interaction = 0.164; RERI = 0.16, 95% CI: 0.04, 0.27).

CONCLUSION

PM2.5 and NO2 exposure may increase GDM risk, and sensitive windows may be the late second trimester for PM2.5 and periconception for NO2. Women with higher pre-pregnancy BMI may be more susceptible to exposure effects.

MTNR1B gene variations and high pre-pregnancy BMI increase gestational diabetes mellitus risk in Chinese women

AIM

To investigate the association of melatonin receptor 1B (MTNR1B) gene variations and pre-pregnancy body mass index (BMI) with gestational diabetes mellitus (GDM).

MATERIALS AND METHOD

In this study, 1566 Chinese Han pregnant women were enrolled and multiple genetic models were used to evaluate the association between MTNR1B gene polymorphisms and the risk of GDM. The clinical value of pre-pregnancy BMI in predicting GDM was analyzed and evaluated using receiver operating characteristic (ROC) curves. Several methods of analysis were used to examine the impact of gene-gene and gene-BMI interactions on the incidence of GDM influence.

RESULTS

For the MTNR1B gene, rs1387153 (C > T), rs10830962 (C > G), rs4753426 (T > C), and rs10830963 (C > G) are all risk mutations associated with the susceptibility of GDM. The ROC curve analysis indicated that the BMI demonstrated an area under the curve (AUC) of 0.595. Alongside, the sensitivity and specificity stood at 0.676 and 0.474 respectively. The maximum Joden index was found to be 0.150, with a corresponding critical BMI value of 20.5691 kg/m2. Interaction analysis revealed that gene-gene and gene-BMI interactions had no significant effect on GDM occurrence.

CONCLUSION

MTNR1B genetic variations confers the risk to GDM in Chinese women. Furthermore, the high pre-pregnancy BMI (≥20.5691 kg/m2) significantly increases the risk of GDM in Chinese women.

Maternal Height Is an Independent Risk of Adverse Outcomes in Women with Gestational Diabetes Mellitus

INTRODUCTION

Maternal height has been shown to be associated with adverse outcomes in women with gestational diabetes mellitus (GDM). The aim of this study is to evaluate the association between maternal height and adverse outcomes stratified for gestational weight gain (GWG) and pre-pregnancy body mass index (BMI) in women with GDM.

METHODS

We conducted a retrospective study that included 2048 women diagnosed with GDM during 24-28 gestational weeks from July 1, 2017, to June 30, 2018, in Zhejiang Province, China. Demographic data, maternal characteristics and pregnancy complications were extracted from medical records. Maternal height was divided into three categories by tertiles. Chi-square was used to evaluate categorical data while one-way ANOVA was utilized to analyze continuous variables. The relationship between maternal height and adverse outcomes was examined using logistic regression.

RESULTS

We found that shorter women had higher rates of low birth weight (LBW) (p = 0.003) and primary cesarean section (primary CS) (p < 0.001) while taller women had higher rates of abnormal neonatal ponderal index (p < 0.001), postpartum hemorrhage (p = 0.044) and macrosomia (p < 0.001). In taller women who had excess GWG, maternal height was positively associated with the risk of macrosomia (aOR 1.97, 95% CI 0.95-4.10). In shorter women who had inadequate GWG, maternal height was significantly associated with LBW (aOR 2.20, 95% CI 1.13-4.29) and primary CS (aOR 2.08, 95% CI 1.38-3.12). Maternal height was a protective factor of postpartum hemorrhage (aOR 0.15, 95% CI 0.03-0.72) in shorter women with excess GWG. In women with normal pre-pregnancy BMI, maternal height was positively associated with LBW (aOR 2.00, 95% CI 1.15-3.49) and primary CS (aOR 1.71, 95% CI 1.28-2.28) in shorter women while it was negatively associated with the risk of abnormal neonatal ponderal index in both shorter and taller women compared to average height women (aOR 0.71, 95% CI 0.55-0.92; aOR 0.66, 95% CI 0.51-0.85).

CONCLUSION

The association between maternal height and adverse pregnancy outcomes varies with pre-pregnancy BMI and GWG in GDM women. Taking maternal height, pre-pregnancy BMI and GWG into account and using personalized prenatal management may reduce the risk of adverse pregnancy outcomes in GDM.

Is the association between mothers' autistic traits and childhood autistic traits moderated by maternal pre-pregnancy body mass index?

BACKGROUND

Previous studies showed that there is a positive association between mothers' and children's autistic traits. We also tested if this association is more pronounced in mothers with a higher pre-pregnancy body mass index (BMI).

METHOD

The study was embedded in two cohorts with information available for 4,659 participants from the Generation R and for 179 participants from the Cambridge Ultrasound Siblings and Parents Project (CUSP) cohort. In both cohorts, maternal autistic traits were assessed using the short form of the Autism Spectrum Quotient, and information about maternal height and weight before pregnancy was obtained by questionnaire. Child autistic traits were assessed with the short form of Social Responsiveness Scale in Generation R (M = 13.5 years) and with the Quantitative Checklist for Autism in Toddlers (Q-CHAT) in the CUSP cohort (M = 1.6 years).

RESULT

Higher maternal autistic traits were associated with higher autistic traits in toddlerhood (CUSP cohort; βadjusted = 0.20, p < 0.01), in early childhood (Generation R; βadjusted = 0.19, p < 0.01), and in early adolescence (Generation R; βadjusted = 0.16, p < 0.01). Furthermore, a higher maternal pre-pregnancy BMI was associated with higher child autistic traits, but only in Generation R (βadjusted = 0.03, p < 0.01). There was no significant moderating effect of maternal pre-pregnancy BMI on the association between autistic traits of mothers and children, neither in Generation R nor in CUSP. In addition, child autistic traits scores were significantly higher in mothers who were underweight and in mothers who were overweight compared to mothers with a healthy weight.

CONCLUSION

We confirm the association between maternal and child autistic traits in toddlerhood, early childhood, and early adolescence. Potential interacting neurobiological processes remain to be confirmed.

Association of pre-pregnancy body mass index with early- and late-onset severe preeclampsia

Objective

To determine whether maternal pre-pregnancy body mass index is associated with preeclampsia with severe features, categorized as early- or late-onset.

Study design

This retrospective cohort study was conducted at the Department of Obstetrics and Gynecology, Rajavithi Hospital. The inclusion criteria were singleton pregnant women who gave birth at Rajavithi Hospital between January 1, 2015 and October 31, 2019. The study group was pregnant women diagnosed with preeclampsia with severe features while the control group was those without preeclampsia. Body mass index was classified based on The Regional Office for the Western Pacific Region of the World Health Organization criteria. The primary outcome was association of pre-pregnancy body mass index and risk of preeclampsia with severe features, classified by gestational age into early- (< 34 weeks) and late- (≥ 34 weeks) onset preeclampsia. Comparisons were made using the Student's t-test, Chi-square, or Fisher's exact tests, as appropriate. Logistic regression was used to assess associations.

Results

There were 589 pregnant women in the control group and 519 women with preeclampsia in the study group. The study group was subdivided into early-onset (32.4 %, 168/519) and late-onset (67.6 %, 351/519) preeclampsia. Women who had preeclampsia with severe features had higher mean pre-pregnancy BMI than those without preeclampsia. Women with class I (63.6 %, 136/214) and II (81.0 %, 111/137) obesity (body mass index, 25.0-29.9 and ≥ 30.0 kg/m2, respectively) had significantly increased risk of preeclampsia with severe features (adjusted odds ratio 2.71, 95 % confidence interval 1.85-4.00 and adjusted odds ratio 3.84, 95 % confidence interval 2.22-6.64, respectively). In preeclampsia subgroup analysis, class I obesity was significantly associated with late-onset severe preeclampsia (adjusted odds ratio 2.02, 95 % confidence interval 1.40-2.93), while class II obesity was significantly associated with both early- and late-onset severe preeclampsia (adjusted odds ratio 1.69, 95 % confidence interval 1.01-2.84 and adjusted odds ratio 2.13, 95 % confidence interval 1.36-3.33, respectively).

Conclusions

Class I and II obesity are significantly associated with preeclampsia with severe features. Class I obesity is significantly related to late-onset severe preeclampsia with, whereas class II obesity is associated with both early- and late-onset severe preeclampsia.

Pre-pregnancy body mass index and risk of maternal or infant complications with gestational diabetes mellitus as a mediator: A multicenter, longitudinal cohort study in China

AIMS

We explored the complex relationships between pre-pregnancy body mass index (pBMI) and maternal or infant complications and the mediating role of gestational diabetes mellitus (GDM) in these relationships.

METHODS

Pregnant women from 24 hospitals in 15 different provinces of China were enrolled in 2017 and followed through 2018. Propensity score-based inverse probability of treatment weighting, logistic regression, restricted cubic spline models, and causal mediation analysis were utilized. In addition, the E-value method was used to evaluate unmeasured confounding factors.

RESULTS

A total of 6174 pregnant women were finally included. Compared to women with a normal pBMI, obese women had a higher risk for gestational hypertension (odds ratio [OR] = 5.38, 95% confidence interval [CI]: 3.48-8.34), macrosomia (OR = 2.65, 95% CI: 1.83-3.84), and large for gestational age (OR = 2.05, 95% CI: 1.45-2.88); 4.73% (95% CI: 0.57%-8.88%), 4.61% (95% CI: 0.51%-9.74%), and 5.02% (95% CI: 0.13%-10.18%) of the associations, respectively, were mediated by GDM. Underweight women had a high risk for low birth weight (OR = 1.42, 95% CI: 1.15-2.08) and small for gestational age (OR = 1.62, 95% CI: 1.23-2.11). Dose-response analyses indicated that 21.0 kg/m² may be the appropriate tipping point pBMI for risk for maternal or infant complications in Chinese women.

CONCLUSION

A high or low pBMI is associated with the risk for maternal or infant complications and partly mediated by GDM. A lower pBMI cutoff of 21 kg/m² may be appropriate for risk for maternal or infant complications in pregnant Chinese women.

The investigation of the association of pregnancy weight gain on maternal and neonatal gut microbiota composition and abundance using 16sRNA sequencing

OBJECTIVE

To investigate the association of pregnancy weight gain on gut microbiota in pregnant women and newborns.

METHODS

Pregnant women who had regular antenatal check-ups and were hospitalised for delivery at Shanxi Maternal and Child Health Hospital from September 2020 to December 2020 were selected as the study subjects. They were divided into the normal pre-pregnancy weight-normal pregnancy weight gain group (N-NG group), the normal pregnancy weight-excessive pregnancy weight gain group (N-EG group), the pre-pregnancy overweight/obese-normal pregnancy weight gain group (O-NG group) and the pre-pregnancy overweight/obese-excessive pregnancy weight gain group (O-EG group). Faecal samples of the pregnant women before delivery (37-41^+ 6 weeks of gestation) and the first meconium samples of their newborns were collected, sequenced for 16S rRNA gut microbiota and analysed. The results of different gut microbiota were compared separately. χ2 test, a one-way analysis of variance or the rank sum test were performed according to data type and distribution. The differences in the Alpha diversity between the groups were analysed using the Kruskal-Wallis rank sum test. The differences in the Beta diversity between the groups were analysed using the Adonis method.

RESULTS

A total of 126 pre-delivery faecal samples from pregnant women and the first faecal samples from their newborns were collected. Seven species with significant abundance differences between the maternal O-NG and N-EG groups and 27 species with significant abundance differences in the newborns were analysed by LEfSe. In the Alpha diversity analysis, the differences in the maternal observed species index and the Chao1 index were statistically significant (p < 0.05) when compared between the groups (O-EG group versus the O-NG group, N-EG group and N-NG group), and the differences in the Shannon index and Simpson index were not statistically significant (p > 0.05) when compared between the groups. The neonatal observed species index, Chao1 index, Shannon index and Simpson index showed statistically significant differences in the comparison between the N-EG and O-EG groups (p < 0.05). In the Beta diversity analysis, the maternal samples did not differ Significantly between the four groups (p > 0.05), while the neonatal samples differed Significantly between the N-EG and N-NG, O-NG, and O-EG groups (p < 0.05).

CONCLUSION

Pregnancy weight gain affects the composition and abundance of maternal and neonatal gut microbiota species as well as the diversity of neonatal gut microbiota.

The interactive effects of pre-pregnancy body mass index, thyroid function, and blood lipid levels on the risk of gestational diabetes mellitus: a crossover analysis

Background

Studies have demonstrated the associations between pre-pregnancy obesity, thyroid dysfunction, dyslipidemia, and increased risk of gestational diabetes mellitus (GDM) in pregnant women. This study was designed to investigate whether and to what extent, the interactions between these factors contribute to the risk of GDM.

Methods

A case–control study of 232 GDM cases and 696 controls was conducted among pregnant women from Hangzhou, China. Multiple logistic regression analysis was applied to identify independent risk factors of GDM. Crossover analysis was performed to assess the interactive effects of pre-pregnancy body mass index (pBMI), thyroid hormones, and blood lipid profiles on the risk of GDM. The indexes including attributable proportion (AP) to the interaction and the relative excess risk due to interaction (RERI) were calculated.

Results

Chinese pregnant women with pBMI > 23 kg/m² (adjusted: OR = 4.162, p < 0.001), high triglyceride levels (> 2.30 mmol/L) (adjusted: OR = 1.735, p < 0.001), and the free triiodothyronine/free thyroxine (FT3/FT4) ratio ≥ 0.502 (OR = 4.162, p < 0.001) have significantly increased risk of GDM. Crossover analysis indicated that there were significant interactions between pre-pregnancy overweight/obesity and FT3/FT4 ≥ 0.502 (AP = 0.550, p < 0.001; RERI = 7.586, p = 0.009), high TG levels and FT3/FT4 ≥ 0.502 (AP = 0.348, 95%CI = 0.081–0.614, P = 0.010; RERI = 2.021, 95%CI = 0.064–3.978, p = 0.043) on the risk of GDM.

Conclusion

The interactions between pBMI and FT3/FT4 ratio, TG level and FT3/FT4 ratio may have significant impacts on the risk of GDM in pregnant women. Such findings may help improve our understanding of the pathogenesis of GDM as well as develop comprehensive strategies for the management of GDM.

Inadequate gestational weight gain contributes to increasing rates of low birth weight in Taiwan: 2011-2016 nationwide surveys

OBJECTIVE

Low birth weight (LBW) is associated with adverse health outcomes. Incidence of LBW in Taiwan grew from 5% in 1997 to 8.4% in 2016. This study aims to identify the role of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) in LBW rate changes during 2011-2016.

MATERIALS AND METHODS

We analyzed 66 135 postpartum women from 6 cross-sectional national surveys. Data were collected through telephone interviews with randomly selected mothers. Logistic regression was applied to assess contribution of maternal characteristics to LBW time changes.

RESULTS

LBW increased from 5.3% to 7.0% during 2011-2016 (crude odds ratio (OR) = 1.04/year, p-value for trend = 0.001). Inadequate GWG increased from 27.9% to 41.5% (p-value for trend <0.001). Along with the increase in overweight (9.7%-11.1%) and obese (4.8%-7.4%), prevalence of underweight fluctuated between 16.0% and 17.8%. LBW increased in underweight group from 6.3% to 9.5% (crude OR = 1.09/year, p-value for trend<0.001). Adjustment for GWG attenuated odds ratio per year in total sample (adjusted OR = 1.03, p-value for trend = 0.04) and in underweight (adjusted OR = 1.08, p-value for trend = 0.002).

CONCLUSIONS

Increasing percentage of women with inadequate GWG could contribute to LBW increase in Taiwan during 2011-2016, especially for the underweight. Prenatal advice on GWG should be individualized according to pre-pregnancy BMI.

Maternal overweight but not paternal overweight before pregnancy is associated with shorter newborn telomere length: evidence from Guangxi Zhuang birth cohort in China

Background

Telomere length (TL) is variable at birth and is inversely associated with body mass index (BMI) in adulthood. A growing number of evidences suggested that a higher maternal pre-pregnancy BMI results in adverse offspring health outcomes, especially shorter newborn TL. However, a newborn’s genetic endowment is equally derived from both parents, the association between parental pre-pregnancy BMI and newborn TL has been rarely discussed. We aimed to determine the association between parental pre-pregnancy BMI and newborn TL.

Methods

A total of 1082 parent-newborn pairs were recruited from the Guangxi Zhuang Birth Cohort (GZBC). TL in cord blood was measured using quantitative real-time polymerase chain reaction (qPCR) and expressed as the ratio of telomere copy number to single-copy gene number (T/S). A series of linear regressions were performed to assess the associations between parental pre-pregnancy BMI and newborn TL.

Results

Mothers who were overweight before pregnancy had significantly shorter cord blood telomere length in their newborns than those who were normal weight before pregnancy [percentage change: − 7.96% (95% CI: − 14.49 to − 0.69%; P = 0.032)]. Further analysis of the combined effects of parental weight status on newborn TL showed that TL was significantly shortened among newborns whose mothers were overweight and fathers were of healthy weight when compared with those whose mothers and fathers were both of normal weight [percentage change: − 8.38% (95% CI: − 15.47 to − 0.92%; P = 0.028)]. Subgroup analysis indicated these effects were more pronounced among male newborns and those whose paternal age < 31 years or maternal age ≥ 28 years at delivery.

Conclusions

Maternal pre-pregnancy overweight, but not paternal pre-pregnancy overweight is associated with shorter newborn TL. Weight control in reproductive women and effective healthy weight management before pregnancy may be of particular benefit for improving longevity and life quality of offspring.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03757-x.

Maternal and fetal outcomes during pregnancy and puerperium in obese and overweight pregnant women. A cohort study

PURPOSE

compare incidences of maternal-fetal complications during pregnancy, labor, and early puerperium according to baseline BMI in a consecutive cohort of pregnant women.

METHODS

This retrospective cohort study compares pregnancy outcome indicators by body mass index (BMI) in 1236 pregnant women managed over the period January 2017 to May 2018. Data were collected regarding the personal history (smoking, diabetes and hypertension), obstetrics and BMI (kg/m²) (normoweight 18.5-24.9, overweight 25-29.9, obese ≥ 30).

RESULTS

Of the 1236 women, 354 (28.6%) were overweight and 206 (16.7%) were obese at the start of pregnancy follow-up. Mean age at this time was 33 years (SD 6). Risk factors for a cesarean-section delivery assessed through logistic regression were maternal age (OR 1.05 95% CI 2.06-6.15; p < 0.001) and previous C-section (OR 4.21 95% CI 2.89-6.14; p < 0.001) regardless of BMI. In a propensity score analysis, pregnancy weight gain was found lower in obese vs normoweight (- 2.73 kg 95% CI - 3.74 to - 1.72 p < 0.001), and newborn weight higher in obese vs normoweight women (161.21 g 95% CI 57.94-264.48 p = 0.002). Labor duration and weight gain were reduced in overweight vs normoweight subjects (- 0.72 h 95% CI - 1.27 to - 0.17 p = 0.010 and 0.81 kg 95% CI - 1.50 to - 0.12 p = 0.021, respectively).

CONCLUSIONS

In this cohort, obese women showed higher rates of prenatal complications yet obesity and overweight were not related to worse puerperium outcomes.

Exposure to heavy metals modifies optimal gestational weight gain: A large nationally representative cohort of the Japan Environment and Children's Study

Clinical guidelines including those set by the US Institute of Medicine, have based optimal gestational weight gain (GWG) on maternal pre-pregnancy body mass index (BMI), but have not considered the role of environmental toxicants such as heavy metals that can disrupt these processes. This study designed to determine optimal GWG ranges in women grouped according to BMI, and to assess whether blood concentrations of heavy metals alter the relationships between GWG and outcomes. A total of 103,060 participants in the Japan Environment and Children's Study recruited between 2011 and 2014 were followed until their children reached 3 years of age. Outcomes included 1 min Apgar score <7, caesarean delivery, childhood obesity, gestational diabetes, pregnancy-induced hypertension, low birth weight, large for gestational age, macrosomia, operative vaginal delivery, postpartum weight retention, preterm birth and small for gestational age. The optimal GWG ranges were determined using multivariate logistic regression models. Stratified analyses were performed to determine optimal GWG ranges according to quartiles of heavy metals. Optimal GWGs for underweight, normal weight and overweight women were found to be 10.0 to <14.0 kg, 6.0 to <12.0 kg and 4.0 to <8.0 kg, respectively. However, the benefits of optimal GWG were attenuated in women exposed to high concentrations of mercury (Hg), lead (Pb) and cadmium (Cd). Despite being within optimal GWG, underweight women with Hg > 5.21 ng/g and overweight women with Hg 3.67-5.21 ng/g, Pb > 7.31 ng/g and Cd > 0.66 ng/g had null effects. Heavy metals can modify the associations between GWG and outcomes, particularly for underweight and overweight women. Because of the complex interactions of environmental toxicants with pre-pregnancy BMI, GWG and adverse outcomes, GWG guidelines should be interpreted cautiously. Environmental toxicants may influence the determination of a clinical guideline.

Maternal dietary pattern in early pregnancy is associated with gestational weight gain and hyperglycemia: A cohort study in South West of Iran

BACKGROUND AND AIMS

Maternal dietary pattern could influence on fetal health outcome. Thus, this study was conducted to evaluate the relationship between maternal dietary pattern and Gestational Weight Gain (GWG) in each trimester and hyperglycemia amongst Arab pregnant women in south-west of Iran.

METHODS

This longitudinally study was performed in urban healthcare centers of south-west of Iran. Among 610 candidates, 488 pregnant women were included in the final analysis. Consequently, two diet patterns were determined by principal component analysis and the association between GWG and blood glucose level was determined using quartile regression. Using generalized linear model, a model was adjusted for pre-pregnancy BMI, maternal age, income, and education levels.

RESULTS

Two dietary patterns were identified as follows: "high fat -fast food" and "vegetable-fruits & protein" pattern. High adherence to "high fat -fast food" pattern was associated with higher GWG and hyperglycemia in 3rd trimester (adjusted β: 0.029 95%CI 0.012; 0.049 P = 0.001) (adjusted β: 0.029 95%CI 0.012; 0.049 P = 0.001) respectively. High tendency to "vegetable-fruits & protein" pattern was inversely associated with development of hyperglycemia in 3rd trimester. Higher SES level was associated with low adherence to "high fat-fast food" pattern.

CONCLUSION

Findings of the study revealed that, higher adherence to high -fat diet is related to excessive GWG and hyperglycemia in late pregnancy.

Low birth weight and abnormal pre-pregnancy body mass index were at higher risk for hypertensive disorders of pregnancy

Low birth weight is known to be associated with hypertension, cardiovascular disease and hypertensive disorders of pregnancy (HDP); however, this association might vary by race/ethnicity. This study aimed to clarify the association between women's own birth weight and their subsequent risk for HDP in a Japanese population, in combination with pre-pregnancy body mass index (BMI). We conducted a cohort study as part of the Tohoku Medical Megabank Birth and Three-Generation Cohort Study in Miyagi, Japan. Our study's population included 4810 women. A multivariate logistic regression analysis was performed to calculate the adjusted odds ratio (aOR) and the 95% confidence interval (CI) of the women's own birth weight for HDP, in the combination categories of birth weight and pre-pregnancy BMI. As a result, the group with a low birth weight of <2500 g had a significant association with HDP (the aOR, 1.50; 95% CI, 1.02-2.21). In the subtype analysis, the odds ratio for only preeclampsia was significantly increased in the low birth weight group (aOR, 3.37; 95% CI, 1.84-6.16). In the group with a low birth weight, the prevalence of HDP was higher in both the underweight and overweight groups. In conclusion, there was a significant association between low birth weight and subsequent HDP in Japanese women. Furthermore, a significant association with HDP was found for women born with a low birth weight who were underweight or overweight as adults. Maintaining a normal weight may be effective for preventing HDP even if a woman was born small.

Does overweight before pregnancy reduce the occurrence of gastroschisis?: the Japan Environment and Children's Study

Objective

For several observational studies that have reported the factors related to gastroschisis, the target population in these studies was mainly residents of Europe or the US, and there is little data on the Asian population. In this study, we summarised characteristics of Japanese women who delivered infants with gastroschisis, particularly focusing on the pre-pregnancy body mass index (BMI), which was found to be inversely associated with gastroschisis in past studies, because the distribution of BMI is clearly different in Asia and the West.

Results

We used data from a nationwide birth cohort study which recruited pregnant women between 2011 and 2014. Among 92,796 women who delivered singleton live births, the frequency of underweight (pre-pregnancy BMI < 18.5 kg/m²) was 16.2%, reference weight (18.5–24.9 kg/m²) 73.1%, and overweight (≥ 25.0 kg/m²) 10.6%. We identified only 9 infants with gastroschisis, 2 of whose women were underweight (frequency of gastroschisis = 0.01%), 5 were in the reference group (0.01%), and 2 were overweight (0.02%). Of these 9 women, none were aged < 20 years, 2 were aged 20–29 years (frequency = 0.01%), and 7 were aged 30–39 years (0.01%). No reduction in the occurrence of gastroschisis was apparent among Japanese women who were overweight before pregnancy.

Associations of pre-pregnancy body mass index, middle-upper arm circumference, and gestational weight gain

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.

Prepregnancy obesity as a risk factor for exclusive breastfeeding initiation in Japanese women

OBJECTIVES

Breastfeeding rates in many countries fall short of the World Health Organization's recommendations. It has been reported that exclusive breastfeeding (EBF) is negatively associated with obesity; however, the association varies with ethnicity, and little information is available from Asia. We explored whether prepregnancy body mass index (BMI) and gestational weight gain (GWG) were associated with initiation of EBF.

METHODS

We investigated 6125 Japanese women with full-term (37-42 wk of gestation) singleton babies between January 2010 and June 2013, in a hospital with the largest annual number of deliveries in Tokyo, Japan.

RESULTS

Successful EBF initiation was observed in 72% of women 1 mo after delivery. The average GWG was 10 kg in underweight (BMI < 18.5 kg/m²) and normal weight (BMI 18.5-24.9 kg/m²) women; 7 kg in overweight (BMI 25-29.9 kg/m²) women, and 4 kg in obese (BMI ≥ 30 kg/m²) women. After adjusting for covariates, stepwise modeling revealed that compared with women of normal weight, obesity (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.16-0.53), and a single-unit increase in the GWG (OR, 0.98; 95% CI, 0.96-1.00) were significantly associated with unsuccessful EBF initiation. No statistical interaction was evident between prepregnancy BMI and GWG. Other significant risk factors for unsuccessful EBF initiation included older maternal age (P < 0.001), nulliparity (P < 0.001), cesarean delivery (P < 0.001), an earlier gestational week (P < 0.001), a light-for-date infant (P < 0.05), and mother-child separation for clinical reasons (P < 0.001).

CONCLUSIONS

This study suggested that prepregnancy obesity is a risk factor for EBF initiation among Japanese women.

Exposure to arsenic in tap water and gestational diabetes: A French semi-ecological study

INTRODUCTION

The increase in the prevalence of gestational diabetes mellitus (GDM) and its consequences for mother and children prompts research on their risk factors including environmental factors. Studies on exposure to arsenic (As) in tap water and the risk of GDM have not provided conclusive evidence, particularly when levels of exposure were low (from 10 to 50µg As/L). The main objective of this study was to assess the association between exposure to As in tap water and the risk of GDM.

METHODS

A semi-ecological study was conducted from births recorded at the University Hospital of Clermont-Ferrand, France, in 2003, 2006 and 2010. Individual medical/obstetric data were available. As exposure was estimated from the concentrations of As measured during sanitary control of tap water supplied in the mothers' commune of residence (aggregate data). French guidelines for As in tap water were used to identify groups potentially exposed, designated "As +" (≥ 10µg As/L) and "As -" (< 10µg As/L). Multivariate logistic regression analysis was performed.

RESULTS

5053 women (5.7% with a GDM) were included. Overall, women in the As + group had a higher risk of GDM than those in the As - group (adjusted OR = 1.62; 95%CI: 1.01-2.53). Stratified analysis of pre-pregnancy body mass index (BMI) showed a positive association only for obese or overweight women (adjusted OR = 2.30; 95%CI: 1.13-4.50).

CONCLUSION

This French semi-ecological study provides additional arguments for an association between As exposure and the risk of GDM in particular in a context of low exposure. Further studies are needed to assess a potential interaction between As exposure and body mass index.

Effects of pre-pregnancy body mass index and gestational weight gain on neonatal birth weight

To evaluate the effects of maternal pre-pregnancy body mass index (pre-BMI) and gestational weight gain (GWG) on neonatal birth weight (NBW) in the population of Chinese healthy pregnant women, attempting to guide weight control in pregnancy. A retrospective cohort study of 3772 Chinese women was conducted. The population was stratified by maternal pre-BMI categories as underweight (<18.5 kg/m²), normal weight (18.5-23.9 kg/m²), overweight (24.0-27.9 kg/m²), and obesity (≥28.0 kg/m²). The NBW differences were tested among the four groups, and then deeper associations among maternal pre-BMI, GWG, and NBW were investigated by multivariate analysis. NBW increased significantly with the increase of maternal pre-BMI level (P<0.05), except overweight to obesity (P>0.05). The multivariate analysis showed that both pre-BMI and GWG were positively correlated with NBW (P<0.05). Compared with normal pre-BMI, underweight predicted an increased odds ratio of small-for-gestational-age (SGA) and decreased odds ratio for macrosomia and large-for-gestational-age (LGA), and the results were opposite for overweight. With the increase of GWG, the risk of SGA decreased and the risks of macrosomia and LGA increased. In addition, in different pre-BMI categories, the effects of weight gain in the first trimester on NBW were different (P<0.05). NBW is positively affected by both maternal pre-BMI and GWG, extreme pre-BMI and GWG are both associated with increased risks of abnormal birth weight, and maternal pre-BMI may modify the effect of weight gain in each trimester on NBW. A valid GWG guideline for Chinese women is an urgent requirement, whereas existing recommendations seem to be not very suitable for the Chinese.

Gestational weight gain and fetal growth in underweight women

Background

Despite the current obesity epidemic, maternal underweight remains a common occurrence with potential adverse perinatal outcomes.

Methods

We aimed to investigate the relationship between weight gain during pregnancy, and fetal growth in underweight women with low and late fertility. Women body mass index (BMI), defined according to the World Health Organization’s definition, gestational weight gain (GWG), defined by the Institute of Medicine and National Research Council and neonatal birth weight were prospectively collected at maternity ward of Policlinico Abano Terme (Italy) in 793 consecutive at term, uncomplicated deliveries.

Results

Among those, 96 (12.1 %) were categorized as underweight (BMI < 18.5 kg/m²), 551 (69.5 %) as normal weight, 107 (13.4 %) as overweight, and 39 (4.9 %) as obese, respectively. In all mother groups, GWG was within the range recommended by IOM 2009 guidelines. However, underweight women gained more weight in pregnancy (12.8 ± 3.9 kg) in comparison to normal weight (12.3 ± 6.7 kg) and overweight (11.0 ± 4.7 kg) women and their GWG was significantly higher (p < 0.001) with respect to obese women 5.8 ± 6.1 kg). In addition, offspring of underweight women were comparable in size at birth to offspring of normal weight women, whereas they were significantly lighter to offspring of both overweight and obese women.

Conclusions

Pre-pregnancy underweight does not impact birth weight of healthy, term neonates in presence of normal GWG. Presumably, medical or personal efforts to reach ‘optimal’ GWG could be a leading choice for many women living in industrialized and in low-income countries.