Cause-Specific Stillbirth and Neonatal Death According to Prepregnancy Obesity and Early Gestational Weight Gain: A Study in the Danish National Birth Cohort

Abstract

Maternal obesity is associated with impaired fetal and neonatal survival, but underlying mechanisms are poorly understood. We examined how prepregnancy BMI and early gestational weight gain (GWG) were associated with cause-specific stillbirth and neonatal death. In 85,822 pregnancies in the Danish National Birth Cohort (1996–2002), we identified causes of death from medical records for 272 late stillbirths and 228 neonatal deaths. Prepregnancy BMI and early GWG derived from an early pregnancy interview and Cox regression were used to estimate associations with stillbirth or neonatal death as a combined outcome and nine specific cause-of-death categories. Compared to women with normal weight, risk of stillbirth or neonatal death was increased by 66% with overweight and 78% with obesity. Especially deaths due to placental dysfunction, umbilical cord complications, intrapartum events, and infections were increased in women with obesity. More stillbirths and neonatal deaths were observed in women with BMI < 25 and low GWG. Additionally, unexplained intrauterine death was increased with low GWG, while more early stillbirths were seen with both low and high GWG. In conclusion, causes of death that relate to vascular and metabolic disturbances were increased in women with obesity. Low early GWG in women of normal weight deserves more clinical attention.

Associations between Gestational Weight Gain Adequacy and Neonatal Outcomes in Tanzania

“…To the best of our knowledge, these find-ings are novel and have not been previously reported in the context of sub-Saharan Africa. Studies using birth cohort data in Denmark, and birth and death registration records in the USA, have also shown a higher risk of stillbirth and neonatal mortality associated with maternal overweight and obesity [32,33]. Placental dysfunction, inflammation, metabolic abnormalities, and intrapartum events are the most commonly cited mechanisms contributing to the risk of stillbirth with excessive weight [34].…”

Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis

“…For example, a population based cohort study in Sweden found no association between GWG and stillbirth,18 whereas a recent multicentre case-control study from the United States found that low GWG measured by internally standardised z scores was associated with higher odds of stillbirth 103. Findings from a recent analysis of 85 822 pregnancies in the Danish Birth Cohort suggest that placental dysfunction and infections might partly explain the higher risk of stillbirth among women with low GWG,104 although the risk of unexplained intrauterine death in this Danish study was greater with low GWG compared with high GWG. Placental dysfunction, inflammation, metabolic abnormalities, and intrapartum events remain the most commonly cited mechanisms contributing to stillbirth 105.…”

Obesity in Pregnancy Maternal and Fetal Outcome

“…[17][18][19] Some of the unfavorable fetal consequences linked to obesity during pregnancy include macrosomia, stillbirths, neonatal fatalities, congenital abnormalities, and childhood obesity. 20 Fetal macrosomia, which is more prevalent in overweight women, raises the likelihood of birth harm, shoulder dystocia, and low blood sugar in newborns. Moreover, research indicates that obesity during pregnancy augments the chances of fetal demise and neonatal mortality, despite the fact that the precise mechanisms are not completely comprehended.…”