Effects of Prepregnancy Body Mass Index and Gestational Weight Gain on Pregnancy Outcomes

Zhang, Cui Hong; Liu, Xiangyu; Zhan, Yi; Zhang, Long; Huang, Yan; Zhou, Hong

doi:10.1177/1010539515589810

Cited by 38 publications

(52 citation statements)

References 30 publications

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“…However, in studies applying ethnic-specific regional BMI categories, women in Asia had similar rates of GWG above guidelines. The prevalence of GWG above guidelines is consistent with observational studies [47–50]. Excess GWG increases adverse pregnancy outcomes, independent of BMI, as demonstrated here, and also increases postpartum weight retention and obesity [45, 51].…”

Section: Discussionsupporting

confidence: 87%

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Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women

Goldstein

Abell

Ranasinha

et al. 2018

BMC Med

358

334

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BackgroundThe association between Institute of Medicine (IOM) guidelines and pregnancy outcomes across ethnicities is uncertain. We evaluated the associations of gestational weight gain (GWG) outside 2009 IOM guidelines, with maternal and infant outcomes across the USA, western Europe and east Asia, with subgroup analyses in Asia. The aim was to explore ethnic differences in maternal prepregnancy body mass index (BMI), GWG and health outcomes across these regions.MethodsSystematic review, meta-analysis and meta-regression of observational studies were used for the study. MEDLINE, MEDLINE In-Process, Embase and all Evidence-Based Medicine (EBM) Reviews were searched from 1999 to 2017. Studies were stratified by prepregnancy BMI category and total pregnancy GWG. Odds ratio (ORs) 95% confidence intervals (CI) applied recommended GWG within each BMI category as the reference. Primary outcomes were small for gestational age (SGA), preterm birth and large for gestational age (LGA). Secondary outcomes were macrosomia, caesarean section and gestational diabetes.ResultsOverall, 5874 studies were identified and 23 were included (n = 1,309,136). Prepregnancy overweight/obesity in the USA, Europe and Asia was measured at 42%, 30% and 10% respectively, with underweight 5%, 3% and 17%. GWG below guidelines in the USA, Europe and Asia was 21%, 18% and 31%, and above was 51%, 51% and 37% respectively. Applying regional BMI categories in Asia showed GWG above guidelines (51%) was similar to that in the USA and Europe.GWG below guidelines was associated with a higher risk of SGA (USA/Europe [OR 1.51; CI 1.39, 1.63]; Asia [1.63; 1.45, 1.82]) and preterm birth (USA/Europe [1.35; 1.17, 1.56]; Asia [1.06; 0.78, 1.44]) than GWG within guidelines. GWG above guidelines was associated with a higher risk of LGA (USA/Europe [1.93; 1.81, 2.06]; Asia [1.68; 1.51 , 1.87]), macrosomia (USA/Europe [1.87; 1.70, 2.06]; Asia [2.18; 1.91, 2.49]) and caesarean (USA/Europe [1.26; 1.21, 1.33]; Asia [1.37; 1.30, 1.45]). Risks remained elevated when regional BMI categories were applied for GWG recommendations. More women in Asia were categorised as having GWG below guidelines using World Health Organization (WHO) (60%) compared to regional BMI categories (16%), yet WHO BMI was not accompanied by increased risks of adverse outcomes.ConclusionsWomen in the USA and western Europe have higher prepregnancy BMI and higher rates of GWG above guidelines than women in east Asia. However, when using regional BMI categories in east Asia, rates of GWG above guidelines are similar across the three continents. GWG outside guidelines is associated with adverse outcomes across all regions. If regional BMI categories are used in east Asia, IOM guidelines are applicable in the USA, western Europe and east Asia.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1128-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 87%

“…Overall, 16% of Chinese women were underweight, 74% normal weight and 9% overweight and obese. These values are lower than those of recent cohort studies, where 15–28% of reproductive-aged women in China are above healthy weight [13, 47]. This contrasted with Japan, with 18%, 71% and 11% respectively.…”

Section: Discussioncontrasting

confidence: 62%

Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women

Goldstein

Abell

Ranasinha

et al. 2018

BMC Med

358

334

View full text Add to dashboard Cite

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“…In our study, the average GWG was 14.2 kg among normal weight women with normal birth weight babies; our finding was lower than found in a recent publication, which indicated an average weight gain of 16.2 kg in the same BMI category of women who lived in Beijing 32. Chongqing is a southwestern city in China and Beijing is the capital.…”

Section: Discussioncontrasting

confidence: 88%

Associations of neonatal high birth weight with maternal pre-pregnancy body mass index and gestational weight gain: a case–control study in women from Chongqing, China

et al. 2016

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ObjectivesTo examine the associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with neonatal high birth weight (HBW) in a sample of Chinese women living in southwest China.MethodsA hospital-based case–control study was conducted in Chongqing, China. A total of 221 mothers who delivered HBW babies (>4.0 kg) were recruited as cases and 221 age-matched (2-year interval) mothers with normal birth weight babies (2.5–4.0 kg) were identified as controls. ORs were estimated using conditional logistic regression analysis. For the analysis, pre-pregnancy BMI was categorised as underweight/normal weight/overweight and obesity and GWG was categorised as inadequate/appropriate/excessive.ResultsAmong the cases, mean pre-pregnancy BMI was 21.8±2.8 kg/m2, mean GWG was 19.7±5.1 kg and mean neonatal birth weight was 4.2±0.2 kg. In the controls, the corresponding values were 21.1±3.1 kg/m2, 16.4±5.0 kg and 3.3±0.4 kg, respectively. More cases than controls gained excessive weight during pregnancy (80.1% vs 48.4%, p<0.001). No significant association was found between pre-pregnancy BMI and HBW babies (OR=1.04, 95% CI 0.97 to 1.11; p>0.05). GWG was positively related to HBW after adjustment for gravidity, gestational age, newborns' gender and family income (OR=1.18, 95% CI 1.12 to 1.25; p<0.001). The adjusted OR of delivering HBW babies was 5.39 (95% CI 2.94 to 9.89; p<0.001) for excessive GWG versus appropriate GWG. This OR was strengthened among pre-pregnancy normal weight women (OR=10.27, 95% CI 3.20 to 32.95; p<0.001).ConclusionsOverall, the findings suggest a significantly positive association between GWG and HBW. However, pre-pregnancy BMI shows no independent relationship with HBW.

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“…We hypothesize that since maternal diabetes, obesity, and excess weight gain during pregnancy have been shown to promote fetal growth, these conditions will increase the risk of childhood cancers that have been associated with higher birthweight [27–31]. Whereas pre-pregnancy underweight and insufficient gestational weight gain, which have been linked to restricted fetal growth, will result in an increased risk of childhood cancers that have been associated with lower birthweight [27, 28, 32].…”

Section: Introductionmentioning

confidence: 99%

Maternal pre-pregnancy and gestational diabetes, obesity, gestational weight gain, and risk of cancer in young children: a population-based study in California

Contreras

Ritz

Virk

et al. 2016

Cancer Causes Control

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Purpose We aimed to examine the influence of pre-pregnancy diabetes, pre-pregnancy body mass index (BMI), gestational diabetes, and gestational weight gain on childhood cancer risk in offspring. Methods We identified cancer cases (n=11,149) younger than age 6 years at diagnosis from the California Cancer Registry registered between 1988–2013. Controls (n=270,147) were randomly sampled from California birth records, and frequency-matched by year of birth to all childhood cancers during the study period. Exposure and covariate information was extracted from birth records. Unconditional logistic regression models were generated to assess the importance of pre-pregnancy diabetes, pre-pregnancy BMI, gestational diabetes, and gestational weight gain on childhood cancer risk. Results We observed increased risks of acute lymphoblastic leukemia (ALL) and Wilms’ tumor in children of mothers with pre-pregnancy diabetes [odds ratio (OR) =1.37, 95% confidence interval (CI): (1.11, 1.69), OR=1.45, 95% CI: (0.97, 2.18), respectively]. When born to mothers who were overweight prior to pregnancy (BMI 25–<30), children were at increased risk of leukemia [OR=1.27, 95% CI: (1.01, 1.59)]. Insufficient gestational weight gain increased the risk of acute myeloid leukemia (AML) [OR=1.50 (95% CI: 0.92, 2.42)] while excessive gestational weight gain increased the risk of astrocytomas [OR=1.56, 95% CI: (0.97, 2.50)]. No associations were found between gestational diabetes and childhood cancer risk in offspring. Conclusions We estimated elevated risks of several childhood cancers in the offspring of mothers who had diabetes and were overweight prior to pregnancy, as well as mothers who gained insufficient or excessive weight. Since few studies have focused on these factors in relation to childhood cancer, replication of our findings in future studies is warranted.

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Effects of Prepregnancy Body Mass Index and Gestational Weight Gain on Pregnancy Outcomes

Cited by 38 publications

References 30 publications

Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women

Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women

Associations of neonatal high birth weight with maternal pre-pregnancy body mass index and gestational weight gain: a case–control study in women from Chongqing, China

Maternal pre-pregnancy and gestational diabetes, obesity, gestational weight gain, and risk of cancer in young children: a population-based study in California

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