Maternal Pre-pregnancy Body Mass Index Categories and Infant Birth Outcomes: A Population-Based Study of 9 Million Mother–Infant Pairs

Zong, Xin-Nan; Wang, Huan; Yang, Liu; Guo, Yajun; Zhao, Min; Magnussen, Costan G.; Xi, Bo

doi:10.3389/fnut.2022.789833

Cited by 22 publications

(17 citation statements)

References 36 publications

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“…10 In agreement with these findings, a larger study (9,282,486 mother-infant pairs in the USA) focussed on offspring outcomes indicated that higher maternal BMI was associated with higher risk of high birthweight, LGA, as well as low Apgar score and reported a nonlinear relationship with PTB risk. 36 Other observational studies using multivariable regression have reported that maternal BMI is associated with higher risk of stillbirths 37 , induction 38 , caesarean section 38 , and not initiating breastfeeding. 39 Previous Mendelian randomization studies have focused on a limited set of outcomes and are supportive of higher maternal BMI being related to higher mean offspring birthweight 4,40,41 (N ~ 9,000 to 400,000) and GDM 42 (N = 5,485 cases and 347,856 controls).…”

Section: Discussionmentioning

confidence: 98%

Integrating multiple lines of evidence to assess the effects of maternal BMI on pregnancy and perinatal outcomes in up to 497,932 women

Borges

Clayton

Freathy

et al. 2022

Preprint

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Importance: Higher maternal pre-pregnancy body mass index (BMI) is associated with adverse pregnancy and perinatal outcomes. However, which of these associations are causal remains unclear. Objective: To explore the relation of maternal pre-pregnancy BMI with pregnancy and perinatal outcomes by integrating evidence from three different methods (i.e. multivariable regression, Mendelian randomization, and paternal negative control analyses). Design: Triangulation of multivariable regression, Mendelian randomization and paternal negative control results from up to 14 studies in the MR-PREG collaboration. Setting: Europe and North America. Participants: Up to 497,932 women of European ancestry. Exposure: Maternal pre- or early- pregnancy BMI based on self-reported or measured weight and height. Main outcomes and Measures: Miscarriage, stillbirth, hypertensive disorders of pregnancy, gestational hypertension, preeclampsia, gestational diabetes, maternal anaemia, perinatal depression, pre-labour rupture of membranes, induction of labour, caesarean section, preterm birth, small- and large-for-gestational age, low and high birthweight, low Apgar score at 1 and 5 minutes, neonatal intensive care unit admission, and no initiation of breastfeeding. Results: Multivariable regression, Mendelian randomization and paternal negative control analyses supported an association of higher maternal BMI with lower risk of small-for-gestational age and higher risk of hypertensive disorders of pregnancy, gestational hypertension, preeclampsia, gestational diabetes, pre-labour membrane rupture, induction of labour, large-for-gestational age, and high birthweight. As an example, higher maternal BMI was associated with higher risk of gestational hypertension in multivariable regression (OR: 1.67; 95% CI: 1.64, 1.71 per standard unit in BMI) and Mendelian randomization (OR: 1.58; 95% CI: 1.29, 1.93), which was not seen for paternal BMI (OR: 1.02; 95% CI: 0.99, 1.05). Findings did not support a relation between maternal BMI and perinatal depression. For other outcomes, evidence was inconclusive due to inconsistencies across the applied approaches or substantial imprecision in effect estimates from Mendelian randomization. Conclusions and Relevance: Our findings support a causal role for maternal pre-/early-pregnancy BMI on a range of adverse pregnancy and perinatal outcomes. Pre-conception interventions to support women maintaining a healthy BMI may reduce the burden of obstetric and neonatal complications.

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Section: Discussionmentioning

confidence: 98%

Integrating multiple lines of evidence to assess the effects of maternal BMI on pregnancy and perinatal outcomes in up to 497,932 women

Borges

Clayton

Freathy

et al. 2022

Preprint

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“…Pre-pregnancy overweight and obesity are both associated with an increased risk of gestational hypertension and gestational diabetes 9,33 , which are associated with increased risk of induction of labour and/or planned caesarean section. This likely explains the increased risk of MPTB with higher BMI.…”

Section: Discussionmentioning

confidence: 99%

Maternal pre-pregnancy body mass index and risk of preterm birth: a collaboration using large routine health datasets

Cornish

Magnus

Urhøj

et al. 2023

Preprint

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Importance: Preterm birth (PTB), is a leading cause of child morbidity and mortality. Objective: To examine the associations of maternal pre-pregnant body mass index (BMI) with any PTB, spontaneous (SPTB) and medically indicated PTB (MPTB). Design: A meta-analysis of eight population-based datasets. Setting: Three UK datasets, two USA datasets, and one each from South Australia, Norway and Denmark, with different characteristics and sources of bias. Participants: All pregnancies resulting in a live birth or stillbirth after 24 completed gestational weeks. Exposure: Maternal pre-or early pregnancy BMI derived from self-reported or measured weight and height between 12 months pre-pregnancy and 15 weeks gestation. Main Outcome(s) and Measures(s): Any PTB (delivery <37 completed weeks), SPTB and medically indicated PTB. Fractional polynomial multivariable logistic regression was applied to eight datasets from different high-income countries and time periods. The results were combined using a random effects meta-analysis. Results: We found non-linear associations between pre-pregnant BMI and all three outcomes, across all datasets. The adjusted risk of any PTB and MPTB was elevated at both low and high BMIs, whereas the risk of SPTB was increased at lower levels of BMI but remained low or increased only slightly with higher BMI. In the meta-analysed data, the lowest risk of any PTB was at a BMI of 24.5 kg/m2 (95% confidence interval: 23.1, 30.3), with a value of 21.3 kg/m2 (20.8, 21.9) for MPTB; for SPTB, the risk remained roughly constant above a BMI of around 25-30 kg/m2. Conclusions and Relevance: Consistency of findings across different populations, despite differences between them in the time period covered, BMI distribution, missing data and control for key confounders, highlight the importance of promoting pre-conception BMI between 21 to 30 kg/m2 to prevent MPTB and SPTB.

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“…Each birth weight percentile category was compared with the 50th–less than the 75th percentile category as a reference. Adjustments were performed for predetermined covariates: race, 22 ethnicity, 22 maternal age, 23 prepregnancy BMI, 24 chronic hypertension, 25 pregestational diabetes, 26 parity, 27 assisted reproductive therapy, 28 preeclampsia, 29,30 eclampsia, gestational hypertension, gestational diabetes mellitus (GDM), 31,32 chorioamnionitis, 33 steroids use, mode of delivery, 34 insurance type, 35 and neonatal sex. 36 Previous studies have shown that these factors could be associated with birth weight, infant mortality, or morbidity.…”

Section: Methodsmentioning

confidence: 99%

Infant Outcomes Categorized by Birth Weight Percentile for Deliveries Between 28 and 41 Weeks of Gestation

Onishi,

Kawakita

2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To examine the association between birth weight percentile and severe infant outcomes according to gestational age category. METHODS: We conducted a population-based retrospective cohort study using publicly available U.S. birth certificate data linked to infant death data from 2017 to 2019. Maternal–neonate pairs of singleton live births between 28 0/7 and 41 6/7 weeks of gestation (vaginal or cesarean delivery) were evaluated. We excluded infants with major fetal anomalies, chromosomal disorders, missing data, and birth weight outliers. The primary outcome was infant mortality within 1 year of life. Neonates were divided into eight sex-specific birth weight percentile categories: less than the 3rd, 3rd–less than the 10th, 10th–less than the 25th, 25th–to less than the 49th, 50th–less than the 75th, 75th–to less than the 90th, 90th–less than the 97th, and 97th or higher. RESULTS: There were 10,459,388 births between 28 and 41 weeks of gestation: 69,793 (0.7%) at 28–31 weeks, 88,673 (0.8%) at 32–33 weeks, 635,904 (6.1%) at 34–36 weeks, 2,763,110 (26.4%) at 37–38 weeks, 6,269,894 (59.9%) at 39–40 weeks, and 632,014 (6.0%) at 41 weeks. Infant mortality during the first year of life significantly increased at higher and lower birth weight percentiles at 28–36 weeks of gestation, with the lowest risk observed at the 50th–less than the 75th percentile. The highest mortality rates were 13.6% at less than the 3rd percentile and 8.4% at the 97th percentile or higher at 28–31 weeks of gestation; the second-highest mortality rates were 7.7% at less than the 3rd percentile and 3.1% at the 97th percentile or higher at 32–33 weeks of gestation. At 34–36 weeks of gestation, the highest and second-highest mortality rates were 3.4% at less than the 3rd percentile and 1.4% at the 3rd–10th percentile. At 37–41 weeks of gestation, infant mortality was associated with lower birth weight percentile, but higher birth weight percentiles were not significantly associated with increased mortality. CONCLUSION: We found different patterns in the association between birth weight percentile and infant mortality depending on gestational age category.

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Maternal Pre-pregnancy Body Mass Index Categories and Infant Birth Outcomes: A Population-Based Study of 9 Million Mother–Infant Pairs

Cited by 22 publications

References 36 publications

Integrating multiple lines of evidence to assess the effects of maternal BMI on pregnancy and perinatal outcomes in up to 497,932 women

Integrating multiple lines of evidence to assess the effects of maternal BMI on pregnancy and perinatal outcomes in up to 497,932 women

Maternal pre-pregnancy body mass index and risk of preterm birth: a collaboration using large routine health datasets

Infant Outcomes Categorized by Birth Weight Percentile for Deliveries Between 28 and 41 Weeks of Gestation

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