Retrospective cohort study of the effects of obesity in early pregnancy on maternal weight gain and obstetric outcomes in an obstetric population in Africa

Abstract

ObjectiveThe purpose of this study was to compare maternal weight gain in pregnancy and obstetric outcomes between women with obesity in early pregnancy and those with a normal body mass index (BMI) in early pregnancy.MethodsThis was a retrospective cohort study of women with obesity in early pregnancy and those with a normal BMI who were seen at three teaching hospitals in South-East Nigeria. Statistical analysis was performed using Statistical Package for the Social Sciences version 17.0 software, with descriptive and inferential statistics at the 95% level of confidence.ResultsThe study sample consisted of 648 women (324 obese and 324 healthy-weight). The mean age of the obese women was 26.7 ± 5.1 years and that of the healthy-weight women was 26.6 ± 4.9 years. Although both excessive weight gain (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.23–0.54) and inadequate weight gain (OR 0.08, 95% CI 0.04–0.15) were less common in women with early pregnancy obesity than in healthy-weight women, a significantly higher proportion of obese women with excessive weight gain had adverse fetomaternal outcomes. Also, a significantly higher proportion of obese women had specific complications, such as premature rupture of membranes (OR 2.36, 95% CI 1.12–5.04), gestational hypertension/pre-eclampsia (OR 2.31, 95% CI 1.12–5.04), antepartum hemorrhage (OR 2.78, 95% CI 1.02–7.93), gestational diabetes (OR 4.24, 95% CI 1.62–11.74), cesarean delivery (OR 2.3, 95% CI 1.2–5.44), macrosomia (OR 4.08, 95% CI 1.06–8.41), severe birth asphyxia (OR 2.8, 95% CI 1.2–6.63), abnormal Apgar scores (OR 2.67, 95% CI 1.46–4.93), and newborn special care admissions (OR 1.18, 95% CI 1.0–3.29).ConclusionEarly pregnancy obesity was associated with a wide range of adverse fetomaternal outcomes, and could be a genuine risk factor for increased pregnancy-related morbidity and/or mortality in this population. Interventions to reduce prepregnancy obesity could therefore be useful in this low-resource African setting.

Impact of diabetes mellitus and obesity on delivery outcomes

“…This might be explained with the higher Cesarean Section rates in population of women with DM, bearing in mind that caesarean section excludes the creation of these injuries. Obesity and greater weight gain independently increase the risk of cesarean delivery, prolonged duration of labor, as well as of several adverse outcomes with vaginal delivery 4,5 , although our study could not confirm this statement. This is probably due to the fact that our study involved insufficient number of obese women with DM.…”

Higher pre‐pregnancy body mass index is associated with excessive gestational weight gain in normal weight Chinese mothers with gestational diabetes

“…A previous report stated that different determinant factors identified in the beginning of pregnancy, for example pre‐pregnancy weight related to insufficient and excessive GWG, can predict unfavorable gestational outcome . A retrospective cohort study also showed that a substantial proportion of normal weight women with excessive GWG have adverse outcomes . In contrast, inadequate weight gain is not associated with adverse outcome in obese women.…”

Obstetric predictors of hypertension: A cross-sectional study of women attending the postnatal clinic of Jos University Teaching Hospital

“…Iyoke et al . studying an African obstetric population found that early pregnancy obesity was associated with wide-ranging poor feto-maternal outcomes that increase the risk of pregnancy and childbirth-related morbi-mortality 16. WC, HC, and BMI (though not significant here despite the tendency; P = 0.092) were among the anthropometric variables found to diagnose obesity in pregnant Nigerians by Okereke et al 17.…”