Objective The aim of the present study was to evaluate the single and joint associations of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) with pregnancy outcomes in Tianjin, China. Methods Between June 2009 and May 2011, health care records of 33,973 pregnant women were collected and their children were measured for birth weight and birth length. The independent and joint associations of prepregnancy BMI and GWG based on the Institute of Medicine (IOM) guidelines with the risks of pregnancy and neonatal outcomes were examined by using Logistic Regression. Results After adjustment for all confounding factors, maternal prepregnancy BMI was positively associated with risks of gestational diabetes mellitus (GDM), pregnancy-induced hypertension, caesarean delivery, preterm delivery, large-for-gestational age infant (LGA), and macrosomia, and inversely associated with risks of small-for-gestational age infant (SGA) and low birth weight. Maternal excessive GWG was associated with increased risks of pregnancy-induced hypertension, caesarean delivery, LGA, and macrosomia, and decreased risks of preterm delivery, SGA, and low birth weight. Maternal inadequate GWG was associated with increased risks of preterm delivery and SGA, and decreased risks of LGA and macrosomia, compared with maternal adequate GWG. Women with both prepregnancy obesity and excessive GWG had 2.2–5.9 folds higher risks of GDM, pregnancy-induced hypertension, caesarean delivery, LGA, and macrosomia compared with women with normal prepregnancy BMI and adequate GWG. Conclusions Maternal prepregnancy obesity and excessive GWG were associated with greater risks of pregnancy-induced hypertension, caesarean delivery, and greater infant size at birth. Health care providers should inform women to start the pregnancy with a BMI in the normal weight category and limit their GWG to the range specified for their prepregnancy BMI.
References
[1]
Kim SY, Dietz PM, England L, Morrow B, Callaghan WM (2007) Trends in pre-pregnancy obesity in nine states, 1993–2003. Obesity 15: 986–993.
[2]
Frederick IO, Williams MA, Sales AE, Martin DP, Killien M (2008) Pre-pregnancy body mass index, gestational weight gain, and other maternal characteristics in relation to infant birth weight. Maternal and child health journal 12: 557–567.
[3]
Nohr EA, Vaeth M, Baker JL, Sorensen T, Olsen J, et al. (2008) Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr 87: 1750–1759.
[4]
Guelinckx I, Devlieger R, Beckers K, Vansant G (2008) Maternal obesity: pregnancy complications, gestational weight gain and nutrition. Obesity reviews : an official journal of the International Association for the Study of Obesity 9: 140–150.
[5]
Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, et al. (2001) Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity 25: 1175–1182.
[6]
Young TK, Woodmansee B (2002) Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain. American journal of obstetrics and gynecology 187: 312–318 discussion 318–320.
[7]
National Center for Health Statistics (2013) Pregnancy Nutrition Surveillance. Centers for Disease Control and Prevention (CDC) website. Available: http://www.cdc.gov/pednss/pdfs/PedNSS_20？09.pdf. Accessed 2013 Nov 3.
[8]
Institute of Medicine (2009) Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: National Academies Press.
[9]
Johnson J, Clifton RG, Roberts JM, Myatt L, Hauth JC, et al. (2013) Pregnancy Outcomes With Weight Gain Above or Below the 2009 Institute of Medicine Guidelines. Obstetrics and gynecology 121: 969–975.
[10]
Yang YD, Yang HX (2012) Investigation into the clinical suitability of Institute of Medicine 2009 guidelines regarding weight gain during pregnancy for women with full term singleton fetus in China. Zhonghua fu chan ke za zhi 47: 646–650.
[11]
Liu Y, Dai W, Dai X, Li Z (2012) Prepregnancy body mass index and gestational weight gain with the outcome of pregnancy: a 13-year study of 292,568 cases in China. Archives of gynecology and obstetrics 286: 905–911.
[12]
Tianjin Women's and Children's Health Center (2010) 2010 Tianjin Women and Children Health Care Report: Tianjin Women's and Children's Health Center. Tianjin Women's and Children's Health Center.
[13]
Li N, Liu E, Guo J, Pan L, Li B, et al. (2013) Maternal Prepregnancy Body Mass Index and Gestational Weight Gain on Offspring Overweight in Early Infancy. PLoS ONE 8: e77809 doi:77810.71371/journal.pone.0077809.
[14]
Working Group on Obesity in China (2004) Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults. Acta Nutrimenta Sinica 26: 1–4.
[15]
Wang Y, Mi J, Shan XY, Wang QJ, Ge KY (2007) Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China. International journal of obesity 31: 177–188.
[16]
Zhou BF (2002) Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults—study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomedical and environmental sciences : BES 15: 83–96.
[17]
Chen CM (2008) Overview of obesity in Mainland China. Obesity reviews : an official journal of the International Association for the Study of Obesity 9 Suppl 1: 14–21.
[18]
Mamun AA, Callaway LK, O'Callaghan MJ, Williams GM, Najman JM, et al. (2011) Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay. BMC pregnancy and childbirth 11: 62.
[19]
Zhang F, Dong L, Zhang CP, Li B, Wen J, et al. (2011) Increasing prevalence of gestational diabetes mellitus in Chinese women from 1999 to 2008. Diabet Med 28: 652–657.
[20]
WHO/IDF (2006) Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. Geneva: World Health Organization, WHO/IDF consultation.
[21]
Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM (2001) The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertension in pregnancy : official journal of the International Society for the Study of Hypertension in Pregnancy 20: IX–XIV.
[22]
Tsai IH, Chen CP, Sun FJ, Wu CH, Yeh SL (2012) Associations of the pre-pregnancy body mass index and gestational weight gain with pregnancy outcomes in Taiwanese women. Asia Pacific journal of clinical nutrition 21: 82–87.
[23]
Fortner RT, Pekow P, Solomon CG, Markenson G, Chasan-Taber L (2009) Prepregnancy body mass index, gestational weight gain, and risk of hypertensive pregnancy among Latina women. American journal of obstetrics and gynecology 200: e161–167, 167, e161-167.
[24]
Macdonald-Wallis C, Tilling K, Fraser A, Nelson SM, Lawlor DA (2013) Gestational weight gain as a risk factor for hypertensive disorders of pregnancy. Am J Obstet Gynecol 209: 327 e321–327 e317.
[25]
Frias AE, Grove KL (2012) Obesity: a transgenerational problem linked to nutrition during pregnancy. Seminars in reproductive medicine 30: 472–478.
[26]
Frederick IO, Rudra CB, Miller RS, Foster JC, Williams MA (2006) Adult weight change, weight cycling, and prepregnancy obesity in relation to risk of preeclampsia. Epidemiology 17: 428–434.
[27]
Taler SJ, Driscoll N, Tibor M, Sprau G, Augustine JE, et al. (2004) Obesity raises blood pressure in normal subjects via high cardiac output and impaired vasodilation. Am J Hypertens 17: 25A.
[28]
Saldana TM, Siega-Riz AM, Adair LS, Suchindran C (2006) The relationship between pregnancy weight gain and glucose tolerance status among black and white women in central North Carolina. American journal of obstetrics and gynecology 195: 1629–1635.
[29]
Kabiru W, Raynor BD (2004) Obstetric outcomes associated with increase in BMI category during pregnancy. American journal of obstetrics and gynecology 191: 928–932.
[30]
Murakami M, Ohmichi M, Takahashi T, Shibata A, Fukao A, et al. (2005) Prepregnancy body mass index as an important predictor of perinatal outcomes in Japanese. Archives of gynecology and obstetrics 271: 311–315.
[31]
Catalano PM, Roman-Drago NM, Amini SB, Sims EA (1998) Longitudinal changes in body composition and energy balance in lean women with normal and abnormal glucose tolerance during pregnancy. American journal of obstetrics and gynecology 179: 156–165.
[32]
Okereke NC, Huston-Presley L, Amini SB, Kalhan S, Catalano PM (2004) Longitudinal changes in energy expenditure and body composition in obese women with normal and impaired glucose tolerance. American journal of physiology Endocrinology and metabolism 287: E472–479.
[33]
Stotland NE, Cheng YW, Hopkins LM, Caughey AB (2006) Gestational weight gain and adverse neonatal outcome among term infants. Obstet Gynecol 108: 635–643.
[34]
Hull HR, Thornton JC, Ji Y, Paley C, Rosenn B, et al. (2011) Higher infant body fat with excessive gestational weight gain in overweight women. American journal of obstetrics and gynecology 205: e211–217, 211, e211-217.
[35]
Leung TY, Leung TN, Sahota DS, Chan OK, Chan LW, et al. (2008) Trends in maternal obesity and associated risks of adverse pregnancy outcomes in a population of Chinese women. BJOG : an international journal of obstetrics and gynaecology 115: 1529–1537.
[36]
Feng XL, Xu L, Guo Y, Ronsmans C (2012) Factors influencing rising caesarean section rates in China between 1988 and 2008. Bulletin of the World Health Organization 90: 30–39A, 30-39, 39A.
[37]
Gibson KS, Waters TP, Catalano PM (2012) Maternal weight gain in women who develop gestational diabetes mellitus. Obstet Gynecol 119: 560–565.
