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Relationship between pregnancy outcome and maternal BMI and weight gain
International Congress Series 1271 (2004) 380 – 383
www.ics-elsevier.com
Relationship between pregnancy outcome and maternal BMI and weight gain Maryam-sadat Hosseini a,*, Jameie Nastaran b a
Department of Gynecology Obstetrics, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Flat No. 8, No. 99 Medical Complex Rooyan St., Tehran 1415994963, Iran b Resident of Gynecology, Shahid Beheshti University of Medical Sciences, Tehran 1415994963, Iran
Abstract. Background: Previous studies have suggested the effects of maternal BMI and weight gain on pregnancy outcomes, thus, the present study was conducted over 106 parturients referring to Imam Hossein Hospital to determine the maternal BMI and weight gain and its relationship with pregnancy outcomes. Materials and methods: One hundred and six parturients had entered this longitudinal study. Initial data including weight, height, and previous deliveries were all recorded. Perinatal care was achieved. Maternal weight gain was determined and the relationship between pregnancy outcomes and maternal BMI and weight gain was assessed. Results: Of a total of 106 parturients, 101 (95.3%) aged 18 – 35 years. Most of the candidates (47.2%) had BMI of 19.8 – 26. Thirty-seven percent had weight gain below the standard level, whereas 35% had weight gain above the standard level. BMI was revealed to be correlated with weight gain. Preterm delivery was noted in 33.3% of the females with BMI between 26 and 29; however, normal candidates have experienced preterm delivery in 24%. Conclusion: Abnormal weight gain and BMI were revealed to be associated with severe maternal and neonatal complications that are associated with extra expenses for the society and the family. Maternal education and consultation seems to be helpful. D 2004 Elsevier B.V. All rights reserved. Keywords: Body mass index; Weight gain; Preterm delivery
1. Introduction Pregnancy outcome is a matter of importance that is determined with criteria such as term delivery, normal birth weight, premature rupture of membrane (PROM), preterm delivery and its complications, etc. [1,3,4]. Unusual conditions such as preterm delivery and low birth weight (LBW) were reported in up to 10% of pregnancies. Apparently, careful prenatal care may decrease complications such as PROM, infections, LBW, macrosomia and other lifethreatening factors, and of course, would prevent severe permanent maternal and neonatal complications as well as excessive expenses of the society [6,7]. Of these factors, primary maternal BMI and her weight gain during pregnancy are of utmost importance, indeed, low BMI is a risk factor for LBW [9]. Prior investigators have * Corresponding author. Tel.: +98-21-2586544. E-mail address: [email protected] (M. Hosseini). 0531-5131/ D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2004.06.022
M. Hosseini, J. Nastaran / International Congress Series 1271 (2004) 380–383
381
shown the association between the ratio of weight to height prior to the pregnancy and weight gain during pregnancy with fetal growth and development. Milckey et al. [2] have explained a reverse correlation between BMI and simultaneous preterm delivery among different ethnic groups. Copper et al. [8] have reported a lesser tendency among obese females for weight gain during pregnancy; however, thin females had got further weight gain y but their neonates did not weigh more. National Academy of Science has recommended a weight gain of 12.5 – 18 kg for thin females, 11.5– 16 kg for females weigh within the normal range, 7 – 11.5 kg for obese females and 6 kg for very obese females. This classification was made according to the BMI. The present study was conducted on parturients referring to an academic hospital in Tehran to determine the association between pregnancy outcome with BMI and weight gain. 2. Materials and methods For this longitudinal study, all females who had referred to the hospital clinic during a 12-month period were selected and entered the study after completing an informed contest. Initial data including age, parity, occupation, smoking habit, interval between pregnancies, and LMP were recorded. Our exclusion criteria were as follow: diabetes mellitus, preeclampsia, cardiovascular diseases, renal or any other disease that may affect pregnancy outcome, multiple pregnancies, and fetal anomalies. Prior to the pregnancy, weight (kg) and height (cm) were determined and BMI was calculated. Females were assigned in any of the following four groups based on their BMI: < 19.8 kg/m2 (underweight), 19.8– 26 kg/m2 (normal), 26.1 –29 kg/m2 (overweight), and >29 kg/m2 (extra overweight). Females were followed and their weight was determined during the pregnancy with a unique scale. Prior to the delivery, candidates’ weight was determined and they were assigned in three groups of normal, below, and above the normal level according to the guidelines published by National Academy of Science. Neonatal weight was determined by means of a sensitive scale in the operation room and PROM was also noted. Maternal gestational age was reported according to the LMP and sonography examination during the first trimester (complete 37 weeks was considered as term pregnancy). Pregnancy outcome was assessed by weight gain during pregnancy, neonatal birth weight, PROM, and gestational age. Finally, the association between BMI and weight gain with either of the criteria for pregnancy outcome was assessed. 3. Results A total of 106 females entered our study, of these, 101(95.3%) aged 18– 35 years, 4(3.8%) aged >35 years and one case (0.9%) < 18 years. Ninety-four subjects (88.7%) were housewife and 5 (4.7%) had positive history for smoking. 63 (40.6%) were less than 157 cm in height and 37(34.9%) experienced their first pregnancy. Regarding the BMI, 14.1% of the subjects were underweight, 47.2% were normal, 19.8% were overweight, and the remaining 18.9% were extra overweight. Fig. 1 shows the frequency of preterm delivery among different BMI groups. PROM was more frequently observed among females with BMI of 26.1 –29 kg/m2 (14.3%). It was reported in 6.7%, 4%, and 5% of the subjects belonging to the underweight, normal, and extra overweight group, respectively.
382
M. Hosseini, J. Nastaran / International Congress Series 1271 (2004) 380–383
Fig. 1. Association between preterm delivery and BMI in a group of Iranian female.
Fig. 2. Neonatal birth weight according to the maternal BMI in a group of Iranian females.
Neonatal birth weight presents in Fig. 2 according to the maternal BMI. Among females with normal BMI, 85.9% had neonates with birth weight within the normal range, however, 6.6% were LBW and the other 7.5% neonates weighed more than 4000 g. Macrosomia was more frequently observed in females with BMI of >29 kg/m2 (15%).
Data of maternal weight gain were as below. 9.4% less than 6 kg, 33% 6 – 9.9 kg, 38.7% 10– 13.9 kg, 11.4% 14 –17.9 kg, and 7.5% z 18 kg. Table 1 shows the association between weight gain with preterm delivery, PROM, and macrosomia. Preterm delivery was more obvious among subjects with weight gain of 6– 10 kg (20%), however. Macrosomia was more frequent among females with weight gain of z 18 kg. Table 2 shows the association between maternal weight gain and BMI (just prior to the pregnancy). Among these, 36.8% weighed below the normal range, and 34.9% above the Table 1 Association between maternal weight gain with preterm delivery, PROM and macrosomia in a group of Iranian females Weight gain
Below normal Normal Above normal
Pregnancy outcome
Total
PROM
Preterm delivery
1(10%) 5(6.5%) 1(5%)
1(10%) 14(18.5%) 3(15%)
Pregnancy outcome
Total
macrosomia 10 76 20
0 3(4%) 3(15%)
10 76 20
There was not a significant association between weight gain and prom and between prom and preterm delivery. There was a significant relation ( p < 0.05) between weight gain and neonate birth weight.
Table 2 Association between maternal weight gain and BMI (prior to the pregnancy) in a group of Iranian females a
BMI (kg/m2)
< 19.8 19.8 – 26 26.1 – 29 >29 Total
Maternal weight gain Below the normal
Normal
Above the normal
10(66.7) 29(58) – – 39(36.8)
5(33.3) 14(28) 9(42.9) 2(10) 30(28.3)
– 7(14) 12(57.1) 18(90) 37(34.9)
There was not a significant relation between BMI and maternal weight gain. a Just prior to the pregnancy.
M. Hosseini, J. Nastaran / International Congress Series 1271 (2004) 380–383
383
normal range. Meanwhile, there was a direct correlation between weight gain and BMI. It means increment in BMI did accompany increment in weight gain. Indeed, weight gain above the normal range was noted in 90% of females with BMI >29 kg/m2, however, this did not occur among subjects with BMI of < 19.8 kg/m2. 4. Discussion Results have revealed that 37% of parturients had weight below the normal level and 34% above this level, meanwhile, BMI was correlated with weight gain. Preterm delivery and PROM was more frequent among obese subjects. Neonates of mothers who were within the normal range of BMI had normal birth weight. The statistical analysis, however, showed there is a significant correlation ( p < 0.005) between BMI and neonate birth weight. Also, there was a coefficient relation between maternal weight gain and neonate birth weight ( p < 0.05). The analysis showed no meaningful relation between BMI and PROM, between BMI and preterm delivery and between BMI and maternal weight gain. With respect to the prior reports [5,10,11,12], one can conclude the importance of BMI, nutritional status during pregnancy and weight gain. All parturients require to be educated about complementary feeding and weight gain during pregnancy. To meet this demand, the appropriate pattern of weight gain should be designed and fetal growth must be monitored. We recommend another study to evaluate the efficacy of education on maternal weight gain during pregnancy. References [1] M.E. Cogwell, et al., Gestational weight gain among average and overweight woman; what is excessive? Am. J. Obstet. Gynecol. 172 (2PT1) (1995) 705 – 712. [2] C.A. Mickey, et al., Low pregnancy body mass index as a risk factor for preterm birth, variation by ethnic group, Obstet. Gynecol. 82 (2) (1997) 206 – 212. [3] R.D. Hickey, et al., Prenatal weight gain within upper and lower recommended ranges effect on birth weight of black and white infants, Obstet. Gynecol. 90 (4) (1997) 489 – 494. [4] R.S. Strauss, W.H. Dietz, Low maternal weight gain in the second or third trimester increases the risk for intrauterine growth retardation, J. Nutr. 129 (5) (1999) 988 – 993. [5] A. Spinillo, et al., Risk for spontaneous preterm delivery by combined body mass index and gestational weight gain patterns, Acta Obstet. Gynecol. Scand. 77 (1) (1998) 32 – 36. [6] B. Abrams, S. Carmicheal, S. Selvin, Factors associated with the pattern of maternal weight gain during pregnancy, Obstet. Gynecol. 86 (2) (1995) 170 – 176. [7] C.A. Mickey, et al., Prenatal weight gain patterns and spontaneous preterm birth among nonobeses black and white women, Obstet. Gynecol. 85 (6) (1995) 909 – 914. [8] R.L. Copper, et al., The relationship of maternal attitude towards weight gain during pregnancy and low birth weight, Ostet. Gynecol. 85 (4) (1995) 590 – 595. [9] L.H. Allen, et al., Maternal body mass index and pregnancy outcome in the Nutrition Collaborative Research Support Program, Eur. J. Clin. Nutr. 48 (Suppl. 3) (1994) 563 – 577. [10] A.M. Siega Riz, L.S. Adair, C.J. Hobel, Maternal weight gain recommendations and pregnancy outcome in a predominately Hispanic population, Obstet. Gynecol. 84 (4) (1994) 565 – 577. [11] Y.H. Neggers, et al., The relationship between maternal delivery intake and infant birth weight, Acta Obstet. Gynecol. Scand. 165 (1997) 71 – 75. [12] S.L. Carmicheal, B. Abrams, A critical review of relationship between gestational weight gain and preterm delivery, Obstet. Gynecol. 89 (2) (1997) 865 – 873.
www.ics-elsevier.com
Relationship between pregnancy outcome and maternal BMI and weight gain Maryam-sadat Hosseini a,*, Jameie Nastaran b a
Department of Gynecology Obstetrics, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Flat No. 8, No. 99 Medical Complex Rooyan St., Tehran 1415994963, Iran b Resident of Gynecology, Shahid Beheshti University of Medical Sciences, Tehran 1415994963, Iran
Abstract. Background: Previous studies have suggested the effects of maternal BMI and weight gain on pregnancy outcomes, thus, the present study was conducted over 106 parturients referring to Imam Hossein Hospital to determine the maternal BMI and weight gain and its relationship with pregnancy outcomes. Materials and methods: One hundred and six parturients had entered this longitudinal study. Initial data including weight, height, and previous deliveries were all recorded. Perinatal care was achieved. Maternal weight gain was determined and the relationship between pregnancy outcomes and maternal BMI and weight gain was assessed. Results: Of a total of 106 parturients, 101 (95.3%) aged 18 – 35 years. Most of the candidates (47.2%) had BMI of 19.8 – 26. Thirty-seven percent had weight gain below the standard level, whereas 35% had weight gain above the standard level. BMI was revealed to be correlated with weight gain. Preterm delivery was noted in 33.3% of the females with BMI between 26 and 29; however, normal candidates have experienced preterm delivery in 24%. Conclusion: Abnormal weight gain and BMI were revealed to be associated with severe maternal and neonatal complications that are associated with extra expenses for the society and the family. Maternal education and consultation seems to be helpful. D 2004 Elsevier B.V. All rights reserved. Keywords: Body mass index; Weight gain; Preterm delivery
1. Introduction Pregnancy outcome is a matter of importance that is determined with criteria such as term delivery, normal birth weight, premature rupture of membrane (PROM), preterm delivery and its complications, etc. [1,3,4]. Unusual conditions such as preterm delivery and low birth weight (LBW) were reported in up to 10% of pregnancies. Apparently, careful prenatal care may decrease complications such as PROM, infections, LBW, macrosomia and other lifethreatening factors, and of course, would prevent severe permanent maternal and neonatal complications as well as excessive expenses of the society [6,7]. Of these factors, primary maternal BMI and her weight gain during pregnancy are of utmost importance, indeed, low BMI is a risk factor for LBW [9]. Prior investigators have * Corresponding author. Tel.: +98-21-2586544. E-mail address: [email protected] (M. Hosseini). 0531-5131/ D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2004.06.022
M. Hosseini, J. Nastaran / International Congress Series 1271 (2004) 380–383
381
shown the association between the ratio of weight to height prior to the pregnancy and weight gain during pregnancy with fetal growth and development. Milckey et al. [2] have explained a reverse correlation between BMI and simultaneous preterm delivery among different ethnic groups. Copper et al. [8] have reported a lesser tendency among obese females for weight gain during pregnancy; however, thin females had got further weight gain y but their neonates did not weigh more. National Academy of Science has recommended a weight gain of 12.5 – 18 kg for thin females, 11.5– 16 kg for females weigh within the normal range, 7 – 11.5 kg for obese females and 6 kg for very obese females. This classification was made according to the BMI. The present study was conducted on parturients referring to an academic hospital in Tehran to determine the association between pregnancy outcome with BMI and weight gain. 2. Materials and methods For this longitudinal study, all females who had referred to the hospital clinic during a 12-month period were selected and entered the study after completing an informed contest. Initial data including age, parity, occupation, smoking habit, interval between pregnancies, and LMP were recorded. Our exclusion criteria were as follow: diabetes mellitus, preeclampsia, cardiovascular diseases, renal or any other disease that may affect pregnancy outcome, multiple pregnancies, and fetal anomalies. Prior to the pregnancy, weight (kg) and height (cm) were determined and BMI was calculated. Females were assigned in any of the following four groups based on their BMI: < 19.8 kg/m2 (underweight), 19.8– 26 kg/m2 (normal), 26.1 –29 kg/m2 (overweight), and >29 kg/m2 (extra overweight). Females were followed and their weight was determined during the pregnancy with a unique scale. Prior to the delivery, candidates’ weight was determined and they were assigned in three groups of normal, below, and above the normal level according to the guidelines published by National Academy of Science. Neonatal weight was determined by means of a sensitive scale in the operation room and PROM was also noted. Maternal gestational age was reported according to the LMP and sonography examination during the first trimester (complete 37 weeks was considered as term pregnancy). Pregnancy outcome was assessed by weight gain during pregnancy, neonatal birth weight, PROM, and gestational age. Finally, the association between BMI and weight gain with either of the criteria for pregnancy outcome was assessed. 3. Results A total of 106 females entered our study, of these, 101(95.3%) aged 18– 35 years, 4(3.8%) aged >35 years and one case (0.9%) < 18 years. Ninety-four subjects (88.7%) were housewife and 5 (4.7%) had positive history for smoking. 63 (40.6%) were less than 157 cm in height and 37(34.9%) experienced their first pregnancy. Regarding the BMI, 14.1% of the subjects were underweight, 47.2% were normal, 19.8% were overweight, and the remaining 18.9% were extra overweight. Fig. 1 shows the frequency of preterm delivery among different BMI groups. PROM was more frequently observed among females with BMI of 26.1 –29 kg/m2 (14.3%). It was reported in 6.7%, 4%, and 5% of the subjects belonging to the underweight, normal, and extra overweight group, respectively.
382
M. Hosseini, J. Nastaran / International Congress Series 1271 (2004) 380–383
Fig. 1. Association between preterm delivery and BMI in a group of Iranian female.
Fig. 2. Neonatal birth weight according to the maternal BMI in a group of Iranian females.
Neonatal birth weight presents in Fig. 2 according to the maternal BMI. Among females with normal BMI, 85.9% had neonates with birth weight within the normal range, however, 6.6% were LBW and the other 7.5% neonates weighed more than 4000 g. Macrosomia was more frequently observed in females with BMI of >29 kg/m2 (15%).
Data of maternal weight gain were as below. 9.4% less than 6 kg, 33% 6 – 9.9 kg, 38.7% 10– 13.9 kg, 11.4% 14 –17.9 kg, and 7.5% z 18 kg. Table 1 shows the association between weight gain with preterm delivery, PROM, and macrosomia. Preterm delivery was more obvious among subjects with weight gain of 6– 10 kg (20%), however. Macrosomia was more frequent among females with weight gain of z 18 kg. Table 2 shows the association between maternal weight gain and BMI (just prior to the pregnancy). Among these, 36.8% weighed below the normal range, and 34.9% above the Table 1 Association between maternal weight gain with preterm delivery, PROM and macrosomia in a group of Iranian females Weight gain
Below normal Normal Above normal
Pregnancy outcome
Total
PROM
Preterm delivery
1(10%) 5(6.5%) 1(5%)
1(10%) 14(18.5%) 3(15%)
Pregnancy outcome
Total
macrosomia 10 76 20
0 3(4%) 3(15%)
10 76 20
There was not a significant association between weight gain and prom and between prom and preterm delivery. There was a significant relation ( p < 0.05) between weight gain and neonate birth weight.
Table 2 Association between maternal weight gain and BMI (prior to the pregnancy) in a group of Iranian females a
BMI (kg/m2)
< 19.8 19.8 – 26 26.1 – 29 >29 Total
Maternal weight gain Below the normal
Normal
Above the normal
10(66.7) 29(58) – – 39(36.8)
5(33.3) 14(28) 9(42.9) 2(10) 30(28.3)
– 7(14) 12(57.1) 18(90) 37(34.9)
There was not a significant relation between BMI and maternal weight gain. a Just prior to the pregnancy.
M. Hosseini, J. Nastaran / International Congress Series 1271 (2004) 380–383
383
normal range. Meanwhile, there was a direct correlation between weight gain and BMI. It means increment in BMI did accompany increment in weight gain. Indeed, weight gain above the normal range was noted in 90% of females with BMI >29 kg/m2, however, this did not occur among subjects with BMI of < 19.8 kg/m2. 4. Discussion Results have revealed that 37% of parturients had weight below the normal level and 34% above this level, meanwhile, BMI was correlated with weight gain. Preterm delivery and PROM was more frequent among obese subjects. Neonates of mothers who were within the normal range of BMI had normal birth weight. The statistical analysis, however, showed there is a significant correlation ( p < 0.005) between BMI and neonate birth weight. Also, there was a coefficient relation between maternal weight gain and neonate birth weight ( p < 0.05). The analysis showed no meaningful relation between BMI and PROM, between BMI and preterm delivery and between BMI and maternal weight gain. With respect to the prior reports [5,10,11,12], one can conclude the importance of BMI, nutritional status during pregnancy and weight gain. All parturients require to be educated about complementary feeding and weight gain during pregnancy. To meet this demand, the appropriate pattern of weight gain should be designed and fetal growth must be monitored. We recommend another study to evaluate the efficacy of education on maternal weight gain during pregnancy. References [1] M.E. Cogwell, et al., Gestational weight gain among average and overweight woman; what is excessive? Am. J. Obstet. Gynecol. 172 (2PT1) (1995) 705 – 712. [2] C.A. Mickey, et al., Low pregnancy body mass index as a risk factor for preterm birth, variation by ethnic group, Obstet. Gynecol. 82 (2) (1997) 206 – 212. [3] R.D. Hickey, et al., Prenatal weight gain within upper and lower recommended ranges effect on birth weight of black and white infants, Obstet. Gynecol. 90 (4) (1997) 489 – 494. [4] R.S. Strauss, W.H. Dietz, Low maternal weight gain in the second or third trimester increases the risk for intrauterine growth retardation, J. Nutr. 129 (5) (1999) 988 – 993. [5] A. Spinillo, et al., Risk for spontaneous preterm delivery by combined body mass index and gestational weight gain patterns, Acta Obstet. Gynecol. Scand. 77 (1) (1998) 32 – 36. [6] B. Abrams, S. Carmicheal, S. Selvin, Factors associated with the pattern of maternal weight gain during pregnancy, Obstet. Gynecol. 86 (2) (1995) 170 – 176. [7] C.A. Mickey, et al., Prenatal weight gain patterns and spontaneous preterm birth among nonobeses black and white women, Obstet. Gynecol. 85 (6) (1995) 909 – 914. [8] R.L. Copper, et al., The relationship of maternal attitude towards weight gain during pregnancy and low birth weight, Ostet. Gynecol. 85 (4) (1995) 590 – 595. [9] L.H. Allen, et al., Maternal body mass index and pregnancy outcome in the Nutrition Collaborative Research Support Program, Eur. J. Clin. Nutr. 48 (Suppl. 3) (1994) 563 – 577. [10] A.M. Siega Riz, L.S. Adair, C.J. Hobel, Maternal weight gain recommendations and pregnancy outcome in a predominately Hispanic population, Obstet. Gynecol. 84 (4) (1994) 565 – 577. [11] Y.H. Neggers, et al., The relationship between maternal delivery intake and infant birth weight, Acta Obstet. Gynecol. Scand. 165 (1997) 71 – 75. [12] S.L. Carmicheal, B. Abrams, A critical review of relationship between gestational weight gain and preterm delivery, Obstet. Gynecol. 89 (2) (1997) 865 – 873.