Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004–2013

English version

Autoři: U. Vivian Ukah ^aff001; Hamideh Bayrampour ^aff002; Yasser Sabr ^aff003; Neda Razaz ^aff004; Wee-Shian Chan ^aff005; Kenneth I. Lim ^aff006; Sarka Lisonkova ^aff006
Působiště autorů: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada ^aff001; Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada ^aff002; Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia ^aff003; Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden ^aff004; Department of Medicine, University of British Columbia and BC Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada ^aff005; Department of Obstetrics and Gynaecology, University of British Columbia, BC Children’s Hospital, and BC Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada ^aff006; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada ^aff007
Vyšlo v časopise: Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004–2013. PLoS Med 16(12): e32767. doi:10.1371/journal.pmed.1003009
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1003009

Souhrn

Background

Suboptimal weight gain during pregnancy is a potentially modifiable risk factor. We aimed to investigate the association between suboptimal gestational weight gain and severe adverse birth outcomes by pre-pregnancy body mass index (BMI) categories, including obesity class I to III.

Methods and findings

We conducted a population-based study of pregnant women with singleton hospital births in Washington State, US, between 2004 and 2013. Optimal, low, and excess weight gain in each BMI category was calculated based on weight gain by gestational age as recommended by the American College of Obstetricians and Gynecologists and the Institute of Medicine. Primary composite outcomes were (1) maternal death and/or severe maternal morbidity (SMM) and (2) perinatal death and/or severe neonatal morbidity. Logistic regression was used to obtain adjusted odds ratios (AORs) and 95% confidence intervals. Overall, 722,839 women with information on pre-pregnancy BMI were included. Of these, 3.1% of women were underweight, 48.1% had normal pre-pregnancy BMI, 25.8% were overweight, and 23.0% were obese. Only 31.5% of women achieved optimal gestational weight gain. Women who had low weight gain were more likely to be African American and have Medicaid health insurance, while women with excess weight gain were more likely to be non-Hispanic white and younger than women with optimal weight gain in each pre-pregnancy BMI category. Compared with women who had optimal weight gain, those with low gestational weight gain had a higher rate of maternal death, 7.97 versus 2.63 per 100,000 (p = 0.027). In addition, low weight gain was associated with the composite adverse maternal outcome (death/SMM) in women with normal pre-pregnancy BMI and in overweight women (AOR 1.12, 95% CI 1.04–1.21, p = 0.004, and AOR 1.17, 95% CI 1.04–1.32, p = 0.009, respectively) compared to women in the same pre-pregnancy BMI category who had optimal weight gain. Similarly, excess gestational weight gain was associated with increased rates of death/SMM among women with normal pre-pregnancy BMI (AOR 1.20, 95% CI 1.12–1.28, p < 0.001) and obese women (AOR 1.12, 95% CI 1.01–1.23, p = 0.019). Low gestational weight gain was associated with perinatal death and severe neonatal morbidity regardless of pre-pregnancy BMI, including obesity classes I, II, and III, while excess weight gain was associated with severe neonatal morbidity only in women who were underweight or had normal BMI prior to pregnancy. Study limitations include the ascertainment of pre-pregnancy BMI using self-report, and lack of data availability for the most recent years.

Conclusions

In this study, we found that most women do not achieve optimal weight gain during pregnancy. Low weight gain was associated with increased risk of severe adverse birth outcomes, and in particular with maternal death and perinatal death. Excess gestational weight gain was associated with severe adverse birth outcomes, except for women who were overweight prior to pregnancy. Weight gain recommendations for this group may need to be reassessed. It is important to counsel women during pregnancy about specific risks associated with both low and excess weight gain.

Klíčová slova:

Birth – Body Mass Index – Labor and delivery – Morbid obesity – Morbidity – Obesity – Pregnancy – Weight gain

Zdroje

1. American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol. 2013;121(1):210–2. 23262962

2. Voerman E, Santos S, Inskip H, Amiano P, Barros H, Charles M, et al. Association of gestational weight gain with adverse maternal and infant outcomes. JAMA. 2019;321(17):1702–15. doi: 10.1001/jama.2019.3820 31063572

3. Institute of Medicine and National Research Council Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines. Washington (DC): National Academies Press; 2009.

4. Feghali MN, Catov JM, Zantow E, Mission J, Caritis SN, Scifres CM. Timing of gestational weight gain and adverse perinatal outcomes in overweight and obese women. Obstet Gynecol. 2019;133(5):962–70. doi: 10.1097/AOG.0000000000003234 30969214

5. Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017;317(21):2207–25. doi: 10.1001/jama.2017.3635 28586887

6. Bodnar LM, Siega-Riz AM, Simhan HN, Himes KP, Abrams B. Severe obesity, gestational weight gain, and adverse birth outcomes. Am J Clin Nutr. 2010;91(6):1642–8. doi: 10.3945/ajcn.2009.29008 20357043

7. Bodnar LM, Pugh SJ, Lash TL, Hutcheon JA, Himes KP, Parisi SM, et al. Low gestational weight gain and risk of adverse perinatal outcomes in obese and severely obese women. Epidemiology. 2016;27(6):894–902. doi: 10.1097/EDE.0000000000000535 27682365

8. Beyerlein A, Schiessl B, Lack N, von Kries R. Optimal gestational weight gain ranges for the avoidance of adverse birth weight outcomes: a novel approach. Am J Clin Nutr. 2009;90(6):1552–8. doi: 10.3945/ajcn.2009.28026 19812177

9. Stotland NE, Cheng YW, Hopkins LM, Caughey AB. Gestational weight gain and adverse neonatal outcome among term infants. Obstet Gynecol. 2006;108:635–43. doi: 10.1097/01.AOG.0000228960.16678.bd 16946225

10. Fixler J, DeFranco E. Gestational weight gain and pregnancy outcomes: where does delivery timing fit in? Women’s Health Investigation. 2019;2:1–3. doi: 10.21037/whi.2019.01.01

11. Dzakpasu S, Fahey J, Kirby RS, Tough SC, Chalmers B, Heaman MI, et al. Contribution of prepregnancy body mass index and gestational weight gain to adverse neonatal outcomes: population attributable fractions for Canada. BMC Pregnancy Childbirth. 2015;15(1):21.

12. Schieve LA, Cogswell ME, Scanlon KS. Maternal weight gain and preterm delivery: differential effects by body mass index. Epidemiology. 1999;10(2):141–7. 10069249

13. Aune D, Saugstad OD, Henriksen T, Tonstad S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA. 2014;311(15):1536–46. doi: 10.1001/jama.2014.2269 24737366

14. Truong YN, Yee LM, Caughey AB, Cheng YW. Weight gain in pregnancy: does the Institute of Medicine have it right? Obstet Gynecol. 2015;212(3):362.e1–8.

15. Haugen M, Brantsæter AL, Winkvist A, Lissner L, Alexander J, Oftedal B, et al. Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: a prospective observational cohort study. BMC Pregnancy Childbirth. 2014;14(1):201.

16. Platner MH, Ackerman C, Howland RE, Xu X, Pettker CM, Illuzzi JL, et al. Gestational weight gain and severe maternal morbidity at delivery hospitalization. Obstet Gynecol. 2019;133(3):515–24. doi: 10.1097/AOG.0000000000003114 30741805

17. Katzmarzyk PT. The Canadian obesity epidemic: an historical perspective. Obes Res. 2002;10(7):666–74. doi: 10.1038/oby.2002.90 12105289

18. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief. 2015;(219):1–8. 26633046

19. Berger H, Melamed N, Murray-Davis B, Hasan H, Mawjee K, Barrett J, et al. Prevalence of pre-pregnancy diabetes, obesity, and hypertension in Canada. J Obstet Gynaecol Can. 2019;41(11):1579–88. doi: 10.1016/j.jogc.2019.01.020 30914233

20. ACOG practice bulletin no 156: obesity in pregnancy. Obstet Gynecol. 2015;126(6):e112–26. 26595582

21. American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: obesity in pregnancy. Obstet Gynecol 2013;121(1):213–7. 23262963

22. Lydon-Rochelle MT, Holt VL, Cárdenas V, Nelson JC, Easterling TR, Gardella C, et al. The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data. Obstet Gynecol. 2005;193(1):125–34.

23. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation (WHO Technical Report Series 894). Geneva: World Health Organization; 2000 [cited 2019 May 21]. http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en.

24. Joseph KS, Liu S, Rouleau J, Kirby RS, Kramer MS, Sauve R, et al. Severe maternal morbidity in Canada, 2003 to 2007: surveillance using routine hospitalization data and ICD-10CA codes. J Obstet Gynaecol Can. 2010;32(9):837–46. doi: 10.1016/S1701-2163(16)34655-2 21050516

25. Callaghan WM, MacKay AP, Berg CJ. Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991–2003. Obstet Gynecol. 2008;199(2):133.e1–e8.

26. Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. 2012;120(5):1029–36. 23090519

27. Kuklina EV, Meikle SF, Jamieson DJ, Whiteman MK, Barfield WD, Hillis SD, et al. Severe obstetric morbidity in the United States: 1998–2005. Obstet Gynecol. 2009;113:293–9. doi: 10.1097/AOG.0b013e3181954e5b 19155897

28. Wasserstein RL, Lazar NA. The ASA’s statement on p-values: context, process, and purpose. Am Stat. 2016;70(2):129.

29. Practice bulletin no. 156 summary: obesity in pregnancy. Obstet Gynecol 2015;126(6):1321–2.

30. Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ. 2017;360:j1.

31. Goldstein RF, Abell SK, Ranasinha S, Misso ML, Boyle JA, Harrison CL, et al. Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women. BMC Med. 2018;16(1):153. doi: 10.1186/s12916-018-1128-1 30165842

32. Bodnar LM, Siminerio LL, Himes KP, Hutcheon JA, Lash TL, Parisi SM, et al. Maternal obesity and gestational weight gain are risk factors for infant death. Obesity. 2016;24(2):490–8. doi: 10.1002/oby.21335 26572932

33. Durnwald C. Gestational diabetes: linking epidemiology, excessive gestational weight gain, adverse pregnancy outcomes, and future metabolic syndrome. Semin Perinatol. 2015;39(4):254–8. doi: 10.1053/j.semperi.2015.05.002 26093518

34. Lin CJ, DeRoo LA, Jacobs SR, Sandler DP. Accuracy and reliability of self-reported weight and height in the Sister Study. Public Health Nutr. 2012;15(6):989–99. doi: 10.1017/S1368980011003193 22152926

35. Skeie G, Mode N, Henningsen M, Borch KB. Validity of self-reported body mass index among middle-aged participants in the Norwegian Women and Cancer study. Clin Epidemiol. 2015;7:313–23. doi: 10.2147/CLEP.S83839 26170718

36. Hutcheon JA, Bodnar LM. Good practices for observational studies of maternal weight and weight gain in pregnancy. Paediatr Perinat Epidemiol. 2018;32(2):152–60. doi: 10.1111/ppe.12439 29345321

37. Boyd AD, Yang YM, Li J, Kenost C, Burton MD, Becker B, et al. Challenges and remediation for patient safety indicators in the transition to ICD-10-CM. J Am Med Inform Assoc. 2015; 22(1):19–28. doi: 10.1136/amiajnl-2013-002491 25186492

38. Wacholder S, Hartge P, Lubin JH, Dosemeci M. Non-differential misclassification and bias towards the null: A clarification. Occup Environ Med. 1995;52(8):557–8. doi: 10.1136/oem.52.8.557 7663646