Maternal interpregnancy weight change and premature birth: Findings from an English population-based cohort study

Autoři: Grace Grove aff001;  Nida Ziauddeen aff001;  Scott Harris aff001;  Nisreen A. Alwan aff001
Působiště autorů: School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom aff001;  NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225400



The relationship between maternal weight change between pregnancies and premature birth is unclear. This study aimed to investigate whether interpregnancy weight change between first and second, or second and third pregnancy is associated with premature birth.


Routinely collected data from 2003 to 2018 from one English maternity centre was used to produce two cohorts. The primary cohort (n = 14,961 women) consisted of first and second live-birth pregnancies. The secondary cohort (n = 5,108 women) consisted of second and third live-birth pregnancies. Logistic regression models were used to examine associations between interpregnancy BMI change and premature births adjusted for confounders. Subgroup analyses were carried out, stratifying by initial pregnancy BMI groups and analysing spontaneous and indicated premature births separately.


In the primary cohort, 3.4% (n = 514) of births were premature compared to 4.2% (n = 212) in the secondary cohort, with fewer indicated than spontaneous premature births in both cohorts.

Primary cohort

Weight loss (>3kg/m2) was associated with increased odds of premature birth (adjusted odds ratio (aOR):3.50, 95% CI: 1.78–6.88), and spontaneous premature birth (aOR: 3.34, 95%CI: 1.60–6.98), in women who were normal weight (BMI 18.5-25kg/m2) at first pregnancy. Weight gain >1kg/m2 was not associated with premature birth regardless of starting BMI.

Secondary cohort

Losing >3kg/m2 was associated with increased odds of premature birth (aOR: 2.01, 95%CI: 1.05–3.87), when analysing the whole sample, but not when restricting the analysis to women who were overweight or obese at second pregnancy.


Normal-weight women who lose significant weight (>3kg/m2) between their first and second live pregnancies have greater odds of premature birth compared to normal-weight women who remain weight stable in the interpregnancy period. There was no evidence of association between weight change in women who were overweight or obese at the start of their first pregnancy and premature birth.

Klíčová slova:

Body Mass Index – Ethnicities – Labor and delivery – Obesity – Pregnancy – Preterm birth – Weight gain – Weight loss


1. World Health Organization, March of Dimes, Save the Children, The Partnership for Maternal and Newborn and Child Health. Born too soon; The global action report on preterm birth2012 15/06/2018. Available from:

2. Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. The Lancet. 2016;388(10063):3027–35. doi: 10.1016/S0140-6736(16)31593-8 27839855

3. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. The Lancet. 2012;379(9832):2162–72. Epub 2012/06/12. doi: 10.1016/s0140-6736(12)60820-4 22682464.

4. Frey HA, Klebanoff MA. The epidemiology, etiology, and costs of preterm birth. Seminars in Fetal and Neonatal Medicine. 2016;21(2):68–73. doi: 10.1016/j.siny.2015.12.011 26794420

5. Harrison MS, Goldenberg RL. Global burden of prematurity. Seminars in Fetal and Neonatal Medicine. 2016;21(2):74–9. doi: 10.1016/j.siny.2015.12.007 26740166

6. Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. The Lancet. 2008;371(9608):261–9.

7. Hruby A, Hu FB. The epidemiology of obesity: a big picture. PharmacoEconomics. 2015;33(7):673–89. doi: 10.1007/s40273-014-0243-x PMC4859313. 25471927

8. Poston L, Caleyachetty R, Cnattingius S, Corvalan C, Uauy R, Herring S, et al. Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol. 2016;4(12):1025–36. doi: 10.1016/S2213-8587(16)30217-0 WOS:000393025700029. 27743975

9. NHS Digital. Health Survey for England 2017: Adult and child overweight and obesity: @NHSDigital; 2017 [13/03/2019]. Available from:

10. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. The Lancet. 2008;371(9606):75–84.

11. McBain RD, Dekker GA, Clifton VL, Mol BW, Grzeskowiak LE. Impact of inter-pregnancy BMI change on perinatal outcomes: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2016;205:98–104. doi: 10.1016/j.ejogrb.2016.07.487 27567535

12. Villamor E, Cnattingius S. Interpregnancy weight change and risk of preterm delivery. Obesity (Silver Spring). 2016;24(3):727–34. doi: 10.1002/oby.21384 26833699.

13. Wallace JM, Bhattacharya S, Campbell DM, Horgan GW. Inter-pregnancy weight change impacts placental weight and is associated with the risk of adverse pregnancy outcomes in the second pregnancy. BMC Pregnancy Childbirth. 2014;14:40. doi: 10.1186/1471-2393-14-40 24450357.

14. Wallace JM, Bhattacharya S, Campbell DM, Horgan GW. Inter-pregnancy weight change and the risk of recurrent pregnancy complications. PLoS ONE [Internet]. 2016; 11(5):[e0154812 p.].

15. Wallace JM, Bhattacharya S, Horgan GW. Weight change across the start of three consecutive pregnancies and the risk of maternal morbidity and SGA birth at the second and third pregnancy. PLoS ONE [Internet]. 2017; 12(6):[e0179589 p.].

16. Goldenberg RL. The plausibility of micronutrient deficiency in relationship to perinatal infection. The journal of nutrition. 2003;133(5 Suppl 2):1645s–8s. Epub 2003/05/06. doi: 10.1093/jn/133.5.1645S 12730479.

17. Gravett MG, Rubens CE, Nunes TM, the GRG. Global report on preterm birth and stillbirth (2 of 7): discovery science. BMC Pregnancy and Childbirth. 2010;10(Suppl 1):S2–S. doi: 10.1186/1471-2393-10-S1-S2 PMC2841774. 20233383

18. Kivimäki M, Head J, Ferrie JE, Shipley MJ, Brunner E, Vahtera J, et al. Work stress, weight gain and weight loss: evidence for bidirectional effects of job strain on body mass index in the Whitehall II study. International Journal Of Obesity. 2006;30:982–7. doi: 10.1038/sj.ijo.0803229 16418750

19. Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage, investigation and treatment of couples (Green-top Guideline No. 17)2017 01/08/2018. Available from:

20. World Health Organization. Obesity: preventing and managing the global epidemic. WHO. 2000. /entity/nutrition/publications/obesity/WHO_TRS_894/en/index.html.

21. National Institute for Health and Care Excellence. Guidance and guidelines CG62: Antenatal care for uncomplicated pregnancies: NICE; 2018 [24/07/2018]. Available from:

22. Whiteman VE, Rao K, Duan J, Alio A, Marty PJ, Salihu HM. Changes in prepregnancy body mass index between pregnancies and risk of preterm phenotypes. Am J Perinatol. 2011;28(1):67–74. doi: 10.1055/s-0030-1262905 20640971.

23. Hoff GL, Cai J, Okah FA, Dew PC. Pre-pregnancy overweight status between successive pregnancies and pregnancy outcomes. J Womens Health (Larchmt). 2009;18(9):1413–7. doi: 10.1089/jwh.2008.1290 19698074.

24. Ziauddeen N, Wilding S, Roderick PJ, Macklon NS, Alwan NA. Is maternal weight gain between pregnancies associated with risk of large-for-gestational age birth? Analysis of a UK population-based cohort. BMJ Open. 2019;9(7):e026220. doi: 10.1136/bmjopen-2018-026220 31289065

25. Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. The Lancet. 2006;368(9542):1164–70.

26. Heslehurst N, Rankin J, Wilkinson JR, Summerbell CD. A nationally representative study of maternal obesity in England, UK: trends in incidence and demographic inequalities in 619,323 births, 1989–2007. International Journal Of Obesity. 2009;34:420–8. doi: 10.1038/ijo.2009.250 20029373

27. Culhane JF, Goldenberg RL. Racial disparities in preterm birth. Semin Perinatol. 2011;35(4):234–9. doi: 10.1053/j.semperi.2011.02.020 21798403

28. Snijder MB, Galenkamp H, Prins M, Derks EM, Peters RJG, Zwinderman AH, et al. Cohort profile: the healthy life in an urban setting (HELIUS) study in Amsterdam, the Netherlands. BMJ Open. 2017;7(12). doi: 10.1136/bmjopen-2017-017873 29247091

29. Ehtisham S, Crabtree N, Clark P, Shaw N, Barrett T. Ethnic differences in insulin resistance and body composition in United Kingdom adolescents. The Journal of Clinical Endocrinology & Metabolism. 2005;90(7):3963–9. doi: 10.1210/jc.2004-2001 15840754

30. Devaux M, Sassi F. Social inequalities in obesity and overweight in 11 OECD countries. European Journal of Public Health. 2013;23(3):464–9. doi: 10.1093/eurpub/ckr058 21646363

31. Drewnowski A. Obesity, diets, and social inequalities. Nutrition Reviews. 2009;67(suppl_1):S36–S9. doi: 10.1111/j.1753-4887.2009.00157.x 19453676

32. Thompson JM, Irgens LM, Rasmussen S, Daltveit AK. Secular trends in socio-economic status and the implications for preterm birth. Paediatr Perinat Epidemiol. 2006;20(3):182–7. Epub 2006/04/25. doi: 10.1111/j.1365-3016.2006.00711.x 16629692.

33. Petersen CB, Mortensen LH, Morgen CS, Madsen M, Schnor O, Arntzen A, et al. Socio-economic inequality in preterm birth: a comparative study of the Nordic countries from 1981 to 2000. Paediatr Perinat Epidemiol. 2009;23(1):66–75. doi: 10.1111/j.1365-3016.2008.00977.x 19228316

34. Jaddoe VWV, Troe E-JWM, Hofman A, Mackenbach JP, Moll HA, Steegers EAP, et al. Active and passive maternal smoking during pregnancy and the risks of low birthweight and preterm birth: the Generation R Study. Paediatr Perinat Epidemiol. 2008;22(2):162–71. doi: 10.1111/j.1365-3016.2007.00916.x 18298691

35. Smith LK, Draper ES, Evans TA, Field DJ, Johnson SJ, Manktelow BN, et al. Associations between late and moderately preterm birth and smoking, alcohol, drug use and diet: a population-based case–cohort study. Archives of Disease in Childhood—Fetal and Neonatal Edition. 2015;100:F486–91. doi: 10.1136/archdischild-2014-307265 25972442

36. Canoy D, Wareham N, Luben R, Welch A, Bingham S, Day N, et al. Cigarette smoking and fat distribution in 21,828 British men and women: a population-based study. Obesity Research. 2005;13(8):1466–75. doi: 10.1038/oby.2005.177 16129730

37. Saurel-Cubizolles M, Zeitlin J, Lelong N, Papiernik E, Di R, Breart G. Employment, working conditions, and preterm birth: results from the Europop case-control survey. Journal of Epidemiology and Community Health. 2004;58(5):395–401. doi: 10.1136/jech.2003.008029 PMC1732750. 15082738

38. Brett KM, Strogatz DS, Savitz DA. Employment, job strain, and preterm delivery among women in North Carolina. American Journal of Public Health. 1997;87(2):199–204. PMC1380794. doi: 10.2105/ajph.87.2.199 9103097

39. Smith LK, Draper ES, Manktelow BN, Dorling JS, Field DJ. Socioeconomic inequalities in very preterm birth rates. Archives of Disease in Childhood—Fetal and Neonatal Edition. 2007;92(1):F11–F4. doi: 10.1136/adc.2005.090308 16595590

40. Ananth CV, Getahun D, Peltier MR, Salihu HM, Vintzileos AM. Recurrence of spontaneous versus medically indicated preterm birth. American Journal of Obstetrics and Gynecology. 2006;195(3):643–50. Epub 2006/09/05. doi: 10.1016/j.ajog.2006.05.022 16949395.

41. Sperrin M, Marshall AD, Higgins V, Buchan IE, Renehan AG. Slowing down of adult body mass index trend increases in England: a latent class analysis of cross-sectional surveys (1992–2010). International Journal Of Obesity. 2013;38:818–24. doi: 10.1038/ijo.2013.161 23995474

42. Schempf AH, Branum AM, Lukacs SL, Schoendorf KC. Maternal age and parity-associated risks of preterm birth: differences by race/ethnicity. Paediatr Perinat Epidemiol. 2007;21(1):34–43. doi: 10.1111/j.1365-3016.2007.00785.x 17239177

43. Newburn-Cook CV, Onyskiw JE. Is older maternal age a risk factor for preterm birth and fetal growth restriction? A systematic review. Health Care for Women International. 2005;26(9):852–75. doi: 10.1080/07399330500230912 16214797

44. Hendler I, Goldenberg RL, Mercer BM, Iams JD, Meis PJ, Moawad AH, et al. The preterm prediction study: association between maternal body mass index and spontaneous and indicated preterm birth. American Journal of Obstetrics and Gynecology. 2005;192(3):882–6. doi: 10.1016/j.ajog.2004.09.021 15746686

45. Auger N, Le TUN, Park AL, Luo Z-C. Association between maternal comorbidity and preterm birth by severity and clinical subtype: retrospective cohort study. BMC Pregnancy and Childbirth. 2011;11(1):67. doi: 10.1186/1471-2393-11-67 21970736

46. Wang JX, Norman RJ, Kristiansson P. The effect of various infertility treatments on the risk of preterm birth. Human Reproduction. 2002;17(4):945–9. doi: 10.1093/humrep/17.4.945 11925387

47. Dunietz GL, Holzman C, McKane P, Li C, Boulet SL, Todem D, et al. Assisted reproductive technology and the risk of preterm birth among primiparas. Fertility and Sterility. 2015;103(4):974–9. doi: 10.1016/j.fertnstert.2015.01.015 25707336

48. Zeitlin J, Saurel-Cubizolles M-J, de Mouzon J, Rivera L, Ancel P-Y, Blondel B, et al. Fetal sex and preterm birth: are males at greater risk? Human Reproduction. 2002;17(10):2762–8. doi: 10.1093/humrep/17.10.2762 12351559

49. Smith GCS, Pell JP, Dobbie R. Interpregnancy interval and risk of preterm birth and neonatal death: retrospective cohort study. Bmj. 2003;327(7410):313. doi: 10.1136/bmj.327.7410.313 12907483

50. Davis EM, Babineau DC, Wang X, Zyzanski S, Abrams B, Bodnar L, et al. Short inter-pregnancy intervals, parity, excessive pregnancy weight gain and risk of maternal obesity. Maternal and child health journal. 2014;18(3):554–62. doi: 10.1007/s10995-013-1272-3 PMC3840151. 23595566

51. World Health Organisation. Report of a WHO Technical Consultation on Birth Spacing Geneva2007 [01/03/2019]. Available from:

52. Smith L, Savory J, Couves J, Burns E. Alcohol consumption during pregnancy: Cross-sectional survey. Midwifery. 2014;30(12):1173–8. doi: 10.1016/j.midw.2014.04.002 24815567

53. Mårdby A-C, Lupattelli A, Hensing G, Nordeng H. Consumption of alcohol during pregnancy—a multinational European study. Women and Birth [Internet]. 2017 2017/08/01/; 30(4):[e207-e13 pp.].

54. StataCorp. Stata Statistical Software: Release 15. College Station, Texas: StataCorp LLC; 2017.

55. Zeitlin J, Szamotulska K, Drewniak N, Mohangoo A, Chalmers J, Sakkeus L, et al. Preterm birth time trends in Europe: a study of 19 countries. BJOG: An International Journal of Obstetrics & Gynaecology. 2013;120(11):1356–65. doi: 10.1111/1471-0528.12281 23700966

56. Chen A, Klebanoff MA, Basso O. Pre-pregnancy body mass index change between pregnancies and preterm birth in the following pregnancy. Paediatr Perinat Epidemiol. 2009;23(3):207–15. doi: 10.1111/j.1365-3016.2009.01029.x 19775382.

57. Neggers Y, Goldenberg RL. Some thoughts on body mass index, micronutrient intakes and pregnancy outcome. The Journal of Nutrition. 2003;133(5):1737S–40S. doi: 10.1093/jn/133.5.1737S 12730492

58. Jans G, Matthys C, Bogaerts A, Lannoo M, Verhaeghe J, Van der Schueren B, et al. Maternal micronutrient deficiencies and related adverse neonatal outcomes after bariatric surgery: a systematic review. Advances in Nutrition. 2015;6(4):420–9. doi: 10.3945/an.114.008086 26178026

59. Riley KL, Carmichael SL, Mayo JA, Shachar BZ, Girsen AI, Wallenstein MB, et al. Body mass index change between pregnancies and risk of spontaneous preterm birth. Am J Perinatol. 2016;33(10):1017–22. doi: 10.1055/s-0036-1572533 27128743.

60. Girsen AI, Mayo JA, Wallenstein MB, Gould JB, Carmichael SL, Stevenson DK, et al. What factors are related to recurrent preterm birth among underweight women? J Matern Fetal Neonatal Med. 2018;31(5):560–6. doi: 10.1080/14767058.2017.1292243 28166677.

61. Merlino A, Laffineuse L, Collin M, Mercer B. Impact of weight loss between pregnancies on recurrent preterm birth. Am J Obstet Gynecol. 2006;195(3):818–21. doi: 10.1016/j.ajog.2006.06.043 16949418.

62. Norman JE, Morris C, Chalmers J. The effect of changing patterns of obstetric care in Scotland (1980–2004) on rates of preterm birth and its neonatal consequences: perinatal database study. PLOS Medicine [Internet]. 2009; 6(9):[e1000153 p.].

63. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Supplimentary Appendix. The Lancet [Internet]. 2012 03/08/2018; 379(9832):[76–81 pp.]. Available from:

64. Bastian LA, Pathiraja VC, Krause K, Namenek Brouwer RJ, Swamy GK, Lovelady CA, et al. Multiparity is associated with high motivation to change diet among overweight and obese postpartum women. Women's health issues: official publication of the Jacobs Institute of Women's Health. 2010;20(2):133–8. Epub 2010/02/13. doi: 10.1016/j.whi.2009.11.005 20149971; PubMed Central PMCID: PMC2849268.

65. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, et al. Maternal obesity and pregnancy outcome: a study of 287 213 pregnancies in London. International Journal Of Obesity. 2001;25:1175–82. doi: 10.1038/sj.ijo.0801670 11477502

66. National Institute for Health Care Excellence. Public health guideline [PH27]: Weight management before, during and after pregnancy: NICE; 2010 [08/08/2018]. Available from:

67. Yu Z, Han S, Zhu J, Sun X, Ji C, Guo X. Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis. PLoS ONE [Internet]. 2013 PMC3628788]; 8(4):[e61627 p.]. Available from:

68. Han Z, Mulla S, Beyene J, Liao G, McDonald SD, on behalf of the Knowledge Synthesis G. Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. International Journal of Epidemiology. 2011;40(1):65–101. doi: 10.1093/ije/dyq195 21097954

69. Oteng-Ntim E, Mononen S, Sawicki O, Seed PT, Bick D, Poston L. Interpregnancy weight change and adverse pregnancy outcomes: a systematic review and meta-analysis. BMJ Open [Internet]. 2018; 8(6):[e018778 p.]. Available from:

70. Bhattacharya S, Campbell DM, Liston WA, Bhattacharya S. Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies. BMC Public Health. 2007;7(1):168. doi: 10.1186/1471-2458-7-168 17650297

71. Edvardsson K, Ivarsson A, Eurenius E, Garvare R, Nyström ME, Small R, et al. Giving offspring a healthy start: parents' experiences of health promotion and lifestyle change during pregnancy and early parenthood. BMC Public Health. 2011;11(1):936. doi: 10.1186/1471-2458-11-936 22171644

Článek vyšel v časopise


2019 Číslo 11