Pregnancy Outcomes after Preeclampsia: The Effects of Interpregnancy Weight Change

Objective This study aimed to examine the effects of interpregnancy weight change on pregnancy outcomes, including recurrent preeclampsia, preterm birth, small-for-gestational age (SGA), large-for-gestational age (LGA), and cesarean delivery, among women with a history of preeclampsia. We also evaluated whether these associations were modified by prepregnancy body mass index (BMI) category in the first pregnancy (BMI < 25 vs. ≥25 kg/m2) and if associations were present among women who maintained a healthy BMI category in both pregnancies. Study Design We conducted a population-based retrospective cohort study including 15,108 women who delivered their first two nonanomalous singleton live births in Missouri (1989–2005) and experienced preeclampsia in the first pregnancy. We performed Poisson regression with robust error variance to estimate relative risks and 95% confidence intervals for outcomes of interest after controlling for potential confounders. Results Interpregnancy weight gain was associated with increased risk of recurrent preeclampsia, LGA, and cesarean delivery. These risks increased in a “dose–response” manner with increasing magnitude of interpregnancy weight gain and were generally more pronounced among women who were underweight or normal weight in the first pregnancy. Interpregnancy weight loss exceeding 1 BMI unit was associated with increased risk of SGA among underweight and normal weight women, while interpregnancy weight loss exceeding 2 BMI units was associated with reduced risk of recurrent preeclampsia among overweight and obese women. Conclusion Even small changes in interpregnancy weight may significantly affect pregnancy outcomes among formerly preeclamptic women. Appropriate weight management between pregnancies has the potential to attenuate such risks. Key Points

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Higher Peripheral Cholesterol and a Positive Correlation With Risk for Large-For-Gestational-Age Neonates in Pre-Pregnancy Underweight Women

Frontiers in Endocrinology ◽

10.3389/fendo.2021.760934 ◽

2021 ◽

Vol 12 ◽

Author(s):

Dongyu Wang ◽

Wenjing Ding ◽

Chengcheng Ding ◽

Haitian Chen ◽

Weihua Zhao ◽

...

Keyword(s):

Weight Gain ◽

Gestational Age ◽

Subgroup Analysis ◽

Pregnancy Outcomes ◽

Normal Weight ◽

Large For Gestational Age ◽

Overweight Women ◽

Gestational Weight ◽

Adverse Pregnancy ◽

Iom Recommendations

ObjectiveAs the high proportion of underweight pregnant women, omission of their weight gain and blood lipids management during gestation might lead to adverse pregnancy outcomes. This study aimed to determine the relationship between lipid profile and risks for adverse pregnancy outcomes in pre-pregnancy underweight women.MethodsThis study was part of an ongoing cohort study including Chinese gravidas delivered from January 2015 to December 2016. Included subjects were grouped into underweight, normal-weight, and overweight by BMI before conception. Logistic regression was used to assess the association between lipid profiles during second trimester and adverse obstetric outcomes in each group. A subgroup analysis according to the gestational weight gain, in which subjects in each group were divided into above and within the Institute of Medicine (IOM) recommendations, was performed.ResultsA total of 6, 223 women were included. The proportion of underweight (19.3%) was similar to that of overweight women (19.4%) in South China. Peripheral total cholesterol (TC) level in underweight women was significantly higher than that in overweight women (P <0.001). After adjusting maternal age, TC level was positively correlated to the risk for large-for-gestational-age (LGA) [aOR =2.24, 95%CI (1.08, 4.63)], and negatively related to the risk for small-for-gestational age (SGA) [aOR =0.71, 95%CI (0.59, 0.85)] in underweight women, but not in normal-weight or overweight women. The subgroup analysis showed that maternal TC level was positively correlated with the risk of LGA only in underweight women who gained weight more than the IOM recommendations.ConclusionUnderweight pregnant women with high TC levels had a higher risk for LGA, especially among women whose gestational weight gain were above the IOM recommendations. Therefore, clinical management of lipids and weight gain during gestation should also be recommended for underweight women.

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Effect of maternal weight gain according to the Institute of Medicine recommendations on pregnancy outcomes in a Chinese population

Journal of International Medical Research ◽

10.1177/0300060519861463 ◽

2019 ◽

Vol 47 (9) ◽

pp. 4397-4412 ◽

Cited By ~ 2

Author(s):

Ping Guan ◽

Fei Tang ◽

Guoqiang Sun ◽

Wei Ren

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Adverse Outcomes ◽

Large For Gestational Age ◽

Maternal Weight ◽

Increased Risk

Objective This study aimed to analyze the effects of maternal weight on adverse pregnancy outcomes. Methods Data were retrospectively collected from a hospital in Wuhan, China. A total of 1593 pregnant women with singletons were included. Adverse outcomes during pregnancy, such as small for gestational age (SGA), large for gestational age (LGA), and hypertensive disorders in pregnancy (HDP) were analyzed. Results The risks of low birth weight, SGA, and preterm birth were significantly higher in the inadequate gestational weight gain (GWG) group compared with the adequate GWG group. GWG over the guidelines was related to a higher risk of macrosomia, LGA, cesarean section, and HDP than GWG within the guidelines. The risks of low birth weight (OR = 5.082), SGA (OR = 3.959), preterm birth (OR = 3.422), and gestational diabetes mellitus (OR = 1.784) were significantly higher in women with a normal pre-pregnancy body mass index (BMI) and inadequate GWG compared with women with a normal pre-pregnancy BMI and adequate GWG. The risks of macrosomia (OR = 3.654) and HDP (OR = 1.992) were increased in women with normal pre-pregnancy BMI and excessive GWG. Conclusion Women with an abnormal BMI and inappropriate GWG have an increased risk of adverse maternal and infant outcomes. Weight management during the perinatal period is required.

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Prognosis Associated with Sub-Types of Hyperglycaemia in Pregnancy

Journal of Clinical Medicine ◽

10.3390/jcm10173904 ◽

2021 ◽

Vol 10 (17) ◽

pp. 3904

Author(s):

Emmanuel Cosson ◽

Sid Ahmed Bentounes ◽

Charlotte Nachetergaele ◽

Narimane Berkane ◽

Sara Pinto ◽

...

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Insulin Requirement ◽

Large For Gestational Age ◽

Gestational Weight ◽

Hypertensive Disorders ◽

Increased Risk ◽

In Pregnancy

We aimed to compare pregnancy outcomes in 4665 women according to the following types of hyperglycaemia in pregnancy sub-types: (i) normoglycaemia, (ii) gestational diabetes mellitus (GDM), (iii) diabetes in pregnancy (DIP), (iv) early-diagnosed (i.e., <22 weeks of gestation) GDM (eGDM), and (v) early-diagnosed DIP (eDIP). The prevalence of normoglycaemia, eGDM, eDIP, GDM, and DIP was 76.4%, 10.8%, 0.6%, 11.7%, and 0.6%, respectively. With regard to pregnancy outcomes, gestational weight gain (11.5 ± 5.5, 9.0 ± 5.4, 8.3 ± 4.7, 10.4 ± 5.3, and 10.1 ± 5.0 kg, p < 0.0001) and insulin requirement (none, 46.0%, 88.5%, 25.5%, and 51.7%; p < 0.001) differed according to the glycaemic sub-types. eGDM and eDIP were associated with higher rates of infant malformation. After adjustment for confounders, with normoglycaemia as the reference, only GDM was associated with large-for-gestational-age infant (odds ratio 1.34 (95% interval confidence 1.01–1.78) and only DIP was associated with hypertensive disorders (OR 3.48 (1.26–9.57)). To conclude, early-diagnosed hyperglycaemia was associated with an increased risk of malformation, suggesting that it was sometimes present at conception. Women with GDM, but not those with eGDM, had an increased risk of having a large-for-gestational-age infant, possibly because those with eGDM were treated early and therefore had less gestational weight gain. Women with DIP might benefit from specific surveillance for hypertensive disorders.

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Application of Japanese guidelines for gestational weight gain to multiple pregnancy outcomes and its optimal range in 101,336 Japanese women

Scientific Reports ◽

10.1038/s41598-019-53809-8 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Kyoko Nomura ◽

Kengo Nagashima ◽

Shunji Suzuki ◽

Hiroaki Itoh

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Multiple Pregnancy ◽

Large For Gestational Age ◽

Obese Women ◽

Operating Characteristics ◽

Gestational Weight ◽

Japanese Guidelines

AbstractThis study was performed to investigate whether the Japanese guidelines for gestational weight gain (GWG) can be used to determine the risks of multiple pregnancy outcomes and estimate optimal GWG in 101,336 women with singleton pregnancies in 2013. Multivariable logistic regression analyses indicated that the risks associated with low birth weight, small for gestational age, and preterm birth increased significantly with weight gain below the Japanese guidelines, and the risks of macrosomia and large for gestational age increased with weight gain above the guidelines regardless of Asian-specific pre-pregnancy body mass index (BMI). The GWG cutoff points estimated from the adjusted area under the receiver operating characteristics curve >0.6 corresponded to 10–13.8 kg in underweight women with pre-pregnancy BMI < 18.5 kg/m2; 10–13.7 kg in normal weight women with pre-pregnancy BMI 18.5–22.9 kg/m2; 8.5–11.4 kg in overweight women with pre-pregnancy BMI 23–24.9 kg/m2, 5–13.3 kg in obese women with pre-pregnancy BMI 25–29.9 kg/m2; and 4.7 kg in obese women with pre-pregnancy BMI ≥ 30 kg/m2. The optimal GWG ranges proposed by the present study are slightly higher than those recommended by the current Japanese guidelines.

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Maternal weight change between successive pregnancies: an opportunity for lifecourse obesity prevention

Proceedings of The Nutrition Society ◽

10.1017/s0029665120007065 ◽

2020 ◽

Vol 79 (3) ◽

pp. 272-282

Author(s):

Nisreen A. Alwan ◽

Grace Grove ◽

Elizabeth Taylor ◽

Nida Ziauddeen

Keyword(s):

Weight Loss ◽

Weight Gain ◽

Childhood Obesity ◽

Weight Change ◽

Health Care Professionals ◽

Public Health Problem ◽

Large For Gestational Age ◽

Healthy Weight ◽

Maternal Weight ◽

Increased Risk

Maternal obesity is a major risk factor for adverse health outcomes for both the mother and the child, including the serious public health problem of childhood obesity which is globally on the rise. Given the relatively intensive contact with health/care professionals following birth, the interpregnancy period provides a golden opportunity to focus on preconception and family health, and to introduce interventions that support mothers to achieve or maintain a healthy weight in preparation for their next pregnancy. In this review, we summarise the evidence on the association between interpregnancy weight gain with birth and obesity outcomes in the offspring. Gaining weight between pregnancies is associated with an increased risk of large-for-gestational age (LGA) birth, a predictor of childhood obesity, and weight loss between pregnancies in women with overweight or obesity seems protective against recurrent LGA. Interpregnancy weight loss seems to be negatively associated with birthweight. There is some suggestion that interpregnancy weight change may be associated with preterm birth, but the mechanisms are unclear and the direction depends if it is spontaneous or indicated. There is limited evidence on the direct positive link between maternal interpregnancy weight gain with gestational diabetes, pre-eclampsia, gestational hypertension and obesity or overweight in childhood, with no studies using adult offspring adiposity outcomes. Improving preconception health and optimising weight before pregnancy could contribute to tackling the rise in childhood obesity. Research testing the feasibility, acceptability and effectiveness of interventions to optimise maternal weight and health during this period is needed, particularly in high-risk and disadvantaged groups.

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Depression-related weight change and incident diabetes in a community sample

Scientific Reports ◽

10.1038/s41598-021-92963-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Eva Graham ◽

Tristan Watson ◽

Sonya S. Deschênes ◽

Kristian B. Filion ◽

Mélanie Henderson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Weight Gain ◽

Weight Change ◽

Short Form ◽

Community Sample ◽

Overweight And Obesity ◽

Community Dwelling ◽

Increased Risk

AbstractThis cohort study aimed to compare the incidence of type 2 diabetes in adults with depression-related weight gain, depression-related weight loss, depression with no weight change, and no depression. The study sample included 59,315 community-dwelling adults in Ontario, Canada. Depression-related weight change in the past 12 months was measured using the Composite International Diagnostic Interview—Short Form. Participants were followed for up to 20 years using administrative health data. Cox proportional hazards models compared the incidence of type 2 diabetes in adults with depression-related weight change and in adults with no depression. Adults with depression-related weight gain had an increased risk of type 2 diabetes compared to adults no depression (HR 1.70, 95% CI 1.32–2.20), adults with depression-related weight loss (HR 1.62, 95% CI 1.09–2.42), and adults with depression with no weight change (HR 1.39, 95% CI 1.03–1.86). Adults with depression with no weight change also had an increased risk of type 2 diabetes compared to those with no depression (HR 1.23, 95% CI 1.04–1.45). Associations were stronger among women and persisted after adjusting for attained overweight and obesity. Identifying symptoms of weight change in depression may aid in identifying adults at higher risk of type 2 diabetes and in developing tailored prevention strategies.

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Pregnancy Outcomes after Early Amniotomy among Class III Obese Gravidas Undergoing Induction of Labor

American Journal of Perinatology ◽

10.1055/s-0038-1675331 ◽

2018 ◽

Vol 36 (05) ◽

pp. 449-454

Author(s):

Daniel Pasko ◽

Kathryn Miller ◽

Victoria Jauk ◽

Akila Subramaniam

Keyword(s):

Cesarean Delivery ◽

Pregnancy Outcomes ◽

Neonatal Morbidity ◽

Induction Of Labor ◽

Obese Women ◽

Class Iii ◽

Membrane Rupture ◽

Nulliparous Women ◽

Increased Risk ◽

Class Iii Obesity

Objective We sought to evaluate differences in pregnancy outcomes following early amniotomy in women with class III obesity (body mass index ≥40 kg/m2) undergoing induction of labor. Study Design This is a retrospective cohort study of women with class III obesity undergoing term induction of labor from January 2007 to February 2013. Early amniotomy was defined as artificial membrane rupture at less than 4 cm cervical dilation. The primary outcome was cesarean delivery. Secondary outcomes included length of labor, a maternal morbidity composite, and a neonatal morbidity composite. A subgroup analysis examined the effect of parity. Multivariable logistic regression was used to adjust for covariates. Results Of 285 women meeting inclusion criteria, 107 (37.5%) underwent early amniotomy and 178 (62.5%) underwent late amniotomy. Early amniotomy was associated with cesarean delivery after multivariable adjustments (adjusted odds ratio [aOR], 2.05; 95% confidence interval [CI], 1.21–3.47). There were no significant differences in length of labor or maternal and neonatal morbidity between groups. When stratified by parity, early amniotomy was associated with increased cesarean delivery (aOR, 3.10; 95% CI, 1.47–6.58) only in nulliparous women. Conclusion Early amniotomy among class III obese women, especially nulliparous women, undergoing labor induction may be associated with an increased risk of cesarean delivery.

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Maternal Lipidomic Signatures in Relation to Spontaneous Preterm Birth and Large-For-Gestational Age Neonates

10.21203/rs.3.rs-138617/v1 ◽

2021 ◽

Author(s):

Max Aung ◽

Pahriya Ashrap ◽

Deborah Watkins ◽

Bhramar Mukherjee ◽

Zaira Rosario ◽

...

Keyword(s):

Fatty Acids ◽

Preterm Birth ◽

Free Fatty Acids ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Lipid Analysis ◽

Lipid Classes ◽

Large For Gestational Age ◽

Spontaneous Preterm Birth ◽

Increased Risk

Abstract Background: Lipidome-wide metabolites may be useful biomarkers of pregnancy outcomes. We sought to characterize maternal lipidomic signatures associated with preterm birth and neonatal anthropometric parameters. Methods: Plasma samples were collected 24-28 weeks gestation, and lipidomic profiling was quantified using high-performance liquid chromatography tandem mass spectrometry. Lipid metabolites were analyzed individually and as whole lipid classes and subgroups based on degree of hydrocarbon chain saturation. Associations were estimated using linear and logistic regression.Results: After false discovery adjustment (q<0.15), four plasmenyl-phosphatidylethanolamines and three free fatty acids associated with increased risk for spontaneous preterm birth. Five phosphatidylinositols, two phosphatidylglycerols, and one phosphatidic acid were associated with large for gestational age neonates. The saturated plasmenyl-phosphatidylethanolamines held the association with increased risk for spontaneous preterm birth. Both the mono- and poly-unsaturated free fatty acids held the association for increased risk for spontaneous preterm birth. Mono- and poly-unsaturated phosphatidylinositols were associated with large for gestational age neonates. Whole lipid classes (plasmenyl-phophatidylcholines and plasmenyl-phosphatidylethanolamines) were associated with increased risk for large for gestational age at delivery.Conclusions: This study provides evidence that finer omics-scale analysis of the maternal lipidome may be more informative biomarkers of pregnancy outcomes compared to whole class level lipid analysis.

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Gestational Weight Gain and Pregnancy Outcomes among Nulliparous Women

American Journal of Perinatology ◽

10.1055/s-0039-1696640 ◽

2019 ◽

Author(s):

Annie M. Dude ◽

William Grobman ◽

David Haas ◽

Brian M. Mercer ◽

Samuel Parry ◽

...

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Gestational Weight Gain ◽

Gestational Age ◽

Small For Gestational Age ◽

Pregnancy Outcomes ◽

Large For Gestational Age ◽

Gestational Weight ◽

Excessive Gestational Weight Gain ◽

Hypertensive Disorders

Abstract Objective To determine the association between total gestational weight gain and perinatal outcomes. Study Design Data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be (NuMoM2b) study were used. Total gestational weight gain was categorized as inadequate, adequate, or excessive based on the 2009 Institute of Medicine guidelines. Outcomes examined included hypertensive disorders of pregnancy, mode of delivery, shoulder dystocia, large for gestational age or small for-gestational age birth weight, and neonatal intensive care unit admission. Results Among 8,628 women, 1,666 (19.3%) had inadequate, 2,945 (34.1%) had adequate, and 4,017 (46.6%) had excessive gestational weight gain. Excessive gestational weight gain was associated with higher odds of hypertensive disorders (adjusted odds ratio [aOR] = 2.05, 95% confidence interval [CI]: 1.78–2.36) Cesarean delivery (aOR = 1.24, 95% CI: 1.09–1.41), and large for gestational age birth weight (aOR = 1.49, 95% CI: 1.23–1.80), but lower odds of small for gestational age birth weight (aOR = 0.59, 95% CI: 0.50–0.71). Conversely, inadequate gestational weight gain was associated with lower odds of hypertensive disorders (aOR = 0.75, 95% CI: 0.62–0.92), Cesarean delivery (aOR = 0.77, 95% CI: 0.65–0.92), and a large for gestational age birth weight (aOR = 0.72, 95% CI: 0.55–0.94), but higher odds of having a small for gestational age birth weight (aOR = 1.64, 95% CI: 1.37–1.96). Conclusion Both excessive and inadequate gestational weight gain are associated with adverse maternal and neonatal outcomes.

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Is maternal weight gain between pregnancies associated with risk of large-for-gestational age birth? Analysis of a UK population-based cohort

BMJ Open ◽

10.1136/bmjopen-2018-026220 ◽

2019 ◽

Vol 9 (7) ◽

pp. e026220 ◽

Cited By ~ 7

Author(s):

Nida Ziauddeen ◽

Sam Wilding ◽

Paul J Roderick ◽

Nicholas S Macklon ◽

Nisreen A Alwan

Keyword(s):

Weight Gain ◽

Gestational Age ◽

Population Based ◽

Overweight And Obesity ◽

Large For Gestational Age ◽

Adjusted Relative Risk ◽

Maternal Weight ◽

Overweight Women ◽

Increased Risk ◽

Maternal Overweight

ObjectiveMaternal overweight and obesity during pregnancy increases the risk of large-for-gestational age (LGA) birth and childhood obesity. We aimed to investigate the association between maternal weight change between subsequent pregnancies and risk of having a LGA birth.DesignPopulation-based cohort.SettingRoutinely collected antenatal healthcare data between January 2003 and September 2017 at University Hospital Southampton, England.ParticipantsHealth records of women with their first two consecutive singleton live-birth pregnancies were analysed (n=15 940).Primary outcome measureRisk of LGA, recurrent LGA and new LGA births in the second pregnancy.ResultsOf the 15 940 women, 16.0% lost and 47.7% gained weight (≥1 kg/m2) between pregnancies. A lower proportion of babies born to women who lost ≥1 kg/m2(12.4%) and remained weight stable between −1 and 1 kg/m2(11.9%) between pregnancies were LGA compared with 13.5% and 15.9% in women who gained 1–3 and ≥3 kg/m2, respectively. The highest proportion was in obese women who gained ≥3 kg/m2(21.2%). Overweight women had a reduced risk of recurrent LGA in the second pregnancy if they lost ≥1 kg/m2(adjusted relative risk (aRR) 0.69, 95% CI 0.48 to 0.97) whereas overweight women who gained ≥3 kg/m2were at increased risk of new LGA after having a non-LGA birth in their first pregnancy (aRR 1.35, 95% CI 1.05 to 1.75). Normal-weight women who gained weight were also at increased risk of new LGA in the second pregnancy (aRR 1.26, 95% CI 1.06 to 1.50 with gain of 1–3 kg/m2and aRR 1.34, 95% CI 1.09 to 1.65 with gain of ≥3 kg/m2).ConclusionsLosing weight after an LGA birth was associated with a reduced LGA risk in the next pregnancy in overweight women, while interpregnancy weight gain was associated with an increased new LGA risk. Preventing weight gain between pregnancies is an important measure to achieve better maternal and offspring outcomes.

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