Weight gain during pregnancy and the risk of severe maternal morbidity by prepregnancy BMI

ABSTRACT Background High and low prepregnancy BMI are risk factors for severe maternal morbidity (SMM), but the contribution of gestational weight gain (GWG) is not well understood. Objectives We evaluated associations between GWG and SMM by prepregnancy BMI group. Methods We analyzed administrative records from 2,483,684 Californian births (2007–2012), utilizing z score charts to standardize GWG for gestational duration. We fit the z scores nonlinearly and categorized GWG as above, within, or below the Institute of Medicine (IOM) recommendations after predicting equivalent GWG at term from the z score charts. SMM was defined using a validated index. Associations were estimated using multivariable logistic regression models. Results We found generally shallow U-shaped relations between GWG z score and SMM in all BMI groups, except class 3 obesity (≥40 kg/m2), for which risk was lowest with weight loss. The weight gain amount associated with the lowest risk of SMM was within the IOM recommendations for underweight and class 2 obesity, but above the IOM recommendations for normal weight, overweight, and class 1 obesity. The adjusted risk ratios (RRs) and 95% CIs for GWG below the IOM recommendations, compared with GWG within the recommendations, were the following for underweight, normal weight, overweight, class 1 obesity, class 2 obesity, and class 3 obesity: 1.13 (0.99, 1.29), 1.09 (1.04, 1.14), 1.10 (1.01, 1.19), 1.07 (0.95, 1.21), 1.03 (0.88, 1.22), and 0.89 (0.73, 1.08), respectively. For GWG above the recommendations, the corresponding RRs and 95% CIs were 0.99 (0.84, 1.15), 1.04 (0.99, 1.08), 0.98 (0.92, 1.04), 1.03 (0.95, 1.13), 1.07 (0.94, 1.23), and 1.08 (0.91, 1.30), respectively. Conclusions High and low GWG may be modestly associated with increased risk of SMM across BMI groups, except in women with class 3 obesity, for whom low weight gain and weight loss may be associated with decreased risk of SMM.

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Pregnancy Outcomes after Preeclampsia: The Effects of Interpregnancy Weight Change

American Journal of Perinatology ◽

10.1055/s-0040-1713000 ◽

2020 ◽

Author(s):

Maya Tabet ◽

Soumya Banna ◽

Lan Luong ◽

Russell Kirby ◽

Jen Jen Chang

Keyword(s):

Weight Loss ◽

Weight Gain ◽

Cesarean Delivery ◽

Gestational Age ◽

Weight Change ◽

Pregnancy Outcomes ◽

Normal Weight ◽

Large For Gestational Age ◽

Obese Women ◽

Increased Risk

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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Prepregnancy Body Mass Index as a Significant Predictor of Total Gestational Weight Gain and Birth Weight

Canadian Journal of Dietetic Practice and Research ◽

10.3148/cjdpr-2016-035 ◽

2017 ◽

Vol 78 (2) ◽

pp. 66-73 ◽

Cited By ~ 8

Author(s):

Anne-Sophie Morisset ◽

Lise Dubois ◽

Cynthia K. Colapinto ◽

Zong-Chen Luo ◽

William D. Fraser

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Gestational Weight Gain ◽

Normal Weight ◽

Institute Of Medicine ◽

3D Design ◽

Gestational Weight ◽

Prepregnancy Bmi ◽

Iom Recommendations ◽

Infant Birth

Purpose: We aimed to describe adherence to gestational weight gain (GWG) recommendations and identify determinants of excessive GWG in a sample of women from Quebec, Canada. Methods: Data were collected from the multi-centre 3D (Design, Develop, Discover) pregnancy cohort study, which included women who delivered between May 2010 and August 2012 at 9 obstetrical hospitals in Quebec, Canada. GWG was calculated for 1145 women and compared to the 2009 Institute of Medicine (IOM) recommendations. Results: Overall, 51% of participants exceeded the recommendations. Approximately 68% of women with obesity gained weight in excess of the IOM recommendations. The corresponding numbers were 75%, 44%, and 27% in overweight, normal weight, and underweight women, respectively. A prepregnancy BMI of 25 kg/m2 or more was the only significant predictor of exceeding GWG recommendations (OR 3.35, 95% CI 2.44–4.64) in a multivariate model. Birth weight was positively associated with GWG. GWG and prepregnancy BMI could explain 3.13% and 2.46% of the variance in birth weight, respectively. Conclusion: About half of women exceeded GWG recommendations, and this was correlated with infant birth weight. This reinforces the need to develop and evaluate strategies, including nutritional interventions, for pregnant women to achieve optimal GWG.

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Body Mass Index is Associated With Appropriateness of Weight Gain but not Leisure-Time Physical Activity During Pregnancy

Journal of Physical Activity and Health ◽

10.1123/jpah.2013-0090 ◽

2014 ◽

Vol 11 (8) ◽

pp. 1593-1599 ◽

Cited By ~ 4

Author(s):

Rebecca A. Schlaff ◽

Claudia Holzman ◽

Lanay M. Mudd ◽

Karin A. Pfeiffer ◽

James M. Pivarnik

Keyword(s):

Physical Activity ◽

Body Mass Index ◽

Weight Gain ◽

Leisure Time ◽

Leisure Time Physical Activity ◽

Normal Weight ◽

Obese Women ◽

Overweight Women ◽

Prepregnancy Bmi ◽

Iom Recommendations

Background:Little is known about how leisure-time physical activity (LTPA) influences gestational weight gain (GWG) among body mass index (BMI) categories. The purpose of this study was to examine the relationship between pregnancy LTPA and the proportion of normal, overweight, and obese women who meet GWG recommendations.Methods:Participants included 449 subcohort women from the Pregnancy Outcomes and Community Health (POUCH) study. LTPA was collapsed into 3 categories [(None, < 7.5 kcal/kg/wk (low), ≥ 7.5 kcal/kg/wk (recommended)]. GWG was categorized according to IOM recommendations (low, recommended, or excess). Chi-square and logistic regression analyses were used to evaluate relationships among LTPA, BMI, and GWG.Results:Overweight women were more likely to have high GWG vs. normal weight women (OR = 2.3, 95% CI 1.3–4.0). Obese women were more likely to experience low GWG (OR = 7.3, 95% CI 3.6–15.1; vs. normal and overweight women) or excess GWG (OR = 3.5, 95% CI 1.9–6.5; vs. normal weight women). LTPA did not vary by prepregnancy BMI category (P = .55) and was not related to GWG in any prepregnancy BMI category (P = .78).Conclusions:Regardless of prepregnancy BMI, LTPA did not affect a woman’s GWG according to IOM recommendations. Results may be due to LTPA not differing among BMI categories.

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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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Early Risk Factors for Obesity in the First 1000 Days—Relationship with Body Fat and BMI at 2 Years

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158179 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8179

Author(s):

Mercedes Díaz-Rodríguez ◽

Celia Pérez-Muñoz ◽

Jesús Carretero-Bravo ◽

Catalina Ruíz-Ruíz ◽

Manuel Serrano-Santamaría ◽

...

Keyword(s):

Risk Factors ◽

Weight Gain ◽

Body Fat ◽

Early Pregnancy ◽

Body Fat Percentage ◽

Z Score ◽

Fat Percentage ◽

Early Risk ◽

Early Risk Factors ◽

Increased Risk

(1) Background: Obesity is defined as an excessive accumulation of body fat. Several early developmental factors have been identified which are associated with an increased risk of childhood obesity and increased adiposity in childhood. The primary objective of the present study is to analyse the effect of various early risk factors on Body Mass Index (BMI) and body fat percentage at 2 years of age. (2) Methods: A prospective cohort study design was used, with the sample consisting of 109 mother-child pairs from whom data were collected between early pregnancy and 2 years old. Adiposity was determined based on skinfold measurements using the Brooks and Siri formulae. Mean comparison tests (Student’s t-test and ANOVAs) and multiple linear regression models were used to analyse the relationship between early programming factors and dependent variables. (3) Results: Maternal excess weight during early pregnancy (β = 0.203, p = 0.026), gestational smoking (β = 0.192, p = 0.036), and accelerated weight gain in the first 2 years (β = − 0.269, p = 0.004) were significantly associated with high body fat percentage. Pre-pregnancy BMI and accelerated weight gain in the first 2 years were associated with high BMI z-score (β = 0.174, p = 0.047 and β = 0.417, p = 0.000 respectively). The cumulative effect of these variables resulted in high values compared to the baseline zero-factor group, with significant differences in BMI z-score (F = 8.640, p = 0.000) and body fat percentage (F = 5.402, p = 0.002) when three factors were present. (4) Conclusions: The presence of several early risk factors related to obesity in infancy was significantly associated with higher BMI z-score and body fat percentage at 2 years of age. The presence of more than one of these variables was also associated with higher adiposity at 2 years of age. Early prevention strategies should address as many of these factors as possible.

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Obesity as a Predictor of Delayed Lactogenesis II

Journal of Human Lactation ◽

10.1177/0890334417727716 ◽

2017 ◽

Vol 33 (4) ◽

pp. 684-691 ◽

Cited By ~ 27

Author(s):

Irma Preusting ◽

Jessica Brumley ◽

Linda Odibo ◽

Diane L. Spatz ◽

Judette M. Louis

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Singleton Pregnancy ◽

Targeted Interventions ◽

Gestational Weight ◽

Prepregnancy Bmi ◽

Increased Risk ◽

Prepregnancy Obesity ◽

Observational Cohort ◽

Breastfeeding Cessation

Background: Lactogenesis II is the onset of copious milk production. A delay in this has been associated with an increased risk of formula supplementation and early cessation of breastfeeding. Prepregnancy obesity has also been associated with decreased breastfeeding rates and early cessation. Research aim: This study aimed to evaluate the effect of prepregnancy obesity on self-reported delayed lactogenesis II. Methods: We conducted a prospective observational cohort study of 216 women with a singleton pregnancy and who planned to breastfeed. We compared the onset of lactogenesis II between women with a body mass index (BMI) < 30 kg/m2 and women with a BMI ≥ 30 kg/m2. Using multivariate logistic regression analyses, we assessed the relationship between maternal BMI and delay of lactogenesis II. Results: The prevalence of delayed lactogenesis II among women with prepregnancy BMI < 30 kg/m2 and BMI ≥ 30 kg/m2 was 46.4% and 57.9%, respectively. Delayed lactogenesis II occurred more frequently among women who were obese at the time of delivery ( p < .05). After controlling for the covariates, age, prepregnancy BMI, and gestational weight gain were positively associated with delayed lactogenesis II. Conclusion: Prepregnancy obesity and excessive gestational weight gain are associated with an increased risk of delayed lactogenesis II. Women who are at risk for delay in lactogenesis II and early breastfeeding cessation will need targeted interventions and support for them to achieve their personal breastfeeding goals.

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Risk of Severe Maternal Morbidity or Death in Relation to Prenatal Biochemical Screening: Population-Based Cohort Study

American Journal of Perinatology ◽

10.1055/s-0039-1694731 ◽

2019 ◽

Vol 38 (01) ◽

pp. 044-059 ◽

Cited By ~ 1

Author(s):

Eric J.M. Lentz ◽

Alison L. Park ◽

Alec W.R. Langlois ◽

Tianhua Huang ◽

Wendy S. Meschino ◽

...

Keyword(s):

Cohort Study ◽

Maternal Mortality ◽

Maternal Morbidity ◽

Protein A ◽

Population Based ◽

Severe Maternal Morbidity ◽

Adjusted Relative Risk ◽

Biochemical Screening ◽

High Concentration ◽

Increased Risk

Abstract Objective This study aimed to examine whether prenatal biochemical screening analytes are associated with an increased risk of severe maternal morbidity (SMM) or maternal mortality. Study Design This population-based cohort study includes all women in Ontario, Canada, who underwent prenatal screening from 2001 to 2011. Increasing fifth percentiles of the multiple of the median (MoM) for alphafetoprotein (AFP), total human chorionic gonadotropin, unconjugated estriol (uE3), dimeric inhibin-A (DIA), and pregnancy-associated plasma protein A were evaluated. An abnormally high concentration (>95th percentile MoM) for each analyte, individually and combined, was also evaluated. The main outcome assessed was the adjusted relative risk (aRR) of SMM or maternal mortality from 20 weeks' gestation up to 26 weeks thereafter. Results Among 748,972 pregnancies, 11,177 resulted in SMM or maternal mortality (1.5%). Except for uE3, the aRR of SMM or maternal mortality increased in association with increasing fifth percentiles of the MoM for all analytes. AFP (aRR: 2.10; 95% confidence interval [CI]: 1.97–2.25) and DIA (aRR: 2.33; 95% CI: 1.98–2.74) > 95th versus ≤ 5th percentile of the MoM were especially associated with SMM or death. Conclusion Women with abnormally high concentrations of certain prenatal biochemical analytes may be at a higher risk of SMM or death in pregnancy or postpartum.

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Pre-pregnancy Obesity and the Risk of Peripartum Cardiomyopathy

American Journal of Perinatology ◽

10.1055/s-0040-1712451 ◽

2020 ◽

Author(s):

Seo-Ho Cho ◽

Stephanie A. Leonard ◽

Audrey Lyndon ◽

Elliott K. Main ◽

Barbara Abrams ◽

...

Keyword(s):

Hospital Admissions ◽

Population Based ◽

Normal Weight ◽

Peripartum Cardiomyopathy ◽

Discharge Data ◽

Obesity Class ◽

Live Births ◽

Increased Risk ◽

Class 1 ◽

Care Payer

Objective The aim of this study is to evaluate the contribution of pre-pregnancy obesity and overweight to peripartum cardiomyopathy. Study Design This population-based study used linked birth record and maternal hospital discharge data from live births in California during 2007 to 2012 (n = 2,548,380). All women who had a diagnosis of peripartum cardiomyopathy during the childbirth hospitalization or who were diagnosed with peripartum cardiomyopathy during a postpartum hospital readmission within 5 months of birth were identified as cases. Pre-pregnancy body mass index (BMI, kg/m2) was classified as normal weight (18.5–24.9), overweight (25.0–29.9), obesity class 1 (30.0–34.9), obesity class 2 (35.0–39.9), and obesity class 3 (≥40). Because of small numbers, we excluded women with underweight BMI, and in some analyses, we combined obesity classes into one group. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) expressing associations between BMI and peripartum cardiomyopathy, adjusted for maternal age, race/ethnicity, education, health care payer, parity, plurality, and comorbidities. Results The overall prevalence of peripartum cardiomyopathy during hospital admissions was 1.3 per 10,000 live births (n = 320). Unadjusted ORs were 1.32 (95% CI: 1.01–1.74) for women with overweight BMI and 2.03 (95% CI: 1.57–2.62) for women with obesity, compared with women with normal pre-pregnancy BMI. Adjusted ORs were 1.26 (95% CI: 0.95–1.66) for overweight women and 1.38 (95% CI: 1.04–1.84) for women with obesity. The ORs suggested a dose–response relationship with increasing levels of obesity, but the 95% CIs for the specific classes of obesity included 1.00. Conclusion Pre-pregnancy obesity was associated with an increased risk of peripartum cardiomyopathy. These findings underscore the importance of BMI during pregnancy. There is a need to recognize the increased risk of peripartum cardiomyopathy in women with high BMI, especially in the late postpartum period. Key Points

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Body Weight Variation Patterns as Predictors of Cognitive Decline over a 5 Year Follow-Up among Community-Dwelling Elderly (MAPT Study)

Nutrients ◽

10.3390/nu11061371 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1371

Author(s):

Kelly Giudici ◽

Sophie Guyonnet ◽

Yves Rolland ◽

Bruno Vellas ◽

Philipe de Souto Barreto ◽

...

Keyword(s):

Weight Loss ◽

Body Weight ◽

Weight Gain ◽

Hippocampal Volume ◽

Community Dwelling ◽

First Year ◽

Z Score ◽

Weight Variation ◽

Variation Patterns

This study aimed to analyze associations between weight variation patterns and changes in cognitive function and hippocampal volume among non-demented, community-dwelling elderly. Sample was formed of 1394 adults >70 years (63.9% female), all volunteers from the Multidomain Alzheimer Preventive Trial (MAPT). Weight loss was defined as ≥5% of body weight decrease in the first year of follow-up; weight gain as ≥5% of weight increase; and stability if <5% weight variation. Cognition was examined by a Z-score combining four tests. Measures were assessed at baseline, 6, 12, 24, 36, 48, and 60 months of follow-up. Hippocampal volume was evaluated with magnetic resonance imaging in 349 subjects in the first year and at 36 months. Mixed models were performed. From the 1394 participants, 5.5% (n = 76) presented weight loss, and 9.0% (n = 125) presented weight gain. Cognitive Z-score decreased among all groups after 5 years, but decline was more pronounced among those who presented weight loss (adjusted between-group mean difference vs. stable: −0.24, 95%CI: −0.41 to −0.07; p = 0.006). After 3 years, hippocampal atrophy was observed among all groups, but no between-group differences were found. In conclusion, weight loss ≥5% in the first year predicted higher cognitive decline over a 5 year follow-up among community-dwelling elderly, independently of body mass index.

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Effectiveness of interventions to support weight loss in adults taking antipsychotics: a review

British Journal of Mental Health Nursing ◽

10.12968/bjmh.2019.8.2.88 ◽

2019 ◽

Vol 8 (2) ◽

pp. 88-100

Author(s):

Deborah Ayodele ◽

Jennifer Oates

Keyword(s):

Weight Loss ◽

Weight Gain ◽

Waist Circumference ◽

Cognitive Abilities ◽

Psychotic Symptoms ◽

Lifestyle Interventions ◽

Control Groups ◽

Multiple Factors ◽

Increased Risk ◽

Life Threatening

Antipsychotic medication is effective in reducing psychotic symptoms but use is associated with weight gain. Weight gain is associated with an increased risk of a number of life threatening health conditions. Multicomponent lifestyle interventions are the recommended non-pharmacological way of tackling weight gain and its consequences. This literature review summarises the evidence for the effectiveness of multicomponent lifestyle interventions in reducing weight and waist circumference in adults taking antipsychotics. The review of eight studies found that such approaches are effective; however, multiple factors affect success, for example tailoring of information to the cognitive abilities of participants and the use of individual combined with group approaches. There were some unexpected results within studies, where some control groups lost weight or decreased waist circumference as well as intervention groups. Reasons for significant weight change in control groups was attributed to possible access to weight loss activities outside of the intervention programmes. Adherence to intervention programmes was also important for success. Nurses who support patients taking antipsychotics to lose weight should promote multicomponent approaches that are tailored to the specific needs of this group.

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