scholarly journals Gestational Weight Gain During the Second and Third Trimesters and Adverse Pregnancy Outcomes, Results From a Prospective Pregnancy Cohort in Urban Tanzania

2021 ◽  
Author(s):  
Jiaxi Yang ◽  
Molin Wang ◽  
Deirdre K. Tobias ◽  
Janet W. Rich-Edwards ◽  
Anne Marie Darling ◽  
...  
Keyword(s):  
Weight Gain ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Gestational Weight Gain ◽  
Early Pregnancy ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Gestational Weight ◽  
Pregnancy Cohort ◽  
Adverse Pregnancy

Abstract Background Appropriate gestational weight gain (GWG) is important for optimal pregnancy outcomes. This study prospectively evaluated the associations between GWG during the second and third trimesters of pregnancy and adverse pregnancy outcomes in an urban Tanzanian pregnancy cohort. Methods We used data from a randomized clinical trial conducted among pregnant women recruited by 27 weeks of gestation in Dar es Salaam, Tanzania (N = 1,230). Women’s gestational weight was measured at baseline and at monthly antenatal visits. Weekly GWG rate during the second and third trimesters was calculated and characterized as inadequate, adequate, or excessive, in conjunction with measured or imputed early-pregnancy BMI status according to the 2009 Institute of Medicine (IOM) GWG guidelines. We used multivariable Poisson regression with a sandwich variance estimator to calculate risk ratios (RR) for associations of GWG with low birth weight, preterm birth, small for gestational age (SGA), and large for gestational age (LGA). Degree of appropriate GWG defined using additional metrics (i.e., percentage of adequacy, z-score) and potential effect modification by maternal BMI were additionally evaluated. Results According to the IOM guidelines, 517 (42.0%), 270 (22.0%), and 443 (36.0%) women were characterized as having inadequate, adequate, and excessive GWG, respectively. Overall, compared to women with adequate GWG, women with inadequate GWG had a lower risk of LGA births (RR=0.54, 95% CI: 0.36 - 0.80) and a higher risk of SGA births (RR=1.32, 95% CI: 0.95 - 1.81). ­­Women with inadequate GWG as defined by percentage of GWG adequacy had a higher risk of LBW (OR=1.93, 95% CI: 1.03 - 3.63). In stratified analyses by early-pregnancy BMI, excessive GWG among women with normal BMI was associated with a higher risk of preterm birth (RR=1.59, 95% CI: 1.03 - 2.44). Conclusions A comparatively high percentage of excessive GWG was observed among healthy pregnant women in Tanzania. Both inadequate and excessive GWGs were associated with elevated risks of poor pregnancy outcomes. Future studies among diverse SSA populations are warranted to confirm our findings, and clinical recommendations on optimal GWG should be developed to promote healthy GWG in SSA settings. Trial registration This trial was registered as “Prenatal Iron Supplements: Safety and Efficacy in Tanzania” (NCT01119612; http://clinicaltrials.gov/show/NCT01119612).

scholarly journals The Impact of Gestational Weight Gain on the Risks of Adverse Maternal and Infant Outcomes among Normal BMI Women with High Triglyceride Levels during Early Pregnancy

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3454
Author(s):  
Xia-Fei Jiang ◽  
Hui Wang ◽  
Dan-Dan Wu ◽  
Jian-Lin Zhang ◽  
Ling Gao ◽  
...  
Keyword(s):  
Weight Gain ◽  
Preterm Birth ◽  
Gestational Diabetes ◽  
Early Pregnancy ◽  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Adverse Pregnancy Outcomes ◽  
Gestational Weight ◽  
Adverse Pregnancy ◽  
The Impact

A high maternal triglyceride (mTG) level during early pregnancy is linked to adverse pregnancy outcomes, but the use of specific interventions has been met with limited success. A retrospective cohort study was designed to investigate the impact of gestational weight gain (GWG) on the relationship between high levels of mTG and adverse pregnancy outcomes in normal early pregnancy body mass index (BMI) women. The patients included 39,665 women with normal BMI who had a singleton pregnancy and underwent serum lipids screening during early pregnancy. The main outcomes were adverse pregnancy outcomes, including gestational hypertension, preeclampsia, gestational diabetes, cesarean delivery, preterm birth, and large or small size for gestational age (LGA or SGA) at birth. As a result, the high mTG (≥2.05mM) group had increased risks for gestational hypertension ((Adjusted odds ratio (AOR), 1.80; 95% CI, 1.46 to 2.24)), preeclampsia (1.70; 1.38 to 2.11), gestational diabetes (2.50; 2.26 to 2.76), cesarean delivery (1.22; 1.13 to 1.32), preterm birth (1.42, 1.21 to 1.66), and LGA (1.49, 1.33 to 1.68) compared to the low mTG group, after adjustment for potential confounding factors. Additionally, the risks of any adverse outcome were higher in each GWG subgroup among women with high mTG than those in the low mTG group. High mTG augmented risks of gestational hypertension, preeclampsia, preterm birth, and LGA among women with 50th or greater percentile of GWG. Interestingly, among women who gained less than the 50th percentile of GWG subgroups, there was no relationship between high mTG level and risks for those pregnancy outcomes when compared to low mTG women. Therefore, weight control and staying below 50th centile of the suggested GWG according to gestational age can diminish the increased risks of adverse pregnancy outcomes caused by high mTG during early pregnancy.

scholarly journals Association of Pre-Pregnancy Body Mass Index and Gestational Weight Gain with Preterm Delivery in Pregnant Women

2021 ◽  
Author(s):  
Bhavya Baxi ◽  
Jigna Shah
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Pregnant Women ◽  
Gestational Weight Gain ◽  
Pregnancy Outcomes ◽  
Caesarean Delivery ◽  
Junk Food ◽  
Economic Class ◽  
Gestational Weight ◽  
Adverse Pregnancy

The perinatal mortality rate, which is one of the important adverse pregnancy outcome and includes stillbirths and infant death within first week of life is estimated to be nearly 40 deaths per 1,000 pregnancies in Gujarat. Also the infant mortality rates have been estimated to be 50 deaths before age of one year per 1,000 pregnancies. It is stated that children whose mothers are illiterate or belong to low socio-economic class have two and half times more chances to die within 1 year of their birth compared to those whose mothers have completed atleast 10 years of education or belong to high socio-economic class. There are nearly 13% of women who does not receive proper antenatal care and facility during pregnancy. In India, there are nearly half of the women (52%) who possess normal BMI range: rest are either underweight or overweight. Approximately 55% of the women of total population in India are anaemic. These maternal parameters directly affect the children causing 48% of the children to be malnourished and 43% to be underweight. Therefore, it is imperative to examine the association of pre-pregnancy Body Mass Index (BMI) as well as Gestational Weight Gain (GWG) with diverse pregnancy outcomes such as gestational diabetes, gestational hypertension and also with preterm delivery, caesarean delivery, etc. The present study was designed to investigate the prevalence, GWG, various pregnancy outcomes of underweight, overweight or obese pregnant women, and to explore the relationship between pre-pregnancy BMI as well as gestational weight gain during pregnancy and adverse pregnancy outcomes. This is a prospective, multi-centric study involving pregnant women with gestation week ≤20 weeks in Ahmedabad in Gujarat region. Our study observed that out of 226 women enrolled, 44 women (19.47%) were underweight, 137 women (60.62%) were normal, 30 women (13.27%) were overweight and 15 women (6.64%) were obese. The incidence of caesarean delivery (56.92%) was found more in nuclear family as compared to joint family (46.92%). It was found that in women taking no junk food at all, the chances of LBW were 16.39%, which was less as compared to mothers who had junk food. It was also observed that amongst women taking 1 glass milk daily (42.92%), about 55.67% of had normal type of delivery. Amongst women taking 1 fruit daily (57.52%), 53% women had normal delivery. Present study spotted decrease in risk of caesarean delivery with increase in maternal haemoglobin level from 9.0 gm/dl till 12.0 gm/dl. Average weight gain observed in underweight was 12.93 ± 1.90, in normal 12.32 ± 1.71, in overweight 10.23 ± 1.28 and in obese 9.6 ± 1.50. A negative correlation was found between GWG and pre-pregnancy BMI, i.e. as pre-pregnancy BMI increase, the GWG decrease. The incidence of pre-term delivery (9.49%) was much less in normal BMI range. The average infant birth weight observed in underweight women was 2.63 ± 0.47, in normal was 2.9 ± 0.49, in overweight was 2.92 ± 0.56 and in obese was 2.95 ± 0.86. It is observed that highest birth weight is obtained in obese women, which decreases as the maternal BMI range decreases. The incidence of LBW in normal and overweight women was 15.33 and 16.67%, which was low as compared to obese and underweight women. Our study reveals that parameters such as GWG, type of family, intake of milk, fruits and junk food, haemoglobin concentration directly affects the pregnancy outcomes such as term of delivery, type of delivery and infant birth weight.

scholarly journals Rate of gestational weight gain and adverse pregnancy outcomes in rural nulliparous women: a prospective cohort analysis from China

2019 ◽  
Vol 122 (03) ◽  
pp. 352-359 ◽  
Author(s):  
Yubo Zhou ◽  
Hongtian Li ◽  
Yali Zhang ◽  
Le Zhang ◽  
Jufen Liu ◽  
...  
Keyword(s):  
Weight Gain ◽  
Preterm Birth ◽  
Gestational Weight Gain ◽  
Infant Death ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Third Trimester ◽  
Gestational Weight ◽  
Nulliparous Women ◽  
Adverse Pregnancy

AbstractBoth inadequate and excessive gestational weight gain (GWG) have been shown to increase the risk of adverse pregnancy outcomes, but the risk profiles of GWG rate are unclear. We aimed to examine the associations between GWG rate in the second/third trimester and a spectrum of pregnancy outcomes. This study consisted of 14 219 Chinese rural nulliparous women who participated in a randomised controlled trial of prenatal micronutrient supplementation during 2006–2009. The outcomes included stillbirth, neonatal and infant death, preterm birth, macrosomia, low birth weight (LBW) and large and small for gestational age (LGA and SGA, respectively). GWG rate was divided into quintiles within each BMI category. Compared with women in the middle quintile, those in the lowest quintile had higher risks of neonatal death (adjusted OR 2·27; 95 % CI 1·03, 5·02), infant death (adjusted OR 1·85; 95 % CI 1·02, 3·37) and early preterm birth (adjusted OR 2·33; 95 % CI 1·13, 4·77), while those in the highest quintile had higher risks of overall preterm birth (adjusted OR 1·28; 95 % CI 1·04, 1·59), late preterm birth (adjusted OR 1·25; 95 % CI 1·00, 1·56), LBW (adjusted OR 1·48; 95 % CI 1·02, 2·15), macrosomia (adjusted OR 1·89; 95 % CI 1·46, 2·45) and LGA (adjusted OR 1·56; 95 % CI 1·31, 1·85). In conclusion, very low and very high GWG rates in the second/third trimester appear to be associated with adverse pregnancy outcomes in Chinese nulliparous women, indicating that an appropriate GWG rate during pregnancy is necessary for neonatal health.

scholarly journals Investigation of optimal gestational weight gain based on the occurrence of adverse pregnancy outcomes for Chinese women: a prospective cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yin Sun ◽  
Zhongzhou Shen ◽  
Yongle Zhan ◽  
Yawen Wang ◽  
Shuai Ma ◽  
...  
Keyword(s):  
Cohort Study ◽  
Weight Gain ◽  
Pregnant Women ◽  
Gestational Weight Gain ◽  
Pregnancy Outcomes ◽  
Chinese Women ◽  
Normal Weight ◽  
Adverse Pregnancy Outcomes ◽  
Gestational Weight ◽  
Adverse Pregnancy

Abstract Objective To investigate recommendations for appropriate gestational weight gain (GWG) of Chinese females. Methods In total of 3,172 eligible women in the first trimester were recruited into the Chinese Pregnant Women Cohort Study (CPWCS) project. Pregnancy complications and outcomes were collated using the hospital medical records system. The method of occurrence of participants with adverse pregnancy outcomes (Occurrence Method) was conducted to calculate the recommended total GWG for each participant’s pre-pregnancy BMI. Occurrence Method data were judged against the Institute of Medicine (IOM) and Japanese recommended criteria in terms of the total occurrence of adverse pregnancy outcomes of pregnant women with appropriate weight gain. Results The most frequent GWG was ≥ 14 kg and < 16 kg (19.4%), followed by ≥ 10 kg and < 12 kg (15.5%) and ≥ 12 kg and < 14 kg (15.2%). The most frequently occurring adverse pregnancy outcomes were cesarean sections for underweight (30.0%), normal weight (40.4%), overweight (53.6%) and obese (53.7%) women. A large for gestational age (LGA) accounted for 18.0% of the overweight and 20.9% of the obesity group. Gestational diabetes mellitus (GDM) occurred in 16.9% of overweight and 23.1% of obese women. The recommended total GWG in a Chinese women population is ≥ 8 and < 12 kg if underweight, ≥ 12 and < 14 kg for normal weight, ≥ 8.0 and < 10.0 kg if overweight, and < 8 kg for women with obesity. Conclusions Current Chinese recommendations provide the optimal ranges of GWG to minimize the occurrence of undesirable pregnancy outcomes for each group of pre-pregnancy BMIs in a Chinese population. Trial registration Registered with ClinicalTrials (NCT03403543).

The Association between Gestational Weight Gain in Each Trimester and Pregnancy Outcomes in Twin Pregnancies

2020 ◽  
Author(s):  
Lilly Y. Liu ◽  
Kelly B. Zafman ◽  
Nathan S. Fox
Keyword(s):  
Weight Gain ◽  
Preterm Birth ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Maternal Weight Gain ◽  
Maternal Weight ◽  
Gestational Weight ◽  
Entire Pregnancy ◽  
Twin Pregnancies

Abstract Objective Adequate maternal weight gain in twin pregnancies is associated with improved outcomes such as increased fetal growth and decreased incidence of preterm birth. However, it remains unclear when gestational weight gain has the greatest influence on pregnancy outcomes. Our objective was to identify at which time in a twin pregnancy does inadequate maternal weight gain have the greatest association with adverse pregnancy outcomes. Study Design This is a retrospective cohort study of women with twin pregnancies and normal prepregnancy body mass index (BMI, 18.5–24.9 kg/m2) who delivered at ≥24 weeks' gestation by a single maternal–fetal medicine practice between 2005 and 2017. Baseline characteristics and pregnancy outcomes were compared between women with and without adequate average gestational weight gain (weight gain per week based on the 2009 Institute of Medicine recommendations). This analysis was performed for weight gain over the entire pregnancy, as well as from 0 to 16, 16 to 24, and 24 weeks to delivery. Multivariable regression analysis was performed to control for potential confounding variables. Results A total of 609 women with twin pregnancies and normal prepregnancy BMI were included, of whom 386 (63.4%) had adequate average gestational weight gain over the entire pregnancy and 223 (36.6%) did not. Inadequate average gestational weight gain between 0 and 16 weeks' gestation was associated with a higher incidence of birthweight less than the 10th percentile for gestational age (adjusted odds ratio [aOR]: 1.67; 95% confidence interval [CI]: 1.11–2.51) and less than the 5th percentile for gestational age (aOR: 2.10; 95% CI: 1.29–3.40). Inadequate gestational weight gain between 16 and 24 weeks was associated with lower birthweight of the larger twin (β: –0.09; p = 0.04). Inadequate weight gain from 24 weeks to delivery was associated with spontaneous preterm birth <37 weeks' gestation (aOR: 1.67; 95% CI: 1.13–2.47), <34 weeks' gestation (aOR: 4.32; 95% CI: 2.45–7.63), <32 weeks' gestation (aOR: 9.07; 95% CI: 3.66–22.48), and a lower incidence of preeclampsia (aOR: 0.31; 95% CI: 0.16–0.63). Conclusion In twin pregnancies, gestational weight gain between 0 and 16 weeks as well as between 16 and 24 weeks is most associated with fetal growth, whereas gestational weight gain after 24 weeks is most associated with preterm birth. This may help elucidate the mechanism of action of the impact of gestational weight gain in twin pregnancies.

scholarly journals Gestational weight gain and adverse pregnancy outcomes: a prospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038187
Author(s):  
Yuelin Wu ◽  
Sheng Wan ◽  
Shengyi Gu ◽  
Zhengqian Mou ◽  
Lingling Dong ◽  
...  
Keyword(s):  
Cohort Study ◽  
Weight Gain ◽  
Caesarean Section ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Late Pregnancy ◽  
Adverse Pregnancy Outcomes ◽  
Gestational Weight ◽  
Maternal And Neonatal Outcomes ◽  
Adverse Pregnancy

ObjectiveTo assess the associations of gestational weight gain (GWG) in early and late pregnancy with subsequent risks of adverse pregnancy outcomes in Chinese women.DesignProspective cohort study.SettingShanghai, China.ParticipantsWe studied 2630 nulliparous singleton pregnant women with complete data on weight gain in early (≤17 weeks of gestation) and late (>17 weeks) pregnancy in the Shanghai Birth Cohort.MethodsGWG was standardised into z-scores by gestational age and categorised as low (z-score <−1), normal (−1 to +1) and high (>1). The adjusted relative risks (aRRs) and 95%CIs were estimated through log-binomial regression models. Interaction effects between GWG and some other adjustment factors were tested, further stratified analyses were performed separately where interaction terms were significant.Outcome measuresAdverse maternal and neonatal outcomes.ResultsIndependent from GWG in late pregnancy, higher GWG in early pregnancy was associated with higher risks of gestational diabetes mellitus (aRR: 1.66; 95% CI: 1.11 to 2.48), caesarean section (aRR: 1.21; 95% CI: 1.05 to 1.39) and prolonged hospitalisation (aRR: 1.56; 95% CI: 1.03 to 2.38). Higher GWG in late pregnancy was independently associated with higher risks of caesarean section (aRR: 1.24; 95% CI: 1.09 to 1.41), large for gestational age (aRR: 2.01; 95% CI: 1.50 to 2.7) and macrosomia (aRR: 1.90; 95% CI: 1.30 to 2.78). In addition, the risk of gestational hypertension increased significantly with increased total GWG (aRR: 1.78; 95% CI: 1.14 to 2.76). The effects of GWG in late pregnancy on maternal and neonatal outcomes were significantly different between the women bearing a female and the women bearing male fetus.ConclusionThe GWG associations with adverse pregnancy outcomes differ at early and late pregnancy, and there may be effect modification by fetal sex in the association of GWG in late pregnancy with some pregnancy outcomes.

scholarly journals Gestational Weight Gain and Pregnancy Outcomes among Nulliparous Women

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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