Low Preconception Complement Levels Are Associated with Adverse Pregnancy Outcomes in a Multicenter Study of 260 Pregnancies in 197 Women with Antiphospholipid Syndrome or Carriers of Antiphospholipid Antibodies

Antiphospholipid antibodies (aPL) can induce fetal loss in experimental animal models. Human studies did find hypocomplementemia associated with pregnancy complications in patients with antiphospholipid syndrome (APS), but these results are not unanimously confirmed. To investigate if the detection of low C3/C4 could be considered a risk factor for adverse pregnancy outcomes (APO) in APS and aPL carriers’ pregnancies we performed a multicenter study including 503 pregnancies from 11 Italian and 1 Russian centers. Data in women with APS and asymptomatic carriers with persistently positive aPL and preconception complement levels were available for 260 pregnancies. In pregnancies with low preconception C3/C4, a significantly higher prevalence of pregnancy losses was observed (p = 0.008). A subgroup analysis focusing on triple aPL-positive patients found that preconception low C3 and/or C4 levels were associated with an increased rate of pregnancy loss (p = 0.05). Our findings confirm that decreased complement levels before pregnancy are associated with increased risk of APO. This has been seen only in women with triple aPL positivity, indeed single or double positivity does not show this trend. Complement levels are cheap and easy to be measured therefore they could represent a useful aid to identify patients at increased risk of pregnancy loss.

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Factors associated with adverse pregnancy outcomes in women with antiphospholipid syndrome: A multicenter study

Journal of Reproductive Immunology ◽

10.1016/j.jri.2017.08.001 ◽

2017 ◽

Vol 122 ◽

pp. 21-27 ◽

Cited By ~ 16

Author(s):

Masashi Deguchi ◽

Hideto Yamada ◽

Mayumi Sugiura-Ogasawara ◽

Mamoru Morikawa ◽

Daisuke Fujita ◽

...

Keyword(s):

Antiphospholipid Syndrome ◽

Multicenter Study ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Factors Associated ◽

Adverse Pregnancy

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The association between adverse pregnancy outcomes and maternal factor V Leiden genotype: a meta-analysis

Thrombosis and Haemostasis ◽

10.1160/th03-10-0637 ◽

2004 ◽

Vol 91 (04) ◽

pp. 700-711 ◽

Cited By ~ 84

Author(s):

John Attia ◽

Tracy Dudding

Keyword(s):

Pregnancy Outcomes ◽

Odds Ratio ◽

Fetal Loss ◽

Factor V Leiden ◽

Adverse Pregnancy Outcomes ◽

Factor V ◽

Third Trimester ◽

Factor V Leiden Mutation ◽

Increased Risk ◽

Adverse Pregnancy

SummaryThe conclusions of studies to date which evaluate a possible association between factor V Leiden and adverse pregnancy outcome have been conflicting. This study was undertaken to further investigate this association. Our objective was to evaluate the association between adverse pregnancy outcomes and maternal factor V Leiden genotype by meta-analysis. Inclusion criteria were: (a) cohort or case control design; (b) outcomes clearly defined as one of the following: first or second/ third trimester miscarriage or intrauterine death, preeclampsia, fetal growth retardation, or placental abruption; (c) both the case and control mothers tested for the factor V Leiden mutation; (d) sufficient data for calculation of an odds ratio. Both fixed and random effect models were used to pool results and heterogeneity and publication bias were checked. For first trimester fetal loss, the pooled odds ratio was heterogeneous (p=0.06) and no dose-response curve could be found. For second/third trimester fetal loss, there was a consistent and graded increase in risk: the odds ratio was 2.4 (95% CI 1.1-5.2) for isolated (non-recurrent) third trimester fetal loss, rising to 10.7 (95% CI 4.0-28.5) for those with 2 or more second/third trimester fetal losses. FactorV Leiden is associated with a 2.9 fold (95% CI 2.0-4.3) increased risk of severe preeclampsia, and a 4.8 fold (95% CI 2.4-9.4) increased risk of fetal growth retardation. These results support factor V Leiden testing for women with recurrent fetal loss in the second/third trimester. Women with only 1 event may also warrant testing if the fetal loss occurred in the third trimester. Conversely, in those women known to have the factor V Leiden mutation, monitoring for adverse pregnancy outcomes is warranted; whether this means increased vigilance or anti-coagulant prophylaxis is still contentious.

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The Association Between Antiphospholipid Antibodies and Adverse Pregnancy Outcomes: A Metaanalysis.

Blood ◽

10.1182/blood.v112.11.1819.1819 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1819-1819

Author(s):

Karim Abou-Nassar ◽

Marc Carrier ◽

Marc Rodger

Keyword(s):

Pregnancy Outcomes ◽

Pregnancy Complications ◽

Antiphospholipid Antibodies ◽

Lupus Anticoagulant ◽

Placental Abruption ◽

Fetal Loss ◽

Anticardiolipin Antibodies ◽

Adverse Pregnancy Outcomes ◽

Clinical Criteria ◽

Adverse Pregnancy

Abstract BACKGROUND: The Sapporo criteria for the diagnosis of the antiphospholipid syndrome (APS) are based on the presence of antiphospholipid antibodies (APLA) and clinical criteria. Although pre-eclampsia, intra-uterine growth restriction (IUGR), late fetal loss and placental abruption, collectively termed “placenta mediated complications”, are recognized as clinical criteria for the APS, their association with APLA remains controversial. OBJECTIVE: This review was conducted to evaluate the association between APLA (anticardiolipin antibodies, lupus anticoagulant, anti B2 glycoprotein 1 antibodies) and placenta mediated complications in untreated women without autoimmune diseases. METHODS: We performed a systematic review of published case-control, cohort and cross sectional studies using MEDLINE (1975 to October week 2 2007), EMBASE 16 (1980 to 2007 week 42) and all EBM Reviews (3rd quarter of 2007). For eligible studies, the rates of adverse pregnancy outcomes were compared between patients with and without specific APLA. Pooled odds ratios with 95% CI were generated using random-effects models. RESULTS: Our search strategy identified 1204 potentially relevant studies. Twenty five were included in the final analysis. Results are outlined in table 1. CONCLUSION: The association between various APLA and pregnancy complications is for the most part weak and inconsistent. There is currently insufficient data to support a significant link between anti-B2 glycoprotein 1 antibodies and pregnancy morbidity. Caution should be used when establishing a diagnosis of APS based on the presence of any APLA, particularly anti-B2 glycoprotein 1 antibodies, in the setting of late pregnancy complications. Table 1 Association Between APLA and Adverse Pregnancy Outcomes Pre-eclampsia OR (95%CI) # studies / participants IUGR OR (95%CI) # studies / participants Placental abruption OR (95%CI) # studies / participants Late fetal loss OR (95%CI) # studies / participants LA: Lupus anticoagulant; aCL: Anticardiolipin antibodies; Anti-B2 GP1 antibodies: Anti-B2 glycoprotein 1 antibodies italic characters indicate statistically significant associations LA 2.88 (1.42, 5.87)  11 / 6085 3.51 (1.38, 8.93)  4 / 3232 0.78 (0.13, 4.80)  2 / 226 3.56 (0.12, 106.05)  3 / 3870 aCL (IgG/IgM) 1.71 (1.09, 2.70)  21 / 9722 2.31 (0.74, 7.17)  6 / 5753 1.35 (0.45, 4.02)  4 / 1274 3.86 (1.14, 13.07)  7 / 5963 aCL IgG 1.65 (0.84, 3.22)  15 / 3627 6.16 (2.50, 15.18)  2 / 1006 1.87 (0.21, 16.83)  2 / 500 10.06 (0.88, 114.96)  2 / 1006 aCL IgM 1.36 (0.93, 1.97)  13 / 5397 0.75 (0.19, 2.93)  2 / 3002 0.96 (0.24, 3.85)  2 / 500 1.37 (0.42, 4.46)  3 / 3212 anti- B2GP1 (IgG/IgM) 2.97 (0.47, 18.69)  4 / 2225 20.03 (4.59, 87.43)  1 / 1108 2.64 (0.14, 50.63)  1 / 510 6.74 (0.24, 191.23)  3 / 1828 anti- B2GP1 IgG 0.87 (0.38, 2.01)  2 / 607 N/A  0 / 0 N/A  0 / 0 0.52 (0.02, 11.02)  1 / 212 anti- B2GP1 IgM 0.37 (0.16, 0.85)  1 / 400 N/A  0 / 0 N/A  0 / 0 1.32 (0.24, 7.42)  1 / 210

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The Association Between Anti-beta2 Glycoprotein 1 Antibodies and Adverse Pregnancy Outcomes.

Blood ◽

10.1182/blood.v114.22.4003.4003 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4003-4003 ◽

Cited By ~ 1

Author(s):

Karim Abou-Nassar ◽

Mark Walker ◽

Shi-Wu Wen ◽

Marisa Freedman ◽

Steve Doucette ◽

...

Keyword(s):

Pregnancy Outcomes ◽

Placental Abruption ◽

Fetal Loss ◽

Adverse Pregnancy Outcomes ◽

Enzyme Linked Immunosorbent Assay ◽

Composite Outcome ◽

Igm Antibodies ◽

Increased Risk ◽

Objective Evidence ◽

Adverse Pregnancy

Abstract Abstract 4003 Poster Board III-939 BACKGROUND The Sapporo criteria include anti-β2 glycoprotein1 (anti-B2GP1) antibodies among antiphospholipid antibodies used to diagnose the antiphospholipid syndrome (APS). Although pre-eclampsia, intra-uterine growth restriction (IUGR), late fetal loss and placental abruption, collectively termed “placenta mediated complications”, are recognized as clinical criteria for the APS, strong evidence to support their association with anti-B2GP1 antibodies is lacking. OBJECTIVE This study aims to assess the association between anti-B2GP1 antibodies and placenta mediated complications. METHODS We performed a nested case-control study from a prospective cohort of 7000 mother baby pairs whereby women and their fetuses were recruited between 12-20 weeks gestation. Five hundred cases were randomly selected amongst women who experienced one of the following adjudicated adverse pregnancy outcomes: pre-eclampsia (BP ≥140/90 with proteinuria), placental abruption (antepartum bleeding with objective evidence of placental thrombus), late pregnancy loss (≥ 12 weeks gestation) and IUGR (birth weight less than the 10th percentile of normal population). Random selection of 500 controls was performed amongst women who did not experience the above mentioned adverse pregnancy outcomes. Stored blood samples were analyzed for the presence of anti-B2GP1 IgG and IgM antibodies by enzyme-linked immunosorbent assay. Titers ≥ than 20 G or M units were considered positive. This study has an 80% power to detect an odds ratio of 2.25 at the 5% level of significance based on an estimated 4 % prevalence of anti-B2GP1 IgG and/or IgM antibodies in titers ≥ 20 G/M units in our cohort of pregnant women. RESULTS Anti-B2GP1 IgG and/or IgM antibodies in titers ≥ 20 G/M units were present in 24/497 (4.8%) controls and 33/503 (6.6%) cases. The presence of anti-B2GP1 IgG and/or IgM in titers ' 20 G/M units was not significantly associated with a composite outcome of pre-eclampsia, IUGR, late fetal loss and placental abruption (OR 1.38; 95%CI 0.8-2.37 p=0.18). This combination of antibodies and titers only demonstrated a weak association with IUGR (OR 1.86; 95%CI 1.09-3.18 p=0.02). The presence of anti-B2GP1 IgG and/or IgM antibodies in titers ≥ 40 G/M units also failed to show an association with a composite outcome of pre-eclampsia, IUGR, late fetal loss and placental abruption (OR 2.65; 95%CI 0.7-10.04 p=0.15). However, stronger associations were observed with placental abruption (OR 4.87; 95%CI 1.02-23.25 p=0.047) and IUGR (OR 3.53; 95%CI 1.03-12.15 p=0.045). CONCLUSION The presence of anti-B2GP1 IgG and/or IgM antibodies in titers 20 ≥ G/M units during pregnancy is only associated with an increased risk of IUGR. Anti-B2GP1 antibodies in titers ' 40 G/M units, as suggested in the Sapporo diagnostic criteria for the APS, are associated with IUGR and placental abruption and possibly other placenta mediated complications. Larger adequately powered studies will be required to provide definitive answers. Disclosures: No relevant conflicts of interest to declare.

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The Need for Personalized Risk-Stratified Approaches to Treatment for Gestational Diabetes: A Narrative Review

Seminars in Reproductive Medicine ◽

10.1055/s-0041-1723778 ◽

2021 ◽

Author(s):

Shamil D. Cooray ◽

Jacqueline A. Boyle ◽

Georgia Soldatos ◽

Shakila Thangaratinam ◽

Helena J. Teede

Keyword(s):

Gestational Diabetes ◽

Pregnancy Outcomes ◽

Population Based ◽

Adverse Pregnancy Outcomes ◽

Therapeutic Interventions ◽

Clinical Prediction Model ◽

Increased Risk ◽

Adverse Pregnancy ◽

The Individual ◽

Personalized Risk

AbstractGestational diabetes mellitus (GDM) is common and is associated with an increased risk of adverse pregnancy outcomes. However, the prevailing one-size-fits-all approach that treats all women with GDM as having equivalent risk needs revision, given the clinical heterogeneity of GDM, the limitations of a population-based approach to risk, and the need to move beyond a glucocentric focus to address other intersecting risk factors. To address these challenges, we propose using a clinical prediction model for adverse pregnancy outcomes to guide risk-stratified approaches to treatment tailored to the individual needs of women with GDM. This will allow preventative and therapeutic interventions to be delivered to those who will maximally benefit, sparing expense, and harm for those at a lower risk.

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Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0430 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Tanapak Wisetmongkolchai ◽

Fuanglada Tongprasert ◽

Kasemsri Srisupundit ◽

Suchaya Luewan ◽

Kuntharee Traisrisilp ◽

...

Keyword(s):

Pregnancy Outcomes ◽

Loss Rate ◽

Fetal Loss ◽

Adverse Pregnancy Outcomes ◽

Expert Group ◽

Second Trimester ◽

Single Institution ◽

Adverse Pregnancy ◽

In Pregnancy ◽

Singleton Pregnancies

AbstractObjectivesTo compare the rate of fetal loss in pregnancy after second trimester amniocentesis between procedures performed by experts and non-experts and to assess other pregnancy complications as secondary outcomes.MethodsA retrospective cohort study was performed on singleton pregnancies that underwent mid-trimester amniocenteses in a single institution. The fetal loss rates of procedures performed by experts and non-experts were collected and analyzed. Other adverse pregnancy outcomes were also examined.ResultsIn total, 14,450 amniocenteses were performed during the study period. These included 11,357 (78.6%) procedures in the group expert operators and 3,093 (21.4%) procedures in the group non-expert operators. In the non-expert group, the fetal loss rate was slightly increased but not significantly (p=0.24).In addition, the higher number of spontaneous abortions was associated with blood-stained amniotic fluid sample (p<0.001; RR=9.28). Multiple needle insertions also increased in the non-expert group significantly. However, no difference in pregnancy outcomes was found between in single and multiple needle insertions.ConclusionsThe amniocentesis procedures performed by the non-experts was not increase the fetal loss rate. However, the other adverse pregnancy outcomes, including preterm birth, low birth weight and fetal growth restriction were significantly increased in the non-expert group.

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Levothyroxine and the risk of adverse pregnancy outcomes in women with subclinical hypothyroidism: a systematic review and meta-analysis

BMC Endocrine Disorders ◽

10.1186/s12902-021-00699-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Magnus Bein ◽

Oriana Hoi Yun Yu ◽

Sonia Marzia Grandi ◽

Francesca Y. E. Frati ◽

Ihab Kandil ◽

...

Keyword(s):

Systematic Review ◽

Subclinical Hypothyroidism ◽

Pregnancy Outcomes ◽

Neonatal Death ◽

Observational Studies ◽

Pregnancy Loss ◽

Meta Analysis ◽

Adverse Pregnancy Outcomes ◽

Adverse Pregnancy ◽

Levothyroxine Treatment

Abstract Background Levothyroxine replacement therapy may decrease the risk of adverse pregnancy outcomes among women with subclinical hypothyroidism (SCH). The aim of this study is to conduct a systematic review and meta-analysis to examine the risk of adverse pregnancy, perinatal, and early childhood outcomes among women with SCH treated with levothyroxine. Methods A systematic literature search was conducted using Ovid-Medline, Ovid-EMBASE, Pubmed (non-Medline), Ebsco-CINAHL Plus with full text and Cochrane Library databases. Randomized controlled studies (RCTs) and observational studies examining the association between treatment of SCH during pregnancy and our outcomes of interest were included. Studies that compared levothyroxine treatment versus no treatment were eligible for inclusion. Data from included studies were extracted and quality assessment was performed by two independent reviewers. Results Seven RCTs and six observational studies met our inclusion criteria. A total of 7342 individuals were included in these studies. RCTs demonstrated several sources of bias, with lack of blinding of the participants or research personnel; only one study was fully blinded. In the observational studies, there was moderate to serious risk of bias due to lack of adjustment for certain confounding variables, participant selection, and selective reporting of results. Pooled analyses showed decreased risk of pregnancy loss (RR: 0.79; 95% CI: 0.67 to 0.93) and neonatal death (RR: 0.35; 95% CI: 0.17 to 0.72) associated with levothyroxine treatment during pregnancy among women with SCH. There were no associations between levothyroxine treatment and outcomes during labour and delivery, or cognitive status in children at 3 or 5 years of age. Conclusion Treatment of SCH with levothyroxine during pregnancy is associated with decreased risks of pregnancy loss and neonatal death. Given the paucity of available data and heterogeneity of included studies, additional studies are needed to address the benefits of levothyroxine use among pregnant women with SCH.

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POS0737 LOW PRECONCEPTIONAL COMPLEMENT LEVEL IS RELATED WITH ADVERSE OBSTETRIC OUTCOME IN A MULTICENTRIC COHORT OF PREGNANCY IN PATIENTS WITH APS AND APL POSITIVITY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1824 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 619.2-620

Author(s):

D. Lini ◽

C. Nalli ◽

L. Andreoli ◽

F. Crisafulli ◽

M. Fredi ◽

...

Keyword(s):

Pregnancy Outcome ◽

Complement Activation ◽

Pregnancy Complications ◽

Antiphospholipid Antibodies ◽

Pregnancy Loss ◽

Adverse Pregnancy Outcome ◽

Obstetric Outcome ◽

Complement Level ◽

Increased Risk ◽

Adverse Pregnancy

Background:The role of complement in the antiphospholipid (aPL) related pathology has been widely studied in animal models. Antiphospholipid antibodies can induce fetal loss in experimental animals but mice deficient in specific complement components (C4, C3, C5) appear somehow protected. In addition, in pregnant mice injected with aPL, antibody deposition has been found at decidual level causing focal necrosis, apoptosis and neutrophil infiltrates and supporting aPL pathogenetic potential. On the other hand, human studies did find hypocomplementemia associated to pregnancy complications in patients with obstetric antiphospholipid syndrome (APS). These results, however, are not unanimously confirmed and, in addition, some studies only show increased levels of complement activation products (i.e. Bb) and not decreased levels of C3 and/or C4. A recently study focusing on complement level in early pregnancy and before pregnancy showed a significant correlation with pregnancy complications and loss in a large cohort of primary APS.Objectives:To investigate if the simple detection of low C3 and/or C4 could be considered a risk factor for adverse pregnancy outcome in APS and aPL carriers pregnancies.Methods:We performed a multicentric study including patients from 10 Italian and 1 Russian Centers. Data on pregnancies in women with primary APS (n=434) and asymptomatic carriers with persistently positive aPL but not fulfilling clinical criteria for APS (n=218) were retrospectively collected. Serum C3 and C4 levels were evaluated by nephelometry; hypocomplementemia was defined by local laboratory reference values. Statistical analysis was performed using GraphPad.Results:Preconceptional complement levels and gestational outcome were available for 107 (25%) pregnancies in APS out of 434 and for 196 (90%) pregnancies in aPL carriers women out of 218. In pregnancies with low preconceptional C3 and/or C4, a significantly higher prevalence of pregnancy losses was observed (p=0.019). A subgroup analysis focusing on triple aPL positive patients was also performed. Preconceptional low C3 and/or C4 levels were found to be associated with an increased rate of pregnancy loss (p = 0.027) in this subgroup also. Otherwise, adverse pregnancy outcomes in single or double aPL positive women were not related to preconception complement levels (p = 0.44) (Table 1). Of note, all the pregnancy losses in the triple positive group occurred in patients treated with low dose aspirin and low molecular weight heparin from the time of positive pregnancy test.Conclusion:Our findings confirm that decreased complement levels before pregnancy are associated with increased risk of adverse outcome. This has been seen only in in women with triple aPL positivity, indeed single or double positivity does not show this trend. Complement levels are cheap and easy to be measured therefore they could represent a useful aid to identify patients at increased risk of pregnancy loss. test positivity.References:[1]De Carolis S, et al. Complementemia and obstetric outcome in pregnancy with antiphospholipid syndrome. Lupus (2012) 21:776–8.[2]Kim MY, et al. Complement activation predicts adverse pregnancy outcome in patients with systemic lupus erythematosus and/or antiphospholipid antibodies. Ann Rheum Dis (2018) 77:549–55.[3]Fredi M, et al. Risk Factors for Adverse Maternal and Fetal Outcomes in Women With Confirmed aPL Positivity: Results From a Multicenter Study of 283 Pregnancies. Front Immunol. 2018 May 7;9:864.Triple aPL positivitySingle or double aPL positivityGestational outcomeLow C3/C4 (n=49)Normal C3/C4(n=17)pLow C3/C4 (n=57)Normal C3/C4(n=165)pTerm live birth (>37w)15 (31%)6 (35%)ns34 (60%)110 (67%)nsPreterm live birth (≤37w)22 (45%)11 (65%)ns15 (26%)38 (23%)nsPregnancy losses (abortion and miscarriages)12 (24%)0 (0%)0.0278 (14%) 17 (10%)nsDisclosure of Interests:None declared

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Maternal educational inequalities about adverse pregnancy outcomes observed in a rural area of a province of China during a time period (2010–2018)

Journal of Epidemiology & Community Health ◽

10.1136/jech-2021-217754 ◽

2022 ◽

pp. jech-2021-217754

Author(s):

Lixin Li ◽

Yanpeng Wu ◽

Yao Yang ◽

Ying Wu ◽

Yan Zhuang ◽

...

Keyword(s):

Pregnancy Outcomes ◽

Maternal Education ◽

Rural China ◽

Education Level ◽

Adverse Pregnancy Outcomes ◽

Secondary Outcome ◽

Health Examination ◽

Educational Inequalities ◽

Increased Risk ◽

Adverse Pregnancy

BackgroundThe relationship between maternal education and adverse pregnancy outcomes is well documented. However, limited research has investigated maternal educational disparities in adverse pregnancy outcomes in China. This study examined maternal educational inequalities associated with adverse pregnancy outcomes in rural China.MethodsWe conducted a population-based cohort study using participants enrolled in the National Free Preconception Health Examination Project in Yunnan province from 2010 to 2018. The primary outcome was stillbirth, and the secondary outcome was adverse pregnancy outcomes, defined as a composite event of stillbirth, preterm birth or low birth weight. The study was restricted to singleton births at 20–42 weeks’ gestation. Univariate and multivariate log-binomial regression models were performed to estimate crude risk ratios (RRs) and confounding-adjusted RRs (ARRs) for stillbirth and adverse pregnancy outcomes according to maternal education level.ResultsA total of 197 722 singleton births were included in the study. Compared with mid-educated women, low-educated women were at a significantly increased risk of stillbirth (ARR, 1.20; 95% CI, 1.05 to 1.38) and adverse pregnancy outcomes (ARR, 1.11; 95% CI, 1.07 to 1.16). However, the risk of stillbirth (ARR, 1.16; 95% CI, 1.01 to 1.35) was significantly higher for high-educated women compared with mid-educated women.ConclusionCompared with women with medium education level, women with lower education level were more likely to experience adverse pregnancy outcomes, including stillbirth, and women with higher education level were more likely to experience stillbirth.

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Interpregnancy Body Mass Index Changes: Distribution and Impact on Adverse Pregnancy Outcomes in the Subsequent Pregnancy

American Journal of Perinatology ◽

10.1055/s-0038-1670634 ◽

2018 ◽

Vol 36 (05) ◽

pp. 517-521 ◽

Cited By ~ 3

Author(s):

Whitney Bender ◽

Adi Hirshberg ◽

Lisa Levine

Keyword(s):

Body Mass Index ◽

Preterm Birth ◽

Body Mass ◽

Pregnancy Outcomes ◽

Subsequent Pregnancy ◽

Adverse Pregnancy Outcomes ◽

Increased Risk ◽

History Of ◽

Index Changes ◽

Adverse Pregnancy

Objective To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes. Study Design We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category. Results In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1–32.7; p = 0.003). Conclusion Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM.

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