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of associations between maternal underweight and obesity and early and late medically-induced and spontaneous PTB compared to term births
Source publication
To evaluate the association between prepregnancy body mass index (BMI) is associated with early vs. late and medically-induced vs. spontaneous preterm birth (PTB) subtypes.
Using data from the Boston Birth Cohort, we examined associations of prepregnancy BMI with 189 early (<34 completed weeks) and 277 late (34-36 completed weeks) medically-induced...
Context in source publication
Context 1
... underweight was associated with an increased odds (1.46 [0.99, 2.16]) of late spontan- eous PTB and maternal obesity was associated with a de- creased odds (0.76 [0.58, 0.98]) of late spontaneous PTB (Table 3, Model 2). We additionally show the direction of the associations of prepregnancy underweight and obesity with early and late medically-induced and spontaneous PTB with arrows in Table 4. ...Similar publications
Background
Maternal body mass index (BMI) below or above the reference interval (18.5–24.9 kg/m ² ) is associated with adverse pregnancy outcomes. Whether BMI exerts an effect within the reference interval is unclear. Therefore, we assessed the association between adverse pregnancy outcomes and BMI, in particular within the reference interval, in a...
Citations
... Evidence from systematic reviews suggests an increased risk of PTB with both maternal overweight/obesity and underweight [7][8][9][10][11][12], with some studies indicating that underweight might be a greater factor than obesity in SPTB [7][8][9][13][14][15][16]. In addition, there is evidence that the association of BMI with PTB may vary by parity, with some suggestion of a stronger association of obesity with SPTB among nulliparous women [17,18] and of different associations of underweight with SPTB and MPTB among nulliparous and parous women [19], although the numbers of women with underweight in these studies have been small. ...
... Our findings are broadly consistent with previous studies that have explored associations of underweight, overweight or obesity using conventional BMI categories, showing an increased risk of PTB among women with underweight as well as with obesity [6][7][8][9][10][11][12][13][14][15][16], with the increased risk with obesity being largely a result of medically indicated PTB [6,7]. To our knowledge, two studies have examined the relationship using BMI as a continuous variable. ...
Background
Preterm birth (PTB) is a leading cause of child morbidity and mortality. Evidence suggests an increased risk with both maternal underweight and obesity, with some studies suggesting underweight might be a greater factor in spontaneous PTB (SPTB) and that the relationship might vary by parity. Previous studies have largely explored established body mass index (BMI) categories. Our aim was to compare associations of maternal pre-pregnancy BMI with any PTB, SPTB and medically indicated PTB (MPTB) among nulliparous and parous women across populations with differing characteristics, and to identify the optimal BMI with lowest risk for these outcomes.
Methods
We used three UK datasets, two USA datasets and one each from South Australia, Norway and Denmark, together including just under 29 million pregnancies resulting in a live birth or stillbirth after 24 completed weeks gestation. Fractional polynomial multivariable logistic regression was used to examine the relationship of maternal BMI with any PTB, SPTB and MPTB, among nulliparous and parous women separately. The results were combined using a random effects meta-analysis. The estimated BMI at which risk was lowest was calculated via differentiation and a 95% confidence interval (CI) obtained using bootstrapping.
Results
We found non-linear associations between BMI and all three outcomes, across all datasets. The adjusted risk of any PTB and MPTB was elevated at both low and high BMIs, whereas the risk of SPTB was increased at lower levels of BMI but remained low or increased only slightly with higher BMI. In the meta-analysed data, the lowest risk of any PTB was at a BMI of 22.5 kg/m² (95% CI 21.5, 23.5) among nulliparous women and 25.9 kg/m² (95% CI 24.1, 31.7) among multiparous women, with values of 20.4 kg/m² (20.0, 21.1) and 22.2 kg/m² (21.1, 24.3), respectively, for MPTB; for SPTB, the risk remained roughly largely constant above a BMI of around 25–30 kg/m² regardless of parity.
Conclusions
Consistency of findings across different populations, despite differences between them in terms of the time period covered, the BMI distribution, missing data and control for key confounders, suggests that severe under- and overweight may play a role in PTB risk.
... It affects their health and the health of their offspring. Overweight/obesity among women is associated with increased pregnancy and childbirth related complications such as gestational diabetes, pre-eclampsia, gestational hypertension, postpartum hemorrhage, instrumental delivery, cesarean delivery, low birth weight, preterm birth, congenital malformation, large-for-gestational-age babies and perinatal death [22][23][24][25][26][27][28]. In addition, underweight women are more likely to have pregnancy and childbirth-related complications, such as low birth weight, small for gestational age, preterm birth, and neonatal mortality [22-24, 29, 30]. ...
Background
Double burden of malnutrition (DBM) is an emerging global public health problem. The United Nations member states adopted eradicating all forms of malnutrition as an integral component of the global agenda. However, there is evidence of a high burden of undernutrition among women and rising rates of overweight and obesity, especially in low and middle income countries (LMICs). Therefore, this study aimed to investigate the prevalence and associated factors of underweight, overweight, and obesity among women of reproductive age in LMICs.
Methods
Data for the study were drawn from a recent 52 Demographic and Health Surveys (DHS) conducted in LMICS. We included a sample of 1,099,187 women of reproductive age. A multilevel multinomial logistic regression model was used to identify factors associated with DBM. Adjusted relative risk ratio (RRR) with a 95% Confidence Interval (CI) was reported to show an association.
Results
The prevalence of underweight, overweight, and obesity in LMICs among women of reproductive age was 15.2% (95% CI: 15.1–15.3), 19.0% (95% CI: 18.9- 19.1), and 9.1% (95% CI: 9.0–9.2), respectively. This study found that women aged 24–34 years, aged ≥ 35 years, with primary, secondary, and above educational level, from wealthy households, using modern contraceptives, exposed to media (radio and television), and with high parity (more than one birth) were more likely to have overweight and obesity and less likely to have underweight. Moreover, the risk of having obesity (RRR = 0.59; 95% CI = 0.58–0.60 and overweight (RRR = 0.78; 95% CI = 0.77–0.79) were lower among rural women, while the risk of being underweight was (RRR = 1.13; 95% CI = 1.11–1.15) higher among rural women compared to urban women.
Conclusion
The prevalence of underweight, overweight, and obesity was high among women of reproductive age in LMICs. Underweight, overweight, and obesity are influenced by sociodemographic, socioeconomic, and behavioral-related factors. This study shows that, in order to achieve Sustainable Development Goal 2, a multifaceted intervention approach should be considered to prevent both forms of malnutrition in women of reproductive age. This can be achieved by raising awareness and promoting healthy behaviors such as healthy eating and physical activity, especially among educated women, women from wealthy households, and women exposed to the media.
... Gebelikte obezite ve aşırı gestasyonel kilo alımı (GKA) anne ve çocuk sağlık riskleri ile ilişkilidir. Maternal obezite ve aşırı GKA'nın makrozomik bebek doğumu, zor doğum, sezaryen doğum, gebelikte hipertansif bozukluklar, gestasyonel diyabet ve postpartum kilo retansiyonu gibi birçok olumsuz maternal ve neonatal sonuçlara neden olmaktadır (2,5,6). Ayrıca, çocuklarda aşırı kilo veya obezite gelişimi için uzun vadeli etkileri vardır. ...
ÖZET Bu derlemenin amacı, akıllı telefon aracılığıyla gönderilen sağlıklı beslenme ve fiziksel aktivite yaşam tarzı kısa mesaj girişimlerinin gebelikte kilo yönetiminde kullanımını literatür doğrultusunda incelemektir. Obez kadınların %60’ı, aşırı kilolu kadınların %68’i ve gebelerin %50’si uygun kilo alım aralığını aşmaktadır. Gebelerin akıllı telefona sahip olduğu ve interneti aktif kullandığı bilinmektedir. Aşırı gestasyonel kilo alımına yönelik akıllı telefon üzerinden yapılan internet temelli kısa mesaj girişimlerinin gebelerde kilo alımını azalttığı çalışmalar vardır. Fakat kilo alımına etki etmediği çalışma sonuçları da literatürde mevcuttur. Konuyla ilgili girişimler planlanırken mesaj gönderim sıklığının oldukça önemli olduğu, telefon görüşmelerinin de dâhil edilmesi gerektiği, çift yönlü iletişim kurabilen uygulamaların gebelerde daha etkili olacağı düşünülmektedir. Aşırı gestasyonel kilo alımını önlemeye yönelik akıllı telefon kısa mesaj girişimlerinin yapıldığı çalışmalar yetersizdir. Hemşirelerin bu konuda aktif rol alması, konuyla ilgili daha fazla çalışma yapılması ve telefon görüşmeleriyle de gebelerin desteklenmesi önerilmektedir.
... ; https://doi.org/10.1101/2023.04.12.23288470 doi: medRxiv preprint regression, Mendelian randomization and a negative control analyses support a causal effect of higher maternal BMI on pre-eclampsia, gestational hypertension, and macrosomia / large for gestational age, and a lower risk of small for gestational age, even linear effects on stillbirth were too imprecise to make robust conclusions [26]. Preterm birth is also a risk factor for infant mortality and evidence suggests non-linear associations of maternal pre-pregnancy BMI with preterm birth, with higher BMI largely contributing to increased risk of medically indicated BMI, and lower BMI to spontaneous preterm birth [27,28]. ...
Background
Higher maternal pre-pregnancy body mass index (BMI) has been associated with higher risk of stillbirth, infant and neonatal mortality. Few studies have explored associations of underweight, with those that have varying in their conclusions. Our aim was to examine the risk of stillbirth, infant and neonatal mortality across the pre-pregnancy BMI distribution and establish a likely healthy BMI range.
Methods
We used publicly available birth, infant death and fetal death datasets from the US National Center for Health Statistics National Vital Statistics System, 2014–2020. Fractional polynomial multivariable logistic regression was used to examine the nature of associations between maternal pre-pregnant BMI and stillbirth (birth with no signs of life at ≥24 weeks), infant mortality (death of a live born baby aged <365 days) and neonatal mortality (death of a live born baby aged <28 days).
Findings
There were 56,376/21,437,556 (0.26%) stillbirths, 108,413/24,742,273 (0.44%) infant deaths and 66,801/24,742,273 (0.27%) neonatal deaths among complete cases. Mean BMI was 27.0 kg/m ² . We found non-linear associations between pre-pregnant BMI and all three outcomes - risk was elevated at both low and high BMIs although, for stillbirth, the increased risk at low BMI was less marked than for infant and neonatal mortality. The lowest risk was at a BMI of 21 kg/m ² for infant and neonatal mortality and, for stillbirth, at 18 kg/m ² .
Interpretation
Public health messaging for preconception and postnatal care should focus on healthy weight to maximise maternal and child health, and not focus solely on maternal overweight or obesity.
... Evidence from systematic reviews suggests an increased risk of PTB with both maternal overweight/obesity and underweight [5][6][7][8][9][10] , with some studies suggesting underweight might be a greater factor than obesity in SPTB [5][6][7][11][12][13][14] . Previous studies have largely explored established BMI categories and not attempted to identify the BMI with lowest risk or compared associations across countries with different levels of obesity. ...
... Our findings are broadly consistent with previous studies that have explored associations of underweight, overweight, or obesity using conventional BMI categories [4][5][6][7][8][9][10][11][12][13][14] . To our knowledge, two studies have examined the relationship using BMI as a continuous variable. ...
Importance
Preterm birth (PTB), is a leading cause of child morbidity and mortality. Objective: To examine the associations of maternal pre-pregnant body mass index (BMI) with any PTB, spontaneous (SPTB) and medically indicated PTB (MPTB).
Design
A meta-analysis of eight population-based datasets.
Setting
Three UK datasets, two USA datasets, and one each from South Australia, Norway and Denmark, with different characteristics and sources of bias.
Participants
All pregnancies resulting in a live birth or stillbirth after 24 completed gestational weeks.
Exposure
Maternal pre-or early pregnancy BMI derived from self-reported or measured weight and height between 12 months pre-pregnancy and 15 weeks gestation.
Main Outcome(s) and Measures(s)
Any PTB (delivery <37 completed weeks), SPTB and medically indicated PTB. Fractional polynomial multivariable logistic regression was applied to eight datasets from different high-income countries and time periods. The results were combined using a random effects meta-analysis.
Results
We found non-linear associations between pre-pregnant BMI and all three outcomes, across all datasets. The adjusted risk of any PTB and MPTB was elevated at both low and high BMIs, whereas the risk of SPTB was increased at lower levels of BMI but remained low or increased only slightly with higher BMI. In the meta-analysed data, the lowest risk of any PTB was at a BMI of 24.5 kg/m ² (95% confidence interval: 23.1, 30.3), with a value of 21.3 kg/m ² (20.8, 21.9) for MPTB; for SPTB, the risk remained roughly constant above a BMI of around 25-30 kg/m ² .
Conclusions and Relevance
Consistency of findings across different populations, despite differences between them in the time period covered, BMI distribution, missing data and control for key confounders, highlight the importance of promoting pre-conception BMI between 21 to 30 kg/m2 to prevent MPTB and SPTB
... Preterm mortality was 69% in Cameron (Ndombo et al., 2017), 52% in East Africa (Marchant et al., 2012), and 21.8%-34% in Ethiopia (CSA andICF, 2016, WHO, 2016;Mekonnen et al., 2013;Mengesha et al., 2017;Muhe et al., 2019). Maternal health problems, mode of delivery, male sex, hypothermia, hypoxia, lower gestational age, hyaline membrane disease, and babies born with a short birth interval all increased the risk of death (Koullali et al., 2016;Abdel Razeq et al., 2017;Whiteman et al., 2015;Wagijo et al., 2017;Lean et al., 2017;Parker et al., 2014;Malloy, 2008). In addition, biological, genetic, social, psychological, regional, and demographic factors all play a role in neonatal mortality (Monangi et al., 2015;Schifano et al., 2013). ...
Introduction
Preterm neonatal death is one of the world's most pressing problems, especially in Ethiopia, despite the implementation of extensive prevention initiatives. As a result, the goal of the study was to determine the incidence of neonatal mortality among preterm neonatal admissions in the hospital setting.
Methods
The study was conducted among preterm neonatal admissions at Debre Tabor Comprehensive Specialized Hospital from January 1, 2014, to December 30, 2017. Cox regression model was used for analysis. Variables with a p-value of 0.2 in the log-rank test were taken to multivariable cox regression analysis and level of statistical significance was declared at P- value ≤ 0.05.
Results
According to current study, the overall rate of premature death was 31.2 per 100 live births (95% CI: 27.3, 35.1). Males ((Adjusted Hazard Ratio (AHR) = 1.38; 95% CI: 1.01, 1.90), neonates under 32 weeks of gestational age (AHR = 1.74; 95% CI: 1.24, 2.46), neonate born from preeclampsia mothers (AHR = 1.95; 95% CI: 1.13, 3.36), neonate with extremely very low birth weight (AHR = 2.94; 95%CI: 1.05, 8.24), and neonate having respiratory distress syndrome (AHR = 1.70; 95% CI: 1.20, 2.41) were significantly associated with preterm mortality.
Conclusion
The burden of preterm mortality at hospital setting was high. As a result, reducing and treating preeclampsia is critical in lowering neonatal mortality. In addition, very low birth weight newborns and premature neonates with respiratory distress syndrome should be given special attention. Considering of every premature neonates as a danger of death, essential care such as; kangaroo mother care, feeding, infection prevention, oxygen therapy, thermal care, close follow-up, and medication administration should be considered.
... The variable importance results of the artificial neural network put more focus on hypertension, diabetes mellitus, and prior cone biopsy, while their random forest counterparts placed more emphasis on cervical length, age, and prior preterm birth. The former outcomes agreed with those of previous research [22][23][24][25][26][27][28][29][30][31][32][33], requesting the change of focus from direct to indirect factors of preterm birth. ...
This study reviews recent advances on the application of artificial intelligence for the early diagnosis of various maternal-fetal conditions such as preterm birth and abnormal fetal growth. It is found in this study that various machine learning methods have been successfully employed for different kinds of data capture with regard to early diagnosis of maternal-fetal conditions. With the more popular use of artificial intelligence, ethical issues should also be considered accordingly.
... Meanwhile, if the initial weight is low or the BMI under the category of underweight reflects poor nutritional intake, including intake of various important micronutrients that play a role in the haematopoiesis process. 14 Majority of respondents in this study had normal ferritin serum. This can occur due to an increase in the regulation of hepsidin which is induced by IL-6 as one of the inflammatory mediators that is triggered due to excess adipose tissue in obese patients. ...
... 1 Apart from adverse pregnancy outcome, it is also associated with increased risks of adverse neonatal outcome, including preterm birth and stillbirth. 2,3 Whilst low birth weight is associated with increased risk of infant mortality, 4 macrosomia, which occurs more commonly in pregnant mothers with obesity, increases risk of obesity in the offspring at a later stage of life. 5,6 In one of a prospective analyses done in India, 46.37% of babies were macrosomic and born to mothers with pre-pregnancy obesity, whereas 19.47% macrosomia babies were born to mothers with normal pre-pregnancy weight. ...
Background
Most studies showing association between mothers with obesity in pregnancy or excessive gestational weight gain (GWG) and adverse neonatal outcome were cross‐sectional or retrospective. Many included patients with gestational diabetes mellitus (GDM), which is a strong risk factor for this adverse outcome. There are no prospective studies on this topic in Malaysia. This study aimed to examine prospectively the effect of obesity in pregnancy and GWG, independent of GDM, on neonatal outcome.
Methods
Pregnant mothers in first trimester, who presented to health clinics in Kuching, were screened. Mothers with existing diabetes mellitus or GDM were excluded using 75‐g OGTT during first and second trimesters. Participants with first trimester BMI≥23kg/m² were recruited as overweight/obese group, whereas those with BMI 18.5‐22.9kg/m² were taken as the comparison group. At every trimester visit, mothers’ weights were recorded. Babies’ birth weight and occurrence of adverse neonatal outcome were documented.
Results
There were 123 mothers recruited as overweight/obese group (mean BMI 29.0kg/m²±4.45) and 102 mothers as comparison group (mean BMI 20.4kg/m²±1.48). The number of low birth weight was similar between groups: 9.8% in overweight/obese group, 6.9% in the comparison group (p=0.416). More than half of these babies were born to mothers with inadequate GWG (58.3% in obese group vs 57.1% in control group, p=0.077). There was no significant difference in mean birth weight (3,000g±454.5 vs 3,038g±340.8, p=0.471), preterm delivery (8.13% vs 3.92%, p=0.193) and admission rate to neonatal intensive care unit (8.13% vs 7.85%, p=0.937) between groups. There was a positive correlation between total GWG in overweight/obese group on baby’s weight (r=0.222, p=0.013). Inadequate GWG was not correlated with lower birth weight (p=0.052).
Conclusions
Obesity in pregnancy was not associated with poor neonatal outcome in this small sample of women in Malaysia. Total GWG showed a weak correlation with baby’s birth weight in overweight/obese group.
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... increased prevalence of SGA. Previous studies speculated that inflammatory or intrauterine infection might be on the causal pathway between pre-pregnancy underweight or obesity and PTB 25,26 , although the increased prevalence of postpartum infective complications was not observed in some studies 4,25 . ...
... increased prevalence of SGA. Previous studies speculated that inflammatory or intrauterine infection might be on the causal pathway between pre-pregnancy underweight or obesity and PTB 25,26 , although the increased prevalence of postpartum infective complications was not observed in some studies 4,25 . ...
This study investigated the association between pre-pregnancy body mass index (BMI) and adverse pregnancy outcomes among women participated in the National Free Preconception Health Examination Project in Guangdong Province, China, and explored these associations according to maternal age. Pre-pregnancy BMI was classified into underweight (BMI < 18.5 kg/m²), healthy weight (18.5–23.9 kg/m²), overweight (24.0–27.9 kg/m²), and obesity (≥ 28.0 kg/m²) according to Chinese criteria. Outcomes were preterm birth (PTB, delivery before 37 weeks of gestation), large for gestational age (LGA, birthweight above the 90th percentile for gestational age by infants’ sex), small for gestational age (SGA, birthweight below the 10th percentile for gestational age by infants’ sex), primary caesarean delivery, shoulder dystocia or birth injury, and stillbirth. Adjusted incidence risk ratios (aIRR) were calculated for underweight, overweight and obesity, respectively. Compared with healthy weight, underweight was associated with increased risk of PTB (aIRR 1.06, 95%CI 1.04–1.09) and SGA (1.23, 1.22–1.26) but inversely associated with LGA (0.83, 0.82–0.85), primary caesarean delivery (0.88, 0.87–0.90) and stillbirth (0.73, 0.53–0.99). Overweight was associated with increased risk of LGA (1.17, 1.14–1.19), primary caesarean delivery (1.18, 1.16–1.20) and stillbirth (1.44, 1.03–2.06), but inversely associated with SGA (0.92, 0.90–0.95) and shoulder dystocia or birth injury (0.86, 0.79–0.93). Obesity was associated with increased risk of PTB (1.12, 1.05–1.20), LGA (1.32, 1.27–1.37), primary caesarean delivery (1.45, 1.40–1.50), but inversely associated with SGA (0.92, 0.87–0.97). The aIRRs for underweight, overweight and obesity in relation to these adverse pregnancy outcomes ranged from 0.65 to 1.52 according to maternal age. In Chinese population, maternal pre-pregnancy BMI was significantly associated with the risk of adverse pregnancy outcomes and the risk differs according to maternal age. Further investigation is warranted to determine whether and how counselling and interventions for women with low or increased BMI before pregnancy can reduce the risk of adverse pregnancy outcomes.
