A prospective population-based multicentre study on the impact of maternal body mass index on adverse pregnancy outcomes: Focus on normal weight

Abstract

Background Maternal body mass index (BMI) below or above the reference interval (18.5–24.9 kg/m2) 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 general unselected pregnant population. Methods Data was extracted from a prospective population-based multicentre cohort (Risk Estimation for PrEgnancy Complications to provide Tailored care (RESPECT) study) conducted between December 2012 to January 2014. BMI was studied in categories (I: <18.5, II: 18.5–19.9, III: 20.0–22.9, IV: 23.0–24.9, V: 25.0–27.4, VI: 27.5–29.9, VII: >30.0 kg/m2) and as a continuous variable within the reference interval. Adverse pregnancy outcomes were defined as composite endpoints for maternal, neonatal or any pregnancy complication, and for adverse pregnancy outcomes individually. Linear trends were assessed using linear-by-linear association analysis and (adjusted) relative risks by regression analysis. Results The median BMI of the 3671 included women was 23.2 kg/m2 (IQR 21.1–26.2). Adverse pregnancy outcomes were reported in 1256 (34.2%). Linear associations were observed between BMI categories and all three composite endpoints, and individually for pregnancy-induced hypertension (PIH), preeclampsia, gestational diabetes mellitus (GDM), large-for-gestational-age (LGA) neonates; but not for small-for-gestational-age neonates and preterm birth. Within the reference interval, BMI was associated with the composite maternal endpoint, PIH, GDM and LGA, with adjusted relative risks of 1.15 (95%CI 1.06–1.26), 1.12 (95%CI 1.00–1.26), 1.31 (95%CI 1.11–1.55) and 1.09 (95%CI 1.01–1.17). Conclusions Graded increase in maternal BMI appears to be an indicator of risk for adverse pregnancy outcomes even among women with a BMI within the reference interval. The extent to which BMI directly contributes to the increased risk in this group should be evaluated in order to determine strategies most valuable for promoting safety and long-term health for mothers and their offspring.

Impact of first-trimester body mass index on pregnancy outcomes: observational study

“…They demonstrated that gestational hypertension, gestational diabetes and pre-eclampsia increased steadily with increasing body mass index. 16 Our study also demonstrated that obese women had bigger babies when compared with their non-obese counterparts (Table 4). There is also increased number of caesarean sections among women with increased Body Mass Index when compared with non-obese women in our participants.…”

“…This is also similar to the finding by study by Van Der Linden et al that demonstrated strong associations between obesity and these conditions. 15 Van Hoorn F. et al 16 also examined high maternal weight status and complications during pregnancy and delivery, where they also found that overweight or obesity during pregnancy was associated with increased odds of several adverse pregnancy and delivery complications. They demonstrated that gestational hypertension, gestational diabetes and pre-eclampsia increased steadily with increasing body mass index.…”

“…This is similar to the findings in similar studies where increased incidence of macrosomia and caesarean sections were also reported. 15,16…”