Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004–2013

Ukah, Ugochinyere Vivian; Bayrampour, Hamideh; Sabr, Yasser; Razaz, Neda; Chan, Wee‐Shian; Lim, Kenneth; Lisonkova, Sarka

doi:10.1371/journal.pmed.1003009

Cited by 55 publications

(57 citation statements)

References 36 publications

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“…However, there is an indirect link through the risk factors of BV. Preterm birth, pregnancy complications, and prematurity are risk factors that greatly affect neonates and infant mortality as reported in the Demographic and Health Surveys (46) and by other authors (47,48). While, in their previous study, Nduati et al excluded intrapartum deaths, stillbirths, and abortions (14), our analysis captured intrapartum deaths.…”

Section: Discussionmentioning

confidence: 84%

Morbidities and mortality among infants of HIV-1-infected mothers with bacterial vaginosis in Kenya

Mwenda

Nduati

Kosgey

et al. 2020

Preprint

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Background: This study aimed to assess the effects of maternal bacterial vaginosis (BV) on the morbidity and mortality of HIV-exposed infants of women enrolled in a randomized controlled trial (pre-dating antiretroviral therapy) at birth, 6 months, and 12 months. Methods: Four hundred and twenty-five HIV-positive pregnant women were enrolled in this trial and were categorized as exposed if they had a laboratory-based diagnosis of BV (Nugent method). We compared the morbidity and mortality of infants of the mothers at birth, 6 months, and 12 months. We assessed morbidities from the mother’s history and clinical examination during scheduled and non-scheduled visits. The data that were collected longitudinally were then analyzed via multiple logistic regression with the generalized estimating equation. An independent correlation structure was assumed to evaluate the specific morbidity risks to infants associated with exposure to BV. We used the Kaplan–Meier method to generate the cumulative hazard curve, to determine mortalities at different stages between the two groups. Overall, only data for 328 infants were complete and used in the analysis.Results: Data were available for 159 and 171 BV exposed and non-exposed mothers, respectively. Exposure to BV was not associated with any neonatal morbidity at birth, but was associated with adverse maternal condition (unadjusted odds ratio [OR], 2.93; 95% confidence interval [CI], 1.19–7.20, P=0.02) and maternal hospital admissions (unadjusted OR, 1.95; 95% CI, 1.08–3.51, P=0.02). At 6 months, infants of BV exposed mothers had higher odds of bloody stool (adjusted OR, 3.08; 95% CI, 1.11–10.00, P=0.04), dehydration (adjusted OR, 2.94; 95% CI, 1.44–6.37, P=0.01), vomiting (adjusted OR, 1.64; 95% CI, 1.06–2.56, P=0.03), and mouth ulcers (adjusted OR, 12.8; 95% CI, 2.27–241.21, P=0.02). At 12 months, exposure to BV was associated with dehydration (adjusted OR, 1.81; 95% CI, 1.05–3.19, P=0.03) and vomiting (adjusted OR, 1.39; 95% CI, 1.01–1.92, P=0.04). Kaplan–Meier survival analysis showed no association of BV with infant mortality (P=0.65); however, the cumulative hazard curve showed a higher trend toward deaths among BV exposed infants.Conclusion: Our findings demonstrate that BV is a good predictor of maternal and infant morbidities. Infants of both HIV and BV exposed mothers can manifest these symptoms at any stage within a year of growth. Adverse maternal condition and hospitalization of mothers after birth could indicate exposure to BV. Bloody stool, dehydration, vomiting, and mouth ulcers could indicate exposure to BV among infants.

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Section: Discussionmentioning

confidence: 84%

Morbidities and mortality among infants of HIV-1-infected mothers with bacterial vaginosis in Kenya

Mwenda

Nduati

Kosgey

et al. 2020

Preprint

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“…Reporting on nutritional outcomes of antenatal intervention by obesity class is needed to understand the relationship between dietary guidance and clinical outcomes for pregnant women with obesity of increasing severity. This is particularly the case for those of Class III obesity, who have been found to exceed the NAM guidelines for weight gain in 40% of cases [32], with adjusted analysis revealing this to significantly increase the risk of severely adverse combined maternal and perinatal outcomes [33].…”

Section: Discussionmentioning

confidence: 99%

The UK Pregnancies Better Eating and Activity Trial (UPBEAT); Pregnancy Outcomes and Health Behaviours by Obesity Class

Peacock

Seed

Dalrymple

et al. 2020

IJERPH

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The effectiveness of antenatal intervention in women with increasing obesity is unknown. This study investigated whether there was a differential effect of antenatal intervention on diet, physical activity and pregnancy outcomes in women stratified by obesity class using data from the UK Pregnancies Better Eating and Activity Trial (UPBEAT) (n = 1555). The stratification was by World Health Organization classifications: Class I, II and III (30–34.9 kg/m2, 35–39.9 kg/m2 and ≥40 kg/m2). Using linear and logistic regression, adjusted for confounders, outcomes were assessed post-intervention (27+0–28+6 weeks’ gestation) and in late pregnancy (34+0–36+0 weeks’ gestation). Interactions between obesity class and the intervention were explored. Compared to the standard care arm, class III intervention women had lower gestational weight gain (GWG) (−1.87 kg; 95% CI −3.29 to −0.47, p = 0.009), and the effect of the intervention was greater in class III compared to class I, by −2.01 kg (95% CI −3.45 to −0.57, p = 0.006). Class I and II intervention women reported significantly lower dietary glycaemic load and saturated fat intake across their pregnancy. This differential effect of the intervention suggests antenatal interventions for women with obesity should stratify outcomes by obesity severity. This would inform evidence-based antenatal strategies for high-risk groups, including women with a BMI ≥ 40 kg/m2.

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“…Gestational weight gain (GWG), whether too much or too little, is associated with adverse maternal and infant outcomes 3 , 4 . With excess GWG, pregnant women are more likely to experience gestational diabetes mellitus and macrosomia, which can contribute to preterm birth 5 , 6 .…”

Section: Introductionmentioning

confidence: 99%

Association between maternal gestational weight gain and preterm birth according to body mass index and maternal age in Quzhou, China

Ying

Han

et al. 2020

Sci Rep

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The aim of this study is to investigate the association between maternal gestational weight gain (GWG) and preterm birth according to pre-pregnancy body mass index (BMI) and maternal age. We did a cohort, hospital-based study in Quzhou, South China, from 1 Jan 2018 to 30 June 2019. We selected 4274 singleton live births in our analysis, 315 (7.4%) of which were preterm births. In the overall population, excess GWG was significantly associated with a decreased risk of preterm birth compared with adequate GWG (adjusted OR 0.81 [95% CI 0.72–0.91]), and the risk varied by increasing maternal age and pre-pregnancy BMI. Interestingly, underweight women who older than 35 years with excess GWG had significantly increased odds of preterm birth compared with adequate GWG in underweight women aged 20–29 years (2.26 [1.06–4.85]) and normal weight women older than 35 years (2.23 [1.13–4.39]). Additionally, low GWG was positively and significantly associated with preterm birth overall (1.92 [1.47–2.50]). Among normal weight women category, compared with adequate GWG women aged 20–29 years did, those older than 20 years with low GWG, had significantly higher odds of preterm birth, which increased with maternal age (1.80 [1.16–2.79] in 20–29 years, 2.19 [1.23–3.91] in 30–34 years, 3.30 [1.68–6.46] in ≫ 35 years). In conclusion, maternal GWG was significantly associated with the risk of preterm birth, but the risk varied by pre-pregnancy BMI and maternal age.

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Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004–2013

Cited by 55 publications

References 36 publications

Morbidities and mortality among infants of HIV-1-infected mothers with bacterial vaginosis in Kenya

Morbidities and mortality among infants of HIV-1-infected mothers with bacterial vaginosis in Kenya

The UK Pregnancies Better Eating and Activity Trial (UPBEAT); Pregnancy Outcomes and Health Behaviours by Obesity Class

Association between maternal gestational weight gain and preterm birth according to body mass index and maternal age in Quzhou, China

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