Abstract:International guidelines recommend women with an overweight or obese body mass index (BMI) aim to reduce their body weight prior to conception to minimize the risk of adverse perinatal outcomes. Recent systematic reviews have demonstrated that interpregnancy weight gain increases women's risk of developing adverse pregnancy outcomes in their subsequent pregnancy. Interpregnancy weight change studies exclude nulliparous women. This systematic review and meta-analysis was conducted following MOOSE guidelines and… Show more
“…A recent systematic review and meta-analysis pooling 61 studies investigating outcomes of interpregnancy weight changes from 11 Western countries highlighted the gaps and clinical needs. 10 Data from this meta-analysis showed that women with interpregnancy weight gain had increased risks of gestational diabetes, hypertensive disorders, large-forgestational-age birth and caesarean delivery, while those with interpregnancy weight loss had increased risks for preterm delivery and small-for-gestational-age birth. In the present study, our aims were to (i) describe the distribution of weight changes in BMI between first and second pregnancies among Singaporean women and (ii) examine whether similar associations between interpregnancy BMI changes and pregnancy outcomes would be observed in Asian women, compared to those reported in the aforementioned meta-analysis among Caucasians.…”
Section: Introductionmentioning
confidence: 89%
“…7,8 However, the extent to which interpregnancy weight change influences the risks of subsequent maternal and neonatal outcomes remain poorly understood, 9 and most studies have been focused on Western populations. 10 Given that Asians have increased health risks at different BMI thresholds to Caucasians, 11 and that unique sociocultural factors may influence weight management behaviours before, during, and after pregnancy, 10 it is essential to personalize weight management planning for Asian women.…”
Section: Introductionmentioning
confidence: 99%
“…In the present study, our aims were to (i) describe the distribution of weight changes in BMI between first and second pregnancies among Singaporean women and (ii) examine whether similar associations between interpregnancy BMI changes and pregnancy outcomes would be observed in Asian women, compared to those reported in the aforementioned meta-analysis among Caucasians. 10…”
Objective To examine the change in maternal body mass index (BMI)
between the first two deliveries and outcomes in the second delivery.
Design Cohort study using electronic medical records. Setting and
population Medical records of women with their first two consecutive
deliveries between 2015 and 2020 at KK Women’s and Children’s Hospital,
Singapore were retrieved. Methods Analysis was limited to women with BMI
available for both pregnancies, which was standardised/adjusted to 12
weeks gestation. The difference between gestational-age-adjusted BMI in
both pregnancies was calculated as the change in interpregnancy BMI. The
risk ratios (RR) of pregnancy outcomes were estimated using modified
Poisson regression models with confounder adjustment. Main outcome
measures Low birthweight (<2.5 kg), high birthweight (≥4 kg),
small-for-gestational-age, large-for-gestational-age, preterm delivery,
gestational diabetes, elective and emergency caesarean deliveries.
Results Of 6264 included women with a median interpregnancy interval of
1.44 years, 40.7% had a stable BMI change within +1 kg/m2, 10.3% lost
>1 kg/m2, 34.3% gained 1-3 kg/m2 and 14.8% gained ≥3
kg/m2. Compared to women with stable BMI change, those with
>1 kg/m2 loss had a higher risk of low birthweight delivery
(RR 1.36; 95% confidence interval 1.02, 1.80), while those with 1-3
kg/m2 gain had higher risks of large-for-gestational-age birth (1.16;
1.03, 1.31), gestational diabetes (1.25; 1.06, 1.49) and emergency
caesarean delivery (1.16; 1.03, 1.31); these risks were higher in those
with ≥3 kg/m2 gain. Conclusion Our study demonstrated the importance of
returning to pre-pregnancy weight and maintaining a stable
interpregnancy BMI, to achieve better pregnancy outcomes.
“…A recent systematic review and meta-analysis pooling 61 studies investigating outcomes of interpregnancy weight changes from 11 Western countries highlighted the gaps and clinical needs. 10 Data from this meta-analysis showed that women with interpregnancy weight gain had increased risks of gestational diabetes, hypertensive disorders, large-forgestational-age birth and caesarean delivery, while those with interpregnancy weight loss had increased risks for preterm delivery and small-for-gestational-age birth. In the present study, our aims were to (i) describe the distribution of weight changes in BMI between first and second pregnancies among Singaporean women and (ii) examine whether similar associations between interpregnancy BMI changes and pregnancy outcomes would be observed in Asian women, compared to those reported in the aforementioned meta-analysis among Caucasians.…”
Section: Introductionmentioning
confidence: 89%
“…7,8 However, the extent to which interpregnancy weight change influences the risks of subsequent maternal and neonatal outcomes remain poorly understood, 9 and most studies have been focused on Western populations. 10 Given that Asians have increased health risks at different BMI thresholds to Caucasians, 11 and that unique sociocultural factors may influence weight management behaviours before, during, and after pregnancy, 10 it is essential to personalize weight management planning for Asian women.…”
Section: Introductionmentioning
confidence: 99%
“…In the present study, our aims were to (i) describe the distribution of weight changes in BMI between first and second pregnancies among Singaporean women and (ii) examine whether similar associations between interpregnancy BMI changes and pregnancy outcomes would be observed in Asian women, compared to those reported in the aforementioned meta-analysis among Caucasians. 10…”
Objective To examine the change in maternal body mass index (BMI)
between the first two deliveries and outcomes in the second delivery.
Design Cohort study using electronic medical records. Setting and
population Medical records of women with their first two consecutive
deliveries between 2015 and 2020 at KK Women’s and Children’s Hospital,
Singapore were retrieved. Methods Analysis was limited to women with BMI
available for both pregnancies, which was standardised/adjusted to 12
weeks gestation. The difference between gestational-age-adjusted BMI in
both pregnancies was calculated as the change in interpregnancy BMI. The
risk ratios (RR) of pregnancy outcomes were estimated using modified
Poisson regression models with confounder adjustment. Main outcome
measures Low birthweight (<2.5 kg), high birthweight (≥4 kg),
small-for-gestational-age, large-for-gestational-age, preterm delivery,
gestational diabetes, elective and emergency caesarean deliveries.
Results Of 6264 included women with a median interpregnancy interval of
1.44 years, 40.7% had a stable BMI change within +1 kg/m2, 10.3% lost
>1 kg/m2, 34.3% gained 1-3 kg/m2 and 14.8% gained ≥3
kg/m2. Compared to women with stable BMI change, those with
>1 kg/m2 loss had a higher risk of low birthweight delivery
(RR 1.36; 95% confidence interval 1.02, 1.80), while those with 1-3
kg/m2 gain had higher risks of large-for-gestational-age birth (1.16;
1.03, 1.31), gestational diabetes (1.25; 1.06, 1.49) and emergency
caesarean delivery (1.16; 1.03, 1.31); these risks were higher in those
with ≥3 kg/m2 gain. Conclusion Our study demonstrated the importance of
returning to pre-pregnancy weight and maintaining a stable
interpregnancy BMI, to achieve better pregnancy outcomes.
“…The number of children and adolescents with obesity has risen to 124 million worldwide and could exceed 250 million by 2030 without substantial interventions 4. A meta-analysis of 61 studies showed that increased preconception and interpregnancy weight gain was associated with gestational diabetes mellitus (GDM; 88% greater risk), pre-eclampsia (92% greater risk) and large-for-gestational-age (36% greater risk) babies 5. A systematic review of 38 studies found a consistent association between maternal prepregnancy weight and offspring obesity 6.…”
IntroductionSouth Africa’s evolving burden of disease is challenging due to a persistent infectious disease, burgeoning obesity, most notably among women and rising rates of non-communicable diseases (NCDs). With two thirds of women presenting at their first antenatal visit either overweight or obese in urban South Africa (SA), the preconception period is an opportunity to optimise health and offset transgenerational risk of both obesity and NCDs.Methods and analysisBukhali is the first individual randomised controlled trial in Africa to test the efficacy of a complex continuum of care intervention and forms part of the Healthy Life Trajectories Initiative (HeLTI) consortium implementing harmonised trials in Canada, China, India and SA. Starting preconception and continuing through pregnancy, infancy and childhood, the intervention is designed to improve nutrition, physical and mental health and health behaviours of South African women to offset obesity-risk (adiposity) in their offspring. Women aged 18–28 years (n=6800) will be recruited from Soweto, an urban-poor area of Johannesburg. The primary outcome is dual-energy X-ray absorptiometry derived fat mass index (fat mass divided by height2) in the offspring at age 5 years. Community health workers will deliver the intervention randomly to half the cohort by providing health literacy material, dispensing a multimicronutrient supplement, providing health services and feedback, and facilitating behaviour change support sessions to optimise: (1) nutrition, (2) physical and mental health and (3) lay the foundations for healthier pregnancies and early child development.Ethics and disseminationEthical approval has been obtained from the Human Ethics Research Committee University of the Witwatersrand, Johannesburg, South Africa (M1811111), the University of Toronto, Canada (19-0066-E) and the WHO Ethics Committee (ERC.0003328). Data and biological sample sharing policies are consistent with the governance policy of the HeLTI Consortium (https://helti.org) and South African government legislation (POPIA). The recruitment and research team will obtain informed consent.Trial registrationThis trial is registered with the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za) on 25 March 2019 (identifier: PACTR201903750173871).Protocol version20 March 2022 (version #4). Any protocol amendments will be communicated to investigators, Institutional Review Board (IRB)s, trial participants and trial registries.
“…In Nagpal et al, 1 an error was published in the last sentence of Section 3.2. The value was incorrectly defined as “BMI ≥ 25 kg/m 2 .” The sentence should have read: Interpregnancy weight loss was associated with a significant reduction in GDM for BMI < 25 kg/m 2 (Figure 3B).…”
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