Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women

Abstract

BackgroundThe association between Institute of Medicine (IOM) guidelines and pregnancy outcomes across ethnicities is uncertain. We evaluated the associations of gestational weight gain (GWG) outside 2009 IOM guidelines, with maternal and infant outcomes across the USA, western Europe and east Asia, with subgroup analyses in Asia. The aim was to explore ethnic differences in maternal prepregnancy body mass index (BMI), GWG and health outcomes across these regions.MethodsSystematic review, meta-analysis and meta-regression of observational studies were used for the study. MEDLINE, MEDLINE In-Process, Embase and all Evidence-Based Medicine (EBM) Reviews were searched from 1999 to 2017. Studies were stratified by prepregnancy BMI category and total pregnancy GWG. Odds ratio (ORs) 95% confidence intervals (CI) applied recommended GWG within each BMI category as the reference. Primary outcomes were small for gestational age (SGA), preterm birth and large for gestational age (LGA). Secondary outcomes were macrosomia, caesarean section and gestational diabetes.ResultsOverall, 5874 studies were identified and 23 were included (n = 1,309,136). Prepregnancy overweight/obesity in the USA, Europe and Asia was measured at 42%, 30% and 10% respectively, with underweight 5%, 3% and 17%. GWG below guidelines in the USA, Europe and Asia was 21%, 18% and 31%, and above was 51%, 51% and 37% respectively. Applying regional BMI categories in Asia showed GWG above guidelines (51%) was similar to that in the USA and Europe.GWG below guidelines was associated with a higher risk of SGA (USA/Europe [OR 1.51; CI 1.39, 1.63]; Asia [1.63; 1.45, 1.82]) and preterm birth (USA/Europe [1.35; 1.17, 1.56]; Asia [1.06; 0.78, 1.44]) than GWG within guidelines. GWG above guidelines was associated with a higher risk of LGA (USA/Europe [1.93; 1.81, 2.06]; Asia [1.68; 1.51 , 1.87]), macrosomia (USA/Europe [1.87; 1.70, 2.06]; Asia [2.18; 1.91, 2.49]) and caesarean (USA/Europe [1.26; 1.21, 1.33]; Asia [1.37; 1.30, 1.45]). Risks remained elevated when regional BMI categories were applied for GWG recommendations. More women in Asia were categorised as having GWG below guidelines using World Health Organization (WHO) (60%) compared to regional BMI categories (16%), yet WHO BMI was not accompanied by increased risks of adverse outcomes.ConclusionsWomen in the USA and western Europe have higher prepregnancy BMI and higher rates of GWG above guidelines than women in east Asia. However, when using regional BMI categories in east Asia, rates of GWG above guidelines are similar across the three continents. GWG outside guidelines is associated with adverse outcomes across all regions. If regional BMI categories are used in east Asia, IOM guidelines are applicable in the USA, western Europe and east Asia.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1128-1) contains supplementary material, which is available to authorized users.

Dietary patterns and their associations with gestational weight gain in the United Arab Emirates: results from the MISC cohort

“…With excessive GWG, mothers tend to have an increased risk of GDM, hypertensive disorders of pregnancy, cesarean section, postpartum weight retention, in addition to a lifelong risk of chronic diseases later on in life for the mother [64][65][66]. On the other hand, women gaining insufficient weight during their pregnancy are at an increased risk of delivering preterm birth and SGA [3,67]. Furthermore, accumulating evidence suggested that both excessive and insufficient GWG increase the risk for obesity and its associated cardiometabolic health consequences for the infant [67][68][69].…”

“…A systematic review and meta-analysis compiled data from one million pregnant women and reported a significant association between excessive GWG and increased risk of delivering a macrosomic and large for gestational age (LGA) babies. On the other hand, insufficient GWG was significantly associated with preterm delivery and small for gestational age (SGA) babies [3]. Such findings are alarming in light of the evidence linking both LGA and SGA with obesity and other chronic diseases later in life [4].…”

Ethnic differences in prevalence, risk factors, and perinatal outcomes of gestational diabetes mellitus: A comparison between immigrant ethnic Chinese women and Australian‐born Caucasian women in Australia

“…Taking the mean BMI of immigrant ethnic Chinese women with GDM in the present study as an example, the mean BMI of this cohort would be classified as overweight using Chinese BMI cut‐off points, yet is within the normal range when Caucasian cut‐off points are used. The importance of using ethnicity‐specific BMI cut‐off points in assessing pregnancy outcomes was highlighted in our recent international meta‐analysis . Clinicians should consider ethnicity‐specific BMI cut‐off points when identifying obesity as a risk factor for GDM.…”

“…The importance of using ethnicity-specific BMI cut-off points in assessing pregnancy outcomes was highlighted in our recent international metaanalysis. 39 Clinicians should consider ethnicity-specific BMI cut-off points when identifying obesity as a risk factor for GDM. Abbreviations: BMI, body mass index; PCOS, polycystic ovary syndrome.…”

Physical development of newborns born to mothers with different carbohydrate metabolism disorders

“…Частота его возникновения в разных странах мира составляет 1-8,6%, и каждые 10-15 лет число больных СД увеличивается в 2 раза [1][2][3][4][5][6][7]. Большинство клиницистов [8][9][10][11][12][13] считают сахарный диабет медико-социальной проблемой. Среди всех эндокринных заболеваний СД оказывает наиболее неблагоприятное влияние на течение беременности, приводя к осложнениям, отрицательно воздействуя на внутриутробное развитие плода и адаптационные возможности новорожденного.…”