Impact of Nulliparous Women's Body Mass Index or Excessive Weight Gain in Pregnancy on Genital Tract Trauma at Birth

Abstract

Objective To explore the impact of body mass index BMI or pregnancy weight gain on the presence, site and severity of genital tract trauma at childbirth in nulliparous women. Methods The present study is a sub-analysis of a prospective cohort of healthy nulliparous women recruited during pregnancy and followed through birth. Weight gain during pregnancy and pre-pregnancy BMI were recorded. At birth, women underwent detailed mapping of genital tract trauma. For analyses, women were dichotomized into obese(BMI ≥30) versus non obese(BMI <30) at baseline as well as into those who gained weight as recommended by the Institute of Medicine (IOM) and those who gained more than the recommended amount to determine the impact of obesity or excessive weight gain on rates of genital tract trauma. Results Data from 445 women were available for analysis. Presence and severity of genital tract trauma did not vary between obese and non-obese women (P = NS). Likewise women who gained more than the IOM recommended weight did not have a higher incidence of perineal lacerations (53% vs 51% with perineal lacerations, P= .61). Obese women were more likely to gain in excess of the IOM guidelines during pregnancy (75% vs 50% excessive weight gain, obese vs non-obese women, P<0.001). Conclusion A woman’s BMI or excessive weight gain in pregnancy did not influence her risk of genital tract trauma at birth.

Is parity a risk factor for excessive weight gain during pregnancy and postpartum weight retention? A systematic review and meta‐analysis

“…Details pertaining to the aim(s), sample, design, relevant measures and findings of the studies are presented in Table S2. The majority of the studies were North American ( n = 17) , with 14 from Europe/UK, two from Australia, two from Brazil, two from Canada and one from each of the following countries: Thailand , Nigeria and Pakistan . A further study used samples from three countries: Australia, New Zealand and Ireland .…”

“…Most of the studies (n = 25) (2,7,8,18,(21)(22)(23)25,27,29,30,32,34,(36)(37)(38)40,42,43,46,47,50) calculated BMI during (or before) pregnancy purely via self-reported weight. Nine (15,26,31,33,42,44,48,49,55) studies obtained weight and height via objective measures and calculated BMI during pregnancy.…”

“…The five (24,28,35,39,52) remaining studies obtained weight and height measures from medical records. In order to categorize pre-pregnancy BMI into weight classes, 19 (15,22,23,25,27,30,33,34,38,(40)(41)(42)46,(48)(49)(50)52,54,56) studies used the World Health Organization's BMI cut-offs, and another 16 (2,7,8,18,21,26,28,29,32,35,36,43,45,47,51,53) studies used guidelines consistent with these. A further six (24,31,37,39,44,55) studies used the 1990 Institute of Medicine (IOM) (57) BMI cut-offs to determine prepregnancy BMI classifications.…”

“…In contrast, 10 studies found that multiparous women had a greater risk of excessive (18,21,35,53) and absolute (28,31,44,47,48) GWG. An additional nine studies (8,27,30,36,37,(42)(43)(44)54,56) did not report/find a significant association between parity and GWG, and a further two (15,25) studies employed an entirely nulliparous sample.…”

Postpartum Weight Retention in Primiparous Women and Weight Outcomes in Their Offspring

“…We performed a retrospective secondary analysis of the Alterations in Pelvic Floor with Pregnancy, Labor and the Ensuing Years (APPLE) study, a NIH funded study conducted at the University of New Mexico from 2005 to 2012 . The primary purpose of the APPLE study was to determine the prevalence of pelvic floor dysfunction and to describe changes in pelvic floor anatomy after childbirth in a low‐risk, primiparous population.…”