Interpregnancy weight change and adverse maternal outcomes: a retrospective cohort study

Abstract

Purpose Examine associations between interpregnancy BMI change and gestational diabetes mellitus (GDM), pre-eclampsia (PE), gestational hypertension (GHtn), primary cesarean delivery, and vaginal birth after cesarean delivery (VBAC). Methods Modified Poisson regression models estimated adjusted associations. Results Every one unit increase in interpregnancy BMI increased risks of GDM (RR: 1.09, 95%CI: 1.07–1.11), PE (RR: 1.06, 95%CI: 1.04–1.09), GHtn (RR: 1.08, 95%CI: 1.06–1.10), and primary cesarean delivery (RR: 1.03, 95%CI: 1.01–1.05) and decreased the risk of a successful VBAC (RR: 0.98, 95%CI: 0.97–0.997) in the second pregnancy. A BMI increase ≥3 units increased risks of GDM (RR: 1.71, 95%CI: 1.52–1.93), PE (RR: 1.60, 95%CI: 1.33–1.94), GHtn (RR: 1.66, 95%CI: 1.42–1.94), and primary cesarean delivery (RR: 1.29, 95%CI: 1.12–1.49) and decreased the risk of a successful VBAC (RR: 0.89, 95%CI: 0.80–0.99) compared to women with interpregnancy BMI change within −1 and +1 unit. GDM was also increased among women increasing their BMI by ≥2 but <3 units (RR: 1.40, 95%CI: 1.21–1.61) and among those gaining ≥ 1 but <2 units (RR: 1.23, 95%CI: 1.08–1.40). Conclusion An interpregnancy BMI increase ≥3 units is associated with an increased risk of all outcomes. These findings emphasize the importance of interpregnancy weight management.

Pregnancy Outcomes after Preeclampsia: The Effects of Interpregnancy Weight Change

“…17,21 In addition, we found that interpregnancy weight gain of >2 to 4 and >4 BMI units was associated with increasingly elevated risk of cesarean delivery, results that are consistent with previous studies among unselected populations. 19,29,43,44 Unlike Wallace et al who separately examined emergency cesarean delivery, 45 but similar to Lynes et al who did not differentiate between the different types of cesarean delivery, 19 we found similar magnitude of risk regardless of BMI in the first pregnancy. Observed association between interpregnancy weight gain and cesarean delivery may be mediated by LGA, fetal dystocia, or fetal distress, which are associated with interpregnancy weight gain and may constitute indications for a cesarean delivery.…”

The impact of interpregnancy weight change on perinatal outcomes in women and their children: A systematic review and meta‐analysis

“…Eleven studies assessed GDM, of which five studies were eligible for the meta‐analysis. The meta‐analysis found a significant, positive association between interpregnancy BMI gain and GDM development during the second pregnancy (Figure S1: OR 1.64 [95%CI 1.28‐2.11]; I 2 = 78% for BMI gain of 1 to 3 kg/m 2 ; OR 2.42 [1.62‐3.62]; I 2 = 89% for BMI gain of ≥3 kg/m 2 ).…”

“…In six studies, GH was assessed . Four studies were included in the meta‐analysis, which resulted in a nonsignificant effect for BMI loss of ≥1 kg/m 2 (Figure S2: OR 1.07 [0.85‐1.34]; I 2 = 42%) on the development of GH. Increasing interpregnancy BMI gain was associated with a significantly increased risk of GH development (Figure S2: OR 1.49 [1.34‐1.66]; I 2 = 0% for BMI gain of 1 to 3 kg/m 2 ; OR 1.98 [1.56‐2.50]; I 2 = 62% for BMI gain of ≥3 kg/m 2 ).…”

“…The studies of Hoff et al and Bender et al which were not included in the meta‐analysis, found no effect of weight change between pregnancies on GH. The studies of Villamor and Cnattingius, Lynes et al and Wallace et al showed that, in women who started with normal weight, interpregnancy BMI gain resulted in a higher risk of developing GH during the second pregnancy compared to women who started with overweight or obesity (Table S9).…”

“…Six studies assessed preeclampsia as an outcome . Three studies were included in the meta‐analysis, which found no effect for preeclampsia after loss of >1 kg/m 2 between pregnancies (Figure S3: OR 0.84 [0.69‐1.01]; I 2 = 0%). An increased risk for developing preeclampsia during the second pregnancy was found for interpregnancy BMI gain of 1 to 3 kg/m 2 (Figure S3: OR 1.36 [1.22‐1.53]; I 2 = 0%) and an even higher risk was found for BMI gain ≥3 kg/m 2 (OR 1.77 [1.53‐2.04]; I 2 = 0%).…”