Maternal Obesity and Risk of Preterm Delivery

Cnattingius, Sven; Villamor, Eduardo; Johansson, Stefan; Bonamy, Anna Karin Edstedt; Persson, Martina; Wikström, Anna Karin; Granath, Fredrik

doi:10.1001/jama.2013.6295

Cited by 559 publications

(306 citation statements)

References 35 publications

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“…The indicated preterm births were higher in group II (58.4%) as compared to group I (30%), while the spontaneous preterm births were lower in comparison to group I. These findings were consistent with the study by Hendler et al [18], Cnattingius et al [19]. Bhattacharya et al [11] in their study found that obese women were at increased risk of delivery before 33 weeks (OR 2.0, 95% CI 1.3, 2.9), but the rate of postdated delivery was similar.…”

Section: Discussionsupporting

confidence: 91%

Can Waist Circumference Be Used as an Anthropometric Parameter to Assess the Obesity Related Pregnancy Outcome: A Case Control Study

Gupta¹,

Mann²,

Sethi³

2015

OJOG

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Introduction: The prevalence of obesity is increasing in women of reproductive age. Maternal obesity is associated with increased morbidity and mortality for both mother and offspring. BMI has been criticized as a limited measure of total obesity. Measurement of waist circumference can be useful in the assessment of abdominal obesity and disease risk. The study is aimed to evaluate the waist circumference as an anthropometric parameter in identifying women at risk of developing obstetric complications. Material and Methods: A prospective study was conducted at a tertiary health care centre on 200 antenatal women of age between 18 to 35 years with singleton pregnancy attending the antenatal clinic before 8 weeks of gestation. Women were divided into two groups. Group I included 100 women with waist circumference < 80 cm and Group II included 100 women with waist circumference ≥ 80 cm. Weight, height and waist circumference were measured and BMI was calculated. All the women were followed throughout their pregnancies as per the routine antenatal follow up. The fetomaternal outcome was recorded and analyzed statistically.

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Section: Discussionsupporting

confidence: 91%

Can Waist Circumference Be Used as an Anthropometric Parameter to Assess the Obesity Related Pregnancy Outcome: A Case Control Study

Gupta¹,

Mann²,

Sethi³

2015

OJOG

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“…64 The pathophysiology of preterm delivery is not well characterized, although inflammation is associated with both maternal obesity and preterm labor. 65 In a systematic review and meta-analyses, the risk of perinatal mortality was related to increasing maternal BMI.…”

Section: Premature Delivery and Stillbirthmentioning

confidence: 99%

Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child

Catalano

Shankar

2017

BMJ

778

659

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Obesity is the most common medical condition in women of reproductive age. Obesity during pregnancy has short term and long term adverse consequences for both mother and child. Obesity causes problems with infertility, and in early gestation it causes spontaneous pregnancy loss and congenital anomalies. Metabolically, obese women have increased insulin resistance in early pregnancy, which becomes manifest clinically in late gestation as glucose intolerance and fetal overgrowth. At term, the risk of cesarean delivery and wound complications is increased. Postpartum, obese women have an increased risk of venous thromboembolism, depression, and difficulty with breast feeding. Because 50-60% of overweight or obese women gain more than recommended by Institute of Medicine gestational weight guidelines, postpartum weight retention increases future cardiometabolic risks and prepregnancy obesity in subsequent pregnancies. Neonates of obese women have increased body fat at birth, which increases the risk of childhood obesity. Although there is no unifying mechanism responsible for the adverse perinatal outcomes associated with maternal obesity, on the basis of the available data, increased prepregnancy maternal insulin resistance and accompanying hyperinsulinemia, inflammation, and oxidative stress seem to contribute to early placental and fetal dysfunction. We will review the pathophysiology underlying these data and try to shed light on the specific underlying mechanisms.

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“…108 Three types of delivery were included in the model: Caesarean section, assisted delivery and vaginal delivery. The outcome of the delivery was either a stillbirth (or IUD) or live baby.…”

Section: Model Structurementioning

confidence: 99%

Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation

Rogozińska

Marlin

Jackson

et al. 2017

Health Technol Assess

213

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BackgroundDiet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes.ObjectivesTo assess whether or not the effects of diet and lifestyle interventions vary in subgroups of women, based on maternal body mass index (BMI), age, parity, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions.Data sourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment database were searched from October 2013 to March 2015 (to update a previous search).Review methodsResearchers from the International Weight Management in Pregnancy Collaborative Network shared the primary data. For each intervention type and outcome, we performed a two-step IPD random-effects meta-analysis, for all women (except underweight) combined and for each subgroup of interest, to obtain summary estimates of effects and 95% confidence intervals (CIs), and synthesised the differences in effects between subgroups. In the first stage, we fitted a linear regression adjusted for baseline (for continuous outcomes) or a logistic regression model (for binary outcomes) in each study separately; estimates were combined across studies using random-effects meta-analysis models. We quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions.ResultsDiet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI –0.92 to –0.48 kg; 33 studies, 9320 women). The effects on composite maternal outcome [summary odds ratio (OR) 0.90, 95% CI 0.79 to 1.03; 24 studies, 8852 women] and composite fetal/neonatal outcome (summary OR 0.94, 95% CI 0.83 to 1.08; 18 studies, 7981 women) were not significant. The effect did not vary with baseline BMI, age, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre-eclampsia or pregnancy-induced hypertension (OR 0.95, 95% CI 0.78 to 1.16) and preterm birth (OR 0.94, 95% CI 0.78 to 1.13). There was no significant effect on fetal outcomes. The interventions were not cost-effective. GWG, including adherence to the Institute of Medicine-recommended targets, was not associated with a reduction in complications. Predictors of GWG were maternal age (summary estimate –0.10 kg, 95% CI –0.14 to –0.06 kg) and multiparity (summary estimate –0.73 kg, 95% CI –1.24 to –0.23 kg).LimitationsThe findings were limited by the lack of standardisation in the components of intervention, residual heterogeneity in effects across studies for most analyses and the unavailability of IPD in some studies.ConclusionDiet and lifestyle interventions in pregnancy are clinically effective in reducing GWG irrespective of risk factors, with no effects on composite maternal and fetal outcomes.Future workThe differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation.Study registrationThis study is registered as PROSPERO CRD42013003804.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Maternal Obesity and Risk of Preterm Delivery

Cited by 559 publications

References 35 publications

Can Waist Circumference Be Used as an Anthropometric Parameter to Assess the Obesity Related Pregnancy Outcome: A Case Control Study

Can Waist Circumference Be Used as an Anthropometric Parameter to Assess the Obesity Related Pregnancy Outcome: A Case Control Study

Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child

Effects of antenatal diet and physical activity on maternal and fetal outcomes: individual patient data meta-analysis and health economic evaluation

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