Maternal Prepregnancy Body Mass Index, Gestational Weight Gain, and Risk of Adverse Perinatal Outcomes in Taiwan: A Population-Based Birth Cohort Study

Abstract

Epidemiological studies have shown that maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) are associated with increased risk of perinatal outcomes. However, the evidence of such associations in Asian populations is limited. We conducted a secondary data analysis to investigate the relationships of prepregnancy BMI and GWG with the risks of adverse perinatal outcomes, including gestational diabetes (GDM), gestational hypertension (GHTN), preeclampsia, cesarean delivery, preterm birth, low birth weight (LBW), and macrosomia. We categorized prepregnancy BMI by the WHO classification and GWG by the Institute of Medicine guidelines. We performed adjusted logistic regression models to estimate the odds ratios of adverse perinatal outcomes. A total of 19,052 women were included; prepregnancy overweight and obesity were associated with a greater risk of GDM, GHTN, preeclampsia, cesarean delivery, preterm birth, and macrosomia. Women with excessive GWG had a greater risk of GHTN, preeclampsia, cesarean delivery, and macrosomia. In conclusion, regardless of the range of GWG during pregnancy, maternal prepregnancy BMI is significantly associated with the risk of adverse perinatal outcomes in Taiwan. Public health attention regarding obesity reduction before conception and prenatal counseling for optimal GWG is needed to mitigate the risk of poor perinatal outcomes.

Association between Maternal Pre-pregnancy Body Mass Index and Breastfeeding Duration in Taiwan: A Population-Based Cohort Study

“…The inconsistency in previous literature might result from differences in study designs, study populations, sample sizes and various breastfeeding outcome definitions. In our previous study, the prevalence of underweight was greater in Taiwan than in the United States and European countries [11,24]. It is unclear whether pre-pregnancy underweight status may have a certain effect on breastfeeding behaviors from a population with a higher proportion of women who are underweight.…”

“…The survey contents include comprehensive information about prenatal care history, dietary behaviors, parental health status, family socioeconomic status, and the growth and development of the offspring. A detailed history of the TBCS has been previously provided elsewhere [1,24,25].…”

Management of prepregnancy, pregnancy, and postpartum obesity from the FIGO Pregnancy and Non‐Communicable Diseases Committee: A FIGO (International Federation of Gynecology and Obstetrics) guideline

“…Women with obesity may be unaware of the extent of adverse health outcomes of pregnancy that are related to obesity and may hold misconceptions about the relationship between diet, weight, and health in pregnancy 40–42 . Advice should be given to women with obesity of the effect on their fertility and the risks of obesity during pregnancy and childbirth, which include neural tube defects, macrosomia, preterm delivery, stillbirth, shoulder dystocia, cesarean delivery, GDM, metabolic syndrome, sleep apnea, hypertension, and thromboembolic disorders 37,43–45 .…”

“…While the amount of gestational weight gain considered “normal” will vary regionally, consider advising pregnant women with obesity and a singleton pregnancy to limit gestational weight gain to approximately 5–9 kg to reduce the risk of adverse pregnancy outcomes 43,45,64 . This is based on the Institute of Medicine guidelines (IOM) 65 .…”

Peer Review #1 of "Association of pre-pregnancy body mass index with adverse pregnancy outcome among first-time mothers (v0.2)"

“…However, the conclusions of various studies on the correlation between pre-pregnancy BMI and PTB appear to be paradoxical. It was reported that the risk of PTB in women with pre-pregnancy high BMI was significantly increased (Baeten et al 2001;Chen et al 2020;Cnattingius et al 1998;Cnattingius et al 2013;Weiss et al 2004;Zhou et al 2019), whereas other studies contradicted this result, suggesting that women with a high pre-pregnancy BMI could have a protective impact on PTB (Chen et al 2013;Khashan & Kenny 2009;Sebire et al 2001). Furthermore, similar results have also been reported on association between pre-pregnancy BMI and LBW (Li et al 2020;Ronnenberg et al 2003a;Wu et al 2020).…”