Iranian Society of Gynecology Oncology

Document Type : Original Research Article

Authors

Department of Obstetrics and Gynaecology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India

Abstract

Background & Objective: The maintenance of an appropriate weight before and during pregnancy has a significant effect on pregnancy outcomes. Therefore, this study attempts to explore the relationship between pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) in the Indian antenatal population. This was a prospective study.
Materials & Methods: This study was conducted on a total of 301 pregnant women who fulfilled the inclusion criteria booked from the first trimester till delivery in the department of Obstetrics and Gynecology, SGRRIM & HS, from January 2020 to June 2021. The weight and height of the participants were recorded at their first visit to the antenatal clinic using standard protocol. BMI was recorded and GWG was calculated at each antenatal clinic visit. BMI and GWG were correlated with antepartum, intrapartum and postpartum complications with the application of appropriate statistical tests.
Results: In our study, higher pre-pregnancy BMI and GWG significantly increased the risk of perinatal adverse outcomes. Increased rates of cesarean section (57.1%), operative vaginal delivery (9.5%), gestational diabetes mellitus (9.5%), and pre-eclampsia (28.6%) were observed in obese women as compared to women with normal pre-pregnancy BMI and gestational weight gain. These were found to be statistically significant (p-value <0.001).
Conclusion: Appropriate nutrition prior to and throughout the pregnancy plays an important role in determining the health of both mother and fetus. There is a positive correlation between early pregnancy BMI and GWG, and the course of pregnancy, and its outcome.

Highlights

 Appropriate nutrition prior to and throughout the pregnancy plays an important role in determining the health of both mother and fetus. There is a positive correlation between early pregnancy BMI and GWG, and the course of pregnancy, and its outcome.

Keywords

Main Subjects

1. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet. 2016;387(10026):1377-96. [DOI:10.1016/S0140-6736(16)30054-X] [PMID]
2. Magliano D, Health N, Council MR, Barr ELM, Institute ID. AusDiab 2005: The Australian Diabetes, Obesity and Lifestyle Study: Tracking the Accelerating Epidemic: Its Causes and Outcomes: International Diabetes Institute; 2006.
3. Loria CM, Signore C, Arteaga SS. The need for targeted weight-control approaches in young women and men. Am J Prev Med. 2010;38(2):233-5. [DOI:10.1016/j.amepre.2009.11.001] [PMID] [PMCID]
4. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA. 2006;295(13):1549-55. [DOI:10.1001/jama.295.13.1549] [PMID]
5. De Boo HA, Harding JE. The developmental origins of adult disease (Barker) hypothesis. Aust N Z J Obstet Gynaecol. 2006;46(1):4-14. [DOI:10.1111/j.1479-828X.2006.00506.x] [PMID]
6. Barker DJ. The fetal and infant origins of adult disease. BMJ. 1990;301(6761):1111. [DOI:10.1136/bmj.301.6761.1111] [PMID] [PMCID]
7. Denison FC, Price J, Graham C, Wild S, Liston WA. Maternal obesity, length of gestation, risk of postdates pregnancy and spontaneous onset of labour at term. Int J Gynaecol Obstet. 2008;115(6):720-5. [DOI:10.1111/j.1471-0528.2008.01694.x] [PMID] [PMCID]
8. Naeye RL. Maternal body weight and pregnancy outcome. Am J Clin Nutr. 1990;52(2):273-9. [DOI:10.1093/ajcn/52.2.273] [PMID]
9. Spinillo A, Capuzzo E, Piazzi G, Ferrari A, Morales V, Mario MD. Risk for spontaneous preterm delivery by combined body mass index and gestational weight gain patterns. Acta Obstet Gynecol Scand. 1998;77(1):32-6. [DOI:10.1080/00016349808565807] [PMID]
10. Abdulmalik MA, Ayoub JJ, Mahmoud A, collaborators M, Nasreddine L, Naja F. Pre-pregnancy BMI, gestational weight gain and birth outcomes in Lebanon and Qatar: Results of the MINA cohort. PLoS One. 2019;14(7):e0219248. [DOI:10.1371/journal.pone.0219248] [PMID] [PMCID]
11. Siega-Riz AM, Viswanathan M, Moos M-K, Deierlein A, Mumford S, Knaack J, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol. 2009;201(4):339.e1-.e14. [DOI:10.1016/j.ajog.2009.07.002] [PMID]
12. Birdsall KM, Vyas S, Khazaezadeh N, Oteng-Ntim E. Maternal obesity: a review of interventions. Int J Clin Pract. 2009;63(3):494-507. [DOI:10.1111/j.1742-1241.2008.01910.x] [PMID]
13. Kriebs JM. Obesity as a complication of pregnancy and labor. J Perinat Neonatal Nurs. 2009;23(1):15-22. [DOI:10.1097/JPN.0b013e318197bf1b] [PMID]
14. Kim MK, Lee SM, Bae S-H, Kim HJ, Lim NG, Yoon S-J, et al. Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system. Int J Equity Health. 2018;17(1):1-8. [DOI:10.1186/s12939-017-0715-7] [PMID] [PMCID]
15. Silva LM, Coolman M, Steegers EA, Jaddoe VW, Moll HA, Hofman A, et al. Low socioeconomic status is a risk factor for preeclampsia: the Generation R Study. J Hypertens. 2008;26(6):1200-8. [DOI:10.1097/HJH.0b013e3282fcc36e] [PMID]
16. Heude B, Thiébaugeorges O, Goua V, Forhan A, Kaminski M, Foliguet B, et al. Pre-Pregnancy Body Mass Index and Weight Gain During Pregnancy: Relations with Gestational Diabetes and Hypertension, and Birth Outcomes. Matern Child Health J. 2012;16(2):355-63. [DOI:10.1007/s10995-011-0741-9] [PMID] [PMCID]
17. Simko M, Totka A, Vondrova D, Samohyl M, Jurkovicova J, Trnka M, et al. Maternal body mass index and gestational weight gain and their association with pregnancy complications and perinatal conditions. Int J Environ Res Public Health. 2019;16(10):1751. [DOI:10.3390/ijerph16101751] [PMID] [PMCID]
18. Dinatale A, Ermito S, Fonti I, Giordano R, Cacciatore A, Romano M, et al. Obesity and fetal-maternal outcomes. J Prenat Med. 2010;4(1):5-8.
19. Weiss JL, Malone FD, Emig D, Ball RH, Nyberg DA, Comstock CH, et al. Obesity, obstetric complications and cesarean delivery rate-a population-based screening study. Am J Obstet Gynecol. 2004;190(4):1091-7. [DOI:10.1016/j.ajog.2003.09.058] [PMID]
20. Lopez-Jaramillo P, Barajas J, Rueda-Quijano SM, Lopez-Lopez C, Felix C. Obesity and preeclampsia: common pathophysiological mechanisms. Front Physiol. 2018;9:1838. [DOI:10.3389/fphys.2018.01838] [PMID] [PMCID]
21. O'Brien TE, Ray JG, Chan W-S. Maternal Body Mass Index and the Risk of Preeclampsia: A Systematic Overview. Epidemiology. 2003;14(3):368-74. [DOI:10.1097/00001648-200305000-00020] [DOI:10.1097/01.EDE.0000059921.71494.D1] [PMID]
22. Catalano PM, Drago NM, Amini SB. Maternal carbohydrate metabolism and its relationship fetal growth and body composition. Am J Obstet Gynecol. 1995;172(5):1464-70. [DOI:10.1016/0002-9378(95)90479-4] [PMID]
23. Baeten JM, Bukusi EA, Lambe M. Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health. 2001;91(3):436-40. [DOI:10.2105/AJPH.91.3.436] [PMID] [PMCID]
24. Tang J, Zhu X, Chen Y, Huang D, Tiemeier H, Chen R, et al. Association of maternal pre-pregnancy low or increased body mass index with adverse pregnancy outcomes. Sci Rep. 2021;11(1):3831. [DOI:10.1038/s41598-021-82064-z] [PMID] [PMCID]
25. Al-Kubaisy W, Al-Rubaey M, Al-Naggar RA, Karim B, Mohd Noor NA. Maternal obesity and its relation with the cesarean section: a hospital based cross sectional study in Iraq. BMC Pregnancy Childbirth. 2014;14(235):1-5. [DOI:10.1186/1471-2393-14-235] [PMID] [PMCID]
26. Deshmukh VL, Jadhav M, Yelikar K. Impact of HIGH BMI on Pregnancy: Maternal and Foetal Outcome. J Obstet Gynaecol India. 2016;66(1):192-7. [DOI:10.1007/s13224-015-0825-3] [PMID] [PMCID]
27. Rahman MM, Abe SK, Kanda M, Narita S, Rahman MS, Bilano V, et al. Maternal body mass index and risk of birth and maternal health outcomes in low- and middle-income countries: a systematic review and meta-analysis. Obes Rev. 2015;16(9):758-70. [DOI:10.1111/obr.12293] [PMID]
28. Kalk P, Guthmann F, Krause K, Relle K, Godes M, Gossing G, et al. Impact of maternal body mass index on neonatal outcome. Eur J Med Res. 2009;14(5):216-22. [DOI:10.1186/2047-783X-14-5-216] [PMID] [PMCID]
29. Naik R, Karmali D, Nagarsenkar A, Mainath S, Pednekar G. Impact of maternal pre-pregnancy body mass index on neonatal outcomes: a hospital based study in a tertiary care hospital in Goa. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2021;10(2):550-5. [DOI:10.18203/2320-1770.ijrcog20210300]
30. Njagu R, Adkins L, Tucker A, Gatta L, Brown HL, Reiff E, et al. Maternal weight gain and neonatal outcomes in women with class III obesity. J Matern Fetal Neonatal Med. 2022;35(3):546-50. [DOI:10.1080/14767058.2020.1729116] [PMID]