Retrospective cohort study of the effects of obesity in early pregnancy on maternal weight gain and obstetric outcomes in an obstetric population in Africa

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Abstract

Objective

The purpose of this study was to compare maternal weight gain in pregnancy and obstetric outcomes between women with obesity in early pregnancy and those with a normal body mass index (BMI) in early pregnancy.

Methods

This was a retrospective cohort study of women with obesity in early pregnancy and those with a normal BMI who were seen at three teaching hospitals in South-East Nigeria. Statistical analysis was performed using Statistical Package for the Social Sciences version 17.0 software, with descriptive and inferential statistics at the 95% level of confidence.

Results

The study sample consisted of 648 women (324 obese and 324 healthy-weight). The mean age of the obese women was 26.7 ± 5.1 years and that of the healthy-weight women was 26.6 ± 4.9 years. Although both excessive weight gain (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.23–0.54) and inadequate weight gain (OR 0.08, 95% CI 0.04–0.15) were less common in women with early pregnancy obesity than in healthy-weight women, a significantly higher proportion of obese women with excessive weight gain had adverse fetomaternal outcomes. Also, a significantly higher proportion of obese women had specific complications, such as premature rupture of membranes (OR 2.36, 95% CI 1.12–5.04), gestational hypertension/pre-eclampsia (OR 2.31, 95% CI 1.12–5.04), antepartum hemorrhage (OR 2.78, 95% CI 1.02–7.93), gestational diabetes (OR 4.24, 95% CI 1.62–11.74), cesarean delivery (OR 2.3, 95% CI 1.2–5.44), macrosomia (OR 4.08, 95% CI 1.06–8.41), severe birth asphyxia (OR 2.8, 95% CI 1.2–6.63), abnormal Apgar scores (OR 2.67, 95% CI 1.46–4.93), and newborn special care admissions (OR 1.18, 95% CI 1.0–3.29).

Conclusion

Early pregnancy obesity was associated with a wide range of adverse fetomaternal outcomes, and could be a genuine risk factor for increased pregnancy-related morbidity and/or mortality in this population. Interventions to reduce prepregnancy obesity could therefore be useful in this low-resource African setting.

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Most cited references 11

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The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis.

N Heslehurst, H. Simpson, L J Ells … (2008)

Obesity is rising in the obstetric population, yet there is an absence of services and guidance for the management of maternal obesity. This systematic review aimed to investigate relationships between obesity and impact on obstetric care. Literature was systematically searched for cohort studies of pregnant women with anthropometric measurements recorded within 16-weeks gestation, followed up for the term of the pregnancy, with at least one obese and one comparison group. Two researchers independently data-extracted and quality-assessed each included study. Outcome measures were those that directly or indirectly impacted on maternity resources. Primary outcomes included instrumental delivery, caesarean delivery, duration of hospital stay, neonatal intensive care, neonatal trauma, haemorrhage, infection and 3rd/4th degree tears. Meta-analysis shows a significant relationship between obesity and increased odds of caesarean and instrumental deliveries, haemorrhage, infection, longer duration of hospital stay and increased neonatal intensive care requirement. Maternal obesity significantly contributes to a poorer prognosis for mother and baby during delivery and in the immediate post-partum period. National clinical guidelines for management of obese pregnant women, and public health interventions to help safeguard the health of mothers and their babies are urgently required.

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Associations of gestational weight gain with short- and longer-term maternal and child health outcomes.

Emily Oken, Ken Kleinman, Mandy Belfort … (2009)

The authors investigated the rate of gestational weight gain associated with the lowest combined risk of 5 short- and longer-term maternal and child health outcomes for 2,012 mother-child pairs recruited in 1999-2002 into Project Viva, a prebirth cohort study in Massachusetts. Within each maternal prepregnancy body mass index (BMI, kg/m(2)) stratum, they performed a logistic regression analysis predicting all 5 outcomes, from which they determined the rate of gain at which average predicted prevalence of the adverse outcomes was the lowest. The mean rate of total gestational weight gain was 0.39 kg/week (standard deviation, 0.14). The prevalence of small for gestational age was 6%, large for gestational age was 14%, preterm delivery was 7%, substantial postpartum weight retention was 16%, and child obesity was 10%. The lowest predicted outcome prevalence occurred with a 0.28-kg/week gain for women whose BMI was 18.5-24.9, a 0.03-kg/week loss for a BMI of 25.0-29.9, and a 0.19-kg/week loss for a BMI of >or=30.0 kg/m(2)--the lowest observed weight changes in overweight and obese women. For normal-weight and overweight women, lowest-risk gains varied modestly with adjustment for maternal characteristics and with different outcome weightings. For obese women, the lowest-risk weight change was weight loss in all models. Recommendations for gestational weight gain for obese women should be revised.

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Fetal and early life growth and body mass index from birth to early adulthood in 1958 British cohort: longitudinal study.

O Manor, Michael Parsons, Melinda Power (2001)

To determine the influence of birth weight on body mass index at different stages of later life; whether this relation persists after accounting for potential confounding factors; and the role of indicators of fetal growth (birth weight relative to parental size) and childhood growth. Longitudinal study of the 1958 British birth cohort. England, Scotland, and Wales. All singletons born 3-9 March 1958 (10 683 participants with data available at age 33). Body mass index at ages 7, 11, 16, 23, and 33 years. The relation between birth weight and body mass index was positive and weak, becoming more J shaped with increasing age. When adjustments were made for maternal weight, there was no relation between birth weight and body mass index at age 33. Indicators of poor fetal growth based on the mother's body size were not predictive, but the risk of adult obesity was higher among participants who had grown to a greater proportion of their eventual adult height by age 7. In men only, the effect of childhood growth was strongest in those with lower birth weights and, to a lesser extent, those born to lighter mothers. Maternal weight (or body mass index) largely explains the association between birth weight and adult body mass index, and it may be a more important risk factor for obesity in the child than birth weight. Birth weight and maternal weight seem to modify the effect of childhood linear growth on adult obesity in men. Intergenerational associations between the mother's and her offspring's body mass index seem to underlie the well documented association between birth weight and body mass index. Other measures of fetal growth are needed for a fuller understanding of the role of the intrauterine environment in the development of obesity.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Womens Health

Journal ID (iso-abbrev): Int J Womens Health

Journal ID (publisher-id): International Journal of Women's Health

Title: International Journal of Women's Health

Publisher: Dove Medical Press

ISSN (Electronic): 1179-1411

Publication date Collection: 2013

Publication date (Electronic): 14 August 2013

Volume: 5

Pages: 501-507

Affiliations

[1 ]Departments of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria

[2 ]Departments of Obstetrics and Gynaecology, Enugu State University Teaching Hospital, Enugu, Nigeria

[3 ]Departments of Obstetrics and Gynaecology, Federal Medical Centre, Abakaliki, Ebonyi State, Nigeria

Author notes

Correspondence: Chukwuemeka Iyoke Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, PO Box 4998, Enugu Headquarters, Enugu, Nigeria, Tel +234 8085 831 167, Email caiyoke@ 123456yahoo.co.uk

Article

Publisher ID: ijwh-5-501

DOI: 10.2147/IJWH.S49909

PMC ID: 3747850

PubMed ID: 23983492

SO-VID: 5fb970dd-80ac-4744-b838-162f9e32a935

License:

The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Retrospective cohort study of the effects of obesity in early pregnancy on maternal weight gain and obstetric outcomes in an obstetric population in Africa

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Abstract

Objective

Methods

Results

Conclusion

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Advocacy for Maternal and Women’s Health

Most cited references 11

The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis.

Associations of gestational weight gain with short- and longer-term maternal and child health outcomes.

Fetal and early life growth and body mass index from birth to early adulthood in 1958 British cohort: longitudinal study.

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