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      Does interpregnancy BMI change affect the risk of complications in the second pregnancy? Analysis of pooled data from Aberdeen, Finland and Malta

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          Abstract

          Objective

          Weight management interventions during pregnancy have had limited success in reducing the risk of pregnancy complications. Focus has now shifted to pre-pregnancy counselling to optimise body weight before subsequent conception. We aimed to assess the effect of interpregnancy body mass index (BMI) change on the risk of perinatal complications in the second pregnancy.

          Methods

          A cohort study was performed using pooled maternity data from Aberdeen, Finland and Malta. Women with a BMI change of ±2 kg/m 2 between their first and second pregnancies were compared with those who were BMI stable (remained within ±2 kg/m 2). Outcomes assessed included pre-eclampsia (PE), intrauterine growth restriction (IUGR), preterm birth, birth weight, and stillbirth in the second pregnancy. We also assessed the effect of unit change in BMI for PE and IUGR. Logistic regression was used to calculate odds ratios with 95% confidence intervals.

          Results

          An increase of ≥2 kg/m 2 between the first two pregnancies increased the risk of PE (1.66 (1.49–1.86)) and high birthweight (>4000 g) (1.06 (1.03–1.10)). A reduction of ≥2 kg/m 2 increased the chance of IUGR (1.15 (1.01–1.31)) and preterm birth (1.14 (1.01–1.30)), while reducing the risk of instrumental delivery (0.75 (0.68–0.85)) and high birthweight (0.93 (0.87–0.98)). Reducing BMI did not significantly decrease PE risk in women with obesity or those with previous PE. A history of PE or IUGR in the first pregnancy was the strongest predictor of recurrence independent of interpregnancy BMI change (5.75 (5.30–6.24) and (7.44 (6.71–8.25), respectively).

          Conclusion

          Changes in interpregnancy BMI have a modest impact on the risk of high birthweight, PE and IUGR in contrasting directions. However, a prior history of PE and IUGR is the dominant predictor of recurrence at second pregnancy.

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          Most cited references 33

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          Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study.

          Maternal obesity has been positively associated with risk of adverse pregnancy outcomes, but evidence of a causal relation is scarce. Causality would be lent support if temporal changes in weight affected risk of adverse pregnancy outcomes. We examined the associations between change in prepregnancy body-mass index (BMI) from the first to the second pregnancies, and the risk of adverse outcomes during the second pregnancy in a nationwide Swedish study of 151 025 women who had their first two consecutive singleton births between 1992 and 2001. Compared with women whose BMI changed between -1.0 and 0.9 units, the adjusted odds ratios for adverse pregnancy outcomes for those who gained 3 or more units during an average 2 years were: pre-eclampsia, 1.78 (95% CI 1.52-2.08); gestational hypertension 1.76 (1.39-2.23); gestational diabetes 2.09 (1.68-2.61); caesarean delivery 1.32 (1.22-1.44); stillbirth 1.63 (1.20-2.21); and large-for-gestational-age birth 1.87 (1.72-2.04). The associations were linearly related to the amount of weight change and were also noted in women who had a healthy prepregnancy BMI for both pregnancies. These findings lend support to a causal relation between being overweight or obese and risks of adverse pregnancy outcomes. Additionally they suggest that modest increases in BMI before pregnancy could result in perinatal complications, even if a woman does not become overweight. Our results provide robust epidemiological evidence for advocating weight loss in overweight and obese women who are planning to become pregnant and, to prevent weight gain before pregnancy in women with healthy BMIs.
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            Effect of prepregnancy maternal overweight and obesity on pregnancy outcome.

            To estimate the association between maternal overweight and obesity on complications during pregnancy and delivery in Denmark. A population-based study on a cohort consisting of all Danish women giving birth to a singleton from 2004 through June 30, 2010 (N = 403,092) was undertaken. Women were identified from the Danish Medical Birth Registry, which contains data on 99.8% of all deliveries in Denmark. Maternal complications during pregnancy and delivery and fetal complications were classified according to the International Classification of Diseases, 10th Revision. The final study population consisted of 369,347 women, 20.9% being overweight (body mass index [BMI] 25-29.9), 7.7% obese (BMI 30-35), and 4% severely obese (BMI higher than 35). Overweight, obese, and severely obese women had more complications than did normal weight women. Adjusted odds ratios (ORs) were significantly increased as follows: for gestational diabetes mellitus, 3.5, 7.7, and 11.0 for each BMI category; for preeclampsia 1.9, 3, and 4.4. Planned and especially emergency cesarean delivery was significantly increased with increasing BMI (OR ranging from 1.2 to 2.1). The risk of giving birth to a macrosomic neonate (greater than 4,500 g) increased significantly with increasing BMI (1.6, 2.2, and 2.7), as did the risks of having a neonate with a low Apgar score (1.3, 1.4, and 1.9) and having a stillborn fetus (1.4, 1.6, and 1.9). For shoulder dystocia the risk was significantly increased in the unadjusted analysis, but the significance disappeared in the adjusted analysis. No statistically significance was seen for hemorrhage and thrombosis. This study shows a significant increased risk of a wide variety of pregnancy, birth, and neonatal complications in overweight, obese, and severely obese women. II.
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              The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004-2011.

              To assess the prevalence of overweight and obesity, and the impact of body mass index (BMI) on maternal and neonatal outcomes, in a UK obstetric population. Retrospective study. A tertiary referral unit in Northern Ireland. A total of 30 298 singleton pregnancies over an 8-year period, 2004-2011. Women were categorised according to World Health Organization classification: underweight (BMI 5 days (OR 2.1, 99% CI 1.5-3.1), and infant requiring admission to a neonatal unit (OR 1.6, 99% CI 1.0-2.6). By categorising women into overweight and obesity subclassifications (classes I -III), this study clearly demonstrates an increasing risk of adverse outcomes across BMI categories, with women who are overweight also at significant risk. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.
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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                International Journal of Obesity
                Int J Obes
                Springer Science and Business Media LLC
                0307-0565
                1476-5497
                October 04 2021
                Article
                10.1038/s41366-021-00971-7
                87f49b31-54a8-4cf7-a1b0-3c9c7ab6dd1e
                © 2021

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