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      Maternal body mass index and gestational weight gain and their association with perinatal outcomes in Viet Nam Translated title: Indice maternel de masse corporelle et augmentation du poids en gestation et leur association avec les observations périnatales au Viet Nam Translated title: Relación entre los resultados perinatales en Viet Nam y el índice de masa corporal de la madre y el aumento de peso durante el embarazo


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          OBJECTIVE: To examine the association between gestational weight gain and maternal body mass index (BMI) among Vietnamese women and the risk of delivering an infant too small or too large for gestational age. METHODS: A prospective health-facility-based study of 2989 pregnant Vietnamese women was conducted in the city of Nha Trang in 2007-2008. Cubic logistic regression was used to investigate the association of interest. Infants were classified into weight-for-gestational-age categories according to weight centiles for the Asian population. Gestational age was based on the date of last menstrual period and adjusted by the results of first-trimester ultrasound. FINDINGS: BMI was low (< 18.5), normal (18.5-22.9) and high (> 23.0) in 26.1%, 65.4% and 8.5% of the women, respectively. In each of these BMI categories, the percentage of women who delivered infants too small for gestational age was 18.1, 10.0 and 9.4, respectively, and the mean gestational weight gain was 12.5 kg (standard deviation, SD: ± 3.6), 12.2 kg (SD: ± 3.8) and 11.5 kg (SD: ± 4.7), respectively. Among women with low BMI, the risk of delivering an infant too small for gestational age ranged from approximately 40% if the gestational weight gain was < 5 kg to 20% if it was 5-10 kg. CONCLUSION: Having a low BMI, commonly found in Viet Nam, puts women at risk of delivering an infant too small for gestational age, especially when total maternal gestational weight gain is < 10 kg.

          Translated abstract

          OBJECTIF: Examiner le rapport entre l'augmentation de poids en gestation et l'indice maternel de masse corporelle (IMC) chez les femmes vietnamiennes avec le risque d'accoucher d'un enfant trop petit ou trop grand pour son âge gestationnel MÉTHODES: Une étude prospective, en établissements de soins, a été menée auprès de 2 989 femmes enceintes vietnamiennes dans la ville de Nha Trang en 2007-2008. Une régression logistique cubique a été utilisée pour rechercher l'association pertinente. Les nouveau-nés ont été classés en plusieurs catégories selon le rapport/âge gestationnel, par référence aux centiles de poids de la population asiatique. L'âge gestationnel a été basé sur la date de la dernière période menstruelle et ajusté au vu des résultats de l'échographie du premier trimestre. RÉSULTATS: L'IMC était faible (<18,5), normal (18,5 - 22,9) et élevé (³23,0) chez 26,1%; 65% et 8,5% des femmes, respectivement. Dans chacune de ces catégories d'IMC, le pourcentage de femmes qui ont accouché d'enfants trop petits pour leur âge gestationnel était respectivement de 18,1, 10,0 et 9,4, et l'augmentation moyenne de poids a été respectivement de 12,5 kg (écart des normes, EN: ±3,6), 12,2 kg (EN: ±3,8), et 11,5 kg (EN: ±4.7). Pour les femmes avec un faible IMC, le risque d'accoucher d'un enfant trop petit pour son âge gestationnel s'étendait de 40% environ si l'augmentation gestationnelle de poids était <5 kg, à 20% s'il était entre 5 et 10 kg. CONCLUSION: Un faible IMC, courant au Viet Nam, crée un risque pour les femmes d'accoucher d'un enfant trop petit pour son âge gestationnel, particulièrement quand l'augmentation gestationnelle du poids de la mère est <10 kg.

          Translated abstract

          OBJETIVO: Examinar la relación existente entre el aumento de peso durante el embarazo y el índice de masa corporal (IMC) de las madres en Viet Nam y el riesgo de dar a luz a niños demasiado pequeños o demasiado grandes para su edad gestacional. MÉTODOS: Se desarrolló un estudio prospectivo en 2989 embarazadas vietnamitas en centros sanitarios de la ciudad de Nha Trang entre 2007 y 2008. Se empleó una regresión logística y cúbica para investigar la asociación de interés. Los niños se clasificaron en diversas categorías según el peso para la edad gestacional, de acuerdo con los centiles de peso para la población asiática. La edad gestacional se basó en la fecha de la última menstruación y se ajustó con los resultados de la ecografía del primer trimestre. RESULTADOS: El IMC fue bajo (< 18,5), normal (18,5-22,9) y alto (> 23,0) en un 26,1%, 65,4% y 8,5% de las mujeres, respectivamente. En cada una de estas categorías de IMC, el porcentaje de madres que dio a luz a niños demasiado pequeños para su edad gestacional fue del 18,1, 10,0 y 9,4 por ciento, respectivamente, y la media del aumento de peso durante el embarazo fue de 12,5 kg (desviación estándar, DE: ± 3,6), 12,2 kg (DE: ± 3,8) y 11,5 kg (DE: ± 4,7), respectivamente. Entre las mujeres con un IMC bajo, el riesgo de dar a luz a un niño demasiado pequeño para su edad gestacional osciló entre aproximadamente un 40% si el aumento de peso durante el embarazo fue inferior a 5 kg hasta un 20% si dicho aumento fue de entre 5 y 10 kg. CONCLUSIÓN: Tener un IMC bajo, algo muy común en Viet Nam, aumenta el riesgo de dar a luz a un niño demasiado pequeño para su edad gestacional, especialmente cuando el aumento total de peso durante el embarazo es inferior a los 10 kilos.

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          Most cited references71

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          Regression Modeling Strategies

          Springer Series in Statistics
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            Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus.

            C. Boney (2005)
            Childhood obesity has contributed to an increased incidence of type 2 diabetes mellitus and metabolic syndrome (MS) among children. Intrauterine exposure to diabetes and size at birth are risk factors for type 2 diabetes mellitus, but their association with MS in childhood has not been demonstrated. We examined the development of MS among large-for-gestational-age (LGA) and appropriate-for-gestational age (AGA) children. The major components of MS (obesity, hypertension, dyslipidemia, and glucose intolerance) were evaluated in a longitudinal cohort study of children at age 6, 7, 9, and 11 years who were LGA (n = 84) or AGA (n = 95) offspring of mothers with or without gestational diabetes mellitus (GDM). The cohort consisted of 4 groups, ie, LGA offspring of control mothers, LGA offspring of mothers with GDM, AGA offspring of control mothers, and AGA offspring of mothers with GDM. Biometric and anthropometric measurements were obtained at 6, 7, 9, and 11 years. Biochemical testing included measurements of postprandial glucose and insulin levels and high-density lipoprotein (HDL) cholesterol levels at 6 and 7 years and of fasting glucose, insulin, triglyceride, and HDL cholesterol levels at 9 and 11 years. We defined the components of MS as (1) obesity (BMI >85th percentile for age), (2) diastolic or systolic blood pressure >95th percentile for age, (3) postprandial glucose level >140 mg/dL or fasting glucose level >110 mg/dL, (4) triglyceride level >95th percentile for age, and (5) HDL level 85th percentile) at 11 years was present in 25% to 35% of the children, but rates were not different between LGA and AGA offspring. There was a trend toward a higher incidence of insulin resistance, defined as a fasting glucose/insulin ratio of or =2 components of MS was 50% for the LGA/GDM group, which was significantly higher than values for the LGA/control group (29%), AGA/GDM group (21%), and AGA/control group (18%). The prevalence of > or =3 components of MS at age 11 was 15% for the LGA/GDM group, compared with 3.0% to 5.3% for the other groups. Cox regression analysis was performed to determine the independent hazard (risk) of developing MS attributable to birth weight, gender, maternal prepregnancy obesity, and GDM. For Cox analyses, we defined MS as > or =2 of the following 4 components: obesity, hypertension (systolic or diastolic), glucose intolerance, and dyslipidemia (elevated triglyceride levels or low HDL levels). LGA status and maternal obesity increased the risk of MS approximately twofold, with hazard ratios of 2.19 (95% CI: 1.25-3.82) and 1.81 (95% CI: 1.03-3.19), respectively. GDM and gender were not independently significant. To determine the cumulative hazard of developing MS with time, we plotted the risk according to LGA or AGA category for the control and GDM groups from 6 years to 11 years, with Cox regression analyses. The risk of developing MS with time was not significantly different between LGA and AGA offspring in the control group but was significantly different between LGA and AGA offspring in the GDM group, with a 3.6-fold greater risk among LGA children by 11 years. We showed that LGA offspring of diabetic mothers were at significant risk of developing MS in childhood. The prevalence of MS in the other groups was similar to the prevalence (4.8%) among white adolescents in the 1988-1994 National Health and Nutrition Examination Survey. This effect of LGA with maternal GDM on childhood MS was previously demonstrated for Pima Indian children but not the general population. We also found that children exposed to maternal obesity were at increased risk of developing MS, which suggests that obese mothers who do not fulfill the clinical criteria for GDM may still have metabolic factors that affect fetal growth and postnatal outcomes. Children who are LGA at birth and exposed to an intrauterine environment of either diabetes or maternal obesity are at increased risk of developing MS. Given the increased obesity prevalence, these findings have implications for perpetuating the cycle of obesity, insulin resistance, and their consequences in subsequent generations.
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              Birth weight and subsequent risk of type 2 diabetes: a meta-analysis.

              The "small baby syndrome hypothesis" suggests that an inverse linear relation exists between birth weight and risk of type 2 diabetes. The authors conducted a meta-analysis to examine this association. They included studies that reported odds ratios and 95% confidence intervals (or data with which to calculate them) for the association of type 2 diabetes with birth weight. Fourteen studies involving a total of 132,180 persons were identified. Low birth weight ( /=2,500 g, was associated with increased risk of type 2 diabetes (odds ratio (OR) = 1.32, 95% confidence interval (CI): 1.06, 1.64). High birth weight (>4,000 g), as compared with a birth weight of

                Author and article information

                Bulletin of the World Health Organization
                Bull World Health Organ
                World Health Organization (Genebra, Genebra, Switzerland )
                February 2011
                : 89
                : 2
                : 127-136
                [08] orgnameFukujuji Hospital
                [06] Isehara orgnameTokai University orgdiv1School of Medicine Japan
                [07] Nagasaki orgnameNagasaki University orgdiv1School of Medicine Japan
                [02] Nagasaki orgnameNagasaki University orgdiv1Institute of Tropical Medicine Japan
                [05] Nha Trang orgnameKhanh Hoa General Hospital Viet Nam
                [01] Tokyo orgnameUniversity of Tokyo orgdiv1School of Medicine Japan
                [04] Nha Trang orgnameKhanh Hoa Health Service Viet Nam
                [03] Hanoi orgnameMinistry of Health orgdiv1National Institute of Hygiene and Epidemiology Viet Nam
                [09] Tokyo orgnameJapan Anti-Tuberculosis Association Japan
                S0042-96862011000200012 S0042-9686(11)08900212

                : 18 October 2010
                : 16 October 2010
                : 20 April 2010
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 38, Pages: 10

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