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      Association Between Maternal Nutritional Status of Pre Pregnancy, Gestational Weight Gain and Preterm Birth

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          Abstract

          Introduction:

          Maternal nutritional status of pre pregnancy and gestational weight gain affects the preterm birth. The association between maternal nutritional status of pre pregnancy and preterm birth appears to be complex and varied by studies from different countries, thus this association between the gestational weight gain and preterm birth is more consolidated.

          Objective:

          The study aims to determine any association between the pre pregnancy maternal nutritional status, gestational weight gain and the preterm birth rate in the Albanian context.

          Method and materials:

          In case control study, we analyzed women who have delivered in obstetric institutions in Tirana during the year 2012. Body mass index and gestational weight gain of 150 women who had a preterm delivery were compared with those of 150 matched control women who had a normal delivery regarding the gestation age. The self-reported pre pregnancy weight, height, gestational weight gain, age, education and parity are collected through a structured questioner. The body mass index and gestational weight gain are categorized based on the Institute of Medicine recommendation. The multiple logistic regression is used to measure the association between the nutritional status of pre pregnancy and gestational weight gain and the preterm birth rate.

          Results:

          The women which have a underweight status or obese of pre pregnancy are more likely to have a preterm birth compared to the women of a normal pre-pregnancy nutritional status (respectively OR =2.7 and 4.3 p<0.05). Women who do not reach the recommended gestational weight gain are more likely to have a preterm birth compared to the women which reach this weight (OR=1.8 p< 0.05).

          Discussion:

          Maternal nutritional status and gestational weight gain affects the risk for preterm birth. Pre-pregnancy and gestation nutritional assessments should be part of routine prenatal visits.

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          Most cited references20

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          Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses

          Objective To determine the relation between overweight and obesity in mothers and preterm birth and low birth weight in singleton pregnancies in developed and developing countries. Design Systematic review and meta-analyses. Data sources Medline and Embase from their inceptions, and reference lists of identified articles. Study selection Studies including a reference group of women with normal body mass index that assessed the effect of overweight and obesity on two primary outcomes: preterm birth (before 37 weeks) and low birth weight (<2500 g). Data extraction Two assessors independently reviewed titles, abstracts, and full articles, extracted data using a piloted data collection form, and assessed quality. Data synthesis 84 studies (64 cohort and 20 case-control) were included, totalling 1 095 834 women. Although the overall risk of preterm birth was similar in overweight and obese women and women of normal weight, the risk of induced preterm birth was increased in overweight and obese women (relative risk 1.30, 95% confidence interval 1.23 to 1.37). Although overall the risk of having an infant of low birth weight was decreased in overweight and obese women (0.84, 0.75 to 0.95), the decrease was greater in developing countries than in developed countries (0.58, 0.47 to 0.71 v 0.90, 0.79 to 1.01). After accounting for publication bias, the apparent protective effect of overweight and obesity on low birth weight disappeared with the addition of imputed “missing” studies (0.95, 0.85 to 1.07), whereas the risk of preterm birth appeared significantly higher in overweight and obese women (1.24, 1.13 to 1.37). Conclusions Overweight and obese women have increased risks of preterm birth and induced preterm birth and, after accounting for publication bias, appeared to have increased risks of preterm birth overall. The beneficial effects of maternal overweight and obesity on low birth weight were greater in developing countries and disappeared after accounting for publication bias.
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            Effect of Body Mass Index on pregnancy outcomes in nulliparous women delivering singleton babies

            Background The increasing prevalence of obesity in young women is a major public health concern. These trends have a major impact on pregnancy outcomes in these women, which have been documented by several researchers. In a population based cohort study, using routinely collected data, this paper examines the effect of increasing Body Mass Index (BMI) on pregnancy outcomes in nulliparous women delivering singleton babies. Methods This was a retrospective cohort study, based on all nulliparous women delivering singleton babies in Aberdeen between 1976 and 2005. Women were categorized into five groups – underweight (BMI 35 Kg/m2). Obstetric and perinatal outcomes were compared by univariate and multivariate analyses. Results In comparison with women of BMI 20 – 24.9, morbidly obese women faced the highest risk of pre-eclampsia {OR 7.2 (95% CI 4.7, 11.2)} and underweight women the lowest {OR 0.6 (95% CI 0.5, 0.7)}. Induced labour was highest in the morbidly obese {OR 1.8 (95% CI 1.3, 2.5)} and lowest in underweight women {OR 0.8 (95% CI 0.8, 0.9)}. Emergency Caesarean section rates were highest in the morbidly obese {OR 2.8 (95% CI 2.0, 3.9)}, and comparable in women with normal and low BMI. Obese women were more likely to have postpartum haemorrhage {OR 1.5 (95% CI 1.3, 1.7)} and preterm delivery ( 4,000 g was in the morbidly obese {OR 2.1 (95% CI 1.3, 3.2)} and the lowest in underweight women {OR 0.5 (95% CI 0.4, 0.6)}. Conclusion Increasing BMI is associated with increased incidence of pre-eclampsia, gestational hypertension, macrosomia, induction of labour and caesarean delivery; while underweight women had better pregnancy outcomes than women with normal BMI.
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              The Preterm Prediction Study: association between maternal body mass index and spontaneous and indicated preterm birth.

              The purpose of this study was to evaluate the relationship between prepregnancy maternal body mass index and spontaneous preterm birth and indicated preterm birth. This was a secondary analysis of the Maternal-Fetal Medicine Units Network, Preterm Prediction study. Patients were classified into categories that were based on their body mass index. Rates of indicated and spontaneous preterm birth were compared. Five hundred ninety-seven (20.5%) of 2910 women were obese. Obese women had fewer spontaneous preterm births at or = 35 kg/m2 had 5.2% spontaneous preterm birth (P < .0001). Indicated delivery was responsible for an increasing proportion of preterm births with increasing body mass index (P = .001). Obese women had lower rates of cervical length < 25 mm (5% vs 8%; P = .012). Multivariable regression analysis confirmed a lower rate of spontaneous preterm birth in obese gravid women (odds ratio, 0.57; 95% CI, 0.39-0.83; P = .003). Obesity before pregnancy is associated with a lower rate of spontaneous preterm birth.
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                Author and article information

                Journal
                Mater Sociomed
                Mater Sociomed
                MSM
                Materia Socio-Medica
                AVICENA, d.o.o., Sarajevo
                1512-7680
                1986-597X
                2013
                : 25
                : 1
                : 6-8
                Affiliations
                [1 ]Department of Epidemiology, Institute of Public Health, Tirana, Albania
                [2 ]Department of Obstetrics. University Obstetrics Hospital “Koço Gliozheni”, Faculty of Medicine, University of Tirana, Tirana, Albania
                [3 ]Department of Medical Emergency, University Hospital Centre “Mother Teresa”, Faculty of Medicine, University of Tirana, Tirana, Albania
                Author notes
                Corresponding author: Sonela Xinxo, MD. Institute of Public Health “Rr Aleksander Moisiu”, Tirana, Albania. Tel/Fax + 3552370058. E-mail: sonelak@ 123456yahoo.com
                Article
                MSM-25-6
                10.5455/msm.2013.25.6-8
                3650563
                23678333
                bd9540cf-3d73-43a0-affa-8b96778af53d
                © 2013 AVICENA

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 November 2012
                : 5 March 2013
                Categories
                Original Paper

                pre pregnancy,nutritional status,weight gain,preterm birth.

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