Ethnic disparities in maternal obesity and weight gain during pregnancy. The Generation R Study

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Abstract

Objective

To examine ethnic disparities in maternal prepregnancy obesity and gestational weight gain, and to examine to which extent these differences can be explained by socio-demographic, lifestyle and pregnancy related characteristics.

Methods

In a multi-ethnic population-based prospective cohort study among 6,444 pregnant women in Rotterdam, the Netherlands, maternal anthropometrics were repeatedly measured throughout pregnancy. Ethnicity, socio-demographic, lifestyle and pregnancy related characteristics were assessed by physical examinations and questionnaires.

Results

The prevalence of prepregnancy overweight and obesity was 23.1% among Dutch-origin women. Statistically higher prevalences were observed among Dutch Antillean-origin (40.8%), Moroccan-origin (49.9%), Surinamese-Creole-origin (38.6%) and Turkish-origin (41.1%) women (all p-values <0.05). Only Dutch Antillean-origin, Moroccan-origin, Surinamese-Creole-origin and Turkish-origin women had higher risks of maternal prepregnancy overweight and obesity as compared to Dutch-origin women (p-values <0.05). Socio-demographic and lifestyle related characteristics explained up to 45% of the ethnic differences in body mass index. Compared to Dutch-origin women, total gestational weight gain was lower in all ethnic minority groups, except for Cape Verdean-origin and Surinamese-Creole-origin women (p-values <0.05). Lifestyle and pregnancy related characteristics explained up to 33% and 40% of these associations, respectively. The largest ethnic differences in gestational weight gain were observed in late pregnancy.

Conclusion

We observed moderate ethnic differences in maternal prepregnancy overweight, obesity and gestational weight gain. Socio-demographic, lifestyle and pregnancy related characteristics partly explained these differences. Whether these differences also lead to ethnic differences in maternal and childhood outcomes should be further studied.

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Most cited references 37

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Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis.

Dagfinn Aune, Ola Saugstad, Tore Henriksen … (2014)

Evidence suggests that maternal obesity increases the risk of fetal death, stillbirth, and infant death; however, the optimal body mass index (BMI) for prevention is not known. To conduct a systematic review and meta-analysis of cohort studies of maternal BMI and risk of fetal death, stillbirth, and infant death. The PubMed and Embase databases were searched from inception to January 23, 2014. Cohort studies reporting adjusted relative risk (RR) estimates for fetal death, stillbirth, or infant death by at least 3 categories of maternal BMI were included. Data were extracted by 1 reviewer and checked by the remaining reviewers for accuracy. Summary RRs were estimated using a random-effects model. Fetal death, stillbirth, and neonatal, perinatal, and infant death. Thirty eight studies (44 publications) with more than 10,147 fetal deaths, more than 16,274 stillbirths, more than 4311 perinatal deaths, 11,294 neonatal deaths, and 4983 infant deaths were included. The summary RR per 5-unit increase in maternal BMI for fetal death was 1.21 (95% CI, 1.09-1.35; I2 = 77.6%; n = 7 studies); for stillbirth, 1.24 (95% CI, 1.18-1.30; I2 = 80%; n = 18 studies); for perinatal death, 1.16 (95% CI, 1.00-1.35; I2 = 93.7%; n = 11 studies); for neonatal death, 1.15 (95% CI, 1.07-1.23; I2 = 78.5%; n = 12 studies); and for infant death, 1.18 (95% CI, 1.09-1.28; I2 = 79%; n = 4 studies). The test for nonlinearity was significant in all analyses but was most pronounced for fetal death. For women with a BMI of 20 (reference standard for all outcomes), 25, and 30, absolute risks per 10,000 pregnancies for fetal death were 76, 82 (95% CI, 76-88), and 102 (95% CI, 93-112); for stillbirth, 40, 48 (95% CI, 46-51), and 59 (95% CI, 55-63); for perinatal death, 66, 73 (95% CI, 67-81), and 86 (95% CI, 76-98); for neonatal death, 20, 21 (95% CI, 19-23), and 24 (95% CI, 22-27); and for infant death, 33, 37 (95% CI, 34-39), and 43 (95% CI, 40-47), respectively. Even modest increases in maternal BMI were associated with increased risk of fetal death, stillbirth, and neonatal, perinatal, and infant death. Weight management guidelines for women who plan pregnancies should take these findings into consideration to reduce the burden of fetal death, stillbirth, and infant death.

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Obesity, obstetric complications and cesarean delivery rate--a population-based screening study.

Joshua Weiss, Fergal Malone, Danielle Emig … (2004)

This study was undertaken to determine whether obesity is associated with obstetric complications and cesarean delivery. A large prospective multicenter database was studied. Subjects were divided into 3 groups: body mass index (BMI) less than 30 (control), 30 to 34.9 (obese), and 35 or greater (morbidly obese). Groups were compared by using univariate and multivariable logistic regression analyses. The study included 16,102 patients: 3,752 control, 1,473 obese, and 877 morbidly obese patients. Obesity and morbid obesity had a statistically significant association with gestational hypertension (odds ratios [ORs] 2.5 and 3.2), preeclampsia (ORs 1.6 and 3.3), gestational diabetes (ORs 2.6 and 4.0), and fetal birth weight greater than 4000 g (ORs 1.7 and 1.9) and greater than 4500 g (ORs 2.0 and 2.4). For nulliparous patients, the cesarean delivery rate was 20.7% for the control group, 33.8% for obese, and 47.4% for morbidly obese patients. Obesity is an independent risk factor for adverse obstetric outcome and is significantly associated with an increased cesarean delivery rate.

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

Sarah McDonald, Zhen-Hai Han, Sohail M. Mulla … (2010)

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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Author and article information

Journal

Journal ID (nlm-journal-id): 0375672

Journal ID (pubmed-jr-id): 3335

Journal ID (nlm-ta): Eur J Obstet Gynecol Reprod Biol

Journal ID (iso-abbrev): Eur. J. Obstet. Gynecol. Reprod. Biol.

Title: European journal of obstetrics, gynecology, and reproductive biology

ISSN (Print): 0301-2115

ISSN (Electronic): 1872-7654

Publication date Nihms-submitted: 25 April 2017

Publication date (Electronic): 08 July 2015

Publication date (Print): October 2015

Publication date PMC-release: 28 April 2017

Volume: 193

Pages: 51-60

Affiliations

[1 ]The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, the Netherlands

[2 ]Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands

[3 ]Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, the Netherlands

[4 ]Department of Public Health, Erasmus MC, University Medical Center Rotterdam, the Netherlands

[5 ]Department of Health Sciences, section Prevention and Public Health, VU University Amsterdam, the Netherlands

[6 ]Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, the Netherlands

Author notes

Correspondence to: Vincent W.V. Jaddoe, MD, PhD. The Generation R Study Group (NA2915). Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands. ( v.jaddoe@ 123456erasmusmc.nl ).

Article

Manuscript ID: EMS66131

DOI: 10.1016/j.ejogrb.2015.06.031

PMC ID: 5408938

PubMed ID: 26232727

SO-VID: d211c903-91a4-4f92-ac67-6f3535581c26

License:

This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/

Ethnic disparities in maternal obesity and weight gain during pregnancy. The Generation R Study

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Abstract

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Most cited references 37

Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis.

Obesity, obstetric complications and cesarean delivery rate--a population-based screening study.

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

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