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Risk of adverse pregnancy outcomes by pre-pregnancy Body Mass Index among Italian population: a retrospective population-based cohort study on 27,807 deliveries

Archives of Gynecology and Obstetrics volume 299, pages 983–991 (2019)Cite this article

Abstract

Purpose

To estimate the impact of increasing pre-pregnancy Body Mass Index (BMI) on the risk of adverse maternal and perinatal outcomes, in patients who delivered in an Italian tertiary care Obstetric department.

Methods

Data, related to women who delivered at Sant’Anna Hospital, Turin, between 2011 and 2015, were collected retrospectively from the hospital database. According to BMI, women were considered as normal weight, overweight, and class 1, 2 and 3 obese (WHO criteria). Logistic regression analysis studied the impact of BMI on maternal and neonatal outcomes, adjusting results for maternal age and parity. Adjusted absolute risks of each outcome were reported according to incremental values in pre-pregnancy BMI.

Results

A total of 27,807 women were included. 75.8% of pregnancies occurred among normal-weight women, whereas 16.7% were overweight, and 7.5% obese women (5.4% class 1, 1.7% class 2 and 0.4% class 3). A 10% decrease in pre-pregnancy BMI was associated with a reduction of at least 15% of Gestational diabetes mellitus (GDM), preeclampsia, maternal admission to intensive care unit (ICU), macrosomia, APGAR 5′ < 6 and neonatal admission to ICU. GDM and preeclampsia resulted in the highest reduction being almost 30%. Larger differences in BMI (20–25%) corresponded to at least a 10% in reduction of risk of preterm and very preterm delivery and emergency cesarean section. Differences in maternal pre-pregnancy BMI had no impact on the frequency of shoulder dystocia and stillbirth.

Conclusions

This study offers a quantitative estimation of negative impact of pre-pregnancy obesity on the most common pregnancy and perinatal complications.

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References

  1. American Medical Association. American Medical Association House of Delegates Resolution: 420 (A-13)

  2. World Health Organization (2015) World health statistics. WHO, Geneva, pp 101–111

  3. Adilson M, Miguel P (2017) Prevalence of adult overweight and obesity in 20 European countries, 2014. Eur J Public Health

  4. Heslehurst N, Ells LJ, Simpson H, Batterham A, Wilkinson J, Summerbell CD (2007) Trends in maternal obesity incidence rates, demographic predictors, and health inequalities in 36,821 women over a 15-year period. BJOG 114:187–194

    Article  CAS  PubMed  Google Scholar 

  5. LaCoursiere DY, Bloebaum L, Duncan JD, Varner MW (2005) Population-based trends and correlates of maternal overweight and obesity, Utah 1991–2001. Am J Obstet Gynecol 192:832

    Article  PubMed  Google Scholar 

  6. Flegal KM, Carroll MD, Kit BK, Ogden CL (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 307:491

    Article  PubMed  Google Scholar 

  7. McDonald SD, Han Z, Mulla S, Beyene J, Knowledge Synthesis Group (2010) Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ 341:c3428.

  8. https://www.epicentro.iss.it/problemi/obesita/EpidItalia.asp. Accessed 13 Aug 2018

  9. https://www.istat.it/it/files//2016/07/Fattori-di-rischio_salute_def.pdf. Accessed 13 Aug 2018

  10. Begum KS, Sachchithanantham K, De Somsubhra S (2011) Maternal obesity and pregnancy outcome. Clin Exp Obstet Gynecol 38:14–20

    PubMed  Google Scholar 

  11. Robinson HE, O'Connell CM, Joseph KS, McLeod NL (2005) Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol 106:1357

    Article  PubMed  Google Scholar 

  12. Lim CC, Mahmood T (2015) Obesity in pregnancy. Best Pract Res Clin Obstet Gynaecol 29(3):309–319

    Article  PubMed  Google Scholar 

  13. Cnattingius S, Bergström R, Lipworth L, Kramer MS (1998) Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med 338(3):147–152

    Article  CAS  PubMed  Google Scholar 

  14. Cnattingius S, Villamor E, Johansson S, Edstedt Bonamy AK, Persson M, Wikström AK, Granath F (2013) Maternal obesity and risk of preterm delivery. JAMA 309(22):2362–2370

    Article  CAS  PubMed  Google Scholar 

  15. Persson M, Johansson S, Villamor E, Cnattingius S (2014) Maternal overweight and obesity and risks of severe birth-asphyxia-related complications in term infants: a population-based cohort study in Sweden. PLoS Med 11(5):e1001648

    Article  PubMed Central  PubMed  Google Scholar 

  16. Stothard KJ, Tennant PW, Bell R, Rankin J (2009) Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 301(6):636–650

    Article  CAS  PubMed  Google Scholar 

  17. Yajnik CS (2014) Transmission of obesity–adiposity and related disorders from the mother to the baby. Ann Nutr Metab 64(Suppl 1):8–17

    Article  CAS  PubMed  Google Scholar 

  18. (1998) Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults: the evidence report, NIH Publication No. 98-4083 September 1998

  19. Dodd JM, Turnbull D, et al (2014) Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ 348:g1285

  20. Briley AL, et al (2014) A complex intervention to improve pregnancy outcome in obese women; the UPBEAT randomised controlled trial. BMC Pregnancy Childbirth 14:74

  21. https://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed 13 Aug 2018

  22. (2004) International Classification of Diseases 10th Revision. WHO, Geneva

  23. Schummers L, Hutcheon JA, Bodnar LM, Lieberman E, Himes KP (2015) Risk of adverse pregnancy outcomes by prepregnancy body mass index: a population-based study to inform prepregnancy weight loss counseling. Obstet Gynecol 125(1):133–143

    Article  PubMed Central  PubMed  Google Scholar 

  24. Istat, Report: Fattori di rischio per la salute: fumo, obesità, alcol e sedentarietà, Anno 2015, 26 luglio 2016 Sovrappeso e obesità in Piemonte, I dati del sistema di sorveglianza PASSI 2010–2013

  25. Gross T, Sokol RJ, King KC (1980) Obesity in pregnancy: risks and outcome. Obstet Gynecol 56(4):446

    CAS  PubMed  Google Scholar 

  26. Wolfe KB, Rossi RA, Warshak CR (2011) The effect of maternal obesity on the rate of failed induction of labor. Am J Obstet Gynecol 205(2):128.e1–7

    Article  Google Scholar 

  27. Al-Zirqi I, Vangen S, Forsen L, Stray-Pedersen B (2009) Effects of onset of labor and mode of delivery on severe postpartum hemorrhage. Am J Obstet Gynecol 201:273.e1–9.

  28. Blomberg M (2011) Maternal obesity and risk of postpartum hemorrhage. Obstet Gynecol 118:561

    Article  PubMed  Google Scholar 

  29. Gollop ND, Childs CA, Coupe B, MacFarlane S, Burrell J, Kumar B (2014) Body weight, body image and primary postpartum haemorrhage: a review of the literature. J Obstet Gynaecol 34(5):373–382

    Article  CAS  PubMed  Google Scholar 

  30. Butwick AJ, Abreo A, Bateman BT, Lee HC, El-Sayed YY, Stephansson O, Flood P (2018) Effect of maternal body mass index on postpartum hemorrhage. Anesthesiology 128(4):774–783

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ovesen P, Rasmussen S, Kesmodel U (2011) Effect of prepregnancy maternal overweight and obesity on pregnancy outcome. Obstet Gynecol 118(2 Pt 1):305–312

    Article  PubMed  Google Scholar 

  32. Jensen DM, Damm P, Sorensen B, Molsted-Pedersen L, Westergaard JG, Ovesen P et al (2003) Pregnancy outcome and prepregnancy body mass index in 2459 glucose-tolerant Danish women. Am J Obstet Gynecol 189:239–244

    Article  PubMed  Google Scholar 

  33. Zhang C, Wu Y, Li S, Zhang D (2018) Maternal prepregnancy obesity and the risk of shoulder dystocia: a meta-analysis. BJOG 125:407–413

    Article  CAS  PubMed  Google Scholar 

  34. Harper LM, Renth A, Todd Cade W (2014) Impact of obesity on maternal and neonatal outcomes in insulin-resistant pregnancy. Am J Perinatol 31(05):383–388

    PubMed  Google Scholar 

  35. Eurostat, Obesity rate by body mass index (BMI). https://ec.europa.eu/eurostat/web/products-datasets/-/sdg_02_10. Accessed 13 Aug 2018

  36. www.worldobesity.org/data/. Accessed 13 Aug 2018

  37. Gallus S, Odone A, Lugo A (2013) Overweight and obesity prevalence and determinants in Italy: an update to 2010. Eur J Nutr 52:677–685

    Article  PubMed  Google Scholar 

  38. Farmer B, Larson BT, Fulgoni VL 3rd, Rainville AJ, Liepa GU (2011) A vegetarian dietary pattern as a nutrient-dense approach to weight management: an analysis of the National Health and Nutrition Examination Survey 1999–2004. J Am Diet Assoc 111:819–827

    Article  PubMed  Google Scholar 

  39. Brawarsky P, Stotland NE (2005) Pre-pregnancy and pregnancy-related factors and the risk of excessive or inadequate gestational weight gain. Int J Gynaecol Obstet 91(2):125–131

    Article  CAS  PubMed  Google Scholar 

  40. Wells CS, Schwalberg R, Noonan G, Gabor V (2006) Factors influencing inadequate and excessive weight gain in pregnancy: Colorado, 2000–2002. Matern Child Health J 10(1):55–62

    Article  PubMed  Google Scholar 

  41. Artal R, Lockwood CJ, Brown HL (2010) Weight gain recommendations in pregnancy and the obesity epidemic. Obstet Gynecol 115(1):152–155

    Article  PubMed  Google Scholar 

  42. Eick SM, Welton M, Cordero JF (2019) Relationship between prepregnancy overweight, obesity, and preterm birth in Puerto Rico. Matern Child Health J (epub ahead of print)

  43. Siddiqui A, Azria E, Howell EA, Deneux-Tharaux C, EPIMOMS Study Group (2018) Associations between maternal obesity and severe maternal morbidity: findings from the French EPIMOMS population-based study. Paediatr Perinat Epidemiol (epub ahead of print)

  44. Shen J, Zhang Z, Chen K, Lu M, Qian Q, Liu P, Gao Q, Zhang C (2018) Prepregnancy obesity status and risks on pregnancy outcomes in Shanghai: a prospective cohort study. Medicine (Baltimore) 97:e12670

    Article  Google Scholar 

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Funding

The authors received no specific funding for this study.

Author information

Affiliations

  1. Department of Surgical Sciences, OIRM S. Anna Hospital University of Turin, Turin, Italy

    Bianca Masturzo, Vera Franzè, Chiara Germano, Rossella Attini, Gianluca Gennarelli, Antonella Lezo, Alessandro Rolfo, Claudio Plazzotta & Tullia Todros

  2. Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC) Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    Elena Brunelli, Aly Youssef & Antonio Farina

Authors
  1. Bianca Masturzo
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  2. Vera Franzè
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  3. Chiara Germano
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  4. Rossella Attini
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  5. Gianluca Gennarelli
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  6. Antonella Lezo
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  7. Alessandro Rolfo
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  9. Elena Brunelli
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Contributions

BM: protocol/project development, data collection. VF: protocol/project development, data collection. CG: protocol/project development, data collection, manuscript writing. RA: protocol/project development, manuscript writing. GG: data collection, manuscript writing, data analysis. AL: data collection, data analysis, manuscript writing. AR: Protocol/project development, data collection, manuscript writing. CP: protocol/project development, data collection. EB: data collection, manuscript writing. AY: data collection, manuscript writing. TT: protocol/project development, manuscript writing. AF: protocol/project development, data collection, manuscript writing, data analysis.

Corresponding author

Correspondence to Antonio Farina.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The committee for this study is Dr. Bianca Masturzo.

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Informed consent was obtained from all individual participants included in the study.

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Masturzo, B., Franzè, V., Germano, C. et al. Risk of adverse pregnancy outcomes by pre-pregnancy Body Mass Index among Italian population: a retrospective population-based cohort study on 27,807 deliveries. Arch Gynecol Obstet 299, 983–991 (2019). https://doi.org/10.1007/s00404-019-05093-0

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Keywords

  • Pre-pregnancy BMI
  • Obesity
  • Logistic regression
  • Risk of adverse outcomes