The aim of this systematic review was to evaluate the associations between pre-pregnancy body mass index and gestational weight gain and placental abruption.
Relevant studies were identified from PubMed, EMBASE, Scopus and CINAHL. Unpublished findings from analyses of linked population-based data sets from Western Australia (2012–2015, n = 114,792) were also included. Studies evaluating pre-pregnancy body mass index and/or gestational weight gain and placental abruption were included. Two independent reviewers evaluated studies for inclusion and quality. Data including odds ratios (ORs) and 95% confidence intervals (CIs) were extracted and analysed by random effects meta-analysis.
21 studies were included, of which 15 were eligible for meta-analyses. The summary ORs for the association of being underweight, overweight and obese, and placental abruption, compared to normal weight women, were 1.4 (95% CI 1.1, 1.7), 0.8 (95% CI 0.8, 0.9) and 0.8 (95% CI 0.7, 0.9), respectively. These findings remained unchanged when each study was eliminated from the analysis and in subgroup analyses. Although data were scarce, women with gestational weight gain below the Institute of Medicine recommendations appeared to be at greater risk of abruption compared with women who had optimal weight gain.
Mothers that are underweight prior to or in early pregnancy are at a moderately increased risk of placental abruption.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Ananth CV, Hansen AV, Williams MA et al (2017) Cardiovascular disease in relation to placental abruption: a population-based cohort study from Denmark. Paediatr Perinat Epidemiol 31:209–218
Ananth CV, Keyes KM, Hamilton A et al (2015) An international contrast of rates of placental abruption: an age-period-cohort analysis. PLoS One 10:e0125246
Ananth CV, Oyelese Y, Yeo L et al (2005) Placental abruption in the United States, 1979 through 2001: temporal trends and potential determinants. Am J Obstet Gynecol 192:191–198
Ananth CV, Smulian JC, Vintzileos AM (1999) Incidence of placental abruption in relation to cigarette smoking and hypertensive disorders during pregnancy: a meta-analysis of observational studies. Obstet Gynecol 93:622–628
Anonymous (2016) Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet 387:1377–1396
Audrain-Mcgovern J, Benowitz NL (2011) Cigarette smoking, nicotine, and body weight. Clin Pharmacol Ther 90:164–168
Avci ME, Şanlikan F, Çelik M et al (2015) Effects of maternal obesity on antenatal, perinatal and neonatal outcomes. J Maternal-Fetal Neonatal Med 28:2080–2083
Bhattacharya S, Campbell DM, Liston WA et al (2007) Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies. BMC Public HEALTH 7:168
Bianco AT, Smilen SW, Davis Y et al (1998) Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol 91:97–102
Blumenfeld YJ, Baer RJ, Druzin ML et al (2014) Association between maternal characteristics, abnormal serum aneuploidy analytes, and placental abruption. Am J Obstet Gynecol 211:144.e141–149
Boisrame T, Sananes N, Fritz G et al (2014) Placental abruption: risk factors, management and maternal-fetal prognosis. Cohort study over 10 years. Eur J Obstet Gynecol Reprod Biol 179:100–104
Budde MP, De Lange TE, Dekker GA et al (2007) Risk factors for placental abruption in a socio-economically disadvantaged region. J Maternal-fetal Neonatal Med 20:687–693
Cedergren MI (2004) Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 103:219–224
Cheney K, Farber R, Barratt AL et al (2018) Population attributable fractions of perinatal outcomes for nulliparous women associated with overweight and obesity, 1990–2014. Med J Aust 208:119–125
Christian P (1973S) Micronutrients and reproductive health issues: an international perspective. J Nutr 133:1969S–1973S
Cucó G, Fernández-Ballart J, Sala J et al (2005) Dietary patterns and associated lifestyles in preconception, pregnancy and postpartum. Eur J Clin Nutr 60:364
Denison FC, Norwood P, Bhattacharya S et al (2014) Association between maternal body mass index during pregnancy, short-term morbidity, and increased health service costs: a population-based study. BJOG Int J Obstet Gynaecol 121:72–81
Deutsch AB, Lynch O, Alio AP et al (2010) Increased risk of placental abruption in underweight women. Am J Perinatol 27:235–240
Ding XX, Xu SJ, Hao JH et al (2016) Maternal pre-pregnancy BMI and adverse pregnancy outcomes among Chinese women: Results from the C-ABCS. J Obstet Gynaecol 36:328–332
Downes KL, Shenassa ED, Grantz KL (2017) Neonatal outcomes associated with placental abruption. Am J Epidemiol 186:1319–1328
Goldstein RF, Abell SK, Ranasinha S et al (2017) Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysisAssociation of Gestational Weight Gain With Maternal and Infant OutcomesAssociation of Gestational Weight Gain With Maternal and Infant Outcomes. JAMA 317:2207–2225
Harris RJ, Deeks JJ, Altman DG et al (2008) Metan: fixed-and random-effects meta-analysis. The Stata Journal 8:3–28
Higgins JP, Thompson SG, Deeks JJ et al (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560
Higgins J, Altman D, Sterne J (2008) on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group (editors). Chapter 8: Assessing risk of bias in included studies. Cochrane handbook for systematic reviews of interventions version 5
Holman CD, Bass AJ, Rouse IL et al (1999) Population-based linkage of health records in Western Australia: development of a health services research linked database. Aust N Z J Public Health 23:453–459
Hung TH, Chen SF, Hsu JJ et al (2015) Gestational weight gain and risks for adverse perinatal outcomes: a retrospective cohort study based on the 2009 Institute of Medicine guidelines. Taiwan J Obstet Gynecol 54:421–425
Hung TH, Hsieh CC, Hsu JJ et al. (2007) Risk factors for placental abruption in an Asian population. Reprod Sci (Thousand Oaks, Calif.) 14:59–65
Hung TH, Hsieh TT (2016) Pregestational body mass index, gestational weight gain, and risks for adverse pregnancy outcomes among Taiwanese women: a retrospective cohort study. Taiwan J Obstet Gynecol 55:575–581
Institute of Medicine (Us) and National Research Council (Us) Committee to Reexamine Iom Pregnancy Weight Guidelines (2009) Weight gain during pregnancy; Reexamining the Guidelines. In: Rassmussen KM, Yaktine AL, Institute of Medicine, National Research Council (eds)The National Academic Press, Washington DC
Liu X, Du J, Wang G et al (2011) Effect of pre-pregnancy body mass index on adverse pregnancy outcome in north of China. Arch Gynecol Obstet 283:65–70
Marchi J, Berg M, Dencker A et al (2015) Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev 16:621–638
Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535
Moola S, Munn Z, Tufanaru C et al (2017) Chapter 7: Systematic reviews of etiology and risk. Joanna Briggs Institute Reviewer's Manual, The Joanna Briggs Institute
National Institute on Drug Abuse (2014) DrugFacts: Methamphetamine. http://www.assessmentpsychology.com/icbmi.htm
Pariente G, Wiznitzer A, Sergienko R et al (2011) Placental abruption: critical analysis of risk factors and perinatal outcomes. J Maternal-fetal Neonatal Med 24:698–702
Pink B (2011) Socio-economic indexes for areas (SEIFA). Australian Bureau of Statistics, Canberra
Poston L, Caleyachetty R, Cnattingius S et al (2016) Preconceptional and maternal obesity: epidemiology and health consequences. Lancet Diabetes Endocrinol 4:1025–1036
Royal College of Obstetricians and Gynaecologists (Rcog) (2011) Antepartum Haemorrhage: Green top Guideline No. 63. Royal College of Obstetrics & Gynaecology, London
Salihu HM, Diamond E, August EM et al (2013) Maternal pregnancy weight gain and the risk of placental abruption. Nutr Rev 71(Suppl 1):S9–17
Salihu HM, Lynch O, Alio AP et al (2009) Extreme obesity and risk of placental abruption. Hum Reprod (Oxford, England) 24:438–444
Sayers A, Ben-Shlomo Y, Blom AW et al (2016) Probabilistic record linkage. Int J Epidemiol 45:954–964
Scott-Pillai R, Spence D, Cardwell C et al (2013) The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004–2011. BJOG Int J Obstet Gynaecol 120:932–939
Sebire NJ, Jolly M, Harris J et al (2001) Maternal obesity and pregnancy outcome: a study of 287 213 pregnancies in London. Int J Obes 25:1175
Tikkanen M (2011) Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand 90:140–149
Torheim LE, Ferguson EL, Penrose K et al (2058s) Women in resource-poor settings are at risk of inadequate intakes of multiple micronutrients. J Nutr 140:2051s–2058s
Truong YN, Yee LM, Caughey AB et al (2015) Weight gain in pregnancy: does the Institute of Medicine have it right? Am J Obstet Gynecol 212:362.e361–368
Vinturache A, Moledina N, Mcdonald S et al (2014) Pre-pregnancy Body Mass Index (BMI) and delivery outcomes in a Canadian population. BMC Pregnancy Childbirth 14:422
Voerman E, Santos S, Patro Golab B et al (2019) Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood: an individual participant data meta-analysis. PLoS Med 16:e1002744
Weiss JL, Malone FD, Emig D et al (2004) Obesity, obstetric complications and cesarean delivery rate—a population-based screening study. Am J Obstet Gynecol 190:1091–1097
Williams MA, Lieberman E, Mittendorf R et al (1991) Risk factors for abruptio placentae. Am J Epidemiol 134:965–972
World Health Organization (2006) Global database on body mass index. http://www.assessmentpsychology.com/icbmi.htm
Zhou A, Xiong C, Hu R et al (2015) Pre-pregnancy BMI, gestational weight gain, and the risk of hypertensive disorders of pregnancy: a cohort study in Wuhan, China. PLoS One 10:e0136291
We would like to acknowledge the Data Linkage Branch (Western Australian Government Department of Health), the Midwives’ Notification System and the Hospital Morbidity Data Collection for providing data for this project.
This research was supported by funding from an Australian National Health and Medical Research Council (NHMRC) Project Grant (APP1127265) which funded AAA, CCJS, FJL and HDB. BMF is also funded by an NHRMC Project Grant (APP1098844). The funding bodies had no part in either the study design, conduct, analysis or interpretation of this study nor the decision to submit this study for publication.
Conflict of interest
The authors declare no conflict of interest.
For the review part, ethics approval was not required. All procedures performed in studies involving human participants were in accordance with the ethical standards of the WA Aboriginal Health Ethics Committee (project 797) and the WA Department of Health Human Research Ethics Committee (project 2016/51) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Adane, A.A., Shepherd, C.C.J., Lim, F.J. et al. The impact of pre-pregnancy body mass index and gestational weight gain on placental abruption risk: a systematic review and meta-analysis. Arch Gynecol Obstet 300, 1201–1210 (2019). https://doi.org/10.1007/s00404-019-05320-8
- Placental abruption
- Maternal obesity
- Gestational weight gain
- Systematic review