Canadian Journal of Public Health

, Volume 109, Issue 4, pp 527–538 | Cite as

Interprovincial variation in pre-pregnancy body mass index and gestational weight gain and their impact on neonatal birth weight with respect to small and large for gestational age

  • Sarah D. McDonald
  • Christy Woolcott
  • Núria Chapinal
  • Yanfang Guo
  • Phil Murphy
  • Susie Dzakpasu
Quantitative Research



To explore provincial variation in both excess and inadequate pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) and their impact on small- and large-for-gestational-age (SGA, LGA) infants.


Four provinces with a perinatal database capturing the required exposures participated: British Columbia (BC), Ontario (ON), Nova Scotia (NS), and Newfoundland and Labrador (NL). In multiple, concurrent retrospective studies, we included women ≥ 19 years, who gave birth from 22+0 to 42+6 weeks’ gestation, to a live singleton from April 2013–March 2014. From adjusted odds ratios, we calculated population attributable fractions (PAF) of SGA and LGA for BMI and GWG.


The proportion of overweight and obese women increased from western to eastern Canada. In BC, ON, NS, and NL, the proportions of women who were overweight were 21.1%, 24.0%, 23.7%, and 25.4%, while obesity proportions were 14.2%, 18.1%, 24.2%, and 29.8%, respectively. Excess GWG affected 53.9%, 49.9%, 57.6%, and 65.6% of women, respectively. Excess GWG contributed to 29.5–42.5% of LGA, compared with the PAFs for overweight (6.8–12.0%) and obesity (13.2–20.6%). Inadequate GWG’s contribution to SGA (4.8–12.3%) was higher than underweight BMI’s (2.9–6.2%).


In this interprovincial study, high and increasing proportions of women from west to east had excess pre-pregnancy BMI, and between half to two thirds had excess GWG. The contributions of GWG outside of recommendations to SGA and LGA were greater than that of low or high BMI. GWG is a potentially modifiable determinant of SGA and LGA across Canada.


Pregnancy Weight gain Body mass index Fetal macrosomia Infant Small for gestational age 



Explorer les écarts provinciaux dans l’indice de masse corporelle (IMC) élevé ou faible avant la grossesse et le gain de poids (GPG) excessif ou insuffisant durant la grossesse et leur effet sur la naissance de nourrissons petits ou gros pour l’âge gestationnel (PAG, GAG).


Ont participé quatre provinces ayant des bases de données périnatales saisissant les données requises : la Colombie-Britannique (C.-B.), l’Ontario (Ont.), la Nouvelle-Écosse (N.-É.) et Terre-Neuve-et-Labrador (T.-N.-L.). Dans plusieurs études rétrospectives parallèles, nous avons inclus les femmes ≥19 ans ayant accouché entre la 22e + 0 et la 42e + 6 semaine de grossesse d’un enfant unique vivant entre avril 2013 et mars 2014. D’après les rapports de cotes ajustés, nous avons calculé les fractions attribuables dans la population (FAP) des nourrissons PAG et GAG selon l’IMC et le GPG.


La proportion de femmes en surpoids et obèses augmente d’ouest en est au Canada. En C.-B., en Ont., en N.-É. et à T.-N.-L., les proportions de femmes en surpoids étaient de 21,1 %, 24 %, 23,7 % et 25,4 %, et les proportions de femmes obèses étaient de 14,2 %, 18,1 %, 24,2 % et 29,8 %, respectivement. Le GPG excessif a touché 53,9 %, 49,9 %, 57,6 % et 65,6 % des femmes, respectivement. Le GPG excessif a contribué à 29,5–42,5 % des nourrissons GAG, comparativement aux FAP pour le surpoids (6,8–12 %) et l’obésité (13,2–20,6 %). La contribution du GPG insuffisant aux nourrissons PAG (4,8–12,3 %) était supérieure à celle du faible IMC (2,9–6,2 %).


Dans cette étude interprovinciale, les proportions de femmes ayant un IMC élevé avant la grossesse étaient élevées et augmentaient d’ouest en est, et entre la moitié et les deux tiers des femmes ont eu un GPG excessif. La contribution d’un GPG hors de l’intervalle recommandé à la naissance de nourrissons PAG et GAG était supérieure à la contribution d’un IMC faible ou élevé. À l’échelle du Canada, le GPG est un déterminant potentiellement modifiable de la naissance de nourrissons PAG et GAG.


Grossesse Prise de poids Indice de masse corporelle Macrosomie fœtale Nourrisson Petit pour l’âge gestationnel 


Funding information

Dr. Sarah D. McDonald is supported by a Canadian Institutes of Health Research Tier II Canada Research Chair in Maternal and Child Obesity Prevention and Intervention, Sponsor Award #950-229920. This financial support had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication. No external funding was secured for this study.

Compliance with ethical standards

Conflict of interest

None to declare.

Supplementary material

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Table S1 (DOCX 22 kb)
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Table S2 (DOCX 25 kb)
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Table S3 (DOCX 23 kb)
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Table S4 (DOCX 26 kb)


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Copyright information

© The Canadian Public Health Association 2018

Authors and Affiliations

  • Sarah D. McDonald
    • 1
  • Christy Woolcott
    • 2
  • Núria Chapinal
    • 3
  • Yanfang Guo
    • 4
  • Phil Murphy
    • 5
  • Susie Dzakpasu
    • 6
  1. 1.Department of Obstetrics & Gynecology, Department of Health Research Methods, Evidence, and Impact, Department of RadiologyMcMaster UniversityHamiltonCanada
  2. 2.Departments of Obstetrics & Gynaecology and PediatricsDalhousie UniversityHalifaxCanada
  3. 3.Perinatal Services BCVancouverCanada
  4. 4.Better Outcomes Registry & NetworkOttawaCanada
  5. 5.Perinatal Program Newfoundland and Labrador, and Disciplines of Obstetrics and Gynecology and Pediatrics, Faculty of MedicineMemorial UniversitySt. John’sCanada
  6. 6.Maternal, Child and Youth Health UnitPublic Health Agency of CanadaOttawaCanada

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