Skip to main content
SpringerLink
Log in

The Effects of Prepregnancy Body Mass Index and Gestational Weight Gain on Fetal Macrosomia Among American Indian/Alaska Native Women

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objectives

The American Indian/Alaska Native (AI/AN) population is a high-risk group across many health indicators, including fetal macrosomia. We aimed to investigate the effects of prepregnancy body mass index (BMI) and gestational weight gain (GWG) on macrosomia and explore possible racial and geographical variations among AI/AN women.

Methods

This retrospective cohort study was conducted from the Pregnancy Risk Assessment Monitoring System in eight states (2004–2011) among live, singleton, term births to AI/AN women 20 years or older. Prevalence of macrosomia (birth weight ≥ 4000 g) by select characteristics were estimated; differences were assessed with Chi-squares. Multivariable logistic regression was conducted to calculate adjusted odds ratios (aOR) for effects on macrosomia of BMI and GWG (enumerating the pounds women deviated from the Institute of Medicine guidelines for GWG) controlling for other factors in the total sample and stratified by race and state of residence.

Results

The prevalence of macrosomia was 14 %, ranging from 8 to 21 % (Utah–Alaska). Among AI/AN women, 30 % were obese prepregnancy and 50 % had excess GWG. Significant independent effects were found for macrosomia of prepregnancy overweight (aOR 1.27; 95 % Confidence Interval 1.01–1.59), obesity (aOR 1.63; 1.29–2.07), and excess GWG (aOR 1.16; 1.13–1.20 per five pounds gained beyond appropriate). Adjusted estimates varied between race and state.

Conclusions

Prepregnancy BMI and GWG are independent factors for macrosomia among AI/AN women. Future research should prioritize development, testing, and implementation of weight management programs, which account for variations among AI/AN women, both before and during pregnancy for BMI regulation and GWG control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. ACOG Committee opinion no. 549: obesity in pregnancy. (2013). Obstetrics Gynecology, 121(1), 213–217. doi: 10.1097/01.AOG.0000425667.10377.60.

  2. Alberico, S., Montico, M., Barresi, V., Monasta, L., Businelli, C., Soini, V., et al. (2014). The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: Results from a prospective multicentre study. BMC Pregnancy Childbirth, 14, 23. doi:10.1186/1471-2393-14-23.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Alexander, G. R., Wingate, M. S., & Boulet, S. (2008). Pregnancy outcomes of American Indians: Contrasts among regions and with other ethnic groups. Maternal and Child Health Journal, 12(Suppl 1), 5–11. doi:10.1007/s10995-007-0295-z.

    Article  PubMed  Google Scholar 

  4. Boulet, S. L., Alexander, G. R., Salihu, H. M., & Pass, M. (2003). Macrosomic births in the united states: Determinants, outcomes, and proposed grades of risk. American Journal of Obstetrics and Gynecology, 188(5), 1372–1378.

    Article  PubMed  Google Scholar 

  5. Castor, M. L., Smyser, M. S., Taualii, M. M., Park, A. N., Lawson, S. A., & Forquera, R. A. (2006). A nationwide population-based study identifying health disparities between American Indians/Alaska Natives and the general populations living in select urban counties. American Journal of Public Health, 96(8), 1478–1484. doi:10.2105/ajph.2004.053942.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Centers for Disease Control and Prevention. About BMI for Adults. Healthy weight. Retrieved March 31, 2014, from http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/.

  7. Centers for Disease Control and Prevention. (1998). Diabetes during pregnancy: United States, 1993–1995. MMWR. Morbidity and Mortality Weekly Report, 47(20), 408–414.

    Google Scholar 

  8. Cunningham, S. A., Kramer, M. R., & Narayan, K. M. (2014). Incidence of childhood obesity in the United States. New England Journal of Medicine, 370(5), 403–411. doi:10.1056/NEJMoa1309753.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Harder, T., Rodekamp, E., Schellong, K., Dudenhausen, J. W., & Plagemann, A. (2007). Birth weight and subsequent risk of type 2 diabetes: a meta-analysis. American Journal of Epidemiology, 165(8), 849–857. doi:10.1093/aje/kwk071.

    Article  PubMed  Google Scholar 

  10. Henriksen, T. (2008). The macrosomic fetus: A challenge in current obstetrics. Acta Obstetricia et Gynecologica Scandinavica, 87(2), 134–145. doi:10.1080/00016340801899289.

    Article  PubMed  Google Scholar 

  11. Hutchinson, R. N., & Shin, S. (2014). Systematic review of health disparities for cardiovascular diseases and associated factors among American Indian and Alaska Native populations. PLoS One, 9(1), e80973. doi:10.1371/journal.pone.0080973.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Institute of Medicine and National Research Council Committee to Reexamine I. O. M. Pregnancy Weight Guidelines (2009). The national academies collection: Reports funded by national institutes of health. In K. M. Rasmussen & A. L. Yaktine (Eds.), Weight gain during pregnancy: Reexamining the guidelines. Washington (DC): National Academies Press (US), National Academy of Sciences.

  13. Johnson, P. J., Call, K. T., & Blewett, L. A. (2010). The importance of geographic data aggregation in assessing disparities in American Indian prenatal care. American Journal of Public Health, 100(1), 122–128. doi:10.2105/ajph.2008.148908.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Jolly, M. C., Sebire, N. J., Harris, J. P., Regan, L., & Robinson, S. (2003). Risk factors for macrosomia and its clinical consequences: A study of 350,311 pregnancies. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 111(1), 9–14.

    Article  PubMed  Google Scholar 

  15. Jones, D. S. (2006). The persistence of American Indian health disparities. American Journal of Public Health, 96(12), 2122–2134. doi:10.2105/ajph.2004.054262.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Kim, S. Y., Tucker, M., Danielson, M., Johnson, C. H., Snesrud, P., & Shulman, H. (2008). How can PRAMS survey response rates be improved among American Indian mothers? Data from 10 states. Maternal and Child Health Journal, 12(Suppl 1), 119–125. doi:10.1007/s10995-008-0334-4.

    Article  PubMed  Google Scholar 

  17. King, J. R., Korst, L. M., Miller, D. A., & Ouzounian, J. G. (2012). Increased composite maternal and neonatal morbidity associated with ultrasonographically suspected fetal macrosomia. The Journal of Maternal-Fetal & Neonatal Medicine, 25(10), 1953–1959. doi:10.3109/14767058.2012.674990.

    Article  Google Scholar 

  18. Lindberg, S. M., Adams, A. K., & Prince, R. J. (2012). Early predictors of obesity and cardiovascular risk among American Indian children. Maternal and Child Health Journal, 16(9), 1879–1886. doi:10.1007/s10995-012-1024-9.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Long, C. R., & Curry, M. A. (1998). Living in two worlds: Native American women and prenatal care. Health Care for Women International, 19(3), 205–215. doi:10.1080/073993398246377.

    Article  CAS  PubMed  Google Scholar 

  20. Mamun, A. A., Mannan, M., & Doi, S. A. (2014). Gestational weight gain in relation to offspring obesity over the life course: A systematic review and bias-adjusted meta-analysis. Obesity Reviews, 15(4), 338–347. doi:10.1111/obr.12132.

    Article  CAS  PubMed  Google Scholar 

  21. Martin, J. A., Hamilton, B. E., Ventura, S. J., Osterman, M. J., & Mathews, T. J. (2013). Births: Final data for 2011. National Vital Statistics Reports, 62(1), 1–70.

    Google Scholar 

  22. National Congress of American Indians. (2015). Tribal Nations and the United States: An Introduction (p. 26). Washington, D.C.

  23. Phelan, S., Jankovitz, K., Hagobian, T., & Abrams, B. (2011). Reducing excessive gestational weight gain: Lessons from the weight control literature and avenues for future research. Womens Health (Lond Engl), 7(6), 641–661. doi:10.2217/whe.11.70.

    Article  Google Scholar 

  24. Sarche, M., & Spicer, P. (2008). Poverty and health disparities for American Indian and Alaska Native children: Current knowledge and future prospects. Annals of the New York Academy of Sciences, 1136, 126–136. doi:10.1196/annals.1425.017.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Kim, S. Y., Sharma, A. J., Sappenfield, W., Wilson, H. G., & Salihu, Hamisu M. (2014). Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age Births. Obstetrics and Gynecology, 123(4), 737–744.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Shulman, H. B., Gilbert, B. C., Msphbrenda, C. G., & Lansky, A. (2006). The pregnancy risk assessment monitoring system (PRAMS): Current methods and evaluation of 2001 response rates. Public Health Reports, 121(1), 74–83.

    PubMed Central  PubMed  Google Scholar 

  27. Norris, T., Vines., P. L., & Hoeffel, E. M. (2012). The American Indian and Alaska native population: 2010. 2010 Census Briefs: U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau.

  28. Wallace, S., & McEwan, A. (2007). Fetal macrosomia. Obstetrics, Gynaecology and Reproductive Medicine, 17(2), 58–61. doi:10.1016/j.ogrm.2006.12.010.

    Article  Google Scholar 

  29. World Health Organization. (2014, Jan. 8, 2014). BMI classification. Retrieved Dec. 27, 2013, from http://apps.who.int/bmi/index.jsp?introPage=intro_3.html.

  30. Yu, Z., Han, S., Zhu, J., Sun, X., Ji, C., & Guo, X. (2013). Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: A systematic review and meta-analysis. PLoS One, 8(4), e61627. doi:10.1371/journal.pone.0061627.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

I would like to acknowledge the entire PRAMS working group in Alaska, Minnesota, Nebraska, New Mexico, Oklahoma, Oregon, Utah, Washington, and the CDC. In particular, thank you to Paul Weiss from Emory University and Denise D’Angelo from CDC on their guidance at the start of this project.

Author information

Authors and Affiliations

  1. Emory University, Atlanta, GA, USA

    Karilynn Rockhill, Haley Dorfman, Meghna Srinath & Carol Hogue

  2. 1514 Sheridan Road, Apt. 4310, Atlanta, GA, 30324, USA

    Karilynn Rockhill

  3. 789 Hammond Drive #321, Atlanta, GA, 30328, USA

    Haley Dorfman

  4. 611 East 11th Street, Apt. 4A, New York, NY, 10009, USA

    Meghna Srinath

  5. 1513 Clifton Road NW, Atlanta, GA, 30322, USA

    Carol Hogue

Authors
  1. Karilynn Rockhill
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haley Dorfman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meghna Srinath
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carol Hogue
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karilynn Rockhill.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rockhill, K., Dorfman, H., Srinath, M. et al. The Effects of Prepregnancy Body Mass Index and Gestational Weight Gain on Fetal Macrosomia Among American Indian/Alaska Native Women. Matern Child Health J 19, 2480–2491 (2015). https://doi.org/10.1007/s10995-015-1769-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-015-1769-z

Keywords

Search

Navigation