European Journal of Obstetrics & Gynecology and Reproductive Biology
Gestational weight gain and adverse pregnancy outcomes in a nulliparous cohort
Introduction
The global obesity epidemic affecting women of reproductive age is a major contributor to adverse pregnancy outcomes [1], [2]. Excessive gestational weight gain (GWG) is reported to be a contributing factor to this obesity epidemic in women [1], [2], [3], [4], [5]. Furthermore, excessive GWG has been associated with increased rates of pregnancy complications [3], [4], [6], [7], [8], [9], [10], [11] including large for gestational age (LGA) infants [3], [4], [7], [8], [10], [12], [13], increased non-elective caesarean delivery [3], [4], [10], [12], [14], preeclampsia and gestational hypertension [3], [15]. Conversely, limiting GWG, especially in obese women, has been associated with improved pregnancy outcomes [9], [10], [12]. Inadequate GWG, on the other hand, may increase the risk of small for gestational age (SGA) infants [3], [4], [7], [8], [10], [12], [13], [16], [17]. Some of these previous studies have been retrospective [10], [11], [13], [16], [18], have used self-reported maternal height and weight [3], [7], [10], [12], [13], [18] and not adjusted GWG for gestation at delivery [7], [9], [10].
The Institute of Medicine (IOM) guidelines on GWG were developed in 1990 (prior to the obesity epidemic) to optimise birthweight and to prevent “premature births and SGA infants” [1], [5]. The guidelines were revised in 2009 to match the “dramatic shifts in the demographic and epidemiologic profile” in “U.S. women of childbearing age” [5]. At this time several publications had highlighted the relationship between excessive GWG and pregnancy complications, especially among obese women [3], [4], [5], [6], [19]. The updated guidelines reduced the recommended weight gain for obese women and increased recommended GWG ranges for underweight women [5].
Currently there are no published data regarding GWG groups and the impact of GWG on pregnancy outcome in New Zealand or Ireland and no Australian data apart from a study from a birth cohort in the 1980s [14]. The aims of this study, in participants from the Screening for Pregnancy Endpoints (SCOPE) study, were to (1) report GWG gain categories in a contemporary nulliparous cohort and (2) establish the independent relationship between GWG and rates of caesarean delivery in labour, SGA, LGA and pregnancy-induced hypertension.
Section snippets
Study design and ethics approval
The participants were healthy, nulliparous women with singleton pregnancies recruited to the SCOPE study between November 2004 and February 2011, in Cork, Ireland, Auckland, New Zealand, and Adelaide, Australia. The SCOPE study is a prospective, multicentre international screening study which aims to develop screening tests to predict preeclampsia, SGA infants and spontaneous preterm birth. Ethics approval was obtained from local ethics committees (New Zealand AKX/02/00/364, Australia REC
Results
Of the 5026 women recruited to the SCOPE study in the three participating centres 1950 were eligible for this study – 1211 from Cork, 264 from Auckland and 475 from Adelaide (Fig. 1). In the whole cohort, 55% (n = 1074) of women were of normal weight, 29% (n = 566) were overweight and 16% (n = 310) were obese. High GWG was observed in 67% (n = 724) of normal weight women, 84% (n = 476) of overweight women and 80% (n = 248) of obese women. The first and last recorded weights used to calculate gestational
Comment
Disturbingly, we found that the large majority (74.3%) of healthy nulliparous participants in this study had excessive GWG. Of further concern, and consistent with previous publications [5], [19], we also report that overweight and obese women were the most likely to have high GWG, with mean estimated GWGs of 13.77 ± 5.2 kg for overweight and 11.92 ± 8.1 kg for obese women compared with the recommended IOM optimum GWGs of 7–11 kg and 5–9 kg respectively [5]. These findings are important, as excessive
Conclusion
Approximately three-quarters of healthy nulliparous women in our study had high GWG. High GWG was associated with independent risks of caesarean in labour and LGA infants. Low GWG was associated with elevated risk of SGA infants. These adverse outcomes are potentially modifiable by achievement of normal GWG, which should be an important focus of antenatal care.
Funding
Funding for the study was received from:
New Zealand: New Enterprise Research Fund, Foundation Research Science and Technology; Health Research Council; Evelyn Bond Fund, National Women's, Auckland City Hospital; Mercia Barnes Trust, Royal Australasian and New Zealand College of Obstetricians and Gynaecologists. Australia: Premier's Science and Research Fund, South Australian Government. Ireland: Health Research Board.
Conflicts of interest
No conflict of interest disclosed.
Clinical trial registration
Australian New Zealand Clinical Trials Registry, www.anzctr.org.au, ACTRN12607000551493.
Acknowledgements
We would like to thank the pregnant women who participated in the SCOPE study, Eliza Chan for statistical assistance, Associate Professor Claire Roberts for her contributions in establishing the SCOPE study in Adelaide, Denise Healy for coordinating the Australian SCOPE study, Nicolai Murphy for coordinating the Cork SCOPE study and the SCOPE research midwives.
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On behalf of the SCOPE Consortium.