Advertisement

Prepregnancy body mass index in a first uncomplicated pregnancy and outcomes of a second pregnancy

      Objective

      This study examined the effect of body mass index (BMI) before a first uncomplicated pregnancy on maternal and fetal outcomes in a subsequent pregnancy, including preterm births, preeclampsia, cesarean delivery, small for gestational age, large for gestational age, and neonatal deaths.

      Study Design

      We conducted a population-based cohort study (n = 121,092) using the Missouri maternally linked birth registry (1989 through 2005). Multivariable binary logistic regression models were fit to estimate odds ratios and 95% confidence intervals for the parameters of interest after controlling for sociodemographic and pregnancy-related confounders in the second pregnancy.

      Results

      Compared to women with a normal BMI in their first pregnancy, those who were underweight prepregnancy had increased odds for preterm birth by 20% and small for gestational age by 40% in their second pregnancy, while those with prepregnancy obesity had increased odds for large for gestational age, preeclampsia, cesarean delivery, and neonatal deaths in their second pregnancy by 54%, 156%, 85%, and 37%, respectively.

      Conclusion

      Women starting a first pregnancy with suboptimal BMI may be at risk of adverse maternal and fetal outcomes in a subsequent pregnancy, even if their first pregnancy was uncomplicated or if they reached a normal weight by their second pregnancy. The long-term consequences of suboptimal BMI carry considerable public health implications.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Osterman M.J.K.
        • Martin J.A.
        • Curtin S.C.
        • Mathews T.J.
        • Wilson E.C.
        • Kirmeyer S.
        Newly released data from the revised US birth certificate, 2011.
        Natl Vital Stat Rep. 2013; 62: 1-22
        • Kriebs J.M.
        Obesity in pregnancy: addressing risks to improve outcomes.
        J Perinat Neonatal Nurs. 2014; 28 (quiz E31-2): 32-40
        • Han Z.
        • Mulla S.
        • Beyene J.
        • Liao G.
        • McDonald S.D.
        Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses.
        Int J Epidemiol. 2011; 40: 65-101
        • Aune D.
        • Saugstad O.D.
        • Henriksen T.
        • Tonstad S.
        Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis.
        JAMA. 2014; 311: 1536-1546
        • Gaillard R.
        • Durmus B.
        • Hofman A.
        • Mackenbach J.P.
        • Steegers E.A.
        • Jaddoe V.W.
        Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy.
        Obesity (Silver Spring). 2013; 21: 1046-1055
        • Chandler-Laney P.C.
        • Bush N.C.
        Maternal obesity, metabolic health, and prenatal programming of offspring obesity.
        Open Obes J. 2011; 3 (Available at: http://benthamopen.com/contents/pdf/TOOBESJ/TOOBESJ-3-42.pdf. Accessed July 14, 2015.): 42-50
        • Getahun D.
        • Ananth C.V.
        • Oyelese Y.
        • Chavez M.R.
        • Kirby R.S.
        • Smulian J.C.
        Primary preeclampsia in the second pregnancy: effects of changes in prepregnancy body mass index between pregnancies.
        Obstet Gynecol. 2007; 110: 1319-1325
        • Getahun D.
        • Ananth C.V.
        • Peltier M.R.
        • Salihu H.M.
        • Scorza W.E.
        Changes in prepregnancy body mass index between the first and second pregnancies and risk of large-for-gestational-age birth.
        Am J Obstet Gynecol. 2007; 196: 530.e1-530.e8
        • Getahun D.
        • Kaminsky L.M.
        • Elsasser D.A.
        • Kirby R.S.
        • Ananth C.V.
        • Vintzileos A.M.
        Changes in prepregnancy body mass index between pregnancies and risk of primary cesarean delivery.
        Am J Obstet Gynecol. 2007; 197: 376.e1-376.e7
        • Herman A.
        • McCarthy B.
        • Bakewell J.
        • et al.
        Data linkage methods used in maternally-linked birth and infant death surveillance data sets from the United States (Georgia, Missouri, Utah and Washington State), Israel, Norway, Scotland and Western Australia.
        Paediatr Perinat Epidemiol. 1997; 11: 5-22
        • Ananth C.V.
        Menstrual versus clinical estimate of gestational age dating in the United States: temporal trends and variability in indices of perinatal outcomes.
        Paediatr Perinat Epidemiol. 2007; 21: 22-30
        • Institute of Medicine, National Research Council
        Weight gain during pregnancy: reexamining the guidelines.
        National Academies Press, Washington, DC2009
      1. World Health Organization. International statistical classification of diseases and related health problems: tenth revision. Volume 2: Instructional manual. Geneva: WHO, 4th ed. 2011. Available at: http://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf. Accessed July 14, 2015.

        • Alexander G.R.
        • Kogan M.D.
        • Himes J.H.
        1994-1996 US singleton birth weight percentiles for gestational age by race, Hispanic origin, and gender.
        Matern Child Health J. 1999; 3: 225-231
        • Wilber S.T.
        • Fu R.
        Risk ratios and odds ratios for common events in cross-sectional and cohort studies.
        Acad Emerg Med. 2010; 17: 649-651
        • Cole P.
        • MacMahon B.
        Attributable risk percent in case-control studies.
        Br J Prev Soc Med. 1971; 25: 242-244
        • Benichou J.
        Biostatistics and epidemiology: measuring the risk attributable to an environmental or genetic factor.
        C R Biol. 2007; 330: 281-298
        • Mostello D.
        • Chang J.J.
        • Allen J.
        • Luehr L.
        • Shyken J.
        • Leet T.
        Recurrent preeclampsia: the effect of weight change between pregnancies.
        Obstet Gynecol. 2010; 116: 667-672
        • Whiteman V.E.
        • McIntosh C.
        • Rao K.
        • Mbah A.K.
        • Salihu H.M.
        Interpregnancy BMI change and risk of primary cesarean delivery.
        J Obstet Gynaecol. 2011; 31: 589-593
        • Chen A.
        • Klebanoff M.A.
        • Basso O.
        Pre-pregnancy body mass index change between pregnancies and preterm birth in the following pregnancy.
        Paediatr Perinat Epidemiol. 2009; 23: 207-215
        • Whiteman V.E.
        • Rao K.
        • Duan J.
        • Alio A.
        • Marty P.J.
        • Salihu H.M.
        Changes in prepregnancy body mass index between pregnancies and risk of preterm phenotypes.
        Am J Perinatol. 2011; 28: 67-74
        • Hoff G.L.
        • Cai J.
        • Okah F.A.
        • Dew P.C.
        Pre-pregnancy overweight status between successive pregnancies and pregnancy outcomes.
        J Womens Health (Larchmt). 2009; 18: 1413-1417
        • Wallace J.M.
        • Bhattacharya S.
        • Campbell D.M.
        • Horgan G.W.
        Inter-pregnancy weight change impacts placental weight and is associated with the risk of adverse pregnancy outcomes in the second pregnancy.
        BMC Pregnancy Childbirth. 2014; 14: 40
        • Villamor E.
        • Cnattingius S.
        Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study.
        Lancet. 2006; 368: 1164-1170
        • Diouf I.
        • Charles M.A.
        • Thiebaugeorges O.
        • et al.
        Maternal weight change before pregnancy in relation to birthweight and risks of adverse pregnancy outcomes.
        Eur J Epidemiol. 2011; 26: 789-796
        • Bogaerts A.
        • Van den Bergh B.R.
        • Ameye L.
        • et al.
        Interpregnancy weight change and risk for adverse perinatal outcome.
        Obstet Gynecol. 2013; 122: 999-1009
        • Jain A.P.
        • Gavard J.A.
        • Rice J.J.
        • Catanzaro R.B.
        • Artal R.
        • Hopkins S.A.
        The impact of interpregnancy weight change on birthweight in obese women.
        Am J Obstet Gynecol. 2013; 208: 205.e201-205.e207
        • Lu M.C.
        • Halfon N.
        Racial and ethnic disparities in birth outcomes: a life-course perspective.
        Matern Child Health J. 2003; 7: 13-30
        • Lu M.C.
        • Kotelchuck M.
        • Hogan V.
        • Jones L.
        • Wright K.
        • Halfon N.
        Closing the black-white gap in birth outcomes: a life-course approach.
        Ethn Dis. 2010; 20: 62-76
        • Wolf M.
        • Kettyle E.
        • Sandler L.
        • Ecker J.L.
        • Roberts J.
        • Thadhani R.
        Obesity and preeclampsia: the potential role of inflammation.
        Obstet Gynecol. 2001; 98: 757-762
        • Khong T.Y.
        • Adema E.D.
        • Erwich J.J.H.M.
        On an anatomical basis for the increase in birth weight in second and subsequent born children.
        Placenta. 2003; 24: 348-353
        • Ovesen P.
        • Rasmussen S.
        • Kesmodel U.
        Effect of prepregnancy maternal overweight and obesity on pregnancy outcome.
        Obstet Gynecol. 2011; 118: 305-312
        • McDermott J.
        • Drews C.
        • Green D.
        • Berg C.
        Evaluation of prenatal care information on birth certificates.
        Paediatr Perinat Epidemiol. 1997; 11: 105-121
        • Jurek A.M.
        • Greenland S.
        Adjusting for multiple-misclassified variables in a study using birth certificates.
        Ann Epidemiol. 2013; 23: 515-520
        • Lederman S.A.
        • Paxton A.
        Maternal reporting of prepregnancy weight and birth outcome: consistency and completeness compared with the clinical record.
        Matern Child Health J. 1998; 2: 123-126
        • Ananth C.
        • Peltier M.
        • Chavez M.
        • Kirby R.
        • Getahun D.
        • Vintzileos A.M.
        Recurrence of ischemic placental disease.
        Obstet Gynecol. 2007; 110: 128-133
        • Mathews T.J.
        • MacDorman M.F.
        Infant mortality statistics from the 2010 period linked birth/infant death data set.
        Natl Vital Stat Rep. 2013; 62: 1-26
        • Wang H.
        • Liddell C.A.
        • Coates M.M.
        • et al.
        Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.
        Lancet. 2014; 384: 957-959