Trends in maternal obesity and associated risks of adverse pregnancy outcomes in a population of Chinese women

The use of bubble charts in analyzing second stage cesarean delivery rates

BACKGROUND

The incidence of second stage cesarean delivery has been rising globally because of the failure or the anticipated difficulty of performing instrumental delivery. Yet, the best way to interpret the figure and its optimal rate remain to be determined. This is because it is strongly influenced by the practice of other 2 modes of birth, namely cesarean delivery performed before reaching the second stage and assisted vaginal birth during the second stage. In this regard, a bubble chart that can display 3-dimensional data through its x-axis, y-axis, and the size of each plot (presented as a bubble) may be a suitable method to evaluate the relationship between the rates of these 3 modes of births.

OBJECTIVE

This study aimed to conduct an epidemiologic study on the incidence of second stage cesarean deliveries rates among >300,000 singleton term births in 10 years from 8 obstetrical units and to compare their second stage cesarean delivery rates in relation to their pre-second stage cesarean delivery rates and assisted vaginal birth rates using a bubble chart.

STUDY DESIGN

The territory-wide birth data collected between 2009 and 2018 from all 8 public obstetrical units (labelled as A to H) were reviewed. The inclusion criteria were all singleton pregnancies with cephalic presentation that were delivered at term (≥37 weeks' gestation). Pre-second stage cesarean delivery rate was defined as all elective cesarean deliveries and those emergency cesarean deliveries that occurred before full cervical dilatation was achieved as a proportion of the total number of births. The second stage cesarean delivery rate and assisted vaginal birth rate were calculated according to the respective mode of delivery as a proportion of the number of cases that reached full cervical dilatation. The rates of these 3 modes of births were compared among the parity groups and among the 8 units. Using a bubble chart, each unit's second stage cesarean delivery rate (y-axis) was plotted against its pre-second stage cesarean delivery rate (x-axis) as a bubble. Each unit's second stage cesarean delivery to assisted vaginal birth ratio was represented by the size of the bubble.

RESULTS

During the study period, a total of 353,434 singleton cephalic presenting term pregnancies were delivered in the 8 units, and 180,496 (51.1%) were from nulliparous mothers. When compared with the multiparous group, the nulliparous group had a significantly lower pre-second stage cesarean delivery rate (18.58% vs 21.26%; P<.001) but a higher second stage cesarean delivery rate (0.79% vs 0.22%; P<.001) and a higher assisted vaginal birth rate (17.61% vs 3.58%; P<.001). Using the bubble of their averages as a reference point in the bubble chart, the 8 units' bubbles were clustered into 5 regions indicating their differences in practice: unit B and unit H were close to the average in the center. Unit A and unit F were at the upper right corner with a higher pre-second stage cesarean delivery rate and second stage cesarean delivery rate. Unit D and unit E were at the opposite end. Unit C was at the upper left corner with a low pre-second stage cesarean delivery rate but a high second stage cesarean delivery rate, whereas unit G was at the opposite end. Unit C and unit G were also in the extremes in terms of pre-second stage cesarean delivery to assisted vaginal birth ratio (0.09 and 0.01, respectively). Although some units seemed to have very similar second stage cesarean delivery rates, their obstetrical practices were differentiated by the bubble chart.

CONCLUSION

The second stage cesarean delivery rate must be evaluated in the context of the rates of pre-second stage cesarean delivery and assisted vaginal birth. A bubble chart is a useful method for analyzing the relationship among these 3 variables to differentiate the obstetrical practice between different units.

Lipidomics Reveals Elevated Plasmalogens in Women with Obesity Who Develop Preeclampsia

Objective: Preeclampsia (PE) is a prevalent pregnancy disorder worldwide with limited preventative treatments available. Obesity triples the risk for PE, yet only 10% of women with obesity develop PE. The factors that distinguish PE from uncomplicated pregnancies in the context of obesity have not been fully established. Methods: We studied a cohort of women with obesity throughout pregnancy to identify lipid mediators and/or biomarkers of PE. Blood samples were collected at each trimester and analyzed by both targeted lipidomics and standard lipid panels. Individual lipid species were compared by PE status at each trimester, as well as by self-identified race (Black vs. White) and fetal sex. Results: Standard lipid panels and clinical measurements revealed few differences between PE and uncomplicated pregnancies. Targeted lipidomics, however, identified plasmalogen, phosphatidylethanolamine, and free fatty acid species that were elevated in the third trimester of women with PE. Furthermore, race and trimester of pregnancy were considerable sources of plasma lipidomic variation in women with obesity. Conclusions: First and second trimester individual plasma lipid species do not predict the development of PE in obese women. In the third trimester, PE patients have elevated levels of plasmalogens-a class of lipoprotein-associated phospholipids that have been implicated in the response to oxidative stress.

Association between residential proximity to municipal solid waste incinerator sites and birth outcomes in Shanghai: a retrospective cohort study of births during 2014-2018

We tested the hypothesis of whether maternal residential proximity to municipal solid waste incinerator (MSWI) sites could significantly affect birth outcomes. This retrospective birth cohort study conducted at the International Peace Maternity and Infant Hospital, Shanghai, China, included 59,606 mothers with singleton live births during 2014-2018. Multivariate generalized linear models were used to examine associations between residential proximity to MSWI sites and birth outcomes. Small for gestational age (SGA) was significantly more common among children with maternal residential proximity to MSWI sites (odds ratio [OR]=1.20, 95% confidence interval [CI]: 1.07-1.34). Maternal prepregnancy body mass index (BMI) influenced this association. Infants of underweight mothers (prepregnancy BMI <18.5 kg/m2) with MSWI exposure (OR=2.00, 95% CI: 1.58-2.52) had higher risks of SGA than their counterparts. Our findings underscore the need to prevent adverse environmental effects of MSWI on birth outcomes; improved exposure assessment measures are warranted in future studies.

Placental Growth Factor in First Trimester of Pregnancy for Prediction of Maternal and Perinatal Adverse Outcomes

Purpose of the study

Placental growth factor (PLGF) is an angiogenic factor in pregnancy. To find out correlation of plasma levels of placental growth factor in first trimester of pregnancy in Indian women who develop maternal and perinatal adverse outcomes was the aim of the study.

Methods

A prospective longitudinal noninterventional study was done in the department of Obstetrics and Gynecology after obtaining ethics approval. After enrolling patients in the first trimester (11 weeks to 13 weeks 6 days), a questionnaire was filled for demographic characteristics. Uterine artery doppler was done for every patient and blood sample (5 ml) was taken by venu puncture of median cubital vein. Serum levels of PLGF were measured by enzyme linked immunosorbent assay using Thermo Scientific Pierce Human PLGF kit (Thermo Fisher Scientific, Inc., Waltham, MA, USA). Patients were followed for their whole antenatal period and delivery outcomes.

Results

Incidence of preeclampsia in our study was 9.3% (15/161) and fetal growth restriction (FGR) was 19.8% (32/161). Neither BMI nor nulliparity was found to have statistically significant correlation with development of preeclampsia. However, history of preeclampsia was found to be significant risk factor for prediction of preeclampsia (p value < 0.04). Plasma levels of PLGF were significantly lower in preeclampsia and FGR group and this difference was statistically significant (p value < 0.04). 7.5% still born occurred in complicated group and 10% needed NNU/NICU admission in this group.

Conclusion

Measuring PLGF levels in first trimester of pregnancy can help in prediction of preeclampsia and FGR.

Development of a prediction model on preeclampsia using machine learning-based method: a retrospective cohort study in China

Objective: The aim of this study was to use machine learning methods to analyze all available clinical and laboratory data obtained during prenatal screening in early pregnancy to develop predictive models in preeclampsia (PE).

Material and Methods: Data were collected by retrospective medical records review. This study used 5 machine learning algorithms to predict the PE: deep neural network (DNN), logistic regression (LR), support vector machine (SVM), decision tree (DT), and random forest (RF). Our model incorporated 18 variables including maternal characteristics, medical history, prenatal laboratory results, and ultrasound results. The area under the receiver operating curve (AUROC), calibration and discrimination were evaluated by cross-validation.

Results: Compared with other prediction algorithms, the RF model showed the highest accuracy rate. The AUROC of RF model was 0.86 (95% CI 0.80–0.92), the accuracy was 0.74 (95% CI 0.74–0.75), the precision was 0.82 (95% CI 0.79–0.84), the recall rate was 0.42 (95% CI 0.41–0.44), and Brier score was 0.17 (95% CI 0.17–0.17).

Conclusion: The machine learning method in our study automatically identified a set of important predictive features, and produced high predictive performance on the risk of PE from the early pregnancy information.

Does Maternal Obesity Affect Preterm Birth? Documentary Cohort Study of Preterm in Firstborns—Silesia (Poland)

In addition to low birth weight and intrauterine growth restriction, prematurity is a major problem in modern neonatology. The etiology of premature delivery is multifactorial, but maternal obesity has been indicated as an important risk factor for preterm birth. This study aimed to assess the relationship between early pregnancy body mass index (BMI) and the risk of preterm delivery according to gestational age. In the cohort of 2794 firstborns, preterm deliveries accounted for 9.1%. Of all deliveries, 16, 48, and 189 were classified as extremely preterm, very preterm, and moderately preterm deliveries, respectively. The risk of extremely, very, and moderately preterm deliveries increased with the increasing BMI, with the highest overweight and obesity-related risk for extremely and very preterm delivery. The rate of extremely and very preterm delivery among normal-weight women (BMI 18.5 ≤ 25) was 1.8%, while that among overweight and obese women (BMI ≥ 25) was 2.36%. The rate of all preterm deliveries (22 ≤ 37 weeks) was 8% for normal-weight women and 10.3% for overweight and obese women. Compared with normal-weight women, the adjusted odds ratio (95% CI) for preterm delivery in overweight and obese women was 1.33 (0.98–1.79). In Poland, being overweight and obese during pregnancy was associated with an increased risk of preterm delivery, especially extremely and very preterm delivery. This relationship should be assessed in other populations.

Effects of breastfeeding on postpartum weight change in Japanese women: The Japan Environment and Children’s Study (JECS)

Aim

The aim of this study was to examine the relationship between breastfeeding and postpartum maternal weight change.

Method

This study used data from the Japan Environment and Children’s Study (JECS), an ongoing nationwide birth cohort study. Participants were categorized into two groups: full breastfeeding (FB) and non-full breastfeeding (NFB) groups. Postpartum weight changes between the FB (n = 26,340) and NFB (n = 38,129) groups were compared.

Results

At 6 months postpartum, mean weight retention was significantly lower in the FB group than in the NFB group (0.2 vs 0.8 kg, respectively, p<0.001). Weight retention differed by pre-pregnancy body mass index (BMI), with postpartum weights of overweight (pre-pregnancy BMI 25.0–29.9) and obese (pre-pregnancy BMI ≥30.0) participants being lower than pre-pregnancy weight; this trend was more pronounced in the FB group than in the NFB group (overweight: −2.2 vs −0.7 kg, respectively; obese: −4.8 vs −3.4 kg, respectively). Factors affecting weight retention at 6 months postpartum were weight gain during pregnancy (β = 0.43; p<0.001), pre-pregnancy BMI (β = −0.147; p<0.001) and feeding method. FB resulted in lower weight retention than NFB (β = −0.107; p<0.001).

Conclusion

Breastfeeding reduced maternal weight retention, which was greater in mothers who were obese before pregnancy. For obese women, active breastfeeding may improve their health.

Impact of Maternal Body Mass Index on Maternal and Neonatal Outcomes Among Sudanese Women

Background: Unhealthy weight has an adverse impact on a person’s general health, this is more serious for pregnant a woman as it can affect her baby as well. Nutrition is an important element of antenatal care. Nutrition must be optimum to avoid problems of being underweight, and that of overweight. This study aims to assess the impact of maternal body mass index on maternal and neonatal outcomes among Sudanese women.

Methods: A cross-sectional study was carried out at Saad Abu El Ella Hospital and Soba University Hospital in December 2017. The maternal weight and height were measured for 159 women to calculate BMI. The impact of maternal BMI on maternal and neonatal outcomes was tested using the chi-square test and logistic regression. P-value = or <0.05 was considered as statistically significant.

Results: Fourty-two (26.4%) of studied women were of normal weight, two (1.3%) were underweight, 61 (38.4%) were overweight and 54 (33.9%) were obese. Increasing parity was associated with higher BMI, this was more significant among the obese group with an odds ratio of 3.1 (95% CI = 1.099-8.866, p=0.033). There was a relative increase in the risk of delivery by caesarean section among the obese group with an odds ratio of 1.7 (95% CI =1.079-2.737, p=0.023). No significant association between maternal BMI and preterm or post-term delivery was found. The incidence of macrosomia was more among overweight and obese mothers. There was no association found between maternal BMI and low birth weight, admission of the baby to neonatal intensive care unit (NICU), or low Apgar score at 5 minutes.

Conclusion: This study shows a high incidence of being overweight among Sudanese pregnant ladies. Increased risk of caesarean section as maternal BMI increases. Overweight and obese mothers are more likely to have macrosomic babies.

Macrosomia and large for gestational age in Asia: One size does not fit all

Macrosomia, usually defined as infant birth weight of ≥4000 g, does not consider gestational age, sex, or country/region-specific differences in mean birth weight and maternal body weight. This issue is particularly relevant for Asia, where 60% of the world's population lives, due to variations in maternal size and birth weights across populations. Large for gestational age (LGA), defined as birth weight > 90th centile, is a more sensitive measure as it considers gestational age and sex, though it is dependent on the choice of growth charts. We aimed to review reporting of macrosomia and LGA in Asia. We reviewed the literature on prevalence and risk of macrosomia and LGA in Asia over the last 29 years. Prevalence of macrosomia ranged from 0.5% (India) to 13.9% (China) while prevalence of LGA ranged from 4.3% (Korea) to 22.1% (China), indicating substantial variation in prevalence within and between Asian countries. High pre-pregnancy body mass index, excessive gestational weight gain, and impaired glucose tolerance conferred risk of macrosomia/LGA. Incidence of macrosomia and LGA varies substantially within and between Asian countries, as do the growth charts and definitions. The latter makes it impossible to make comparisons but suggests differences in intrauterine growth between populations. Reporting LGA, using standardized country/regional growth charts, would better capture the incidence of high birth weight and allow for comparison and identification of contributing factors. Better understanding of local drivers of excessive intrauterine growth could enable development of improved strategies for prevention and management of LGA.

Reduced mechanical function of the left atrial predicts adverse outcome in pregnant women with clustering of metabolic risk factors

INTRODUCTION

The left atrial (LA) strain and strain rate are sensitive indicators of LA function. However, they are not widely used for the evaluation of pregnant women with metabolic diseases. The aim of this study was to assess the LA strain and strain rate of pregnant women with clustering of metabolic risk factors and to explore its prognostic effect on adverse pregnancy outcomes.

MATERIALS AND METHODS

Sixty-three pregnant women with a clustering of metabolic risk factors (CMR group), fifty-seven women with pregnancy-induced hypertension (PIH group), fifty-seven women with gestational diabetes mellitus (GDM group), and fifty matched healthy pregnant women (control group) were retrospectively evaluated. LA function was evaluated with two-dimensional speckle-tracking imaging. Iatrogenic preterm delivery caused by severe preeclampsia, placental abruption, and fetal distress was regarded as the primary adverse outcome.

RESULTS

The CMR group showed the lowest LA strain during reservoir phase (LASr), strain during contraction phase (LASct) and peak strain rate during conduit phase (pLASRcd) among the three groups (P < 0.05). LA strain during conduit phase (LAScd) and peak strain rate during reservoir phase (pLASRr) in the CMR group were lower than those in the control and GDM groups (P < 0.05). Multivariable Cox regression analysis demonstrated systolic blood pressure (HR = 1.03, 95% CI 1.01-1.05, p = 0.001) and LASr (HR = 0.86, 95% CI 0.80-0.92, p < 0.0001) to be independent predictors of iatrogenic preterm delivery. An LASr cutoff value ≤ 38.35% predicted the occurrence of iatrogenic preterm delivery.

CONCLUSIONS

LA mechanical function in pregnant women with metabolic aggregation is deteriorated. An LASr value of 38.35% or less may indicate the occurrence of adverse pregnancy outcomes.

The factors affecting the physical development of neonates in pregnant women with or without gestational diabetes mellitus

OBJECTIVES

To explore the factors affecting neonatal physical development in pregnant women with or without gestational diabetes mellitus (GDM).

METHODS

The subjects were selected from the pregnant woman giving birth in 2nd Affiliated Hospital of Zhengzhou University, from November 2015 to May 2016. The age, occupation, education level, gestational age, body weight before pregnancy, body weight at delivery, body height, delivery pattern, GDM status of pregnant women and neonatal gender, birth weight (BW), chest circumference (CC), head circumference (HC) and birth length (BL) were collected through medical records and questionnaires. The clinical data were retrospectively analyzed and studied.

RESULTS

The significant differences were found between women with GDM and without GDM in following neonatal variables (P<0.05): BW, CC, and HC. GDM status increased the incidence of macrosomia (OR = 2.241, 95% CI: 1.406-3.573), large CC (OR = 2.470, 95% CI: 1.687-3.6153). Gestational weight gain (GWG) above IOM guideline was risk factor for macrosomia (OR = 1.763, 95% CI:1.098-2.833), large HC (OR = 1,584, 95% CI: 1.093-2.296) and large CC (OR = 1.707, 95% CI:1.163-2.506). Underweight was risk factor for short BL (OR = 2.543, 95% CI:1.161-5.571) and small CC (OR = 1.901, 95% CI:1.064-3.394). Female neonate was prone to appear short BL(OR = 2.831, 95% CI: 1.478-5.422) and small HC (OR = 2.750, 95% CI: 1.413-5.350), and not likely to macrosomia (OR = 0.538, 95% CI: 0.343-0.843), longer BL (OR = 0.584, 95% CI: 0.401-0.850), large HC (OR = 0.501, 95% CI: 0.352-0.713), and (OR = 0.640, 95% CI: 0.446-0.917). For women with GDM, gestational age was an risk factor of neonatal BW (low BW: OR = 0.207, 95% CI: 0.085-0.503; macrosomia: OR = 1.637, 95% CI: 1.177-2.276), BL (short BL: OR = 0.376, 95% CI: 0.241-0.585; long BL: OR = 1.422, 95% CI: 1.054-1.919), HC (small HC: OR = 0.343, 95% CI: 0.202-0.583; large HC: OR = 1.399, 95% CI: 1.063-1.842) and CC (small CC: OR = 0.524, 95% CI: 0.374-0.733; large CC: OR = 1.485, 95% CI: 1.138-1.936).

CONCLUSIONS

In our study, gestational age, GDM status, neonatal gender, GWG and pre-pregnancy body mass index (BMI) are associated the abnormal physical development of neonates. In women with GDM, gestational age was correlate with neonatal abnormal physical developments.

Amniotic fluid index curves in the obese gravida

OBJECTIVE

To determine whether amniotic fluid volume as measured by amniotic fluid index (AFI) is influenced by maternal pre-gestational obesity as measured by body mass index (BMI).

METHODS

This was a retrospective cohort study of pregnant women between 20 and 43 weeks gestation receiving ultrasounds with AFI measurements at Augusta University Medical Center between 2003 and 2017. A subset of 500 charts that met inclusion and exclusion criteria were reviewed to obtain maternal clinical data. The study cohort was subdivided by maternal BMI at initial obstetric visit into three groups: normal weight (18.5 kg/m2-24.9 kg/m2), overweight (25.0 kg/m2-29.9 kg/m2), and obese (≥ 30 kg/m2). Chi-square analysis was used to compare BMI groups in terms of categorical clinical characteristics and outcome variables, and analysis of variance (ANOVA) was used for continuous variables. Mixed effects regression models (MRMs) were used to evaluate AFI throughout gestation separately in each group, and MRM-based analysis of covariance was used to compare AFI throughout gestation among groups. AFI curves were constructed for the 5th, 50th, and 95th percentiles for all study subjects combined and separately for normal weight, overweight, and obese subjects.

RESULTS

Fitted curves relating AFI percentiles to estimated gestational age (EGA) showed statistically significant differences among BMI groups. There was also a significant difference in AFI over gestation across the obesity groups.

CONCLUSION

Fitted curves for AFI throughout pregnancy showed statistically significant differences among BMI groups.

Association of Maternal Body Mass Index With Risk of Infant Mortality: A Dose-Response Meta-Analysis

Objective: This study presumed that a high or low body mass index (BMI) might increase the risk of infant mortality. Therefore, a meta-analysis was performed to systematically assess the association between maternal BMI and the risk of infant mortality. Methods: The electronic databases, including Pubmed, Embase database, and Cochrane Library, were systemically searched by two investigators from inception to November 26th, 2020, with no language restriction. In parallel, a dose-response was assessed. Results: Finally, 22 cohort studies involving 13,532,293 participants were included into this paper, which showed that compared with normal BMI, maternal overweight significantly increased the risks of infant mortality [risk ratio (RR), 1.16; 95% confidence interval (CI), 1.13-1.19], neonatal mortality (RR, 1.23; 95% CI, 1.08-1.39), early neonatal mortality (RR, 1.55; 95% CI, 1.26-1.92) and post-neonatal mortality (RR, 1.18; 95% CI, 1.07-1.29). Similarly, maternal obesity significantly increased the risk of infant mortality (RR, 1.55; 95% CI, 1.41-1.70), neonatal mortality (RR, 1.55; 95% CI, 1.28-1.67), early neonatal mortality (RR, 1.37; 95% CI, 1.13-1.67), and post-neonatal mortality (RR, 1.30; 95% CI, 1.03-1.65), whereas maternal underweight potentially decreased the risk of infant mortality (RR, 0.93; 95% CI, 0.88-0.98). In the dose-response analysis, the risk of infant mortality significantly increased when the maternal BMI was >25 kg/m². Conclusions: Maternal overweight or obesity significantly increases the risks of infant mortality, neonatal mortality, early neonatal mortality, and post-neonatal mortality compared with normal BMI in a dose-dependent manner. Besides, maternal underweight will not increase the risk of infant mortality, neonatal mortality, early neonatal mortality, or postneonatal mortality; instead, it tends to decrease the risk of infant mortality. Early weight management may provide potential benefits to infants, and more large-scale prospective studies are needed to verify this finding in the future.

Incidence and trend of preterm birth in China, 1990-2016: a systematic review and meta-analysis

OBJECTIVES

To update the WHO estimate of preterm birth rate in China in 1990-2016 and to further explore variations by geographic regions and years of occurrence.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Pubmed, Embase, Cochrane Library and Sinomed databases were searched from 1990 to 2018.

ELIGIBILITY CRITERIA

Studies were included if they provided preterm birth data with at least 500 total births. Reviews, case-control studies, intervention studies and studies with insufficient information or published before 1990 were excluded. We estimated pooled incidence of preterm birth by a random effects model, and preterm birth rate in different year, region and by livebirths or all births in subgroup analyses.

RESULTS

Our search identified 3945 records. After the removal of duplicates and screening of titles and abstracts, we reviewed 254 studies in full text and excluded 182, leaving 72 new studies. They were combined with the 82 studies included in the WHO report (154 studies, 187 data sets in total for the meta-analysis), including 24 039 084 births from 1990 to 2016. The pooled incidence of preterm birth in China was 6.09% (95% CI 5.86% to 6.31%) but has been steadily increasing from 5.36% (95% CI 4.89% to 5.84%) in 1990-1994 to 7.04% (95% CI 6.09% to 7.99%) in 2015-2016. The annual rate of increase was about 1.05% (95% CI 0.85% to 1.21%). Northwest China appeared to have the highest preterm birth rate (7.3%, 95% CI 4.92% to 9.68% from 1990 to 2016).

CONCLUSIONS

The incidence of preterm birth in China has been rising gradually in the past three decades. It was 7% in 2016. Preterm birth rate varied by region with the West having the highest occurrence.

Association between maternal prepregnancy body mass index and risk of preterm birth in more than 1 million Asian American mothers

BACKGROUND

Asian Americans are among the fastest growing subpopulations in the United States. However, evidence about maternal prepregnancy body mass index (BMI) and preterm birth among Asian Americans is lacking.

METHODS

This population-based study used nationwide birth certificate data from the US National Vital Statistics System 2014 to 2018. All Asian American mothers who had a singleton live birth were included. According to Asian-specific cutoffs, maternal prepregnancy BMI was classified into underweight (BMI < 18.5 kg/m2 ), normal weight (BMI 18.5-22.9 kg/m2 ), overweight (BMI 23.0-27.4 kg/m2 ), class I obesity (BMI 27.5-32.4 kg/m2 ), class II obesity (BMI 32.5-37.4 kg/m2 ), and class III obesity (BMI ≥37.5 kg/m2 ). Preterm birth was defined as gestational age less than 37 weeks. Multivariable logistic regression models were used to estimate the odds ratio (OR) of preterm birth.

RESULTS

We included 1 081 341 Asian American mother-infant pairs. The rate of preterm birth was 6.51% (n = 70 434). The rate of maternal prepregnancy overweight and obesity was 46.80% (n = 506 042). Compared with mothers with normal weight, the adjusted OR of preterm delivery was 1.04 (95% CI, 1.01-1.07) for underweight mothers, 1.18 (95% CI, 1.16-1.20) for overweight mothers, 1.41 (95% CI, 1.37-1.44) for mothers with class I obesity, 1.69 (95% CI, 1.63-1.76) for mothers with class II obesity, and 1.78 (95% CI, 1.66-1.90) for mothers with class III obesity. Similar patterns of associations were observed in Asian American mothers across different country origins.

CONCLUSIONS

Among Asian American mothers, maternal prepregnancy overweight or obesity, defined by Asian-specific, lower BMI cutoffs, was significantly associated with an increased risk of preterm birth. The risk of preterm birth increased with increasing obesity severity. These findings highlight the importance of using Asian-specific BMI cutoffs in assessing risk of preterm birth among Asian American mothers.

Associations of maternal hyperglycemia in the second and third trimesters of pregnancy with prematurity

Hyperglycemia in pregnancy (HIP) is related to adverse pregnancy outcomes. However, women with hyperglycemia in the second and third trimester of pregnancy (HISTTP) were not been observed. We aim to reveal associations between HISTTP and prematurity. To confirm which risk factor is better in predicting preterm delivery.This retrospective study included 660 patients, of which 132 have HISTTP and 528 have euglycemia. Univariate analysis was used to extract risk factors and multivariates logistic regression analysis to obtain odds ratio (OR) for prematurity. Mean decrease gini (MDG) in random forest algorithm was used to rank the risk factors.HISTTP women have higher prepregnancy BMI and a higher percentage of family history of hypertension, maternal adiposity, maternal anemia, gestational diabetes mellitus (GDM), prematurity, neonatal asphyxia in 1-minute (P < .05). Univariate analysis of prematurity showed that preterm women had higher rate of HISTTP (P < .01), second births, elderly pregnancy, hypertention, family history of hypertention and multiple perinatal infant (P < .05). Multivariate logistic regression analysis indicates that HISTTP (OR = 2.984, P = .0017), maternal hypertension (OR = 5.208, P = .001) and multiple perinatal infants (OR = 59.815, P < .0001) are independent risk factors for prematurity. After ranked the MDG, the top 3 risk factors were multiple perinatal infants, maternal hypertension, HISTTP. MDG of HISTTP is higher than that of GDM.Women with HISTTP deserve to be concerned, whose prematurity rate are increased. HISTTP is an independent risk factor and a better predictor of prematurity.

Birth weight and prematurity with lung function at ~17.5 years: "Children of 1997" birth cohort

We aimed to determine if prematurity and lower birth weight are associated with poorer lung function in a non-western developed setting with less marked confounding by socioeconomic position. Using multivariable linear regression in Hong Kong’s “Children of 1997” birth cohort, adjusted associations of prematurity and birth weight with forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), and forced expiratory flow at 25–75% of the pulmonary volume (FEF_25–75%) at ~17.5 years were assessed. Associations for birth weight were stronger in boys for FEV₁ (boys: 0.31 L, 95% confidence interval (CI) 0.24 to 0.38, girls: 0.18 L, 95% CI 0.12 to 0.25), FVC (boys: 0.36 L, 95% CI 0.27 to 0.44, girls: 0.22 L, 95% CI 0.15 to 0.28) and FEF_25–75% (boys: 0.35 L, 95% CI 0.21 to 0.49, girls: 0.22 L, 95% CI 0.09 to 0.34) adjusted for age, socioeconomic position and infant and maternal characteristics. Similarly adjusted, preterm birth (compared to full-term birth) was associated with lower FEV₁/FVC and FEF_25–75%. Thus, associations of lower birth weight, especially in boys, and prematurity with poorer lung function at 17.5 years were found. Identifying underlying mechanism might contribute to the improvement of pulmonary health and the prevention of adult respiratory illness.

Maternal Obesity and Pregnancy Outcome: in Perspective of New Asian Indian Guidelines

Background

Prevalence of obesity among women of reproductive age is increasing worldwide. As the prevalence increases among the women of reproductive age group, so it does among pregnant females. This study was conducted with the aim to assess obesity-related adverse maternal, neonatal and perinatal outcomes using new Asian Indian guidelines.

Methodology

Pregnant women up to 16-week gestation on first visit were enrolled. There were two exposure groups: one with BMI < 25 kg/m² and second with BMI ≥ 25 kg/m² matched for maternal age and parity, 100 in each group. The study focused on development of various adverse maternal and foetal/perinatal complications. Comparative analysis of data was done to estimate the odds of each outcome taking non-obese group as reference.

Results

There was a significant increase in risk among obese mothers compared to non-obese mothers for maternal complications like hypertensive disorders of pregnancy{OR 3.83}, preeclampsia{OR 9.2}, gestational diabetes mellitus{OR 4.85} and insulin requirement{OR 12.46}, induction of labour{OR 2.71}, caesarean section post induction{OR 8.50}, prolonged labour{OR 4.69}, caesarean sections{OR 5.18} and postpartum haemorrhage{OR 2.21}. Also, there was a significant increase in risk among obese mothers compared to non-obese mothers for foetal and perinatal complications like miscarriages{OR 4.85}, preterm newborns{OR 4.63}, medically indicated preterm{OR 6.59}, shoulder dystocia{OR could not be calculated}, large for gestational age{OR 5.91}, hyperbilirubinaemia {OR 4.26} and neonatal intensive care unit admissions{OR 3.26}.

Conclusion

It was concluded that obesity defined by Asian Indian guidelines (BMI ≥ 25 kg/m²) is associated with adverse pregnancy outcomes at odds comparable to western studies with obesity taken as BMI ≥ 30 kg/m².

Prepregnancy Overweight and Obesity Are Associated with an Increased Risk of Preterm Birth in Chinese Women

INTRODUCTION

The association between obesity before pregnancy and preterm birth varies with age and ethnicity.

OBJECTIVE

To study the association between early body mass index (BMI) and risk of preterm birth in Chinese women.

METHODS

This was a hospital-based retrospective cohort study including 36,596 Chinese women who gave birth to a live singleton infant from 2015 to 2018. Women were classified as underweight (BMI <18.5), normal weight (BMI 18.5 to <23), overweight (BMI 23 to <27.5), or obese (BMI ≥27.5) according to the most recent criteria for Asian women. Multivariate log-binomial regression models were used to estimate the relative risks (RRs) and 95% confidence intervals (95% CIs) for preterm birth among different groups.

RESULTS

Compared to women with normal weight, women with overweight or obesity before pregnancy had an increased risk of preterm birth; the RRs and 95% CIs were 1.22 (95% CI: 1.08-1.37) and 1.30 (95% CI: 1.01-1.69), respectively. The greatest risk of extremely preterm birth was observed in obese women. The estimators were robust when considering the maternal age and rate of gestational weight gain (GWG) during pregnancy.

CONCLUSIONS

Women with overweight and obesity had an increased risk of preterm birth regardless of GWG in early pregnancy. Our study suggests that it is beneficial to lose weight before conception for both overweight and obese women who plan to become pregnant.

Obesity And Obstetric Anesthesia: Current Insights

Obesity is a significant global health problem. It results in a higher incidence of complications for pregnant women and their neonates. Cesarean deliveries are more common in obese parturients as well. The increased burden of comorbidities seen in this population, such as obstructive sleep apnea, necessitates antepartum anesthetic consultation. These patients pose unique challenges for the practicing anesthesiologist and may benefit from optimization prior to delivery. Complications from anesthesia and overall morbidity and mortality are higher in this population. Neuraxial anesthesia can be challenging to place in the obese parturient, but is the preferred anesthetic for cesarean delivery to avoid airway manipulation, minimize aspiration risk, prevent fetal exposure to volatile anesthetic, and decrease risk of post-partum hemorrhage from volatile anesthetic exposure. Monitoring and positioning of these patients for surgery may pose specific challenges. Functional labor epidural catheters can be topped up to provide conditions suitable for surgery. In the absence of a working epidural catheter, a combined spinal epidural anesthetic is often the technique of choice due to relative ease of placement versus a single shot spinal technique as well as the ability to extend the anesthetic through the epidural portion. For cesarean delivery with a vertical supraumbilical skin incision, a two-catheter technique may be beneficial. Concern for thromboembolism necessitates early mobilization and a multimodal analgesic regimen can help accomplish this. In addition, thromboprophylaxis is recommended in this population after delivery—especially cesarean delivery. These patients also need close monitoring in the post-partum period when they are at increased risk for several complications.

Pregnancy-Related ICU Admissions From 2008 to 2016 in China: A First Multicenter Report

Objectives:

To identify the key points for improving severe maternal morbidity by analyzing pregnancy-related ICU admissions in Beijing.

Design:

This was a retrospective, multicenter cohort study.

Setting:

Three ICUs in tertiary hospitals in Beijing.

Patients:

A total of 491 severe maternal cases in any trimester of pregnancy or within 42 days of delivery were reviewed between January 1, 2008, and December 31, 2016.

Interventions:

None.

Measurements and Main Results:

Among 491 obstetric ICU admissions (median Sequential Organ Failure Assessment score, 2) out of 87,850 hospital deliveries (a frequency of 5.6 admissions per 1,000 deliveries), the leading diagnoses were postpartum hemorrhage (170; 34.62%), hypertensive disorders of pregnancy (156; 31.77%), and cardio-cerebrovascular diseases (78; 15.9%). Comparing 2008–2011 to 2012–2016, the rates of maternal mortality (2.5% vs 1.9%; p = 0.991) and fetal loss (8.5% vs 8.6%; p = 0.977) did not decrease significantly, whereas the rates of ICU admission (3.05% vs 7.85%; p trends < 0.001) and postpartum hemorrhage (23% vs 38.5%; p = 0.002) increased. Hypertensive disorder (150/156; 96.2% transferred to the ICU postpartum, 24/28 women with fetal loss transferred from lower-level hospitals) was an independent maternal factor associated with fetal loss, and infections were the leading cause of maternal death (6/10) in the ICU.

Conclusions:

Our study highlights the increasing rate of intensive care admissions for postpartum hemorrhage. Improving prenatal care quality for pregnancy-induced hypertension and sepsis at lower-level hospitals may improve maternal and fetal outcomes. Specifically, providing more effective regional cooperation before transfer and shifting patients who require continuous surveillance but not necessarily intensive care to a transitional ward in a tertiary hospital would provide more ICU beds for more prenatal intensive care for the most complex medical conditions.

The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention

Pre‐eclampsia (PE) is a multisystem disorder that typically affects 2%–5% of pregnant women and is one of the leading causes of maternal and perinatal morbidity and mortality, especially when the condition is of early onset. Globally, 76 000 women and 500 000 babies die each year from this disorder. Furthermore, women in low‐resource countries are at a higher risk of developing PE compared with those in high‐resource countries. Although a complete understanding of the pathogenesis of PE remains unclear, the current theory suggests a two‐stage process. The first stage is caused by shallow invasion of the trophoblast, resulting in inadequate remodeling of the spiral arteries. This is presumed to lead to the second stage, which involves the maternal response to endothelial dysfunction and imbalance between angiogenic and antiangiogenic factors, resulting in the clinical features of the disorder. Accurate prediction and uniform prevention continue to elude us. The quest to effectively predict PE in the first trimester of pregnancy is fueled by the desire to identify women who are at high risk of developing PE, so that necessary measures can be initiated early enough to improve placentation and thus prevent or at least reduce the frequency of its occurrence. Furthermore, identification of an “at risk” group will allow tailored prenatal surveillance to anticipate and recognize the onset of the clinical syndrome and manage it promptly. PE has been previously defined as the onset of hypertension accompanied by significant proteinuria after 20 weeks of gestation. Recently, the definition of PE has been broadened. Now the internationally agreed definition of PE is the one proposed by the International Society for the Study of Hypertension in Pregnancy (ISSHP). According to the ISSHP, PE is defined as systolic blood pressure at ≥140 mm Hg and/or diastolic blood pressure at ≥90 mm Hg on at least two occasions measured 4 hours apart in previously normotensive women and is accompanied by one or more of the following new‐onset conditions at or after 20 weeks of gestation: 1.Proteinuria (i.e. ≥30 mg/mol protein:creatinine ratio; ≥300 mg/24 hour; or ≥2 + dipstick); 2.Evidence of other maternal organ dysfunction, including: acute kidney injury (creatinine ≥90 μmol/L; 1 mg/dL); liver involvement (elevated transaminases, e.g. alanine aminotransferase or aspartate aminotransferase >40 IU/L) with or without right upper quadrant or epigastric abdominal pain; neurological complications (e.g. eclampsia, altered mental status, blindness, stroke, clonus, severe headaches, and persistent visual scotomata); or hematological complications (thrombocytopenia–platelet count <150 000/μL, disseminated intravascular coagulation, hemolysis); or 3.Uteroplacental dysfunction (such as fetal growth restriction, abnormal umbilical artery Doppler waveform analysis, or stillbirth). It is well established that a number of maternal risk factors are associated with the development of PE: advanced maternal age; nulliparity; previous history of PE; short and long interpregnancy interval; use of assisted reproductive technologies; family history of PE; obesity; Afro‐Caribbean and South Asian racial origin; co‐morbid medical conditions including hyperglycemia in pregnancy; pre‐existing chronic hypertension; renal disease; and autoimmune diseases, such as systemic lupus erythematosus and antiphospholipid syndrome. These risk factors have been described by various professional organizations for the identification of women at risk of PE; however, this approach to screening is inadequate for effective prediction of PE. PE can be subclassified into: 1.Early‐onset PE (with delivery at <34+0 weeks of gestation); 2.Preterm PE (with delivery at <37+0 weeks of gestation); 3.Late‐onset PE (with delivery at ≥34+0 weeks of gestation); 4.Term PE (with delivery at ≥37+0 weeks of gestation). These subclassifications are not mutually exclusive. Early‐onset PE is associated with a much higher risk of short‐ and long‐term maternal and perinatal morbidity and mortality. Obstetricians managing women with preterm PE are faced with the challenge of balancing the need to achieve fetal maturation in utero with the risks to the mother and fetus of continuing the pregnancy longer. These risks include progression to eclampsia, development of placental abruption and HELLP (hemolysis, elevated liver enzyme, low platelet) syndrome. On the other hand, preterm delivery is associated with higher infant mortality rates and increased morbidity resulting from small for gestational age (SGA), thrombocytopenia, bronchopulmonary dysplasia, cerebral palsy, and an increased risk of various chronic diseases in adult life, particularly type 2 diabetes, cardiovascular disease, and obesity. Women who have experienced PE may also face additional health problems in later life, as the condition is associated with an increased risk of death from future cardiovascular disease, hypertension, stroke, renal impairment, metabolic syndrome, and diabetes. The life expectancy of women who developed preterm PE is reduced on average by 10 years. There is also significant impact on the infants in the long term, such as increased risks of insulin resistance, diabetes mellitus, coronary artery disease, and hypertension in infants born to pre‐eclamptic women. The International Federation of Gynecology and Obstetrics (FIGO) brought together international experts to discuss and evaluate current knowledge on PE and develop a document to frame the issues and suggest key actions to address the health burden posed by PE. FIGO's objectives, as outlined in this document, are: (1) To raise awareness of the links between PE and poor maternal and perinatal outcomes, as well as to the future health risks to mother and offspring, and demand a clearly defined global health agenda to tackle this issue; and (2) To create a consensus document that provides guidance for the first‐trimester screening and prevention of preterm PE, and to disseminate and encourage its use. Based on high‐quality evidence, the document outlines current global standards for the first‐trimester screening and prevention of preterm PE, which is in line with FIGO good clinical practice advice on first trimester screening and prevention of pre‐eclampsia in singleton pregnancy.1 It provides both the best and the most pragmatic recommendations according to the level of acceptability, feasibility, and ease of implementation that have the potential to produce the most significant impact in different resource settings. Suggestions are provided for a variety of different regional and resource settings based on their financial, human, and infrastructure resources, as well as for research priorities to bridge the current knowledge and evidence gap. To deal with the issue of PE, FIGO recommends the following: Public health focus: There should be greater international attention given to PE and to the links between maternal health and noncommunicable diseases (NCDs) on the Sustainable Developmental Goals agenda. Public health measures to increase awareness, access, affordability, and acceptance of preconception counselling, and prenatal and postnatal services for women of reproductive age should be prioritized. Greater efforts are required to raise awareness of the benefits of early prenatal visits targeted at reproductive‐aged women, particularly in low‐resource countries. Universal screening: All pregnant women should be screened for preterm PE during early pregnancy by the first‐trimester combined test with maternal risk factors and biomarkers as a one‐step procedure. The risk calculator is available free of charge at https://fetalmedicine.org/research/assess/preeclampsia. FIGO encourages all countries and its member associations to adopt and promote strategies to ensure this. The best combined test is one that includes maternal risk factors, measurements of mean arterial pressure (MAP), serum placental growth factor (PLGF), and uterine artery pulsatility index (UTPI). Where it is not possible to measure PLGF and/or UTPI, the baseline screening test should be a combination of maternal risk factors with MAP, and not maternal risk factors alone. If maternal serum pregnancy‐associated plasma protein A (PAPP‐A) is measured for routine first‐trimester screening for fetal aneuploidies, the result can be included for PE risk assessment. Variations to the full combined test would lead to a reduction in the performance screening. A woman is considered high risk when the risk is 1 in 100 or more based on the first‐trimester combined test with maternal risk factors, MAP, PLGF, and UTPI. Contingent screening: Where resources are limited, routine screening for preterm PE by maternal factors and MAP in all pregnancies and reserving measurements of PLGF and UTPI for a subgroup of the population (selected on the basis of the risk derived from screening by maternal factors and MAP) can be considered. Prophylactic measures: Following first‐trimester screening for preterm PE, women identified at high risk should receive aspirin prophylaxis commencing at 11–14+6 weeks of gestation at a dose of ~150 mg to be taken every night until 36 weeks of gestation, when delivery occurs, or when PE is diagnosed. Low‐dose aspirin should not be prescribed to all pregnant women. In women with low calcium intake (<800 mg/d), either calcium replacement (≤1 g elemental calcium/d) or calcium supplementation (1.5–2 g elemental calcium/d) may reduce the burden of both early‐ and late‐onset PE.

Association of Maternal Obesity in Early Pregnancy with Adverse Pregnancy Outcomes: A Chinese Prospective Cohort Analysis

OBJECTIVE

This study aimed to examine the associations of maternal obesity in early pregnancy with adverse pregnancy outcomes.

METHODS

A prospective cohort analysis was performed among 18,481 Chinese nulliparous women, using data from a 2006 to 2009 trial of prenatal micronutrient supplementation. Obesity was defined as BMI ≥ 27.5 kg/m² . Interested outcomes included fetal loss (spontaneous abortion plus stillbirth), infant death, total mortality, and preterm and birth weight outcomes.

RESULTS

Compared with normal weight, obesity was associated with total mortality (adjusted relative risks [ARR] 1.34; 95% CI: 1.03-1.74) and fetal loss (ARR 1.51; 95% CI: 1.15-1.99) but not with infant death (ARR 0.53; 95% CI: 0.20-1.46). Further analyses showed that obesity was particularly associated with spontaneous abortion (ARR 1.51; 95% CI: 1.13-2.02) rather than stillbirth (ARR 1.52; 95% CI: 0.65-3.57). Moreover, obesity was associated with preterm birth (ARR 1.59; 95% CI: 1.25-2.02), macrosomia (ARR 3.71, 95% CI: 3.01-4.59), and large for gestational age (ARR 2.93; 95% CI: 2.49-3.47).

CONCLUSIONS

Maternal obesity in early pregnancy is associated with various adverse pregnancy outcomes in Chinese nulliparous women, suggesting the importance of an appropriate weight before and during pregnancy.

Associations of growth from birth to puberty with glycemic indicators at ~17.5 years: Evidence from Hong Kong's "Children of 1997" birth cohort

BACKGROUND

From an evolutionary biology perspective, where growth and reproduction trade-off against longevity, we assessed the associations of growth from birth to puberty by phase with later glycemic indicators and any differences by sex.

METHODS

In the population-representative Hong Kong Chinese "Children of 1997" birth cohort (n = 8327), the relation of initial size (weight-for-age z score (WAZ) at birth, length/height-for-age z score (LAZ) at 3 months or body-mass-index-for-age z score (BAZ) at 3 months based on the World Health Organization growth standards/references) and growth at different phases (WAZ gains from 0 to 2 and 2 to 8 years, LAZ or BAZ gains from 3 months to 3 years, 3 to 8 years and 8 to 14 years) with fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) at ~17.5 years, was assessed using adjusted partial least squares regression. Additional analyses further considered growth in late and early infancy.

RESULTS

This study included 3276 of the cohort participants. Higher WAZ gain from 2 to 8 years, LAZ and BAZ gains from 3 to 8 years were consistently associated with higher FPG, adjusted for maternal and infant characteristics, family history of diabetes and household income. Also, higher BAZ gain from 3 to 8 years was associated with higher HbA1c. These associations did not differ by sex.

CONCLUSIONS

Our findings suggest different mechanisms could underlie the pathogenesis of glucose intolerance. Factors that drive specific growth at different phases need to be evaluated to better inform child growth management for long-term health outcomes.

Maternal body mass index and risk of neonatal adverse outcomes in China: a systematic review and meta-analysis

BACKGROUND

Maternal body mass index is linked to short- and long-term unfavorable health outcomes both for child and mother. We conducted a systematic review and meta-analysis of population-based cohort studies to evaluate maternal BMI and the risk of harmful neonatal outcomes in China.

METHODS

Six databases identified 2454 articles; 46 met the inclusion criteria for this study. The dichotomous data on maternal BMI and harmful neonatal outcomes were extracted. Pooled statistics (odds ratios, ORs) were derived from Stata/SE, ver. 12.0. Sensitivity analyses assessed the robustness of the results. Meta-regression and subgroup meta-analyses explored heterogeneity.

RESULTS

The meta-analysis revealed that compared with normal BMI, high maternal BMI is associated with fetal overgrowth, defined as macrosomia ≥4000 g (OR 1.91, 95% CI 1.75-2.09); birth weight ≥ 90% for gestational age (OR 1.88, 95% CI 1.64-2.15); and increased risk of premature birth (OR 1.38, 95% CI 1.25-2.52) and neonatal asphyxia (OR 1.74, 95% CI 1.39-2.17). Maternal underweight increased the risk of low birth weight (OR 1.61, 95% CI 1.33-1.93) and small for gestational age (OR 1.75, 95% CI 1.51-2.02).

CONCLUSIONS

Raised as well as low pre-pregnancy BMI is associated with adverse neonatal outcomes. Management of weight during pregnancy might help reduce their adverse neonatal outcomes in future intervention studies or programmes.

The effect of prepregnancy body mass index on the risk of gestational diabetes mellitus: A systematic review and dose-response meta-analysis

This study was conducted to investigate the effect of the prepregnancy BMI on the risk of gestational diabetes mellitus (GDM). Five electronic databases, including PubMed, Scopus, Embase, Web of Science, and Google Scholar, were searched for literature published until 1 January 2018. The two-stage, random effect meta-analysis was performed to compare the dose-response relationship between BMI and GDM. As well as studies with categorized BMI, studies that treat BMI as a continuous variable were analysed. A total of 33 observational studies with an overall sample size of 962 966 women and 42 211 patients with GDM were included in analysis. The pooled estimate of GDM risk in the underweight, overweight, and obese pregnant women was 0.68, 2.01, and 3.98 using the adjusted OR and 0.34, 1.52, and 2.24 using the adjusted RR. The GDM risk increased 4% per unit of increase in BMI with both the crude and adjusted OR/RR models. Also, the risk of GDM increased 19% with the crude model and 14% with the adjusted model. The existence of dose-response relationship between the pre-pregnancy BMI and GDM can strengthen the scientific background for vigorous public health interventions for the control of pre-pregnancy BMI as well as the weight gain during pregnancy.

Maternal BMI and weight gain in singleton pregnancies: has something changed in the last decade?

Aim: To assess the trend of the pregravid body mass index (BMI), pregnancy weight gain, and BMI gain in singleton pregnancies delivered at ≥38 completed weeks during the last decade.Materials and methods: We used data from a population-based dataset for the period of 2006-2015. Linear regression was used to assess the relationship between BMI, pregnancy weight gain, and BMI change over time.Results: A total of 70,866 women were included and stratified as primiparous and multiparous. The average BMI in the primiparous women increased 0.52 kg/m² in the past decade, increasing for 0.05 kg/m² every year. The average pregnancy weight gain in this group decreased in this period by 0.7 kg, consequently lowering for 0.07 kg per year, the average BMI change during pregnancy decreased overall by 0.26 kg/m² (0.026 kg/m²/year). However, in multiparous women, the average pregravid BMI did not change over time, but the average pregnancy weight gain decreased by 0.21 kg (0.021 kg/year), and the average BMI change decreased for 0.10 kg/m².Conclusions: Our study showed that the pregravid BMI is increasing in the pregnant primiparous women, but the BMI gain, as well as the pregnancy weight gain, decreased irrespective of parity. Given that the range of differences is not clinically significant, we conclude that pregravid BMI, pregnancy weight gain, and BMI change during pregnancy did not change in the last decade.

Gestational diabetes risk factors and long-term consequences for both mother and offspring: a literature review

INTRODUCTION

Established risk factors for gestational diabetes mellitus (GDM) include ethnicity, obesity, and family history of diabetes. Untreated GDM patients have higher rates of maternal and perinatal morbidity. GDM is an independent risk factor for future longer-term risk of type 2 diabetes mellitus (T2DM), metabolic syndrome, cardiovascular morbidity, malignancies, ophthalmic, psychiatric, and renal disease in the mother. Offspring risk long-term adverse health outcomes, including T2DM, subsequent obesity, impacted neurodevelopmental outcome, increased neuropsychiatric morbidity, and ophthalmic disease.

AREAS COVERED

We critically review data from retrospective, prospective, and meta-analysis studies pertaining to established GDM risk factors, complications during pregnancy and birth (both mother and offspring), and long-term consequences (both mother and offspring).

EXPERT COMMENTARY

Many of the adverse consequences of GDM might be avoided with proper management and treatment. Patients belonging to high-risk ethnic groups, and/or with body mass index ≥ 25 kg/m², and/or known history of diabetes in first-degree relatives may benefit from universal screening and diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Group (IADPSG). The IADPSG one-step method has several advantages, including simplicity of execution, greater patient-friendliness, and higher diagnostic accuracy. Additionally, evidence suggests that the recent increased popularity of bariatric surgery will help to decrease GDM rates over next 5 years. Similarly, metformin may be useful for treating and preventing obstetrical complications in confirmed GDM patients.

Do the Low WHRs and BMIs Judged Most Attractive Indicate Higher Fertility?

We examine the widely accepted view that very low waist-hip ratios and low body mass indices (BMIs) in women in well-nourished populations are judged attractive by men because these features reliably indicate superior fertility. In both subsistence and well-nourished populations, relevant studies of fertility do not support this view. Rather studies indicate lower fertility in women with anthropometric values associated with high attractiveness. Moreover, low maternal BMI predisposes to conditions that compromise infant survival. Consistent with these findings from the literature, new data from a large U.S. sample of women past reproductive age show that women with lower BMIs in the late teens had fewer live births, controlling for education, marital history, and race. They also had later menarche and earlier menopause compared with women with higher youth BMIs. In addition, data from the 2013 U.S. natality database show that mothers with lower prepregnancy BMIs have an increased risk of producing both low-birth-weight and preterm infants controlling for other relevant variables-conditions that would have adversely affected fitness over almost all of human evolution. Thus, a review of the relevant literature and three new tests fail to support the view that highly attractive women are more fertile.

Effects of pre-pregnancy body mass index and gestational weight gain on neonatal birth weight in women with gestational diabetes mellitus

AIM

To study the impact of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on neonatal birth weight in women with gestational diabetes mellitus (GDM).

METHODS

This was a prospective cohort study of 622 singleton pregnant women diagnosed with GDM recruited from 1 April 2014 and 30 December 2014 in a university teaching hospital in China. Binary logistic regression was used to analyze the factors influencing macrosomia.

RESULTS

Pre-pregnancy BMI categories were: underweight (10.6%), normal (65.6%), overweight (18.0%) and obese (5.8%). Mean GWG was 14.4 ± 4.8 kg and birth weight 3353.1 ± 467.3 g. The incidence of macrosomia was 7.8% and low birth weight 2.3%. Logistic regression analysis showed that pre-pregnancy BMI was not associated with macrosomia. However, excessive GWG was a risk factor for macrosomia (odds ratio (OR) 2.884, 95% confidence interval (CI) 1.385-6.004, p < 0.01). In addition, high maternal fasting plasma glucose (FPG) (OR 1.933, 95% CI 1.126-3.316) and serum triglyceride (TG) (OR 1.235, 95% CI 1.053-1.449) in the third trimester of pregnancy were risk factors for macrosomia.

CONCLUSIONS

Patients with GDM can be advised that excessive GWG and uncontrolled hyperglycaemia influence their chances for macrosomia.

Using appropriate pre-pregnancy body mass index cut points for obesity in the Chinese population: a retrospective cohort study

BACKGROUND

Appropriate classification of obesity is vital for risk assessment and complication prevention during pregnancy. We aimed to explore which pre-pregnancy BMI cut-offs of obesity, either BMI ≥ 25 kg/m² as recommended by the WHO for Asians or BMI ≥ 28 kg/m² as suggested by the Working Group on Obesity in China (WGOC), best predicts the risk of adverse maternal and perinatal outcomes.

METHODS

We retrospectively reviewed 11,494 medical records for live singleton deliveries in a tertiary center in Guangzhou, China, between January 2013 and December 2016. The primary outcomes included maternal obesity prevalence, adverse maternal and perinatal outcomes. Data were analyzed using the Chi-square test, logistic regression, and diagnostics tests.

RESULTS

Among the study population, 824 (7.2%) were obese according to the WHO criteria for Asian populations, and this would be reduced to 198 (1.7%) based on the criteria of WGOC. Obesity-related adverse maternal and perinatal outcomes were gestational diabetes mellitus, preeclampsia, cesarean section, and large for gestational age (P < 0.05). Compared to the WGOC criterion, the WHO for Asians criterion had a higher Youden index in our assessment of its predictive value in identifying risk of obesity-related adverse outcomes for Chinese pregnant women. Women in the BMI range of 25 to 28 kg/m² are at high risks for adverse maternal and perinatal outcomes, which were similar to women with BMI ≥ 28 kg/m².

CONCLUSIONS

A lower pre-pregnancy BMI cutoff at 25 kg/m² for defining obesity may be appropriate for pregnant women in South China. If WGOC standards are applied to pregnant Chinese populations, a significant proportion of at-risk patients may be missed.

THE CORRELATION BETWEEN NECK CIRCUMFERENCE AND UMBILICAL ARTERY BLOOD FLOW IN PHYSIOLOGIC PREGNANCIES

Objective

To study the correlation between neck circumference(NC) and umbilical artery blood flow in physiologic pregnancies.

Methods

One hundred and one healthy pregnant woman in the third trimester were enrolled. Anthropometric measurements and ultrasonic testing were done.

Results

The women with NC ≥34.7cm had a more elevated umbilical artery pulsatility index(PI) and systolic/diastolic ratio (S/D) than the women with NC <34.7cm (P<0.01). NC were positively correlated with PI(r=0.224,P=0.024) and S/D ratio(r=0.415,P=0.0001). In multivariate analysis, NC was independently associated with PI (β=0.026, P=0.016) and S/D ratio (β=0.132, P=0.0001).

Conclusions

Obesity has an adverse impact on feto-placetal vessels, and NC was superior to body mass index.

Prediction and prevention of pre-eclampsia in Asian subpopulation

The benefit of the early administration of aspirin to reduce preterm pre-eclampsia among screened positive European women from multivariate algorithmic approach (ASPRE trial) has opened an intense debate on the feasibility of universal screening. This review aims to assess the new perspectives in the combined screening of pre-eclampsia in the first trimester of pregnancy and the chances for prevention using low-dose aspirin with special emphasis on the particularities of the Asian population. PubMed, CENTRAL and Embase databases were searched from inception until 15 November 2017 using combinations of the search terms: preeclampsia, Asian, prenatal screening, early prediction, ultrasonography, pregnancy, biomarker, mean arterial pressure, soluble fms-like tyrosine kinase-1, placental growth factor, pregnancy-associated plasma protein-A and pulsatility index. This is not a systematic review or meta-analysis, so the risk of bias of the selected published articles and heterogeneity among the studies need to be considered. The prevalence of pre-eclampsia and serum levels of biochemical markers in Asian are different from Caucasian women; hence, Asian ethnicity needs to be corrected for in the algorithmic assessment of multiple variables to improve the screening performance. Aspirin prophylaxis may still be viable in Asian women, but resource implication needs to be considered. Asian ethnicity should be taken into account before implementing pre-eclampsia screening strategies in the region. The variables included can be mixed and matched to achieve an optimal performance that is appropriate for economical restriction in individual countries.

First trimester screening for pre-eclampsia in Chinese pregnancies: case-control study

OBJECTIVE

To assess the potential of screening for pre-eclampsia (PE) in a Chinese population.

DESIGN

Case-control study.

SETTING

Teaching hospital in Hong Kong.

POPULATION

A total of 3330 women having a viable singleton pregnancy attending first-trimester Down-syndrome screening.

METHODS

Mean arterial pressure (MAP), bilateral uterine artery pulsatility index (UtA-PI), and placental growth factor (PlGF) were measured. Screening markers were transformed to multiples of the gestational median (MoM) and adjusted for maternal and pregnancy characteristics. MoM distributions in PE and non-PE pregnancies were compared with published expected values. PE screening performance was assessed using area under receiver operating curves (AUROC).

MAIN OUTCOME MEASURES

PE detection rate.

RESULTS

A total of 30 (0.9%) women developed either early (<34 weeks) or late (≥34 weeks) onset PE. MAP was dependent on maternal BMI, UtA-PI on fetal crown rump length, uterine artery peak systolic velocity (UtA-PSV) on maternal age and gestation, and PlGF on gestation in non-PE pregnancies. MoM distributions determined using published Fetal Medicine Foundation models deviated significantly from one for both MAP (P < 0.0001) and PI (P < 0.0001), but not PlGF (P = 0.52) in non-PE pregnancies, whilst PlGF MoM distributions in those who developed early as opposed to late onset PE were significantly higher (P = <0.05). AUROC for any PE using multiple markers was 0.72 (95% CI: 0.64-0.81) with detection rates of 72 and 55% for early and late PE, respectively, for a 10% false positive rate.

CONCLUSION

Detection rates for PE in our Chinese population were lower than the expected 90-95% even after adjusting MoM for local women's characteristics.

FUNDING

General Research Fund (Project number 470513).

TWEETABLE ABSTRACT

Pre-eclampsia screening in the Chinese population had detection rates lower than previously published results.

Trend of caesarean deliveries in Egypt and its associated factors: evidence from national surveys, 2005-2014

Background

The continued rise in caesarean section (c-section) deliveries raises a major public health concern worldwide. This study assessed the trend of c-section deliveries and examined factors associated with a rise in c-section deliveries among the Egyptian mothers, from 2005 to 2014, by place of delivery.

Methods

This study utilized the 2005, 2008, and 2014 Egypt Demographic and Health Surveys (EDHS). The EDHS reported on the mode of delivery for the last birth occurred within five years preceding each survey including place of delivery and sociodemographic information for a total sample of over 29,000 mothers in the three surveys. To document trend of c-section, the EDHS-2005 was set as a reference in two binary logistic regression models; among all mothers together and for mothers stratified by place of delivery (public or private). P-value for the trend was assessed by entering the year of the survey as a continuous variable. The study followed STROBE statement in reporting observational studies.

Results

Institutional-based c-sections increased by 40.7 points from EDHS-2005 to EDHS-2014 (aOR, 3.46, 95%CI: 3.15–3.80, P_trend < 0.001). Compared to mothers with low socioeconomic status (SES), mothers with high SES had higher odds (aOR, 1.78, 95%CI: 1.25–2.54, P = 0.001) for c-section, but only in EDHS-2005. The adjusted trend of c-sections was found to be 4.19-time (95%CI: 3.73–4.70, P < 0.001) higher in private sector while that in public sector it was 2.67-time (95%CI: 2.27–3.13, P = 0.001) higher, in EDHS-2014 relative to EDHS-2005. This increase in the private sector is explained by significant increases among mothers who are potentially at low risk for c-sections; mothers aged 19-24 years vs. ≥35 years (aOR: 0.31, 95%CI: 0.21–0.45, in EDHS-2005 vs. 0.43, 95%CI: 0.33–0.56, in EDHS-2014, P < 0.001); primigravida mothers vs. mothers with ≥4 children (aOR: 1.62, 95%CI: 1.12–2.34, in EDHS-2005 vs. 3.76, 95%CI: 2.94–4.80 in EDHS-2014); and among normal compared to high risk birth weight babies (aOR: 0.79, 95%CI: 0.62–0.99 in EDHS-2005 P < 0.05 vs. 0.83, 95%CI: 0.65–1.04 in EDHS-2014, P > 0.05).

Conclusions

Results showed a steady rise in c-sections in Egypt that has reached an alarming level in recent years. This increase appears to be associated with a shift towards delivery in private health care facilities. More vigilance of c-section deliveries, particularly in the private sector, is warranted.

Electronic supplementary material

The online version of this article (10.1186/s12884-017-1591-2) contains supplementary material, which is available to authorized users.

Pre-pregnancy BMI, gestational weight gain and risk of preeclampsia: a birth cohort study in Lanzhou, China

BACKGROUND

To evaluate the independent and joint effects of maternal pre-pregnancy BMI and gestational weight gain (GWG) on the risk of preeclampsia and its subtypes.

METHODS

A birth cohort study was conducted from 2010 to 2012 in Lanzhou, China. Three hundred fourty seven pregnant women with preeclampsia and 9516 normotensive women at Gansu Provincial Maternity and Child Care Hospital were included in the present study. Unconditional logistic regression models were used to evaluate the associations between pre-pregnancy BMI, GWG, and risk of preeclampsia and its subtypes.

RESULTS

Compared to women with normal pre-pregnancy BMI, those who were overweight/obese had an increased risk of preeclampsia (OR = 1.81; 95%CI: 1.37-2.39). Women with excessive GWG had an increased risk of preeclampsia (OR = 2.28; 95%CI: 1.70-3.05) compared to women with adequate GWG. The observed increased risk was similar for mild-, severe- and late-onset preeclampsia. No association was found for early-onset preeclampsia. Overweight/obese women with excessive GWG had the highest risk of developing preeclampsia compared to normal weight women with no excessive weight gain (OR = 3.78; 95%CI: 2.65-5.41).

CONCLUSIONS

Our results suggested that pre-pregnancy BMI and GWG are independent risk factors for preeclampsia and that the risk might vary by preeclampsia subtypes. Our study also proposed a potential synergistic effect of pre-pregnancy BMI and GWG that warrants further investigation.

Prepregnancy Body Mass Index Shift Across Gestation: An Association with Breastfeeding Practices?

BACKGROUND

Research has shown that mother's obesity and underweight are major risk factors for reduced initiation, duration, and exclusivity of breastfeeding.

OBJECTIVE

We compared breastfeeding practices from discharge until the third postnatal month in women, accounting to prepregnancy body mass index (BMI) and its shift across gestation.

STUDY DESIGN

Data on maternal shifts in BMI category from prepregnancy to gestational BMI by gestational weight gain (GWG) were defined according to 2009 Institute of Medicine (IOM) guidelines. Logistic regression models were estimated to assess the effect of prepregnancy and gestational BMI on breastfeeding, adjusting for clinically relevant factors.

RESULTS

The analysis included 658 women. According to prepregnancy BMI, 84 (12.8%) mothers were underweight, 444 (67.4%) were normal weight, 94 (14.3%) were overweight, and 36 (5.5%) were obese. Although in the range defined by IOM 2009, GWG shifted across the BMI categories in 445 (67.6%). Thus, while underweight women shifted in higher BMI categories, normal weight women category halved (230, 35%), and both overweight women (301, 45.7%) and obese women (127, 19.3%) tripled. Breastfeeding patterns at discharge, at first month, and at third month were comparable among prepregnancy and gestational BMI groups, except for prepregnancy BMI groups at third month (p 0.03). At multivariable analysis, neither prepregnancy BMI nor gestational BMI was associated with reduced exclusive breastfeeding within 3 months after discharge.

CONCLUSIONS

Prepregnancy BMI and gestational BMI, in women with adequate GWG, do not affect exclusive breastfeeding initiation, duration, and exclusivity until the third month postpartum. Women need information and support to gain adequate weight during pregnancy.

An analysis of the risk factors of preeclampsia and prediction based on combined biochemical indexes

This study aims to investigate the risk factors and the joint biochemical indicators predictive value for preeclampsia. Related factors and biochemical indicators were investigated in 558 patients with preeclampsia and 435 normal pregnant women. Multiplicity analysis was performed by logistic regression. The predictive value of the biochemical index and joint biochemical indicators for predicting the incidence of pregnant women preeclampsia were analyzed by ROC curve. A progestation BMI of >24 kg/m² (OR = 5.412, 95% CI: 1.169-9.447), hypertension history (OR = 7.487, 95% CI: 2.541-11.247) and advanced age (>35 years old, OR = 6.321, 95% CI: 3.142-20.342) are risk factors for preeclampsia. Tumor necrosis factor-α and plasma protein-A are valuable for preeclampsia prediction. The predictive success of preeclampsia could be improved by clinical risk factors associated with biochemical indicators detection.

Maternal body mass index and post-term birth: a systematic review and meta-analysis

Post-term birth is a preventable cause of perinatal mortality and severe morbidity. This review examined the association between maternal body mass index (BMI) and post-term birth at ≥42 and ≥41 weeks' gestation. Five databases, reference lists and citations were searched from May to November 2015. Observational studies published in English since 1990 were included. Linear and nonlinear dose-response meta-analyses were conducted by using random effects models. Sensitivity analyses assessed robustness of the results. Meta-regression and sub-group meta-analyses explored heterogeneity. Obesity classes were defined as I (30.0-34.9 kg m-2 ), II (35.0-39.9 kg m-2 ) and III (≥40 kg m-2 ; IIIa 40.0-44.9 kg m-2 , IIIb ≥ 45.0 kg m-2 ). Searches identified 16,375 results, and 39 studies met the inclusion criteria (n = 4,143,700 births). A nonlinear association between maternal BMI and births ≥42 weeks was identified; odds ratios and 95% confidence intervals for obesity classes I-IIIb were 1.42 (1.27-1.58), 1.55 (1.37-1.75), 1.65 (1.44-1.87) and 1.75 (1.50-2.04) respectively. BMI was linearly associated with births ≥41 weeks: odds ratio is 1.13 (95% confidence interval 1.05-1.21) for each 5-unit increase in BMI. The strength of the association between BMI and post-term birth increases with increasing BMI. Odds are greatest for births ≥42 weeks among class III obesity. Targeted interventions to prevent the adverse outcomes associated with post-term birth should consider the difference in risk between obesity classes.

The obesity associated FTO gene variant and the risk of adverse pregnancy outcomes: Evidence from the SCOPE study

OBJECTIVE

To investigate whether the FTO rs9939609 single nucleotide polymorphism (SNP), which is a risk factor for obesity and vascular diseases, is also associated with pregnancy complications including pre-eclampsia, gestational hypertension, small for gestational age pregnancy (SGA), and spontaneous preterm birth (sPTB).

METHODS

A case-control study of 1,741 nulliparous Caucasian women, their partners, and infants was conducted. DNA was extracted from peripheral blood or saliva from parents and cord blood from infants and genotyped using the Sequenom MassARRAY system.

RESULTS

The prevalence of maternal and infant AA genotype of FTO rs9939609 was increased in the SGA group compared with the uncomplicated pregnancy group (19.2% vs. 13.4%, OR = 1.7, 95% CI = 1.1-2.6, P = 0.02 and 24.6% vs. 12.5%, OR = 2.7, 95% CI = 1.6-4.6, P = 0.0002). The prevalence of maternal and infant AA genotype of FTO rs9939609 was also increased in the sPTB group compared with the uncomplicated pregnancy group (20.8% vs. 13.4%, OR = 2.1, 95% CI = 1.2-3.8, P = 0.009 and 20.0% vs. 12.5%, OR = 2.4, 95% CI = 1.0-5.3, P = 0.03).

CONCLUSIONS

The maternal and infant AA genotype of the obesity associated FTO rs9939609 SNP associates with increased risk for SGA and sPTB. This SNP may be important in predicting the risk of these pregnancy complications and subsequent vascular diseases.

Persistent influence of maternal obesity on offspring health: Mechanisms from animal models and clinical studies

The consequences of excessive maternal weight and adiposity at conception for the offspring are now well recognized. Maternal obesity increases the risk of overweight and obesity even in children born with appropriate-for-gestational age (AGA) birth weights. Studies in animal models have employed both caloric excess and manipulation of macronutrients (especially high-fat) to mimic hypercaloric intake present in obesity. Findings from these studies show transmission of susceptibility to obesity, metabolic dysfunction, alterations in glucose homeostasis, hepatic steatosis, skeletal muscle metabolism and neuroendocrine changes in the offspring. This review summarizes the essential literature in this area in both experimental and clinical domains and focuses on the translatable aspects of these experimental studies. Moreover this review highlights emerging mechanisms broadly explaining maternal obesity-associated developmental programming. The roles of early developmental alterations and placental adaptations are also reviewed. Increasing evidence also points to changes in the epigenome and other emerging mechanisms such as alterations in the microbiome that may contribute to persistent changes in the offspring. Finally, we examine potential interventions that have been employed in clinical cohorts.

Association between perinatal outcomes and maternal pre-pregnancy body mass index

OBJECTIVE

To quantify the association between maternal pre-pregnancy body mass index (BMI) and perinatal outcomes.

METHODS

We systematically reviewed and collected studies on maternal pre-pregnancy BMI and perinatal outcomes published up to 31 August 2015. For each study, we constructed separate two-by-two tables to calculate the odds ratios (ORs) and 95% confidence intervals (CI).

RESULTS

A total of 60 studies involving 1,392,799 women were included, and the proportions of obesity, overweight, normal weight and underweight pregnant women were 11.72%, 22.08%, 58.03% and 8.18%, respectively. When mothers were overweight or obese, their infants had a significantly higher risk of being large for gestational age (OR, 1.45, 95%CI, 1.29-1.63 and 1.88, 95%CI, 1.67-2.11, respectively), having macrosomia (OR, 1.70, 95%CI, 1.55-1.87 and 2.92, 95%CI, 2.67-3.20, respectively), being admitted to the neonatal intensive care unit (OR, 1.29, 95%CI, 1.12-1.48 and 1.91, 95%CI, 1.60-2.29, respectively) and being stillborn (OR, 1.27, 95%CI, 1.18-1.36 and 1.81, 95%CI, 1.69-1.93, respectively). When mothers were underweight, their infants had a lower risk of the aforementioned outcomes. However, mothers who were underweight had a higher risk of preterm birth (OR, 1.30, 95%CI, 1.13-1.49) and delivering an infant small for gestational age (OR, 1.67, 95%CI, 1.49-1.87). Importantly, infants had a higher risk of having a low birth weight (LBW) when their mothers were underweight (OR, 1.67, 95%CI, 1.39-2.02) or obese (OR, 1.24, 95%CI, 1.09-1.41).

CONCLUSION

Being overweight or obese was associated with an increased risk of still birth, large for gestational age, macrosomia, admission to the neonatal intensive care unit and LBW, while being underweight was associated with an increased risk of preterm birth, small for gestational age, and LBW. Women of childbearing age should maintain a normal body mass index before pregnancy.

Clustering of metabolic risk factors and adverse pregnancy outcomes: a prospective cohort study

BACKGROUND

The relative contributions of a cluster of metabolic risk factors to pregnancy complications are not fully understood. We investigated the correlation between clustering of metabolic risk factors and adverse pregnancy outcomes.

METHODS

This prospective cohort study was performed on pregnant women who sought health care during their whole gestation in a women's and children's hospital. The pregnancy outcomes were also followed. Pre-pregnancy overweight/obesity, as well as pregnancy high triglycerides, low high-density lipoprotein-cholesterol, hyperglycemia and raised blood pressure were defined as metabolic risk factors. Adverse pregnancy outcomes included preterm delivery, small/large for gestational age, preeclampsia, gestational diabetes mellitus, neonatal asphyxia and foetal demise. Stratified analyses were conducted on a total of 5535 women according to classification in each metabolic risk factor. The adjusted odds ratio (OR) for adverse pregnancy outcomes according to the number of clustering metabolic factors was calculated using the logistic regression analysis.

RESULTS

The number of metabolic risk factors and adverse pregnancy outcomes were positively correlated (P_trend  < 0.001). Compared with women without a metabolic risk factor, women with one metabolic risk factor had a risk (OR = 1.67 95%CI 1.42-1.96) of adverse pregnancy outcomes. Women with a cluster of two metabolic risk factors tended to develop more adverse pregnancy outcomes (OR = 3.32 95% CI 2.69-4.10), and the risk was much higher in women with a cluster of three or more metabolic risk factors (OR = 10.40 95%CI 7.37-14.69).

CONCLUSIONS

Pregnant women with a cluster of metabolic risk factors are more likely to have adverse pregnancy outcomes. Copyright © 2016 John Wiley & Sons, Ltd.