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Ma Z, Chu L, Zhang Z, Hu Y, Zhu Y, Wu F, Zhang Y. Association of prepregnancy body mass index and gestational weight gain trajectory with adverse pregnancy outcomes-a prospective cohort study in Shanghai. BMJ Open 2024; 14:e075269. [PMID: 38569715 PMCID: PMC10989183 DOI: 10.1136/bmjopen-2023-075269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES The objective was to investigate the associations of maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) trajectories with adverse pregnancy outcomes (APOs). DESIGN This was a prospective cohort study. SETTING This study was conducted in Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai, China. PRIMARY AND SECONDARY OUTCOME MEASURES A cohort study involving a total of 2174 pregnant women was conducted. Each participant was followed to record weekly weight gain and pregnancy outcomes. The Institute of Medicine classification was used to categorise prepregnancy BMI, and four GWG trajectories were identified using a latent class growth model. RESULTS The adjusted ORs for the risks of large for gestational age (LGA), macrosomia, gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) were significantly greater for women with prepregnancy overweight/obesity (OR=1.77, 2.13, 1.95 and 4.24; 95% CI 1.3 to 2.42, 1.32 to 3.46, 1.43 to 2.66 and 2.01 to 8.93, respectively) and lower for those who were underweight than for those with normal weight (excluding HDP) (OR=0.35, 0.27 and 0.59; 95% CI 0.22 to 0.53, 0.11 to 0.66 and 0.36 to 0.89, respectively). The risk of small for gestational age (SGA) and low birth weight (LBW) was significantly increased in the underweight group (OR=3.11, 2.20; 95% CI 1.63 to 5.92, 1.10 to 4.41; respectively) compared with the normal-weight group; however, the risk did not decrease in the overweight/obese group (p=0.942, 0.697, respectively). GWG was divided into four trajectories, accounting for 16.6%, 41.4%, 31.7% and 10.3% of the participants, respectively. After adjustment for confounding factors, the risk of LGA was 1.54 times greater for women in the slow GWG trajectory group than for those in the extremely slow GWG trajectory group (95% CI 1.07 to 2.21); the risk of SGA and LBW was 0.37 times and 0.46 times lower for women in the moderate GWG trajectory group and 0.14 times and 0.15 times lower for women in the rapid GWG trajectory group, respectively; the risk of macrosomia and LGA was 2.65 times and 2.70 times greater for women in the moderate GWG trajectory group and 3.53 times and 4.36 times greater for women in the rapid GWG trajectory group, respectively; and the women in the other three trajectory groups had a lower risk of GDM than did those in the extremely slow GWG trajectory group, but there was not much variation in the ORs. Notably, different GWG trajectories did not affect the risk of HDP. CONCLUSIONS As independent risk factors, excessively high and low prepregnancy BMI and GWG can increase the risk of APOs.
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Affiliation(s)
- Ziwen Ma
- Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai, China
| | - Liming Chu
- Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai, China
| | - Zhiping Zhang
- Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai, China
| | - Yifan Hu
- Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai, China
| | - Yun Zhu
- Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai, China
| | - Fei Wu
- Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai, China
| | - Yan Zhang
- Shanghai Pudong New Area Health Care Hospital for Women and Children, Shanghai, China
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Lyu Y, Cui M, Zhang L, Zheng G, Zuo H, Xiu Q, Shah PS. Pre-pregnancy body mass index, gestational diabetes mellitus, and gestational weight gain: individual and combined effects on fetal growth. Front Public Health 2024; 12:1354355. [PMID: 38528861 PMCID: PMC10961333 DOI: 10.3389/fpubh.2024.1354355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 03/27/2024] Open
Abstract
Background Pre-pregnancy body mass index (BMI), gestational diabetes mellitus (GDM), and gestational weight gain (GWG) are interlinked and may play a complex role in fetal growth. We aimed to examine the relationship between pre-pregnancy BMI, GDM, GWG, and fetal growth outcomes and explore the contribution of GDM and GWG to the relationship between Pre-pregnancy obesity/overweight and large-for-gestational-age (LGA) in a prospective cohort. Methods We prospectively recruited women in the first trimester and having one-step GDM screened with a 75-g oral glucose tolerance test between 24 and 28 weeks of gestation (n = 802). Outcomes included LGA, small-for-gestational-age (SGA), and preterm birth. To assess the individual and cumulative associations between pre-pregnancy BMI, GDM, GWG, and these outcomes, we used multivariate logistic regression analysis. Furthermore, we employed structural equation modeling (SEM) to investigate the mediating role of GDM and excessive GWG in the correlation between pre-pregnancy overweight/obesity and LGA. Results Pre-pregnancy obesity, GDM, and excessive GWG were all independently associated with increased odds of LGA. Inadequate GWG was associated with higher odds of preterm birth. Compared with women unexposed to pre-pregnancy overweight/obesity, GDM, or excessive GWG, women exposed any two conditions had higher odds for LGA (AOR 3.18, 95% CI 1.25-8.11) and women with coexistence of all had the highest odds for LGA (AOR 8.09, 95% CI 2.18-29.97). The mediation analysis showed that GDM explained 18.60% (p < 0.05) of the total effect of pre-pregnancy overweight/obesity on LGA, and GWG explained 17.44% (p < 0.05) of the total effect. Conclusion Pre-pregnancy obesity/overweight, GDM, and excessive GWG are associated with higher odds of fetal growth disturbances as individual factors and when they co-exist. The effect of pre-pregnancy overweight/obesity on LGA is partially achieved through GDM and excessive GWG.
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Affiliation(s)
- Yanyu Lyu
- Experiment Center, Capital Institute of Pediatrics, Beijing, China
| | - Mingming Cui
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China
| | - Lingling Zhang
- Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
| | - Guang Zheng
- School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Hanxiao Zuo
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Qingyong Xiu
- Department of Pediatrics, Beijing Daxing Maternal and Child Care Hospital, Beijing, China
| | - Prakesh S. Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
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Impact of prepregnancy body mass index on adverse pregnancy outcomes: analysis from the Longitudinal Indian Family hEalth cohort study. AJOG GLOBAL REPORTS 2022; 3:100134. [PMID: 36691397 PMCID: PMC9860159 DOI: 10.1016/j.xagr.2022.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Both high and low maternal prepregnancy body mass index can lead to suboptimal fetal growth and risk of pregnancy complications. In developed countries, nearly half of all women of childbearing age are either overweight or obese, and most data linking maternal body mass index and adverse pregnancy complications are limited to these populations. OBJECTIVE This study aimed to prospectively evaluate the relationships between prepregnancy body mass index and adverse pregnancy outcomes using the Longitudinal Indian Family hEalth (LIFE) study. STUDY DESIGN We modeled the relationships between prepregnancy body mass index and adverse pregnancy outcomes such as low birthweight, preterm birth, cesarean delivery, intrauterine growth restriction, miscarriage, and fetal death among 675 women aged 15 to 35 years with singleton pregnancies in the Longitudinal Indian Family hEalth study, a population-based prospective pregnancy cohort study conducted in Telangana, India. Prepregnancy body mass index was calculated as weight in kilograms divided by height in meters squared and was classified into 4 categories using the World Health Organization recommendations for Asian adults. Prepregnancy body mass index was assessed at a mean of 12.3 months before pregnancy. Odds ratios and 95% confidence intervals of adverse pregnancy outcomes were modeled and adjusted for confounders. RESULTS Obese women had a 3-fold increased risk of cesarean delivery (odds ratio, 3.13; 95% confidence interval, 1.56-6.29) compared with normal-weight women. Those who were overweight also had a marginally increased risk of cesarean delivery, albeit not statistically significant (odds ratio, 1.17; 95% confidence interval, 0.61-2.24). Underweight women had a modestly increased risk of low birthweight, compared with normal-weight women (odds ratio, 1.12; 95% confidence interval, 0.71-1.77), although results were not significant. Conversely, obese (odds ratio, 0.71; 95% confidence interval, 0.28-1.77) and overweight (odds ratio, 0.61; 95% confidence interval, 0.24-1.51) women had a marginally decreased risk of low birthweight. CONCLUSION Our data suggest that women with elevated prepregnancy body mass index may have a higher risk of adverse pregnancy outcomes, especially cesarean delivery. Although this study has limited generalizability, our findings are generalizable to rural to periurban regions of India. Further studies exploring the translatability of these findings to other populations are needed. In addition, targeted prepregnancy intervention studies and programs that include counseling on optimization of preconception health and lifestyle modification for improvement of subsequent pregnancy outcomes among overweight and obese women are needed.
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Benedict MOA, Brits H. Induction of labour practices at Botshabelo District Hospital: Assessing the institutional guidelines. J Public Health Afr 2022; 13:2153. [PMID: 36051530 PMCID: PMC9425927 DOI: 10.4081/jphia.2022.2153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/23/2022] [Indexed: 11/23/2022] Open
Abstract
Induction of labour (IOL) is defined as an artificial stimulation administered to initiate the delivery process before the onset of spontaneous labour. Setting-adapted guidelines need to be developed to promote safe maternal and neonatal care in line with the needs of a specific institution. This study aimed to describe and assess the current IOL practices at Botshabelo District Hospital, focusing on incidence, indications, induction methods, complications, and outcomes. A retrospective-descriptive study included all relevant data from IOL cases over six months between July and December 2017. From 168 attempted inductions of labour, 153 files were retrieved. The majority of cases (69.7%) were for post-dates. Normal vaginal delivery (NVD) was achieved in most patients (69.3%), while one patient had an assisted delivery. Thus, 30.1% of inductions failed and required caesarean sections. The incidence, indications, methods of induction, complications, and outcomes of IOL in BDH are in line with international guidelines; however, including the sweeping of membranes at term and balloon catheters as methods could improve the current guidelines.
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Jenabi E, Salimi Z, Ayubi E, Bashirian S, Salehi AM. The environmental risk factors prior to conception associated with placental abruption: an umbrella review. Syst Rev 2022; 11:55. [PMID: 35365209 PMCID: PMC8973534 DOI: 10.1186/s13643-022-01915-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present umbrella review evaluated risk factors prior to conception associated with placental abruption based on meta-analyses and systematic reviews. METHODS We searched PubMed, Scopus, and Web of Science until June 25, 2021. All meta-analyses that had focused on assessing the risk factors associated with placental abruption were included. We calculated summary effect estimates, 95% CI, heterogeneity I2, 95% prediction interval, small-study effects, excess significance biases, and sensitive analysis. The quality of the meta-analyses was evaluated with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). RESULTS There was no risk factor in the present umbrella review with the high level of evidence (class I or II). Eight risk factors including maternal asthma (RR 1.29 95% CI 1.14, 1.47), prior cesarean section (RR 1.38, 95% CI 1.35-1.42), cocaine using (RR 4.55, 95% CI 1.78-6.50), endometriosis (OR 1.40, 95% CI 1.12-1.76), chronic hypertension (OR 3.13, 95% CI 2.04-4.80), advanced maternal age (OR 1.44, 95% CI 1.35-1.54), maternal smoking (OR 1.80, 95% CI 1.75-1.85) (RR 1.65, 95% CI 1.51-1.80), and use of assisted reproductive techniques (ART) (OR 1.87, 95% CI 1.70-2.06) were graded as suggestive evidence (class III). The other four risk factors including pre-pregnancy underweight (OR 1.38, 95% CI 1.12-1.70), preeclampsia (OR 1.73, 95% CI 1.47-2.04), uterine leiomyoma (OR 2.63, 95% CI 1.38-3.88), and marijuana use (OR 1.78, 95% CI 1.32-2.40) were graded as risk factors with weak evidence (class IV). CONCLUSION Maternal asthma, prior cesarean section, cocaine use, endometriosis, chronic hypertension, advanced maternal age, maternal smoking, and use of ART, pre-pregnancy underweight, preeclampsia, uterine leiomyoma, and marijuana use were risk factors associated with placental abruption. Although factors associated with placental abruption have been investigated, the current meta-analytic associations cannot disentangle the complex etiology of placental abruption mainly due to their low quality of evidence.
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Affiliation(s)
- Ensiyeh Jenabi
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zohreh Salimi
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Erfan Ayubi
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeid Bashirian
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Impact of pre-pregnancy body mass index and gestational weight gain on the risk of maternal and infant pregnancy complications in Korean women. Int J Obes (Lond) 2022; 46:59-67. [PMID: 34489525 PMCID: PMC8748202 DOI: 10.1038/s41366-021-00946-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVE Healthy weight maintenance before and during pregnancy has a significant effect on pregnancy outcomes; however, there are no specific guidelines for gestational weight gain in pregnant Korean women. Therefore, we investigated the impact of pre-pregnancy body mass index (BMI) and gestational weight gain on the risk of maternal and infant pregnancy complications in pregnant Korean women. METHODS Study participants comprised 3454 singleton pregnant women from the Korean Pregnancy Outcome Study who had baseline examination and pregnancy outcome data. Maternal pre-pregnancy BMI and gestational weight gain were categorized according to the Asia-pacific regional guidelines and the Institute of Medicine recommendations, respectively. The primary outcome was any adverse outcomes, defined as the presence of one or more of the following: hypertensive disorders of pregnancy, gestational diabetes mellitus, peripartum depressive symptom, cesarean delivery, delivery complications, preterm birth, small or large weight infant, neonatal intensive care unit admission, or a congenital anomaly. Multiple logistic regression models were applied to examine the independent and combined impact of pre-pregnancy BMI and gestational weight gain on the risk of maternal and infant outcomes. RESULTS Obesity before pregnancy significantly increased the risk of perinatal adverse outcomes by more than 2.5 times [odds ratio (OR): 2.512, 95% confidence interval (CI): 1.817-3.473]. Compared to that in women with appropriate gestational weight gain, women with excessive weight gain had a 36.4% incremental increase in the risk of any adverse outcomes [OR: 1.364, 95% CI: 1.115-1.670]. Moreover, women who were overweight or obese before pregnancy and had excessive gestational weight gain had a three-fold increase in the risk of adverse outcomes [OR: 3.460, 95% CI: 2.210-5.417]. CONCLUSION This study highlights the need for appropriate weight recommendations before and during pregnancy to prevent perinatal complications in Korean women of childbearing age.
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Najafi F, Hasani J, Izadi N, Hashemi-Nazari SS, Namvar Z, Shamsi H, Erfanpoor S. Risk of gestational diabetes mellitus by pre-pregnancy body mass index: A systematic review and meta-analysis. Diabetes Metab Syndr 2021; 15:102181. [PMID: 34214900 DOI: 10.1016/j.dsx.2021.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 05/13/2021] [Accepted: 06/15/2021] [Indexed: 01/01/2023]
Abstract
Gestational diabetes mellitus (GDM) is serious health challenges. This study aimed at determining the risk of GDM among pregnant women by pre-pregnancy BMI. Five electronic databases including Medline (PubMed), Scopus, Embase, Web of Science and Google Scholar were searched for literature published form 2015 to January 1, 2021. The pooled estimate risk of GDM among pregnant women was 16.8% (95% CI: 15.3-18.4). The risk of GDM in underweight/normal group and overweight/obese group were 10.7% (95% CI: 9.1-12.4) and 23% (95% CI: 20.2-25.9), respectively. The risk of GDM is high among overweight/obese pregnant women.
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Affiliation(s)
- Farid Najafi
- Department of Epidemiology, Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jalil Hasani
- Kashmar School of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Izadi
- Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Seyed-Saeed Hashemi-Nazari
- Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Namvar
- Student Research Committee, Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Shamsi
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Erfanpoor
- Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran
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Assessing the relationship between pregravid body mass index and risk of adverse maternal pregnancy and neonatal outcomes: prospective data in Southwest China. Sci Rep 2021; 11:7591. [PMID: 33828166 PMCID: PMC8027183 DOI: 10.1038/s41598-021-87135-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/11/2021] [Indexed: 12/30/2022] Open
Abstract
The relevance of pregestational body mass index (BMI) on adverse pregnancy outcomes remained unclear in Southwest China. This study aimed to investigate the overall and age-category specific association between pre-gestational BMI and gestational diabetes mellitus (GDM), preeclampsia, cesarean delivery, preterm delivery, stillbirth, macrosomia, and small-for-gestational age (SGA) or large-for-gestational age (LGA) neonates in Southwest China. Furthermore, it explores the relative importance of influence of pregravid BMI and maternal age on pregnancy outcomes. 51,125 Chinese singleton pregnant women were recruited as study subjects. Multiple logistic regression models were used to examine the influence of pre-pregnancy BMI on adverse pregnancy outcomes. Gradient boosting machine was used to evaluate the relative importance of influence of pregravid BMI and maternal age on pregnancy outcomes. It is found that women who were overweight or obese before pregnancy are at higher risk of adverse pregnancy outcomes except for SGA neonates, while pre-pregnancy underweight is a protective factor for GDM, preeclampsia, cesarean delivery, macrosomia and LGA, but not SGA. Younger mothers are more susceptible to GDM and macrosomia neonates, while older mothers are more prone to preeclampsia. Pre-pregnancy BMI has more influence on various pregnancy outcomes than maternal age. To improve pregnancy outcomes, normal BMI weight as well as relatively young maternal ages are recommended for women in child-bearing age.
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Tang J, Zhu X, Chen Y, Huang D, Tiemeier H, Chen R, Bao W, Zhao Q. Association of maternal pre-pregnancy low or increased body mass index with adverse pregnancy outcomes. Sci Rep 2021; 11:3831. [PMID: 33589654 PMCID: PMC7884680 DOI: 10.1038/s41598-021-82064-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/05/2021] [Indexed: 12/04/2022] Open
Abstract
This study investigated the association between pre-pregnancy body mass index (BMI) and adverse pregnancy outcomes among women participated in the National Free Preconception Health Examination Project in Guangdong Province, China, and explored these associations according to maternal age. Pre-pregnancy BMI was classified into underweight (BMI < 18.5 kg/m2), healthy weight (18.5–23.9 kg/m2), overweight (24.0–27.9 kg/m2), and obesity (≥ 28.0 kg/m2) according to Chinese criteria. Outcomes were preterm birth (PTB, delivery before 37 weeks of gestation), large for gestational age (LGA, birthweight above the 90th percentile for gestational age by infants’ sex), small for gestational age (SGA, birthweight below the 10th percentile for gestational age by infants’ sex), primary caesarean delivery, shoulder dystocia or birth injury, and stillbirth. Adjusted incidence risk ratios (aIRR) were calculated for underweight, overweight and obesity, respectively. Compared with healthy weight, underweight was associated with increased risk of PTB (aIRR 1.06, 95%CI 1.04–1.09) and SGA (1.23, 1.22–1.26) but inversely associated with LGA (0.83, 0.82–0.85), primary caesarean delivery (0.88, 0.87–0.90) and stillbirth (0.73, 0.53–0.99). Overweight was associated with increased risk of LGA (1.17, 1.14–1.19), primary caesarean delivery (1.18, 1.16–1.20) and stillbirth (1.44, 1.03–2.06), but inversely associated with SGA (0.92, 0.90–0.95) and shoulder dystocia or birth injury (0.86, 0.79–0.93). Obesity was associated with increased risk of PTB (1.12, 1.05–1.20), LGA (1.32, 1.27–1.37), primary caesarean delivery (1.45, 1.40–1.50), but inversely associated with SGA (0.92, 0.87–0.97). The aIRRs for underweight, overweight and obesity in relation to these adverse pregnancy outcomes ranged from 0.65 to 1.52 according to maternal age. In Chinese population, maternal pre-pregnancy BMI was significantly associated with the risk of adverse pregnancy outcomes and the risk differs according to maternal age. Further investigation is warranted to determine whether and how counselling and interventions for women with low or increased BMI before pregnancy can reduce the risk of adverse pregnancy outcomes.
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Affiliation(s)
- Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Room 507, Block 2, Xinzao, Panyu District, 511436, Guangzhou, People's Republic of China. .,Faculty of Education, Health and Wellbeing, University of Wolverhampton, Millennium City Building, Wulfruna Street, Wolverhampton, WV1 1LY, UK.
| | - Xinhong Zhu
- Guangdong Women and Children Hospital, 521-523 Xingnan Street, Panyu District, 511442, Guangzhou, People's Republic of China
| | - Yanbing Chen
- Guangdong Women and Children Hospital, 521-523 Xingnan Street, Panyu District, 511442, Guangzhou, People's Republic of China
| | - Dongming Huang
- Guangdong Institute of Family Planning Science and Technology, 17th Meidong Road, Yuexiu District, 510245, Guangzhou, People's Republic of China.,Family Planning Special Hospital of Guangdong, 17th Meidong Road, Yuexiu District, 510245, Guangzhou, People's Republic of China
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, USA
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Millennium City Building, Wulfruna Street, Wolverhampton, WV1 1LY, UK
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Qingguo Zhao
- Guangdong Institute of Family Planning Science and Technology, 17th Meidong Road, Yuexiu District, 510245, Guangzhou, People's Republic of China. .,Family Planning Special Hospital of Guangdong, 17th Meidong Road, Yuexiu District, 510245, Guangzhou, People's Republic of China. .,Key Laboratory of Male Reproduction and Genetics, National Health Committee of China (NHCC, 17th Meidong Road, Yuexiu District, 510245, Guangzhou, People's Republic of China.
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Associations of early pregnancy BMI with adverse pregnancy outcomes and infant neurocognitive development. Sci Rep 2021; 11:3793. [PMID: 33589705 PMCID: PMC7884778 DOI: 10.1038/s41598-021-83430-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/02/2021] [Indexed: 11/08/2022] Open
Abstract
The prevalence of overweight and obesity amongst reproductive women has been increasing worldwide. Our aim was to compare pregnancy outcomes and infant neurocognitive development by different BMI classifications and investigate whether early pregnancy BMI was associated with risks of adverse outcomes in a Southwest Chinese population. We analysed data from 1273 women enrolled in the Complex Lipids in Mothers and Babies (CLIMB) randomized controlled trial in Chongqing, China. Maternal BMI was classified as underweight, normal weight and overweight/obese according to the Chinese, WHO Asian, and WHO European standards. For the adverse pregnancy outcomes, after adjustment for potential confounders, an underweight BMI was associated with increased risk of small for gestational age (SGA) babies, and an overweight/obese BMI was associated with increased risk of maternal gestational diabetes mellitus (GDM), caesarean section (C-section), macrosomia and large for gestational age (LGA) babies. For infant neurocognitive development, 1017 mothers and their children participated; no significant differences were seen in the Mental Development Index (MDI) or the Psychomotor Development Index (PDI) between the three BMI groups. Our findings demonstrate that abnormal early pregnancy BMI were associated with increased risks of adverse pregnancy outcomes in Chinese women, while early pregnancy BMI had no significant influence on the infant neurocognitive development at 12 months of age.
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Jing S, Chen C, Gan Y, Vogel J, Zhang J. Incidence and trend of preterm birth in China, 1990-2016: a systematic review and meta-analysis. BMJ Open 2020; 10:e039303. [PMID: 33310797 PMCID: PMC7735132 DOI: 10.1136/bmjopen-2020-039303] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/19/2020] [Accepted: 11/24/2020] [Indexed: 01/02/2023] Open
Abstract
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.
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Affiliation(s)
- Shiwen Jing
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuexin Gan
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Joshua Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Jun Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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12
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Lin J, Huang J, Wang N, Kuang Y, Cai R. Effects of pre-pregnancy body mass index on pregnancy and perinatal outcomes in women with PCOS undergoing frozen embryo transfer. BMC Pregnancy Childbirth 2019; 19:487. [PMID: 31823750 PMCID: PMC6902324 DOI: 10.1186/s12884-019-2611-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background Previous studies have shown that among women with polycystic ovary syndrome who have difficulties conceiving, frozen-embryo transfer resulted in increased live birth rates and decreased ovarian hyperstimulation syndrome risk than did fresh-embryo transfer. In the present retrospective analysis, we sought to determine the effect of body mass index (BMI) on pregnancy and perinatal outcomes in women with PCOS undergoing FET. Methods Women with PCOS (n = 1556) undergoing FET were divided into groups based on weight, with those with normal weight having a BMI of 18.5–24.9 kg/m2,those who were overweight having a BMI of 25–29.9 kg/m2, and those who were obese having a BMI ≥30 kg/m2. Both pregnancy and perinatal outcomes were compared among these groups. Results The normal-weight, overweight, or obese groups exhibited similar pregnancy outcomes, including clinical pregnancy rate, miscarriage rate, ongoing pregnancy rate and live birth rate. In singletons, birth characteristics regarding newborn gender, gestational age, birthweight and length at birth were comparable between the three groups. For adverse neonatal outcomes, the three groups showed no significant differences on the rates of low birthweight, very low birthweight, preterm birth, and very preterm birth after adjustment. In addition, the obstetric complications and the frequencies of live-birth defects were also comparable between the three groups except that overweight and obese women were more likely than women of normal weight to have delivered via cesarean section. Conclusion BMI did not affect the pregnancy or perinatal outcomes in women with PCOS undergoing FET.
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Affiliation(s)
- Jiaying Lin
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Jialyu Huang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Ningling Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
| | - Renfei Cai
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
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13
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Adane AA, Shepherd CCJ, Lim FJ, White SW, Farrant BM, Bailey HD. The impact of pre-pregnancy body mass index and gestational weight gain on placental abruption risk: a systematic review and meta-analysis. Arch Gynecol Obstet 2019; 300:1201-1210. [PMID: 31576448 DOI: 10.1007/s00404-019-05320-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/21/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE The aim of this systematic review was to evaluate the associations between pre-pregnancy body mass index and gestational weight gain and placental abruption. METHODS Relevant studies were identified from PubMed, EMBASE, Scopus and CINAHL. Unpublished findings from analyses of linked population-based data sets from Western Australia (2012-2015, n = 114,792) were also included. Studies evaluating pre-pregnancy body mass index and/or gestational weight gain and placental abruption were included. Two independent reviewers evaluated studies for inclusion and quality. Data including odds ratios (ORs) and 95% confidence intervals (CIs) were extracted and analysed by random effects meta-analysis. RESULTS 21 studies were included, of which 15 were eligible for meta-analyses. The summary ORs for the association of being underweight, overweight and obese, and placental abruption, compared to normal weight women, were 1.4 (95% CI 1.1, 1.7), 0.8 (95% CI 0.8, 0.9) and 0.8 (95% CI 0.7, 0.9), respectively. These findings remained unchanged when each study was eliminated from the analysis and in subgroup analyses. Although data were scarce, women with gestational weight gain below the Institute of Medicine recommendations appeared to be at greater risk of abruption compared with women who had optimal weight gain. CONCLUSIONS Mothers that are underweight prior to or in early pregnancy are at a moderately increased risk of placental abruption.
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Affiliation(s)
- Akilew A Adane
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia.
| | - Carrington C J Shepherd
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia.,Ngangk Yira Aboriginal Health and Social Equity Research Centre, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia
| | - Faye J Lim
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology (M550), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.,Department of Maternal Fetal Medicine, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, WA, 6008, Australia
| | - Brad M Farrant
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia
| | - Helen D Bailey
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, WA, 6872, Australia
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Pregnancy-Related ICU Admissions From 2008 to 2016 in China: A First Multicenter Report. Crit Care Med 2019; 46:e1002-e1009. [PMID: 30059363 PMCID: PMC6147102 DOI: 10.1097/ccm.0000000000003355] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
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.
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15
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Zhang Y, Wang L, Yang W, Niu D, Li C, Wang L, Gu P, Xia Y, Shen Y, Yan J, Zhao Q, Mu K, Yan W. Effectiveness of Low Glycemic Index Diet Consultations Through a Diet Glycemic Assessment App Tool on Maternal and Neonatal Insulin Resistance: A Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e12081. [PMID: 30998227 PMCID: PMC6503641 DOI: 10.2196/12081] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 11/08/2018] [Accepted: 02/17/2019] [Indexed: 12/25/2022] Open
Abstract
Background Low glycemic index (LGI) diet has shown to be effective in reducing maternal and neonatal complications in high-risk pregnancies. Objective This trial aimed to examine the effectiveness of individualized LGI diet consultations based on the accurate diet glycemic load (GL) assessment tool on maternal and neonatal insulin resistance levels and diet behavior changes in overweight and obese pregnant women. Methods Overweight and obese pregnant women were recruited before 16 weeks of gestation and randomized to the LGI diet arm or the control arm. All participants received standard dietary education according to the Chinese Dietary Guide for Pregnant Women. In the intervention arm, additional individualized dietary GL assessments were performed using an app and instructions of lowering diet glycemic index (GI) to achieve LGI diet were provided by a clinical dietitian at early, middle, and late gestation. Primary outcomes were serum insulin at late gestation, incidence of gestational diabetes mellitus (GDM) for mothers, and cord blood C-peptide level of neonates. Results In total, 400 subjects were randomized and received different interventions. There were no significant differences in maternal serum insulin levels (13.2 [9.3−13.2] uU/mL vs 12.4 [10.5−12.4] uU/mL), incidence of GDM (45 [22.5%] vs 43 [21.5%]), or cord blood C-peptide levels (mean 0.9ng/mL [SD 0.7] vs mean 0.8ng/mL [SD 0.6]) in the intervention group compared with the controls. The diet GI at late gestation was similar (mean 63.2 [SD 10.4] vs mean 64.3 [SD 10.4]), whereas greater diet fiber intake was observed in the intervention group (mean 11.6 grams [SD 8.0] vs mean 9.0 grams [SD 5.6]; P=.006). Adherence measurements did not significantly differ between 2 groups. Conclusions Individualized LGI diet consultations for overweight and obese pregnant women failed to make a significant difference in maternal or neonatal insulin resistance compared with the standard gestational diet consultation. Trial Registration ClinicalTrials.gov NCT01628835; http://clinicaltrials.gov/ct2/show/NCT01628835 (Archived by WebCite at http://www.webcitation.org/77LHgWP0k)
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Affiliation(s)
- Yi Zhang
- Children's Hospital of Fudan University, Shanghai, China
| | - Liping Wang
- International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Wenhong Yang
- Kunshan Maternity and Child Care Center, Kunshan, China
| | - Dayan Niu
- Children's Hospital of Fudan University, Shanghai, China
| | - Chunying Li
- Kunshan Maternity and Child Care Center, Kunshan, China
| | - Liling Wang
- International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Ping Gu
- Kunshan Maternity and Child Care Center, Kunshan, China
| | - Yingqian Xia
- International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Ying Shen
- International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai, China
| | - Juhua Yan
- Kunshan Maternity and Child Care Center, Kunshan, China
| | - Qian Zhao
- Children's Hospital of Fudan University, Shanghai, China
| | - Kai Mu
- Children's Hospital of Fudan University, Shanghai, China
| | - Weili Yan
- Children's Hospital of Fudan University, Shanghai, China
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16
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Liu L, Ma Y, Wang N, Lin W, Liu Y, Wen D. Maternal body mass index and risk of neonatal adverse outcomes in China: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19:105. [PMID: 30922244 PMCID: PMC6440121 DOI: 10.1186/s12884-019-2249-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 03/18/2019] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Lei Liu
- School of Public Health, Dalian Medical University, Dalian, Liaoning Province, 116044, People's Republic of China
| | - Yanan Ma
- School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Ningning Wang
- School of Public Health, Dalian Medical University, Dalian, Liaoning Province, 116044, People's Republic of China
| | - Wenjing Lin
- School of Public Health, Dalian Medical University, Dalian, Liaoning Province, 116044, People's Republic of China
| | - Yang Liu
- School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China
| | - Deliang Wen
- School of Public Health, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, People's Republic of China.
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Cai X, Duan Y, Li Y, Wang J, Mao Y, Yang Z, Zhao X, Zhao Y, Guan Y, Yin S. Lactoferrin level in breast milk: a study of 248 samples from eight regions in China. Food Funct 2018; 9:4216-4222. [DOI: 10.1039/c7fo01559c] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Lactoferrin plays an important role in infant gastrointestinal health and immunity responses.
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Affiliation(s)
| | - Yifan Duan
- National Institute for Nutrition and Health
- Chinese Center for Disease Control and Prevention
- Beijing
- China
| | - Yang Li
- Abbott Nutrition R&D
- Shanghai
- China
| | - Jie Wang
- National Institute for Nutrition and Health
- Chinese Center for Disease Control and Prevention
- Beijing
- China
| | | | - Zhenyu Yang
- National Institute for Nutrition and Health
- Chinese Center for Disease Control and Prevention
- Beijing
- China
| | | | | | - Yan Guan
- Abbott Nutrition R&D
- Shanghai
- China
| | - Shian Yin
- National Institute for Nutrition and Health
- Chinese Center for Disease Control and Prevention
- Beijing
- China
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18
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Al Rifai RH. Trend of caesarean deliveries in Egypt and its associated factors: evidence from national surveys, 2005-2014. BMC Pregnancy Childbirth 2017; 17:417. [PMID: 29237410 PMCID: PMC5729511 DOI: 10.1186/s12884-017-1591-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/23/2017] [Indexed: 12/29/2022] Open
Abstract
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.
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Affiliation(s)
- Rami H Al Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
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19
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Pan Y, Zhang S, Wang Q, Shen H, Zhang Y, Li Y, Yan D, Sun L. Investigating the association between prepregnancy body mass index and adverse pregnancy outcomes: a large cohort study of 536 098 Chinese pregnant women in rural China. BMJ Open 2016; 6:e011227. [PMID: 27439613 PMCID: PMC4964214 DOI: 10.1136/bmjopen-2016-011227] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Unhealthy maternal weight before pregnancy increases the risk of various adverse pregnancy outcomes. We conducted a nutrition survey to provide baseline data on the prepregnant nutritional status of mothers in order to better understand the association between prepregnancy maternal body mass index (BMI) and adverse pregnancy outcomes. DESIGN A large, prospective, population-based cohort study. SETTING Data from the National Free Preconception Health Examination Project (NFPHEP) in China during 2010-2012. PARTICIPANTS 536 098 pregnant women out of 2 120 131 were evaluated. PRIMARY AND SECONDARY OUTCOME MEASURES The primary adverse pregnancy outcomes included preterm birth (PTB), low birth weight (LBW), spontaneous miscarriage (SM), ectopic pregnancy (EP) and stillbirth (SB). A χ(2) test was used to compare the prevalence of each BMI category during 2010-2012. Univariable and multiple logistic regression analyses were performed to assess the association between prepregnancy BMI and various adverse pregnancy outcomes. RESULTS Between 2010 and 2012, the average BMI decreased from 21.31 to 21.16, while underweight prevalence increased from 10.40% to 14.14%. An age-stratified subgroup analysis indicated that the underweight prevalence increased from 13.52% to 17.02% among women aged 21-24 and from 10.72% to 13.71% among women aged 25-34. Overweight prevalence increased from 9.84% to 10.75% (25-34 years) and from 17.10% to 19.20% (35-49 years). Obesity prevalence increased from 2.17% to 2.42% and from 4% to 4.2% among women aged 25-34 and 35-49 respectively. Prepregnancy underweight was associated with PTB, LBW and SM; overweight women had an increased risk of LBW; obese women had a higher risk of LBW, SM, EP and SB. CONCLUSIONS While the average prepregnancy BMI decreased, the prevalence of underweight individuals in a very large population significantly increased. The abnormal prepregnancy BMIs were associated with increased risks of adverse pregnancy outcomes. Most notably, underweight prepregnant women appeared to be at a greater risk of developing adverse pregnancy outcomes in China's rural areas.
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Affiliation(s)
- Yi Pan
- Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shikun Zhang
- Department of Maternal & Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Qiaomei Wang
- Department of Maternal & Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Haiping Shen
- Department of Maternal & Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Yiping Zhang
- Department of Maternal & Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Yuanyuan Li
- National Research Institute for Family Planning, Beijing, China
| | - Donghai Yan
- Department of Maternal & Child Health, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Lizhou Sun
- Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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