Association of pre-pregnancy obesity versus excessive gestational weight gain with adverse maternal outcomes in the United States.

Abstract

Objective: Pre-pregnancy BMI >30 kg/m2 or obesity (PPO) and excessive gestational weight gain (eGWG) are associated with increased risks for adverse maternal outcomes. There is little is known regarding the individual effects of PPO and eGWG. The objective of this study was to compare the effects of PPO and eGWG with adverse maternal outcomes.

Methods: This was a retrospective cohort study of singleton, live births in the United States in 2018 using data from the National Vital Statistics System. Pregnancies complicated by pregestational diabetes, chronic hypertension, and with unknown maternal body mass index (BMI) were excluded. IOM recommendations was used to define GWG. These births were divided into four groups: 1) normal pre-pregnancy BMI and normal GWG, 2) normal pre-pregnancy BMI and eGWG, 3) PPO and normal GWG and 4) PPO and eGWG. Outcomes such as Gestational diabetes, hypertensive disorders of pregnancy, cesarean delivery, maternal transfusion, and medical intensive care unit (MICU) admissions were compared among groups using ANOVA, and multivariable.

Results: Of the 1,432,602 births included in the study, 22.2%, 42.3%, 10.1%, and 25.4% were in Groups 1-4 respectively. Compared with pregnancies in Group 1 (adjusted OR (95%CI)), Groups 3 and 4 had higher risk for gestational diabetes (2.80 (2.72-2.88) and 2.28 (2.22-2.34)) respectively, while Groups 2-4 had higher risk of hypertensive disease of pregnancy (1.58 (1.53-1.64), 3.88 (3.74-4.03) and 5.07 (4.90-5.23)); eclampsia (1.61 (1.33-1.95), 2.99 (2.42-3.69) and 3.57, (2.97-4.29)), and cesarean delivery (1.21 (1.19-1.23), 1.97 (1.92-2.02), and 2.45 (2.40-2.50)) respectively.

Conclusion: Both PPO and eGWG are independently associated with higher odds of gestational diabetes, gestational hypertension, preeclampsia and cesarean sections, with the highest risk among pregnancies with both PPO and eGWG. This data supports the importance of pre-pregnancy weight management in preventing adverse pregnancy outcomes.