Just Accepted by The Journal of Maternal-Fetal & Neonatal Medicine Association Between Parity, Prepregnancy Body Mass Index And Gestational Weight Gain Daiane Sofia de Morais Paulino, Fernanda Garanhani Surita, Gabriela Bertoldi Peres, Simony Lira do Nascimento, Sirlei Siani Morais doi: 10.3109/14767058.2015.1021674 Abstract
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
Objective: To analyze the relationship between parity, prepregnancy Body Mass Index (BMI), and gestational weight gain (GWG). Methods: This observational controlled study was conducted from November 2013 to April 2014, with postpartum women who started antenatal care up to 14 weeks and had full term births. Data were collected from medical records and antenatal cards. Descriptive and bivariate analyses were performed. The significance level was 5%. Results: Data were collected from 130 primiparous and 160 multiparous women. At the beginning of prenatal care, 54.62% of the primiparous were eutrophic, while the majority of multiparous were overweight or obese (62.51%). Multiparas are two times more likely to be obese at the start of their pregnancies when compared to primiparas. The average prepregnancy weight and final pregnancy weight was significantly higher in multiparous, however the mean GWG was higher among primiparous. Conclusion: We found an inverse correlation between parity and the total GWG, but starting BMI was significantly higher in multiparasNevertheless, monitoring of the GWG through actions that promote a healthier lifestyle is needed, regardless of parity and nutritional status, in order to prevent excessive GWG and postpartum weight retention and consequently inadequate prepregnancy nutritional status in future pregnancies.
© 2014 Informa UK Ltd. This provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. DISCLAIMER: The ideas and opinions expressed in the journal’s Just Accepted articles do not necessarily reflect those of Informa Healthcare (the Publisher), the Editors or the journal. The Publisher does not assume any responsibility for any injury and/or damage to persons or property arising from or related to any use of the material contained in these articles. The reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each drug to be administered to verify the dosages, the method and duration of administration, and contraindications. It is the responsibility of the treating physician or other health care professional, relying on his or her independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient. Just Accepted articles have undergone full scientific review but none of the additional editorial preparation, such as copyediting, typesetting, and proofreading, as have articles published in the traditional manner. There may, therefore, be errors in Just Accepted articles that will be corrected in the final print and final online version of the article. Any use of the Just Accepted articles is subject to the express understanding that the papers have not yet gone through the full quality control process prior to publication.
ASSOCIATION BETWEEN PARITY, PREPREGNANCY BODY MASS INDEX AND GESTATIONAL WEIGHT GAIN Daiane Sofia de Morais Paulino Fernanda Garanhani Surita
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
Gabriela Bertoldi Peres Simony Lira do Nascimento Sirlei Siani Morais
Department of Obstetrics and Gynecology, University of Campinas- UNICAMP. Alexander Fleming Street, 101 – Campinas- São Paulo- Brazil ZIP code 13083-881 Telephone (+5519) 35219304
Correspondence: Fernanda Garanhani Surita Alexander Fleming Street, 101 – Campinas- São Paulo- Brazil ZIP code 13083-881 Telephone (+5519) 35219304 E-mail: [email protected]
Abstract Objective: To analyze the relationship between parity, prepregnancy Body Mass Index (BMI),
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
and gestational weight gain (GWG). Methods: This observational controlled study was conducted from November 2013 to April 2014, with postpartum women who started antenatal care up to 14 weeks and had full term births. Data were collected from medical records and antenatal cards. Descriptive and bivariate analyses were performed. The significance level was 5%. Results: Data were collected from 130 primiparous and 160 multiparous women. At the beginning of prenatal care, 54.62% of the primiparous were eutrophic, while the majority of multiparous were overweight or obese (62.51%). Multiparas are two times more likely to be obese at the start of their pregnancies when compared to primiparas. The average prepregnancy weight and final pregnancy weight was significantly higher in multiparous, however the mean GWG was higher among primiparous. Conclusion: We found an inverse correlation between parity and the total GWG, but starting BMI was significantly higher in multiparasNevertheless, monitoring of the GWG through actions that promote a healthier lifestyle is needed, regardless of parity and nutritional status, in order to prevent excessive GWG and postpartum weight retention and consequently inadequate prepregnancy nutritional status in future pregnancies.
Keywords: Parity,, Gestational Weight Gain, Body Mass Index.
Introduction The gestational period is characterized by physiological adaptations that affect maternal metabolism. These adaptations are accompanied by weight gain and changes in body
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
composition for future fetal tissue formation and for energy reserves for the demands of pregnancy and lactation (1, 2). Maternal nutritional status is an important determinant for fetal health and can have permanent or long-term effects (metabolic programming). For example, it represents a risk factor for the development of several chronic diseases such as diabetes, hypertension and metabolic syndrome in adulthood (3). Low birth weight, resulting from maternal malnutrition, is an epidemiological problem in some specific populations in many countries, including Brazil. However, in the majority of countries, an increasing prevalence of obesity and excessive gestational weight gain (GWG) now reflects the nutritional transition process experienced in the last three decades (4, 5). BMI > 24.9 kg/m2, as well as excessive gestational weight gain, are associated with obstetric risk conditions such as gestational diabetes mellitus, gestational hypertension, preeclampsia, macrossomia, and some perinatal complications (6, 7). While underweight increases risk of uterus grown restriction and low birth weight (4). Excessive GWG may contribute to the occurrence of overweight and obesity among women of reproductive age (8-11) since increases in weight gain above the recommended levels during pregnancy are correlated with higher postpartum weight retention (12, 13). The aim of this study was therefore to examine the relationship between parity and prepregnancy Body Mass Index (BMI) and (GWG).
Methods This observational controlled study was conducted at the Women’s Hospital Prof. Dr. Jose Aristodemo Pinotti (CAISM), University of Campinas (Unicamp), from November 2013 to April 2014.
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
The sample size was calculated based on the difference in GWG between primiparous and multiparous groups in the study by Lan-Pidhainy et al .(14). Assumption of a significance level of 5% and power of 80% resulted in 130 women per group. Data were collected by manual review of medical records and antenatal cards of postpartum women admitted to the hospital. Women who were more than 19 years old, who started antenatal care up to 14 weeks, and had a full term birth were included. A data sheet was developed specifically for this study. Socio-demographic characteristics, obstetric history, and anthropometric data were collected. The “prepregnancy weight” was considered as the first weight measured and recorded in antenatal card, while the “final gestational weight” was the weight recorded at the last antenatal medical consultation. These data, along with “height,” were later used for the calculation and classification of prepregnancy and final BMI of the studied postpartum women. The BMI was classified according to the categories of WHO and IOM (2009) (1). This classification was used for analysis of the adequacy of GWG, according to the recommendation of the Institute of Medicine (2009) (1), which considers that an acceptable weight gain for underweight pregnant women is 12.5–18 kg, for eutrophic pregnant women is 11–16 kg, for overweight pregnant women is 7–11.5 kg, and for obese pregnant women 5–9 kg.
The confidentiality of the subjects was maintained by identifying them only with a number. This study protocol was approved by the University of Campinas (UNICAMP) ethical committee and Brazil Platform CAAE 25351513.7.0000.5404. We first carried out a descriptive analysis using means and standard deviations (SD) for
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
continuous variables, with normal distribution and frequencies and percentages for categorical variables. Bivariate analysis was performed to evaluate the association between parity, prepregnancy nutritional status, and weight gain by using the Student’s t-test for continuous variables and the chi-square for categorical variables with respective odds ratios (OR) and 95% confidence intervals (CI). Multiple logistic regression was then performed and adjusted for age and educational level. The significance level was 5% and the software used for analysis was Epiinfo version 5.1.
Results Data were collected from 290 women; 130 were primiparous and 160 were multiparous (with 2 or more pregnancies). Table 1 shows the sociodemographic characteristics, mean gestational age at the
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
beginning and end of the prenatal, initial, and final gestational weight, and mean weight gain. Multiparous women were older and they had a lower educational level than the primiparous women. Both groups had an average beginning of prenatal care at 11 weeks. The initial and final gestational weights were significantly higher in multiparous than in primiparous women, but the average gestational weight gain was higher in primiparous (p value= 0.03). The prepregnancy BMI differed between the primiparous and multiparous groups, with a higher prevalence of eutrophy in the primiparous and a higher prevalence of obesity in the multiparous. No difference was noted in the prevalence of overweight and underweight among groups. The pregestational BMI confirmed that the multiparous are two times more likely to be obese at the start of their pregnancies when compared to primiparous women. (Table 2). The adequacy of GWG also did not differ by categories of BMI between groups, with only 37.7% of primiparous showing adequate weight gain, 32.3% showing excessive weight gain, and 30.0% showing inadequate weight gain. The multiparous group had 35.5% gaining weight adequately, 30.6% with excessive weight gain, and 33.7% with insufficient weight gain (p = 0.4). However, in both groups, 2/3 of the women did not present an adequate weight gain (Table 2). Excessive gestational weight gain according to the prepregnancy BMI by parity is shown in Table 3. Parity was not associated with excessive weight gain (p value = 0.75), but about 30%
of the women evaluated had excessive weight gain during pregnancy. And the greatest rate of
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
excessive GWG was observed in overweight women.
Discussion This study found differences between prepregnancy BMI and parity of women, since the risk of obesity was two times higher in multiparous women. The prepregnancy and final pregnancy weight, as well as age, were lower in primiparous women, while educational level and
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
GWG were higher in those women. Regardless parity a recent and large study in Brazil also indicates that education is a strong protective factor among women. The percentage of overweight among women with eight years of study was 58.3% and among women with education at least 12 years, this percentage drops to 36.6% .The prevalence of obesity also drops by half between these two groups of women, reaching 24.4% and 11.8%, respectively (15). It might be expected that higher educational level is associated with better nutritional habits. And multiparous women probably had to interrupt their educations earlier to take care of their kids. A fact that draws attention is the amount of women of reproductive age that start pregnancy
with inadequate BMI. In the primiparous group, besidesthe majority have adequate prepregnancy BMI (55%), 40% have inadequate nutritional status, presenting as overweight (26%) or obese (14%). On the other hand, multiparous women were a statistically different age, with an average age of 28 years old, but were relatively young women generally under 30 years old. Multiparous women had a prepregnancy weight significantly higher than primiparous women, with about 60% being overweight and obese. This could reflect what will happen to these women after one or more pregnancies, as many of them are in inadequate ranges of weight/height. Adverse effects on physical and emotional health might be observed in the future.
In accordance with our study, Nucci et al. (2001) and Tanaka et al. (2014) (4, 16) also observed a higher prevalence of obesity in multiparous women. Similar findings were also observed by Zeal et al (2014) (17), who found that multiparity was associated with increased rates of maternal overweight.
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
Although the total GWG was higher in primiparous, we did not find difference between the two groups regarding excessive GWG, as about one third of all women had excessive weight gain during pregnancy. Unlike, Other studies have found that nulliparity is an independent risk factor for excessive GWG, while multiparity is an independent risk factor for low GWG (18, 19)). Note that in all BMI categories, with exception of low weight, only about 35% of both primiparous and multiparous women gained weight in the range recommended by the IOM. This fact for the primiparous women, who were mostly eutrophic, could be the cause of a change in their nutritional status if they do not return to their prepregnancy weights. For multiparous women, this is even more worrying because two-thirds of them were already overweight or obese, and 30% had excessive gestational weight gain. Biopsychosocial studies have found that several lifestyle factors are positively associated with GWG, including increased food intake, reduced physical activity, total daily energy intake, consumption of less than 3 portions fruits and vegetables daily, and quitting smoking (18, 20, 21). Interestingly, and perhaps reflecting the globalization process, changes in eating habits, such as consumption of takeaway meals, is also significantly correlated to the total gestational weight gain, so that the consumption of takeaway meals more than once a week was correlated with a 2 kg greater weight gain (21).
Although genetic and hormonal factors are also intrinsically linked to weight gain in women, especially after menopause, other factors such as postpartum weight retention deserve attention and should be addressed in order to reduce overweight, obesity, and their comorbidities related in the future (22).
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
A cohort of 12875 Canadian women showed a correlation between excessive GWG and increased postpartum weight retention. This retention was correlated with parity, and primiparous women who had excessive weight gain had higher postpartum weight retention compared with multiparous women (23). This is probably one of the main factors that will lead to nulliparous women with excessive weight gain being the multiparous women of tomorrow who start pregnancy as obese. Thus, intervention in the factors that promote the modification of lifestyle during subsequent prenatal periods, including encouraging regular physical activity and adoption of healthy eating habits, should becomes a tool-target to ensure adequate GWG and consequently nutritional status in the postpartum period. A limitation of our study was the low prevalence of underweight women in the population evaluated; however, this characteristic was also observed in a population-based study of 1052 pregnant women in the same country, where a prevalence of only 6.16% of underweight (24) was noted. This again points to the trend of increasing the weight in women in reproductive age. This also raises the question of whether the limitation of the study was in having a nonrepresentative sample or whether the number of adult women with a BMI below the normal range (
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
Objective: To analyze the relationship between parity, prepregnancy Body Mass Index (BMI), and gestational weight gain (GWG). Methods: This observational controlled study was conducted from November 2013 to April 2014, with postpartum women who started antenatal care up to 14 weeks and had full term births. Data were collected from medical records and antenatal cards. Descriptive and bivariate analyses were performed. The significance level was 5%. Results: Data were collected from 130 primiparous and 160 multiparous women. At the beginning of prenatal care, 54.62% of the primiparous were eutrophic, while the majority of multiparous were overweight or obese (62.51%). Multiparas are two times more likely to be obese at the start of their pregnancies when compared to primiparas. The average prepregnancy weight and final pregnancy weight was significantly higher in multiparous, however the mean GWG was higher among primiparous. Conclusion: We found an inverse correlation between parity and the total GWG, but starting BMI was significantly higher in multiparasNevertheless, monitoring of the GWG through actions that promote a healthier lifestyle is needed, regardless of parity and nutritional status, in order to prevent excessive GWG and postpartum weight retention and consequently inadequate prepregnancy nutritional status in future pregnancies.
© 2014 Informa UK Ltd. This provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. DISCLAIMER: The ideas and opinions expressed in the journal’s Just Accepted articles do not necessarily reflect those of Informa Healthcare (the Publisher), the Editors or the journal. The Publisher does not assume any responsibility for any injury and/or damage to persons or property arising from or related to any use of the material contained in these articles. The reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each drug to be administered to verify the dosages, the method and duration of administration, and contraindications. It is the responsibility of the treating physician or other health care professional, relying on his or her independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient. Just Accepted articles have undergone full scientific review but none of the additional editorial preparation, such as copyediting, typesetting, and proofreading, as have articles published in the traditional manner. There may, therefore, be errors in Just Accepted articles that will be corrected in the final print and final online version of the article. Any use of the Just Accepted articles is subject to the express understanding that the papers have not yet gone through the full quality control process prior to publication.
ASSOCIATION BETWEEN PARITY, PREPREGNANCY BODY MASS INDEX AND GESTATIONAL WEIGHT GAIN Daiane Sofia de Morais Paulino Fernanda Garanhani Surita
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
Gabriela Bertoldi Peres Simony Lira do Nascimento Sirlei Siani Morais
Department of Obstetrics and Gynecology, University of Campinas- UNICAMP. Alexander Fleming Street, 101 – Campinas- São Paulo- Brazil ZIP code 13083-881 Telephone (+5519) 35219304
Correspondence: Fernanda Garanhani Surita Alexander Fleming Street, 101 – Campinas- São Paulo- Brazil ZIP code 13083-881 Telephone (+5519) 35219304 E-mail: [email protected]
Abstract Objective: To analyze the relationship between parity, prepregnancy Body Mass Index (BMI),
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
and gestational weight gain (GWG). Methods: This observational controlled study was conducted from November 2013 to April 2014, with postpartum women who started antenatal care up to 14 weeks and had full term births. Data were collected from medical records and antenatal cards. Descriptive and bivariate analyses were performed. The significance level was 5%. Results: Data were collected from 130 primiparous and 160 multiparous women. At the beginning of prenatal care, 54.62% of the primiparous were eutrophic, while the majority of multiparous were overweight or obese (62.51%). Multiparas are two times more likely to be obese at the start of their pregnancies when compared to primiparas. The average prepregnancy weight and final pregnancy weight was significantly higher in multiparous, however the mean GWG was higher among primiparous. Conclusion: We found an inverse correlation between parity and the total GWG, but starting BMI was significantly higher in multiparasNevertheless, monitoring of the GWG through actions that promote a healthier lifestyle is needed, regardless of parity and nutritional status, in order to prevent excessive GWG and postpartum weight retention and consequently inadequate prepregnancy nutritional status in future pregnancies.
Keywords: Parity,, Gestational Weight Gain, Body Mass Index.
Introduction The gestational period is characterized by physiological adaptations that affect maternal metabolism. These adaptations are accompanied by weight gain and changes in body
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
composition for future fetal tissue formation and for energy reserves for the demands of pregnancy and lactation (1, 2). Maternal nutritional status is an important determinant for fetal health and can have permanent or long-term effects (metabolic programming). For example, it represents a risk factor for the development of several chronic diseases such as diabetes, hypertension and metabolic syndrome in adulthood (3). Low birth weight, resulting from maternal malnutrition, is an epidemiological problem in some specific populations in many countries, including Brazil. However, in the majority of countries, an increasing prevalence of obesity and excessive gestational weight gain (GWG) now reflects the nutritional transition process experienced in the last three decades (4, 5). BMI > 24.9 kg/m2, as well as excessive gestational weight gain, are associated with obstetric risk conditions such as gestational diabetes mellitus, gestational hypertension, preeclampsia, macrossomia, and some perinatal complications (6, 7). While underweight increases risk of uterus grown restriction and low birth weight (4). Excessive GWG may contribute to the occurrence of overweight and obesity among women of reproductive age (8-11) since increases in weight gain above the recommended levels during pregnancy are correlated with higher postpartum weight retention (12, 13). The aim of this study was therefore to examine the relationship between parity and prepregnancy Body Mass Index (BMI) and (GWG).
Methods This observational controlled study was conducted at the Women’s Hospital Prof. Dr. Jose Aristodemo Pinotti (CAISM), University of Campinas (Unicamp), from November 2013 to April 2014.
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
The sample size was calculated based on the difference in GWG between primiparous and multiparous groups in the study by Lan-Pidhainy et al .(14). Assumption of a significance level of 5% and power of 80% resulted in 130 women per group. Data were collected by manual review of medical records and antenatal cards of postpartum women admitted to the hospital. Women who were more than 19 years old, who started antenatal care up to 14 weeks, and had a full term birth were included. A data sheet was developed specifically for this study. Socio-demographic characteristics, obstetric history, and anthropometric data were collected. The “prepregnancy weight” was considered as the first weight measured and recorded in antenatal card, while the “final gestational weight” was the weight recorded at the last antenatal medical consultation. These data, along with “height,” were later used for the calculation and classification of prepregnancy and final BMI of the studied postpartum women. The BMI was classified according to the categories of WHO and IOM (2009) (1). This classification was used for analysis of the adequacy of GWG, according to the recommendation of the Institute of Medicine (2009) (1), which considers that an acceptable weight gain for underweight pregnant women is 12.5–18 kg, for eutrophic pregnant women is 11–16 kg, for overweight pregnant women is 7–11.5 kg, and for obese pregnant women 5–9 kg.
The confidentiality of the subjects was maintained by identifying them only with a number. This study protocol was approved by the University of Campinas (UNICAMP) ethical committee and Brazil Platform CAAE 25351513.7.0000.5404. We first carried out a descriptive analysis using means and standard deviations (SD) for
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
continuous variables, with normal distribution and frequencies and percentages for categorical variables. Bivariate analysis was performed to evaluate the association between parity, prepregnancy nutritional status, and weight gain by using the Student’s t-test for continuous variables and the chi-square for categorical variables with respective odds ratios (OR) and 95% confidence intervals (CI). Multiple logistic regression was then performed and adjusted for age and educational level. The significance level was 5% and the software used for analysis was Epiinfo version 5.1.
Results Data were collected from 290 women; 130 were primiparous and 160 were multiparous (with 2 or more pregnancies). Table 1 shows the sociodemographic characteristics, mean gestational age at the
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
beginning and end of the prenatal, initial, and final gestational weight, and mean weight gain. Multiparous women were older and they had a lower educational level than the primiparous women. Both groups had an average beginning of prenatal care at 11 weeks. The initial and final gestational weights were significantly higher in multiparous than in primiparous women, but the average gestational weight gain was higher in primiparous (p value= 0.03). The prepregnancy BMI differed between the primiparous and multiparous groups, with a higher prevalence of eutrophy in the primiparous and a higher prevalence of obesity in the multiparous. No difference was noted in the prevalence of overweight and underweight among groups. The pregestational BMI confirmed that the multiparous are two times more likely to be obese at the start of their pregnancies when compared to primiparous women. (Table 2). The adequacy of GWG also did not differ by categories of BMI between groups, with only 37.7% of primiparous showing adequate weight gain, 32.3% showing excessive weight gain, and 30.0% showing inadequate weight gain. The multiparous group had 35.5% gaining weight adequately, 30.6% with excessive weight gain, and 33.7% with insufficient weight gain (p = 0.4). However, in both groups, 2/3 of the women did not present an adequate weight gain (Table 2). Excessive gestational weight gain according to the prepregnancy BMI by parity is shown in Table 3. Parity was not associated with excessive weight gain (p value = 0.75), but about 30%
of the women evaluated had excessive weight gain during pregnancy. And the greatest rate of
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
excessive GWG was observed in overweight women.
Discussion This study found differences between prepregnancy BMI and parity of women, since the risk of obesity was two times higher in multiparous women. The prepregnancy and final pregnancy weight, as well as age, were lower in primiparous women, while educational level and
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
GWG were higher in those women. Regardless parity a recent and large study in Brazil also indicates that education is a strong protective factor among women. The percentage of overweight among women with eight years of study was 58.3% and among women with education at least 12 years, this percentage drops to 36.6% .The prevalence of obesity also drops by half between these two groups of women, reaching 24.4% and 11.8%, respectively (15). It might be expected that higher educational level is associated with better nutritional habits. And multiparous women probably had to interrupt their educations earlier to take care of their kids. A fact that draws attention is the amount of women of reproductive age that start pregnancy
with inadequate BMI. In the primiparous group, besidesthe majority have adequate prepregnancy BMI (55%), 40% have inadequate nutritional status, presenting as overweight (26%) or obese (14%). On the other hand, multiparous women were a statistically different age, with an average age of 28 years old, but were relatively young women generally under 30 years old. Multiparous women had a prepregnancy weight significantly higher than primiparous women, with about 60% being overweight and obese. This could reflect what will happen to these women after one or more pregnancies, as many of them are in inadequate ranges of weight/height. Adverse effects on physical and emotional health might be observed in the future.
In accordance with our study, Nucci et al. (2001) and Tanaka et al. (2014) (4, 16) also observed a higher prevalence of obesity in multiparous women. Similar findings were also observed by Zeal et al (2014) (17), who found that multiparity was associated with increased rates of maternal overweight.
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
Although the total GWG was higher in primiparous, we did not find difference between the two groups regarding excessive GWG, as about one third of all women had excessive weight gain during pregnancy. Unlike, Other studies have found that nulliparity is an independent risk factor for excessive GWG, while multiparity is an independent risk factor for low GWG (18, 19)). Note that in all BMI categories, with exception of low weight, only about 35% of both primiparous and multiparous women gained weight in the range recommended by the IOM. This fact for the primiparous women, who were mostly eutrophic, could be the cause of a change in their nutritional status if they do not return to their prepregnancy weights. For multiparous women, this is even more worrying because two-thirds of them were already overweight or obese, and 30% had excessive gestational weight gain. Biopsychosocial studies have found that several lifestyle factors are positively associated with GWG, including increased food intake, reduced physical activity, total daily energy intake, consumption of less than 3 portions fruits and vegetables daily, and quitting smoking (18, 20, 21). Interestingly, and perhaps reflecting the globalization process, changes in eating habits, such as consumption of takeaway meals, is also significantly correlated to the total gestational weight gain, so that the consumption of takeaway meals more than once a week was correlated with a 2 kg greater weight gain (21).
Although genetic and hormonal factors are also intrinsically linked to weight gain in women, especially after menopause, other factors such as postpartum weight retention deserve attention and should be addressed in order to reduce overweight, obesity, and their comorbidities related in the future (22).
J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by University of Otago on 03/16/15 For personal use only.
A cohort of 12875 Canadian women showed a correlation between excessive GWG and increased postpartum weight retention. This retention was correlated with parity, and primiparous women who had excessive weight gain had higher postpartum weight retention compared with multiparous women (23). This is probably one of the main factors that will lead to nulliparous women with excessive weight gain being the multiparous women of tomorrow who start pregnancy as obese. Thus, intervention in the factors that promote the modification of lifestyle during subsequent prenatal periods, including encouraging regular physical activity and adoption of healthy eating habits, should becomes a tool-target to ensure adequate GWG and consequently nutritional status in the postpartum period. A limitation of our study was the low prevalence of underweight women in the population evaluated; however, this characteristic was also observed in a population-based study of 1052 pregnant women in the same country, where a prevalence of only 6.16% of underweight (24) was noted. This again points to the trend of increasing the weight in women in reproductive age. This also raises the question of whether the limitation of the study was in having a nonrepresentative sample or whether the number of adult women with a BMI below the normal range (
