www.nature.com/scientificreports
OPEN
Received: 17 May 2017 Accepted: 11 September 2017 Published: xx xx xxxx
Relationship Between Gestational Weight Gain and Pregnancy Complications or Delivery Outcome Wenjia Yang, Feifei Han, Xueying Gao, Yifei Chen, Linong Ji & Xiaoling Cai The purpose of this study is to analyse the association between gestational weight gain and delivery outcome or the morbidity of pregnancy complications. A total of 1,102 pregnant women who delivered at Peking University People’s Hospital in China between January 2011 and December 2012 were included in this study. We divided them into 4 groups according to the baseline BMI quartiles and weight gain quartiles in different trimesters of pregnancy to analyse the status of delivery outcome and morbidity of pregnancy complications. Baseline BMI was significantly positive correlated with the morbidity of gestational hypertension and gestational diabetes. Weight gain in the second trimester of pregnancy was significantly positively correlated with the morbidity of macrosomia. Weight gain in the third trimester of pregnancy showed significantly positive correlation with the morbidity of macrosomia, and significantly negative correlation with the morbidity of neonatal death, preterm birth, gestational diabetes, and low birth-weight infant. Gestational weight gain showed significantly positive correlation with the morbidity of macrosomia and significantly negative correlation with neonatal death, stillbirth, gestational diabetes, preterm birth and low birth-weight infant. There is a correlation between baseline BMI, pregnancy weight gain and gestational complications, adverse pregnancy outcomes, and status of neonate in varying degrees. In China, inadequate body weight control has become a prominent health problem with changes in lifestyle. For pregnant women who are in a special physiological condition1, appropriate pre-pregnancy weight and gestational weight gain (GWG) to meet the demands of mother and foetus is essential. Previous studies showed increasing pre-pregnant body mass index (BMI) was associated with increasing risk of gestational hypertension and gestational diabetes mellitus (GDM)2–5. Women who are overweight or obese before pregnancy are subject to increased risk of macrosomia and dystocia6–8. Women who are underweight were less likely to have adverse pregnancy outcomes, but more likely to have intrauterine growth restricted infants3. GWG also affects obstetrical and neonatal outcomes. Several studies suggest associations between excessive GWG and risk of hypertension, macrosomia, and caesarean section in pregnant women of different ethnics groups9–13. Inadequate GWG increased the risk of preterm birth and growth-restricted infants10–12. However, thus far, few studies have explored appropriate weight gain in different trimesters during pregnancy. In 2009, the Institute of Medicine (IOM) provided specific recommendations regarding the ideal gestational weight gain according to the BMI categories14. However, the report was criticized by some health care providers saying that the recommendation was still too high for the obese women. In Japan, as there are more underweight women, the obesity classification is different, so the recommendation issued by the Japanese Ministry of Health, Labour and Welfare on gestational weigh gain differs from that developed by IOM15. In China, we have been following the recommendation of IOM and there is no established recommendation for Chinese women. Because established recommendations on weight gain during pregnancy are inconsistent and contentious, ethnics groups, national conditions and many other factors should be taken into account for the recommendations, the aim of this study is to analyse the relevance between baseline BMI, gestational weight gain, and delivery outcome in a Chinese population.
Endocrinology and Metabolism Department, Peking University People’s Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, P.R. China. Correspondence and requests for materials should be addressed to L.J. (email: [email protected]) or X.C. (email: [email protected]) Scientific REPOrTS | 7: 12531 | DOI:10.1038/s41598-017-12921-3
1
www.nature.com/scientificreports/ 1st Quartile
2nd Quartile
3rd Quartile
4th Quartile
Baseline BMI(kg/m2)
18.1 ± 1.0
20.3 ± 0.5
22.1 ± 0.6
25.8 ± 2.4
Age(years)
29.5 ± 3.2
30.4 ± 3.3
30.7 ± 3.2
31.2 ± 3.5
Fasting glucose(mmol/L)
4.3 ± 0.5
4.3 ± 0.4
4.3 ± 0.4
4.4 ± 0.8
SBP(mmHg)
107.6 ± 11.2
110.5 ± 10.3
112.5 ± 11.0
116.2 ± 12.1
DBP(mmHg)
69.8 ± 8.3
70.8 ± 8.1
71.9 ± 8.9
74.5 ± 8.5
ALT(U/L)
17.5 ± 5.5
16.0 ± 18.0
17.5 ± 12.8
21.0 ± 23.2
AST(U/L)
16.0 ± 7.2
18.1 ± 6.8
18.6 ± 6.2
18.9 ± 10.6
LDL-C(mmol/L)
1.99 ± 0.40
2.26 ± 0.57
2.21 ± 0.53
2.45 ± 0.58
HDL-C(mmol/L)
1.63 ± 0.29
1.65 ± 0.28
1.61 ± 0.41
1.53 ± 0.32
CRE(μmol/L)
43.3 ± 6.5
44.7 ± 6.2
45.3 ± 6.9
44.7 ± 6.0
Baseline BMI Quartile Category
Weight Gain in the Second Trimester Quartile Category weight gain in the second trimester(kg)
−3.0–6.9
7.0–8.9
9.0–10.5
11.0–21.0
Age(years)
31.2 ± 3.6
30.3 ± 3.2
30.6 ± 3.2
29.9 ± 3.4
Fasting glucose(mmol/L)
4.3 ± 0.5
4.3 ± 0.4
4.3 ± 0.4
4.4 ± 8.3
SBP(mmHg)
113.2 ± 17.3
112.2 ± 11.6
110.0 ± 11.4
111.0 ± 10.7
DBP(mmHg)
72.1 ± 10.9
72.4 ± 8.8
71.0 ± 8.8
71.6 ± 8.1
ALT(U/L)
17.7 ± 18.3
15.4 ± 16.2
17.7 ± 18.9
19.0 ± 21.4
AST(U/L)
18.3 ± 8.7
17.6 ± 7.0
18.5 ± 7.1
19.2 ± 9.2
LDL-C(mmol/L)
2.36 ± 0.63
2.22 ± 0.53
2.17 ± 0.53
2.20 ± 0.52
HDL-C(mmol/L)
1.55 ± 0.32
1.56 ± 0.41
1.59 ± 0.28
1.67 ± 0.32
CRE(μmol/L)
44.2 ± 7.3
44.5 ± 5.7
44.7 ± 6.3
44.7 ± 6.8
Weight Gain in the Third Trimester Quartile Category weight gain in the third trimester(kg/m2)
−2.3–3.6
4.0–5.9
6.0–7.8
7.9–15.0
Age(years)
30.7 ± 3.6
30.8 ± 3.3
30.2 ± 3.2
29.8 ± 3.2
Fasting glucose(mmol/L)
4.3 ± 0.4
4.3 ± 0.4
4.3 ± 0.4
4.4 ± 0.8
SBP(mmHg)
113.0 ± 12.4
112.8 ± 12.0
112.0 ± 10.4
110.2 ± 11.9
DBP(mmHg)
72.6 ± 9.6
72.1 ± 9.1
71.8 ± 7.9
71.0 ± 8.7
ALT(U/L)
18.5 ± 16.1
17.5 ± 20.0
15.3 ± 10.6
17.7 ± 18.9
AST(U/L)
18.7 ± 7.4
18.4 ± 9.1
17.7 ± 6.3
18.5 ± 7.1
LDL-C(mmol/L)
2.44 ± 0.67
2.24 ± 0.50
2.17 ± 0.53
2.16 ± 0.54
HDL-C(mmol/L)
1.57 ± 0.32
1.59 ± 0.32
1.59 ± 0.28
1.61 ± 0.32
CRE(μmol/L)
44.1 ± 6.5
44.6 ± 5.9
44.4 ± 7.1
44.7 ± 6.3
Gestational Weight Gain Quartile Category GWG(kg)
1.0–11.8
12.0–14.6
15.0–17.7
18.0–29.0
Age(years)
31.2 ± 3.6
30.8 ± 3.1
30.2 ± 3.2
29.8 ± 3.4
Fasting glucose(mmol/L)
4.3 ± 0.4
4.3 ± 0.4
4.3 ± 0.4
4.4 ± 0.8
SBP(mmHg)
114.5 ± 12.2
116.7 ± 9.8
118.5 ± 10.8
119.2 ± 10.3
DBP(mmHg)
73.4 ± 8.7
74.8 ± 7.9
75.9 ± 8.7
75.0 ± 8.7
ALT(U/L)
18.1 ± 16.3
15.6 ± 14.2
17.8 ± 21.5
17.0 ± 14.2
AST(U/L)
18.5 ± 8.3
17.8 ± 6.7
18.4 ± 8.8
18.3 ± 6.3
LDL-C(mmol/L)
2.40 ± 0.66
2.19 ± 0.56
2.20 ± 0.42
2.17 ± 0.56
HDL-C(mmol/L)
1.54 ± 0.34
1.58 ± 0.38
1.62 ± 0.29
1.64 ± 0.33
CRE(μmol/L)
43.9 ± 6.6
44.8 ± 6.8
44.3 ± 6.0
44.7 ± 6.8
Table 1. Baseline characteristics of pregnant women categorized by quartile for baseline BMI, weight in the first trimester, weight gain in the second trimester, weight gain in the third trimester, and GWG.
Methods
Populations. All women who delivered at Peking University People’s Hospital in China between January
2011 and December 2012 were considered for inclusion. Inclusion criteria were women who had regular prenatal care and maintained complete data of prenatal care in Peking University People’s Hospital during 2011-2012. Exclusion criteria were women with insufficient information about their gestational weight during the pregnancy; multiple pregnancy. In all, 1,102 women were eligible for the final analysis. Data of women studied were extracted from Peking University People’s Hospital electronic medical records. The study was approved by the ethics committee of Peking University People’s Hospital. All of the health care procedures were carried out in accordance to the approved guidelines and regulations. Informed consent was obtained from all participants.
Scientific REPOrTS | 7: 12531 | DOI:10.1038/s41598-017-12921-3
2
www.nature.com/scientificreports/ Baseline BMI(kg/m2) BMI
OPEN
Received: 17 May 2017 Accepted: 11 September 2017 Published: xx xx xxxx
Relationship Between Gestational Weight Gain and Pregnancy Complications or Delivery Outcome Wenjia Yang, Feifei Han, Xueying Gao, Yifei Chen, Linong Ji & Xiaoling Cai The purpose of this study is to analyse the association between gestational weight gain and delivery outcome or the morbidity of pregnancy complications. A total of 1,102 pregnant women who delivered at Peking University People’s Hospital in China between January 2011 and December 2012 were included in this study. We divided them into 4 groups according to the baseline BMI quartiles and weight gain quartiles in different trimesters of pregnancy to analyse the status of delivery outcome and morbidity of pregnancy complications. Baseline BMI was significantly positive correlated with the morbidity of gestational hypertension and gestational diabetes. Weight gain in the second trimester of pregnancy was significantly positively correlated with the morbidity of macrosomia. Weight gain in the third trimester of pregnancy showed significantly positive correlation with the morbidity of macrosomia, and significantly negative correlation with the morbidity of neonatal death, preterm birth, gestational diabetes, and low birth-weight infant. Gestational weight gain showed significantly positive correlation with the morbidity of macrosomia and significantly negative correlation with neonatal death, stillbirth, gestational diabetes, preterm birth and low birth-weight infant. There is a correlation between baseline BMI, pregnancy weight gain and gestational complications, adverse pregnancy outcomes, and status of neonate in varying degrees. In China, inadequate body weight control has become a prominent health problem with changes in lifestyle. For pregnant women who are in a special physiological condition1, appropriate pre-pregnancy weight and gestational weight gain (GWG) to meet the demands of mother and foetus is essential. Previous studies showed increasing pre-pregnant body mass index (BMI) was associated with increasing risk of gestational hypertension and gestational diabetes mellitus (GDM)2–5. Women who are overweight or obese before pregnancy are subject to increased risk of macrosomia and dystocia6–8. Women who are underweight were less likely to have adverse pregnancy outcomes, but more likely to have intrauterine growth restricted infants3. GWG also affects obstetrical and neonatal outcomes. Several studies suggest associations between excessive GWG and risk of hypertension, macrosomia, and caesarean section in pregnant women of different ethnics groups9–13. Inadequate GWG increased the risk of preterm birth and growth-restricted infants10–12. However, thus far, few studies have explored appropriate weight gain in different trimesters during pregnancy. In 2009, the Institute of Medicine (IOM) provided specific recommendations regarding the ideal gestational weight gain according to the BMI categories14. However, the report was criticized by some health care providers saying that the recommendation was still too high for the obese women. In Japan, as there are more underweight women, the obesity classification is different, so the recommendation issued by the Japanese Ministry of Health, Labour and Welfare on gestational weigh gain differs from that developed by IOM15. In China, we have been following the recommendation of IOM and there is no established recommendation for Chinese women. Because established recommendations on weight gain during pregnancy are inconsistent and contentious, ethnics groups, national conditions and many other factors should be taken into account for the recommendations, the aim of this study is to analyse the relevance between baseline BMI, gestational weight gain, and delivery outcome in a Chinese population.
Endocrinology and Metabolism Department, Peking University People’s Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, P.R. China. Correspondence and requests for materials should be addressed to L.J. (email: [email protected]) or X.C. (email: [email protected]) Scientific REPOrTS | 7: 12531 | DOI:10.1038/s41598-017-12921-3
1
www.nature.com/scientificreports/ 1st Quartile
2nd Quartile
3rd Quartile
4th Quartile
Baseline BMI(kg/m2)
18.1 ± 1.0
20.3 ± 0.5
22.1 ± 0.6
25.8 ± 2.4
Age(years)
29.5 ± 3.2
30.4 ± 3.3
30.7 ± 3.2
31.2 ± 3.5
Fasting glucose(mmol/L)
4.3 ± 0.5
4.3 ± 0.4
4.3 ± 0.4
4.4 ± 0.8
SBP(mmHg)
107.6 ± 11.2
110.5 ± 10.3
112.5 ± 11.0
116.2 ± 12.1
DBP(mmHg)
69.8 ± 8.3
70.8 ± 8.1
71.9 ± 8.9
74.5 ± 8.5
ALT(U/L)
17.5 ± 5.5
16.0 ± 18.0
17.5 ± 12.8
21.0 ± 23.2
AST(U/L)
16.0 ± 7.2
18.1 ± 6.8
18.6 ± 6.2
18.9 ± 10.6
LDL-C(mmol/L)
1.99 ± 0.40
2.26 ± 0.57
2.21 ± 0.53
2.45 ± 0.58
HDL-C(mmol/L)
1.63 ± 0.29
1.65 ± 0.28
1.61 ± 0.41
1.53 ± 0.32
CRE(μmol/L)
43.3 ± 6.5
44.7 ± 6.2
45.3 ± 6.9
44.7 ± 6.0
Baseline BMI Quartile Category
Weight Gain in the Second Trimester Quartile Category weight gain in the second trimester(kg)
−3.0–6.9
7.0–8.9
9.0–10.5
11.0–21.0
Age(years)
31.2 ± 3.6
30.3 ± 3.2
30.6 ± 3.2
29.9 ± 3.4
Fasting glucose(mmol/L)
4.3 ± 0.5
4.3 ± 0.4
4.3 ± 0.4
4.4 ± 8.3
SBP(mmHg)
113.2 ± 17.3
112.2 ± 11.6
110.0 ± 11.4
111.0 ± 10.7
DBP(mmHg)
72.1 ± 10.9
72.4 ± 8.8
71.0 ± 8.8
71.6 ± 8.1
ALT(U/L)
17.7 ± 18.3
15.4 ± 16.2
17.7 ± 18.9
19.0 ± 21.4
AST(U/L)
18.3 ± 8.7
17.6 ± 7.0
18.5 ± 7.1
19.2 ± 9.2
LDL-C(mmol/L)
2.36 ± 0.63
2.22 ± 0.53
2.17 ± 0.53
2.20 ± 0.52
HDL-C(mmol/L)
1.55 ± 0.32
1.56 ± 0.41
1.59 ± 0.28
1.67 ± 0.32
CRE(μmol/L)
44.2 ± 7.3
44.5 ± 5.7
44.7 ± 6.3
44.7 ± 6.8
Weight Gain in the Third Trimester Quartile Category weight gain in the third trimester(kg/m2)
−2.3–3.6
4.0–5.9
6.0–7.8
7.9–15.0
Age(years)
30.7 ± 3.6
30.8 ± 3.3
30.2 ± 3.2
29.8 ± 3.2
Fasting glucose(mmol/L)
4.3 ± 0.4
4.3 ± 0.4
4.3 ± 0.4
4.4 ± 0.8
SBP(mmHg)
113.0 ± 12.4
112.8 ± 12.0
112.0 ± 10.4
110.2 ± 11.9
DBP(mmHg)
72.6 ± 9.6
72.1 ± 9.1
71.8 ± 7.9
71.0 ± 8.7
ALT(U/L)
18.5 ± 16.1
17.5 ± 20.0
15.3 ± 10.6
17.7 ± 18.9
AST(U/L)
18.7 ± 7.4
18.4 ± 9.1
17.7 ± 6.3
18.5 ± 7.1
LDL-C(mmol/L)
2.44 ± 0.67
2.24 ± 0.50
2.17 ± 0.53
2.16 ± 0.54
HDL-C(mmol/L)
1.57 ± 0.32
1.59 ± 0.32
1.59 ± 0.28
1.61 ± 0.32
CRE(μmol/L)
44.1 ± 6.5
44.6 ± 5.9
44.4 ± 7.1
44.7 ± 6.3
Gestational Weight Gain Quartile Category GWG(kg)
1.0–11.8
12.0–14.6
15.0–17.7
18.0–29.0
Age(years)
31.2 ± 3.6
30.8 ± 3.1
30.2 ± 3.2
29.8 ± 3.4
Fasting glucose(mmol/L)
4.3 ± 0.4
4.3 ± 0.4
4.3 ± 0.4
4.4 ± 0.8
SBP(mmHg)
114.5 ± 12.2
116.7 ± 9.8
118.5 ± 10.8
119.2 ± 10.3
DBP(mmHg)
73.4 ± 8.7
74.8 ± 7.9
75.9 ± 8.7
75.0 ± 8.7
ALT(U/L)
18.1 ± 16.3
15.6 ± 14.2
17.8 ± 21.5
17.0 ± 14.2
AST(U/L)
18.5 ± 8.3
17.8 ± 6.7
18.4 ± 8.8
18.3 ± 6.3
LDL-C(mmol/L)
2.40 ± 0.66
2.19 ± 0.56
2.20 ± 0.42
2.17 ± 0.56
HDL-C(mmol/L)
1.54 ± 0.34
1.58 ± 0.38
1.62 ± 0.29
1.64 ± 0.33
CRE(μmol/L)
43.9 ± 6.6
44.8 ± 6.8
44.3 ± 6.0
44.7 ± 6.8
Table 1. Baseline characteristics of pregnant women categorized by quartile for baseline BMI, weight in the first trimester, weight gain in the second trimester, weight gain in the third trimester, and GWG.
Methods
Populations. All women who delivered at Peking University People’s Hospital in China between January
2011 and December 2012 were considered for inclusion. Inclusion criteria were women who had regular prenatal care and maintained complete data of prenatal care in Peking University People’s Hospital during 2011-2012. Exclusion criteria were women with insufficient information about their gestational weight during the pregnancy; multiple pregnancy. In all, 1,102 women were eligible for the final analysis. Data of women studied were extracted from Peking University People’s Hospital electronic medical records. The study was approved by the ethics committee of Peking University People’s Hospital. All of the health care procedures were carried out in accordance to the approved guidelines and regulations. Informed consent was obtained from all participants.
Scientific REPOrTS | 7: 12531 | DOI:10.1038/s41598-017-12921-3
2
www.nature.com/scientificreports/ Baseline BMI(kg/m2) BMI
