Introduction
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Gestational Weight Gain and Pregnancy Outcomes in Women Who Came for Delivery in a District Hospital
Hateeza Z, Noorazmi MA, Rahmah S, Balanathan K, Matthew S, Sharmini D, Yuzainov A.University of Malaya Medical Centre (UMMC) & Seberang Jaya Hospital
Introduction
• Excessive gestational weight gain and obesity has long been regarded as a pregnancy risk factor 1-7
• The upward trend in the prevalence of obesity is increasing despite its well-publicised adverse effects on health 8,9,10
• Study has shown that postpartum retention of weight is proportional to weight gain during pregnancy 10-13
• Maternal antepartum medical complications, such as hypertension and diabetes mellitus, are significantly increased in obese mother 1,3,5,7,8
• Obese patient also do poorly during the intrapartum period. Deliveries by obese women tend to have higher rates of induction of labour , caesarean section and dystocia from macrosomic babies 14-17
OBJECTIVE
• To determine the value of total gestational weight gain, describe the association of gestational weight gain with sociodemographic background and to evaluate whether gestational weight gain has a role in predicting the pregnancy outcomes amongst the obstetrics population in Seberang Jaya Hospital in 3 months duration
METHODOLOGY
• A cross-sectional cohort study• A total of 674 pregnant women with singleton pregnancy who
came to deliver vaginally in Seberang Jaya Hospital from 17th February 2010 until 17th May 2010 and were booked at their respective health clinic at ≤ 12 weeks period of amenorrhoea were successfully recruited
• Their maternal antepartum, intrapartum and postpartum event as well as neonatal outcomes were documented
• The data was analysed using Statistical Package for Social Science version 18
RESULTS
• Total deliveries in Seberang Jaya Hospital during the 3 months study period were 1865 deliveries
• The number of recruited patients was 674, therefore at least 36% of obstetric population of Seberang Jaya were booked at ≤ 12 weeks period of amenorrhoea
• Majority of the mothers were Malay (81.6%), primigravida (29.9%) and were less than 35 years old (81.5%)
• The mean of total gestational weight gain in the recruited sample was 10.3 ± 4.95 kg
• Gestational weight gain is observed to be higher in the younger age group and in women who came to deliver at more advanced period of gestation
• Less weight gain is observed in women with higher gravidity, parity and higher pre-pregnancy body mass index
Conclusions
References
• Women of younger age and lower parity were associated with more gestational weight gain compared to older and higher parity women.
• Although there is no optimum or normal amount of weight to be gained during pregnancy, this study showed significant correlations between total pregnancy weight gain to maternal and fetal complications.
• The results of this study emphasized the importance of educating women to know their pre-pregnancy weight and not to put on excessive weight during their pregnancy
OPTIONALLOGO HERE
OPTIONALLOGO HERE
• Gestational weight gain does not show any association with race, history of previous LSCS and miscarriage
• Patients with higher gestational weight gain had a longer duration of labour, higher degree of perineal tear and higher neonatal birthweight.
• Weight gain also shows association with different group of gestational diabetes mellitus, analgesia usage in labour, postpartum haemorrhage, Apgar score at 1 minute, shoulder dystocia and wound complications.
• On the other hand, it does not shows any role in predicting hypertension in pregnancy, the mode of delivery, the need for induction of labour, duration of emergency caesarean section, Apgar score at 5 minute, infection status and duration of hospital stay.
Total gestational weight gain (n=674)
Mean (sd) Median (IQR) Min Max
Pre pregnancy weight (kg)
58.77 (13.03)
56.50 (16.60) 34.00 109.00
Height (m)
1.56 (0.06) 1.56 (0.07) 1.40 1.82
Pre pregnancy BMI (kg/m2)
24.25 (5.09) 23.60 (6.54)
14.34
46.56
Weight at delivery (kg)
69.00 (12.92)
67.50 (16.0)
39.00
120.00
Gestational weight gain (kg)
10.30 (4.95) 10.00 (6.00) 0.00 35.50
Overall study population characteristics (n=674)
Age (in years) Pre-pregnancy weight (in kg)
Total weight gain(in kg)
Primigravida, n=202
Mean (std dev)MinimumMaximum
25.21 (3.85)1637
55.78 (11.9)35.593.7
12.39 (5.27)2.035.5
Gravida 2 & 3, n=300
Mean (std dev)MinimumMaximum
28.41 (4.44)1941
58.43 (13.27)34.0100.0
10.06 (4.32)0.324.4
Gravida 4, n=84
Mean (std dev)MinimumMaximum
33.14 (3.83)2442
62.63 (12.89)40.9109.0
9.24 (4.97)0.025.0
Gravida 5 and above, n=88
Mean (std dev)MinimumMaximum
35.25 (4.04)26.044.0
63.11 (13.61)39.0105.0
8.13 (3.92)0.923.50
Age, Pre pregnancy weight and Total weight gain in different group of Gravidity (n=674)
Age (in years)
Pre-pregnancy weight (in kg)
Total weight gain (in kg)
Baby birth weight (in grams)
No GDM, n=569
Mean (std dev)MinimumMaximum
28.47 (5.21)16.044.0
57.31 (12.19)34.0100.0
10.56 (4.93)0.635.5
3019.23 (459.20)15704390
GDM on diet control, n=85
Mean (std dev)MinimumMaximum
31.01 (5.38)20.043.0
65.44 (14.24)36.0103.0
9.51 (4.91)0.924.4
3094.91 (435.64)16204330
GDM on insulin, n=19
Mean (std dev)MinimumMaximum
33.37 (6.31)23.043.0
72.75 (17.76)47.0109.0
6.12 (3.63)2.013.0
2994.74 (462.71)22403960
Age, Pre-pregnancy weight, Total weight gain and Birth weight in different group of patient with Gestational Diabetes Mellitus (n=674)
Variables n Weight gainmean (sd)
F(df)
p-value
GDM No GDM Diet Control On Insulin
5698519
10.56 (4.93)9.51 (4.91)6.12 (3.63)
8.841(2,670)
<0.001
Analgesia No Analgesia Entonox I/M Pethidine Epidural
35828
22260
9.61 (4.74)11.14 (5.81)11.17 (5.02)10.64 (5.09)
4.990(3,664)
0.002
PPH
No Yes
65420
10.21 (4.92)13.17 (5.20)
6.955(1,672)
0.009
Wound Complication
Yes No
6668
10.26 (4.94)14.53 (4.68)
4.445(1,672)
0.035
Birthweight Less than 2500g 2500g – 3599g 3600g – 3999g More than 4000g
725384420
9.21 (4.51)10.17 (4.86)12.77 (6.10)12.20 (4.11)
6.641(1.672)
<0.001
Shoulder dystocia Yes No
1673
23.00 (-)10.28 (4.93)
0.010
Variables n Correlation p-value
Age 674 -0.261# <0.001
Gravidity 674 -0.331@ <0.001
Parity
674 -0.322@ <0.001
POG at delivery
669 0.125@ 0.001
Maternal weight at delivery
674 0.173# <0.001
Pre-pregnancy weight
674 -0.208# <0.001
Pre-pregnancy BMI
674 -0.255# <0.001
Duration of labour in SVD
509 0.105@ 0.018
Perineal tear
512 0.275@ <0.001
Apgar score (at 1 minute)
674 -0.088@ 0.023
Birthweight
673 0.162# <0.001
Comparison in the mean of total gestational weight gain and the statistically significant categorical independent variables using ANOVA (F test)
Correlation between total gestational weight gain and statistically significant continuous variable (@ Spearman rho’s correlation, # Pearson correlation)
1. Health implications of obesity. National Institutes of Health Consensus Development Conference Statement. Annual Internal Medicine. 1985; 103:1073-1077.
2. Manson JE, Willett WC, Stampfer MJ, et al. Body weight and mortality among women. The New England Journal of Medicine. 1995; 333:677-685.
3. Yu C, Teoh T, Robinson S. Obesity in pregnancy. BJOG. 2006;113:1117-1125.4. Gross et al. Obesity in Pregnancy: Risks and Outcome. The American College of Obstetricians and Gynecologists.
October 1980; Vol.56: 446-450.5. Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol. 2004; 103:219-
224.6. Mamun et al. Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse
pregnancy outcomes and length of hospital stay. Pregnancy and Childbirth. 2001 11:62. 7. Kumari AS. Pregnancy outcome in women with morbid obesity. Int J Gynecol Obstet. 2001; 73:101-107.8. Sidik MS, Rampal L. The prevalence and factors associated with obesity among adult women in Selangor, Malaysia.
Asia Pacific Family Medicine. 2009; 8:2.9. Sebire NJ, Jolly M, Harris JP, et al. Maternal obesity and pregnancy outcome. a study of 287,213 pregnancies in
London. Int J Obes Relat Metab Disord. 2001; 25:1175-1182.10. Edwards LE, Hellerstedt WL, Alton IR, Story M, Himes JH. Pregnancy complications and birth outcomes in obese and
normal-weight women: effects of gestational weight change. Obstet Gynecol. 1996; 87:389-39.11. Lu GC, Rouse DJ, DuBard M, et al. The effect of the increasing prevalence of maternal obesity on perinatal morbidity.
Am J Obstet Gynecol. 2001; 185:845-849.12. Bianco AT, Smilen SW, Davis Y, et al. Pregnancy outcome and weight gain recommendations for the morbidly obese
woman. Obstet Gynecol. 1998; 91:97-102.13. Polley BA, Wing RR, Sims CJ. Randomized controlled trial to prevent excessive gain in pregnant women. Internal
Journal of Obesity and Related Disorder. 2002; 26:1494-1502.14. Eric H, Carol C.C, Shelley L.G. Trends in weight gain during pregnancy: A population study across 16 years in North
Carolina. American Journal of Obstetrics and Gynecology (2006) 194, e32–e3.15. Rossner S. Weight gain in pregnancy. Human Reproduction Volume 12 Supplement 1 1997.16. Ash et al. Maternal Weight Gain, Smoking and other factors in pregnancy as predictors of Infant Birth-Weight in
Sydney Women. A.N.J.O.G 1989. Vol 29. No. 3, 212-219.17. Abrams B, Altman SL, Pickett KE. Pregnancy weight gain: still controversial. Am J Clinical Nutrition. 2000;71:1233s-
41s.