engleski

Body mass index and pregnancy outcome

Summary. According to the World Health Organization criteria, underweight, normal weight, overweight and obesity are defined by body mass index (BMI). Underweight, overweight and obesity in pregnancy increase the risk of unfavorable maternal and perinatal outcome. The aim of the study was to analyze the impact of maternal BMI before and during pregnancy, and the impact of gestational weight gain on the occurrence of maternal and neonatal morbidity. Subjects and methods. This retrospective study included 4646 pregnant women that underwent oral glucose tolerance test between 24th and 32nd week of gestation and gave birth to their children at Clinical Department of Gynecology and Obstetrics, Zagreb University Hospital Center during the 2013-2015 period. There were 136 (2.9%) underweight, 3066 (66%) normal weight, 949 (20.4%) overweight and 467 (10.01%) obese women. The following data were analyzed: maternal age, BMI, gestational weight gain, parity, prevalence of preeclampsia, method of delivery termination (cesarean section, vaginal delivery or vacuum extraction), and neonatal birth weight, ponderal index, fetal macrosomia, and Apgar index at 1 min and 5 min. Results were expressed as mean value and standard deviation. The SPSS ver. 17 statistical software was used on data analysis. The χ2-test and ANOVA were calculated. Study parameters were compared between study groups and control group. The level of statistical significance was set at p<0.05. Relative risk (RR) and standard error (95% confidence interval, 95% CI) were calculated according to Altman. Results. The prevalence of gestational diabetes was 18.5% and 20.5% in normal weight and underweight women, respectively, versus 30.5% and 39.2% in overweight and obese women, respectively. Manifest diabetes (diabetes in pregnancy or overt diabetes) was recorded in 0.8%, 0.5%, 1.2% and 3% of normal weight, underweight, overweight and obese women, respectively. RR for gestational diabetes was 1.64 (95% CI 1.4-1.8) in overweight women and 2.1 (95% CI 1.8-2.4) in obese women (P<0.001 both). The prevalence of gestational diabetes increased with BMI increase. Gestational hypertension developed in 1.7%, 2.8%, 7.4% and 25.7% of underweight, normal weight, overweight and obese women, respectively. RR for gestational hypertension was 2.6 (95% CI 1.9-3.6) in normal weight women versus 8.9 (95% CI 6.9-11.6) in obese women (P<0.001 both). The prevalence of gestational hypertension also increased with BMI increase. In comparison to normal weight women, the risk of macrosomia was greater in overweight women (RR=1.3 ; 95% CI 1.2-1.6 ; P<0.001) and obese women (RR=1.4 ; 95% CI 1.2-1.6 ; P<0.001). RR for cesarean section was increased in underweight (RR=1.9 ; 95% CI 1.4-2.6 ; P<0.001), overweight (RR=1.3 ; 95% CI 1.1.1.6 ; P<0.01) and obese women (RR=2.1 ; 95% CI 1.8-2.5 ; P<0.001). Out of 4646 women, gestational weight gain ≤8 kg was recorded in 348 (7.5%), 9-15 kg in 2836 (56.7%) and ≥16 kg in 1662 (35.8%) women. The prevalence of macrosomic infants was 10.6%, 12.6% and 22.6% in women with gestational weight gain ≤8 kg, 9-15 kg and ≥16 kg, respectively (RR=1.9 ; 95% CI 1.7-2.2 ; P<0.001). The prevalence of hypotrophic newborns was 11.9% in underweight, 3.0% in normal weight, 3.1% in overweight and 1.7% in obese women. Conclusion. The risk of maternal and neonatal complications was increased in underweight, overweight and obese women, as well as in those with excess gestational weight gain.

pregnancy; body mass index; gestational weight gain; gestational diabetes; gestational hypertension; fetal macrosomia; cesarean section

nije evidentirano