Pre-pregnancy Body Mass Index And Gestational Weight Gain With The Outcome Of Pregnancy

Objective:To investigate the effects of pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes.Methods:The clinical data of 7,688 cases of single birth pregnant women delivered in the First Affiliated Hospital of Soochow University from January 2015 to July 2017 were retrospectively analyzed.The pre-pregnancy body mass index(BMI)was divided into 4 groups according to the Working Group of Obesity standard:932 cases with BMI<18.5 kg/m~2 as underweight;5,320 cases with BMI 18.5~23.9 kg/m~2 as normal weight;1,172 cases with BMI 24.0~27.9 kg/m~2 as overweight;and 264 cases with BMI≥28.0kg/m~2 as obese.In each group,according to the recommendations of the 2009 American Institute of Medical(IOM),it was divided into inadequate,adequate and excessive gestational weight gain.It was aimed to analyze the relationship between pre-pregnancy body mass index and gestational weight gain and pregnancy outcomes,and to calculate the appropriate range of gestational weight gain in each group.Results:(1)Pre-pregnancy underweight was associated with an increased risk of small-for-gestational-age(OR=1.72,95%CI:1.30~2.26).Overweight and obesity were associated with an increased risk of cesarean delivery(OR=1.18;1.63),intrapartum cesarean delivery(OR=1.46;2.28),macrosomia(OR=1.20;1.63),large-for-gestational-age(OR=1.30;1.67),hypertensive disorders of pregnancy(OR=2.02;4.06),gestational diabetes mellitus(OR=2.65;5.47),preterm premature rupture of membranes(OR=2.48;4.50),preterm birth(OR=1.77;3.58),and prolonged or stagnant labor(OR=1.31;1.88).(2)Inadequate gestational weight gain increased the risk of small-for-gestational-age(OR=1.29,95%CI:1.01~1.66),gestational diabetes mellitus(OR=1.95,95%CI:1.63~2.34),and preterm birth(OR=2.43,95%CI:1.79~3.31).Excessive gestational weight gain increased the risk of cesarean delivery(OR=1.32,95%CI:1.17~1.50),macrosomia(OR=2.01,95%CI:1.69~2.40),large-for-gestational-age(OR=1.90,95%CI:1.62~2.22),and hypertensive disorders of pregnancy(OR=1.63,95%CI:1.21~2.19).(3)In the underweight group,excessive gestational weight gain had increased risk of postpartum hemorrhage(OR=2.81,95%CI:1.11~7.14).In the normal weight group,inadequate gestational weight gain had increased risk of preterm premature rupture of membranes(OR=1.97,95%CI:1.08~3.60).In the overweight group,excessive gestational weight gain had increased risk of intrapartum cesarean delivery(OR=1.50,95%CI:1.02~2.21)and postpartum hemorrhage(OR=3.84,95%CI:1.33~11.05).In the obese group,excessive gestational weight gain had increased risk of intrapartum cesarean delivery(OR=2.49,95%CI:1.04~5.95).(4)The appropriate range of gestational weight gain for single-term pregnant women with pre-pregnancy underweight,normal weight,overweight and obesity was 11.5~16.5 kg,11.0~16.0 kg,10.0~15.0 kg and 7.0~13.5 kg,respectively.Conclusion:Inappropriate pre-pregnancy body mass index and gestational weight gain were closely related to adverse pregnancy outcomes.Women of childbearing age can achieve good pregnancy outcomes through pre-pregnancy and pregnancy weight management.The appropriate range of gestational weight gain for women with pre-pregnancy underweight and normal weight in our hospital was slightly lower than the2009 IOM guidelines.