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T

HE EFFECT OF MATERNAL OBESITY ON BIRTH WEIGHT

:

A RETROSPECTIVE COHORT STUDY

1

Irani R,

1

Yao R,

3

Park BY,

1,2

Croft DJ,

1,2

Plante LA

Drexel University College of Medicine,

1

Department of Obstetrics and Gynecology,

2

Division of Maternal-fetal Medicine,

3

School of Public Health

Introduction

There is a dose-dependent relationship between obesity and stillbirth 1-3 which is most evident in the late third trimester 1 .

An improved understanding of the effect of maternal obesity on fetal growth velocity may shed light on the pathophysiology behind the association between obesity and stillbirth.

GOAL: to establish the pattern of fetal growth throughout gestation among obese women based on the weight of their infants at delivery in comparison to the normal growth curve.

Methods

Retrospective cohort study.

Birth data obtained from the Texas Vital Records

Database from 2006-2011.

1,849,773 births were used in analysis after exclusion criteria were applied

Linear regression used to assess the rate of fetal growth throughout gestation.

% of large and small for gestational age (LGA and

SGA) deliveries for each Body Mass Index (BMI) class at each gestational week was compared to those of non-obese women.

Logistic regression was used to obtain the adjusted odds ratio for deliveries of LGA and SGA infants within each BMI class.

STATA 12 was used for statistical analyses

.

Figure 1: Cohort Selection

Texas Birth Registry

2,422,520

Multiple Gestation: 75,082

2,347,438

Gestational Age <20 or >42 weeks: 5,733

2,341,705

Severe Fetal Anomalies: 3,922

2,337,783

Missing Variables: 18,424

2,319,359

Underweight (BMI <18.5) and Maternal

Height<48inches : 111,318

2,208,041

Deliveries Included in Analysis

1,825,194

Medical Comorbidities: 382,847

Pregestational Diabetes: 14,432

Pregestational Hypertension: 16,942

Gestational Diabetes: 89,220

Gestational Hypertension: 89,220

Eclampsia: 2,279

Smoking: 166,242

Results

- Birth weight differs throughout gestation in infants born to overweight and obese women vs. those of normal BMI.

- This is most apparent at 37 weeks where infants born to Class III obese women are 206g larger than those born to a woman with a normal BMI.

- During 32-37 weeks gestation, the mean rate of fetal weight gain per week is accelerated [230g/wk (95% CI 222-238)] in

Class III obese women compared to patients with normal BMI [198g/wk (95% CI 197-200)].

- The increased fetal weight gain is followed by a decline in the rate of growth in the Class III Obese at late term.

- This pattern of rapid acceleration then deceleration results in a parallel increase in LGA infants among obese women; OR is 2.62 (95% CI 2.54-2.71) in Class III obese from 36-39 weeks gestation.

- An inverse pattern is observed for deliveries of SGA infants.

Table 1: Adjusted Average Fetal Weight Gain Per Week of Gestation

a

24-31 weeks

Obesity

Class

Grams/wk 95% CI

Normal

BMI

156 151 162

Overweight

155

Class I 167

Class II 158

Class III 151

149

159

145

138

163

175

172

165

Grams/wk a Results adjusted for maternal age, maternal height, primiparity and race/ethnicity

Figure 2: Mean Birth Weight by Obesity

3700.0

3500.0

3300.0

3100.0

2900.0

2700.0

2500.0

35 36 37 38 39

Gestational Age

40 41 42

198

208

213

226

230

32-37 weeks

197

250.0

200.0

150.0

Normal Weighta

Overweighta

Class Ia

Class Iia

Class IIIa

100.0

50.0

205

210

219

222

95% CI

200

210

217

232

238

Grams/wk

120

114

108

103

92

38-42 weeks

119

112

106

99

87

95% CI

Figure 3: Differences in Average Birth Weight

0.0

30 32 34 36 38 40 42 44

-50.0

Gestational Age (weeks)

121

115

110

106

97

Overweight

Class I

Class II class III

20

15

10

5

Figure 4: Large for Gestational Age by Obesity

25

20

15

10

5

0

32 34 36 38

Gestational Age at Delivery

40 42

Figure 5: Small for Gestational Age by Obesity

25

Normal Weight

Overweight

Class I

Class II

Class III

Normal Weight

Overweight

Class I

Class II

Class III

0

34 36 38

Gestational Age

40

Conclusions

42

The differences in birth weight associated with obesity reflect an increased incidence of LGA infants in the late preterm and early term, followed by slowed growth and decreased LGA deliveries with an increase in SGA deliveries.

This dose-dependent pattern may suggest that placental function may be outstripped in obese women and could be an underlying mechanism to the increased rate of stillbirth in the obese at term.

References

1. Yao, R., Ananth, C. V, Park, B. Y., Pereira, L. & Plante, L. A. Obesity and the risk of stillbirth: a population-based cohort study. Am J Obstet

Gynecol 2014 Vol 210, pp. 457.e1-457.e9

2. Salihu H, Dunlop AL, Hedayatzadeh M, et al. Extreme Obesity and

Risk of Stillbirth Among Black and White Gravidas. Obstet Gynecol

Sept 2007 Vol 110, No 3 pp. 552-7

3. Cnattingius S, Bergstrom R, Lipworth L, et al. Prepregnancy Weight and the Risk of Adverse Pregnancy Outcomes. The New England

Journal of Medicine, January 1998 Vol 338 No 3 pp. 147-152

Q U I C K S TA RT ( c o n t . )

How to change the template color theme

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