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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


28.41 (4.44)1941

58.43 (13.27)34.0100.0

10.06 (4.32)0.324.4

Gravida 4, n=84


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


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


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


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


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)

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