Interprovincial variation in pre-pregnancy body mass index and gestational weight gain and their impact on neonatal birth weight with respect to small and large for gestational age

doi:10.17269/s41997-018-0086-x

. 2018 Aug;109(4):527-538.

doi: 10.17269/s41997-018-0086-x. Epub 2018 Sep 6.

Interprovincial variation in pre-pregnancy body mass index and gestational weight gain and their impact on neonatal birth weight with respect to small and large for gestational age

Sarah D McDonald¹, Christy Woolcott², Núria Chapinal³, Yanfang Guo⁴, Phil Murphy⁵, Susie Dzakpasu⁶

Affiliations

¹ Department of Obstetrics & Gynecology, Department of Health Research Methods, Evidence, and Impact, Department of Radiology, McMaster University, 1280 Main Street West, Room 3N52B, Hamilton, ON, L8S 4K1, Canada. mcdonals@mcmaster.ca.
² Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University, Halifax, NS, Canada.
³ Perinatal Services BC, Vancouver, Canada.
⁴ Better Outcomes Registry & Network, Ottawa, ON, Canada.
⁵ Perinatal Program Newfoundland and Labrador, and Disciplines of Obstetrics and Gynecology and Pediatrics, Faculty of Medicine, Memorial University, Newfoundland, St. John's, NL, Canada.
⁶ Maternal, Child and Youth Health Unit, Public Health Agency of Canada, Ottawa, ON, Canada.

PMID: 30191462
PMCID: PMC6964407
DOI: 10.17269/s41997-018-0086-x

Interprovincial variation in pre-pregnancy body mass index and gestational weight gain and their impact on neonatal birth weight with respect to small and large for gestational age

Sarah D McDonald et al. Can J Public Health. 2018 Aug.

. 2018 Aug;109(4):527-538.

doi: 10.17269/s41997-018-0086-x. Epub 2018 Sep 6.

Authors

Sarah D McDonald¹, Christy Woolcott², Núria Chapinal³, Yanfang Guo⁴, Phil Murphy⁵, Susie Dzakpasu⁶

Affiliations

¹ Department of Obstetrics & Gynecology, Department of Health Research Methods, Evidence, and Impact, Department of Radiology, McMaster University, 1280 Main Street West, Room 3N52B, Hamilton, ON, L8S 4K1, Canada. mcdonals@mcmaster.ca.
² Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University, Halifax, NS, Canada.
³ Perinatal Services BC, Vancouver, Canada.
⁴ Better Outcomes Registry & Network, Ottawa, ON, Canada.
⁵ Perinatal Program Newfoundland and Labrador, and Disciplines of Obstetrics and Gynecology and Pediatrics, Faculty of Medicine, Memorial University, Newfoundland, St. John's, NL, Canada.
⁶ Maternal, Child and Youth Health Unit, Public Health Agency of Canada, Ottawa, ON, Canada.

PMID: 30191462
PMCID: PMC6964407
DOI: 10.17269/s41997-018-0086-x

Abstract
in English, French

Objectives: To explore provincial variation in both excess and inadequate pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) and their impact on small- and large-for-gestational-age (SGA, LGA) infants.

Methods: Four provinces with a perinatal database capturing the required exposures participated: British Columbia (BC), Ontario (ON), Nova Scotia (NS), and Newfoundland and Labrador (NL). In multiple, concurrent retrospective studies, we included women ≥ 19 years, who gave birth from 22⁺⁰ to 42⁺⁶ weeks' gestation, to a live singleton from April 2013-March 2014. From adjusted odds ratios, we calculated population attributable fractions (PAF) of SGA and LGA for BMI and GWG.

Results: The proportion of overweight and obese women increased from western to eastern Canada. In BC, ON, NS, and NL, the proportions of women who were overweight were 21.1%, 24.0%, 23.7%, and 25.4%, while obesity proportions were 14.2%, 18.1%, 24.2%, and 29.8%, respectively. Excess GWG affected 53.9%, 49.9%, 57.6%, and 65.6% of women, respectively. Excess GWG contributed to 29.5-42.5% of LGA, compared with the PAFs for overweight (6.8-12.0%) and obesity (13.2-20.6%). Inadequate GWG's contribution to SGA (4.8-12.3%) was higher than underweight BMI's (2.9-6.2%).

Conclusion: In this interprovincial study, high and increasing proportions of women from west to east had excess pre-pregnancy BMI, and between half to two thirds had excess GWG. The contributions of GWG outside of recommendations to SGA and LGA were greater than that of low or high BMI. GWG is a potentially modifiable determinant of SGA and LGA across Canada.

Objectifs: Explorer les écarts provinciaux dans l’indice de masse corporelle (IMC) élevé ou faible avant la grossesse et le gain de poids (GPG) excessif ou insuffisant durant la grossesse et leur effet sur la naissance de nourrissons petits ou gros pour l’âge gestationnel (PAG, GAG).

Méthode: Ont participé quatre provinces ayant des bases de données périnatales saisissant les données requises : la Colombie-Britannique (C.-B.), l’Ontario (Ont.), la Nouvelle-Écosse (N.-É.) et Terre-Neuve-et-Labrador (T.-N.-L.). Dans plusieurs études rétrospectives parallèles, nous avons inclus les femmes ≥19 ans ayant accouché entre la 22^{e + 0} et la 42^{e + 6} semaine de grossesse d’un enfant unique vivant entre avril 2013 et mars 2014. D’après les rapports de cotes ajustés, nous avons calculé les fractions attribuables dans la population (FAP) des nourrissons PAG et GAG selon l’IMC et le GPG.

Résultats: La proportion de femmes en surpoids et obèses augmente d’ouest en est au Canada. En C.-B., en Ont., en N.-É. et à T.-N.-L., les proportions de femmes en surpoids étaient de 21,1 %, 24 %, 23,7 % et 25,4 %, et les proportions de femmes obèses étaient de 14,2 %, 18,1 %, 24,2 % et 29,8 %, respectivement. Le GPG excessif a touché 53,9 %, 49,9 %, 57,6 % et 65,6 % des femmes, respectivement. Le GPG excessif a contribué à 29,5–42,5 % des nourrissons GAG, comparativement aux FAP pour le surpoids (6,8–12 %) et l’obésité (13,2–20,6 %). La contribution du GPG insuffisant aux nourrissons PAG (4,8–12,3 %) était supérieure à celle du faible IMC (2,9–6,2 %).

Conclusion: Dans cette étude interprovinciale, les proportions de femmes ayant un IMC élevé avant la grossesse étaient élevées et augmentaient d’ouest en est, et entre la moitié et les deux tiers des femmes ont eu un GPG excessif. La contribution d’un GPG hors de l’intervalle recommandé à la naissance de nourrissons PAG et GAG était supérieure à la contribution d’un IMC faible ou élevé. À l’échelle du Canada, le GPG est un déterminant potentiellement modifiable de la naissance de nourrissons PAG et GAG.

Keywords: Body mass index; Fetal macrosomia; Infant; Pregnancy; Small for gestational age; Weight gain.

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Conflict of interest statement

None to declare.

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References

1. Adegboye ARA, Heitmann BL. Accuracy and correlates of maternal recall of birthweight and gestational age. BJOG: An International Journal of Obstetrics & Gynaecology. 2008;115(7):886–893. doi: 10.1111/j.1471-0528.2008.01717.x. - DOI - PMC - PubMed
1. Bergmann RL, Richter R, Bergmann KE, et al. Secular trends in neonatal macrosomia in Berlin: influences of potential determinants. Paediatric and Perinatal Epidemiology. 2003;17(3):244–249. doi: 10.1046/j.1365-3016.2003.00496.x. - DOI - PubMed
1. Bodnar LM, Siega-Riz AM, Simhan HN, et al. The impact of exposure misclassification on associations between prepregnancy BMI and adverse pregnancy outcomes. Obesity. 2010;18(11):2184–2190. doi: 10.1038/oby.2010.25. - DOI - PMC - PubMed
1. Callaway LK, Prins JB, Chang AM, et al. The prevalence and impact of overweight and obesity in an Australian obstetric population. The Medical Journal of Australia. 2006;184(2):56. - PubMed
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[1] Adegboye ARA, Heitmann BL. Accuracy and correlates of maternal recall of birthweight and gestational age. BJOG: An International Journal of Obstetrics & Gynaecology. 2008;115(7):886–893. doi: 10.1111/j.1471-0528.2008.01717.x. - DOI - PMC - PubMed

[2] Adegboye ARA, Heitmann BL. Accuracy and correlates of maternal recall of birthweight and gestational age. BJOG: An International Journal of Obstetrics & Gynaecology. 2008;115(7):886–893. doi: 10.1111/j.1471-0528.2008.01717.x. - DOI - PMC - PubMed

[3] Bergmann RL, Richter R, Bergmann KE, et al. Secular trends in neonatal macrosomia in Berlin: influences of potential determinants. Paediatric and Perinatal Epidemiology. 2003;17(3):244–249. doi: 10.1046/j.1365-3016.2003.00496.x. - DOI - PubMed

[4] Bergmann RL, Richter R, Bergmann KE, et al. Secular trends in neonatal macrosomia in Berlin: influences of potential determinants. Paediatric and Perinatal Epidemiology. 2003;17(3):244–249. doi: 10.1046/j.1365-3016.2003.00496.x. - DOI - PubMed

[5] Bodnar LM, Siega-Riz AM, Simhan HN, et al. The impact of exposure misclassification on associations between prepregnancy BMI and adverse pregnancy outcomes. Obesity. 2010;18(11):2184–2190. doi: 10.1038/oby.2010.25. - DOI - PMC - PubMed

[6] Bodnar LM, Siega-Riz AM, Simhan HN, et al. The impact of exposure misclassification on associations between prepregnancy BMI and adverse pregnancy outcomes. Obesity. 2010;18(11):2184–2190. doi: 10.1038/oby.2010.25. - DOI - PMC - PubMed

[7] Callaway LK, Prins JB, Chang AM, et al. The prevalence and impact of overweight and obesity in an Australian obstetric population. The Medical Journal of Australia. 2006;184(2):56. - PubMed

[8] Callaway LK, Prins JB, Chang AM, et al. The prevalence and impact of overweight and obesity in an Australian obstetric population. The Medical Journal of Australia. 2006;184(2):56. - PubMed

[9] Cedergren M. Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. International Journal of Gynaecology and Obstetrics. 2006;93(3):269–274. doi: 10.1016/j.ijgo.2006.03.002. - DOI - PubMed

[10] Cedergren M. Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. International Journal of Gynaecology and Obstetrics. 2006;93(3):269–274. doi: 10.1016/j.ijgo.2006.03.002. - DOI - PubMed

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Interprovincial variation in pre-pregnancy body mass index and gestational weight gain and their impact on neonatal birth weight with respect to small and large for gestational age

Affiliations

Interprovincial variation in pre-pregnancy body mass index and gestational weight gain and their impact on neonatal birth weight with respect to small and large for gestational age

Authors

Affiliations

Abstract
in English, French

Conflict of interest statement

Similar articles

Cited by

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

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Medical

Miscellaneous

Abstract in English, French

Conflict of interest statement

Similar articles

Cited by

References

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Related information

Grants and funding

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Medical

Miscellaneous

Abstract
in English, French