Obesity in pregnant women: a 20-year analysis of the German experience

Abstract

Background/objective: To investigate the longitudinal development of maternal body weight and analyze the influence of obesity on obstetrics during more than two decades in Germany.

Subjects/methods: Data collected from the Federal state of Schleswig-Holstein (German Perinatal Survey) were analyzed with regard to the dynamics of maternal anthropometric variables (body weight, BMI) between 1995-7 and 2004-17. In total 335,511 mothers substantiated the presented study-collective. The statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY.

Results: Maternal BMI advanced significantly over the study period. Among a rise in mean periconceptional body weight (67.6-72.0 kg), the segment of obese women increased disproportionately (in average 9.4-19.2%). Despite the observed trend to late giving birth (mean maternal age 1995: 29.3 vs. 30.7 years in 2017), it was not advanced maternal age but parity that influenced the continuous increase in maternal weight (mean maternal body weight 1995-7: primi- bi-, multiparae 67.4, 68.3 and 69.0 kg vs. 2004-17: primi- bi-, multiparae 70.0, 71.5 and 73.2 kg respectively).

Conclusion: Obesity is a major problem on health issues in obstetrics. Advancing maternal BMI, increasing mother's age and derived prenatal risks considerably complicate pregnancy and delivery. It has to be emphasized that its consequences do not end with delivery or childbed, but represent a livelong burden to the mother and their offspring. Hence, multimodal strategies to reduce/control periconceptional body weight are mandatory.

Fig. 1. Maternal body weight.

Longitudinal observation of maternal body weight (mean and standard deviation [s]) at the first obstetrical visit (proof of pregnancy) in Schleswig-Holstein of the periods 1995–7 and 2004–17 (a: Primiparae, b: Biparae, c: Multiparae).

Fig. 2. Preconceptional BMI.

Development of the BMI repartition of pregnant women in Schleswig-Holstein (1995–7 and 2004–17) according to the WHO body weight classification of adults (underweight, normal weight; pre-obesity, obesity I°, II° und III°): significant increasing percentage and Odds ratio for maternal obesity.

Fig. 3. Maternal age and paritiy.

Change of maternal age distribution in Schleswig-Holstein between 1995 (purple) and 2017 (orange) depending on parity (a: Primiparae, b: Biparae, c: Multiparae).

Fig. 4. Body weight and mothers age.

Differences in periconceptional maternal body weight (mean and standard deviation [s]) according to maternal age in Schleswig-Holstein). The purple curve shows weight distribution in correlation to maternal age (years) in 1995 (n = 23,746), the orange curve gives the corresponding information for 2017 (n = 20,274).