| ObjectivesTo investigate the prevalence of maternal pre-pregnancy overweight/obese and excessive gestational weight gain,the association between maternal pre-pregnancy body mass index(BMI),gestational weight gain(GWG)with delivery mode,birth weight.MethodsWe chose Xiaoxian,Anhui province as our study site.With informed consent,we recruited three months old or six months old children who received regular physical examinations matched their mothers in the 13 XiaoXian Maternal and Child Health Care Hospitals from August 2014 to February 2015.All participants were asked to complete the self-administered questionnaires to collect information by trained research assistants.We distributed 1 810 questionnaire,and tack back 1 773,the response rate was 97.9%.Then we excluded mothers with gestational hypertension,premature birth,multiplets,gestational diabetes and other pregnant complications,finally 1 617 children matched their mothers were included in our study.The contents of the questionnaire included maternal age,height,weight before pregnancy,weight at delivery,education level,paternal education level,pregnancy history,lifestyle before and during pregnancy(alcohol consumption and smoking),anxiety trait,stress during pregnancy and bleeding in the first trimester,vomiting in the first trimester,offspring characteristics(including delivery mode,gender,birth weight and height).The medical information of pregnantwomen(such as height,weight,blood pressure,delivery mode,birth weight,and birth height.)were excerpted by investigators from the health care manual of pregnant women,and the data of maternal weight and height before pregnancy were filled by themselves.Criteria for gestational weight gain(GWG): a new revision of the American Institute of medical research(IOM)in 2009.Maternal stress during pregnancy was assessed using the Life Events Scale for Pregnant Women,and maternal anxiety trait was assessed using the State-trait Anxiety Inventory.Low birth weight(birth weight<2 500 g),macrosomia(birth weight?4 000 g),SGA(defined as birth weight below the 10 th percentile of mean weight corrected for fetal sex and gestational age),LGA(defined as birth weight above the 90 th percentile of mean weight corrected for fetal sex and gestational age).One-way analysis of variance(ANOVA)and ?2 test were used to compare continuous and categorical variables in groups,respectively.Binary logistic regressions were conducted to determine the effect of maternal pre-pregnancy body mass index(BMI),gestational weight gain(GWG)on delivery mode,birth weight.ResultsThe prevalence of underweight was 16.3%(n=263),normal weight was 71.4%(n=1 155),overweight and obesity was 12.3%(n=199)of the 1 617 mothers.The prevalence of inadequate GWG was 15.2%(n=246),appropriate GWG was 32.7%(n=529)and excessive GWG was 52.1%(n=824).Of the infants,the prevalence of low birth weight,macrosomia,small for gestational age and large for gestational age were respectively 3.7%(n=60),11.8%(n=119),6.7%(n=109)and 13.4%(n=217).The prevalence of cesarean delivery were 36.0%(n=582).Inadequate GWG,appropriate GWG and excessive GWG were respectively14.4%,43.0% and 42.6% in women with pre-pregnancy underweight.Excessive GWG were respectively 52.0% and 64.3% in women with pre-pregnancy normal weight and overweight/obesity.After adjusting confounding factors,our study showed that compared with normal weight before pregnancy,pre-pregnancy overweight and obesity were risk factors of cesarean(OR=1.49,95%CI:1.09-2.04).Compared with appropriate gestational weight gain,excessive gestational weight gain was also risk factors for cesarean(OR=1.33,95%CI:1.06-1.69).We also noticed that excessive gestational weight gain was risk factors for cesarean(OR=3.73,95%CI:1.68-8.25)in women with pre-pregnancy overweight/obesity.Our study also found that pre-pregnancy overweight/obesity were risk factors for macrosomia(OR=1.89,95%CI:1.26-2.08)and large for gestational age(LGA)(OR=1.85,95% CI: 1.26-2.71).Inadequate gestational weight gain was risk factor for low birth weight(OR=2.13,95%CI: 1.07-4.25)and small for gestational age(SGA)(OR=2.07,95% CI: 1.21-3.56),but excessive gestational weight gain was risk factors for macrosomia(OR=1.85,95%CI:1.28-2.69)and large for gestational age(LGA)(OR=1.78,95% CI: 1.26-2.53).We also noticed that excessive gestational weight gain was risk factors for macrosomia(OR=1.77,95% CI: 1.13-2.76)and large for gestational age(LGA)(OR=1.64,95% CI: 1.08-2.48)in women with pre-pregnancy normal weight.ConclusionMaternal pre-pregnancy overweight/obesity and excessive gestational weight gain were risk factors for cesarean delivery,and compared to pre-pregnancy overweight/obesity or excessive gestational weight gain,combination of them,the rate of cesarean delivery were much higher.Maternal pre-pregnancy overweight/obesity and excessive gestational weight gain were risk factors for macrosomia and large for gestational age(LGA),and inadequate gestational weight gain was risk factor for low birth weight and small for gestational age(SGA),and the rate of macrosomia and large for gestational age were much higher in women with pre-pregnancy normal weight and excessive gestational weight gain.Thus,interventions of providing more assistance ofweight gain control may be recommended as a part of antenatal care for mothers and children,and nutritional plan should be individualized according to pre-pregnancy BMI. |
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