Body Mass Index Changes during Pregnancy and Perinatal Outcomes - A Cross-Sectional Study

Morais, Sirlei Siani; Nascimento, Simony Lira; Godoy-Miranda, Ana Carolina; Kasawara, Karina Tamy; Surita, Fernanda Garanhani

doi:10.1055/s-0037-1608885

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Articles, Obstetrics • Rev. Bras. Ginecol. Obstet. 40 (01) • Jan 2018 • https://doi.org/10.1055/s-0037-1608885 copy

Body Mass Index Changes during Pregnancy and Perinatal Outcomes - A Cross-Sectional Study

Mudanças do índice de massa corporal na gravidez e resultados perinatais - um estudo transversal

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate the relation between changes the body mass index (BMI) percentile, reflected in the Atalah curve, and perinatal outcomes.

Methods

A cross-sectional study with 1,279 women was performed. Data regarding gestational weight, sociodemographic characteristics and perinatal outcomes were collected through medical charts, prenatal card and interviews in the postpartum period. Women could be classified according to the Atalah curve in the following categories: low weight, adequateweight, overweight, and obese. The BMIwas calculated at the first and at the last prenatal care visits, and these values were compared.

Results

An increase in the BMI category according to the Atalah classification occurred in 19.9% of pregnant women, and an increase of 3.4, 5.8 and 6.4 points of BMI were found for women respectively classified in the adequate weight, overweight and obese categories at the first prenatal visit. Women with high school education presented a lower chance of increasing their BMI (odds ratio [OR] 0:47 [0.24- 0.95]). Women who evolved with an increase in the the Atalah classification were associated with cesarean section (OR 1.97-2.28), fetalmacrosomia (OR 4.13-12.54) and large for gestational age newborn (OR 2.88-9.83).

Conclusion

Pregnant women who gained enough weight to move up in their BMI classification according to the Atalah curve had a higher chance of cesarean section and macrosomia. Women classified as obese, according to the Atalah curve, at the first prenatal visit had a high chance of cesarean section and delivering a large for gestational age newborn.

Keywords:
pregnancy; weight gain; Atalah curve; obesity; cesarean-section; fetal weight

Classification according to the Atalah curve (BMI)				First prenatal visit				Last prenatal visit				Gestational weight gain
Classification according to the Atalah curve (BMI)				BMI(kg/m²)		Weight(kg)		BMI(kg /m²))		Weight(kg)		BMI (%)		Weight (kg)
First prenatal visit	Last prenatal visit	n	%	mean	SD	mean	SD	mean	SD	mean	SD	mean	SD	mean	SD
Low weight	Low weight	129	77.7%	18.9	2.1	51.0	7.0	22.7	1.5	61.2	6.3	29.0	105.5	10.2	5.0
Low weight	Adequate	37	22.3%	20.1	1.0	52.4	5.8	26.0	1.1	67.6	7.3	29.3	7.4	15.2	4.0
Adequate Weight	Low weight	44	9.2%	22.2	1.2	59.6	6.5	24.0	0.8	64.5	6.9	8.5	6.5	4.9	3.7
	Adequate	325	67.8%	23.2	1.5	61.0	6.4	27.2	1.1	71.6	6.3	17.7	7.0	10.6	3.9
	Overweight	108	22.5%	24.0	1.1	61.8	6.1	30.4	1.1	78.1	6.5	26.7	7.1	16.3	3.7
	Obesity	2	0.4%	24.2	1.2	60.8	4.6	33.9	0.2	85.3	1.8	40.6	7.7	24.5	2.8
Overweight	Adequate	49	15.8%	26.4	1.0	70.4	6.8	28.1	0.9	74.8	6.9	6.4	5.4	4.4	3.7
	Overweight	187	60.3%	27.4	1.4	71.6	6.9	31.1	1.2	81.0	6.9	13.5	6.2	9.5	4.1
	Obesity	74	23.9%	28.7	1.2	75.4	7.8	34.5	1.3	90.7	8.9	20.5	6.5	15.3	4.5
Obesity	Adequate	1	0.6%	30.1	–	79.0	–	28.0	–	73.4	–	–7.1	–	–5.6	–
	Overweight	13	8.4%	31.4	0.9	82.9	8.8	32.3	0.7	85.1	7.7	2.8	3.6	2.2	3.0
	Obesity	141	91.0%	35.2	4.2	91.7	12.8	38.6	4.2	100.6	12.7	10.0	6.3	8.9	5.5

Variables	All women					Women with adequate BMI in the first prenatal visit				Women with overweight BMI in the last prenatal visit
	Stag	Incr	OR(CI 95%)*			Stag	Incr	OR(CI 95%)*		Stag	Incr	OR(CI 95%)*
	n	n	OR(CI 95%)*			n	n	OR(CI 95%)*		n	n	OR(CI 95%)*
Age
≤ 19	99	36	0.74	(0.48–1.12)		46	18	0.86	(0.47–1.58)	15	6	0.96	(0.35–2.61)
20–34	574	154	Ref			231	78	Ref		138	53	Ref
35–39	89	25	0.96	(0.59–1.54)		40	11	1.23	(0.60–2.51)	27	13	0.80	(0.38–1.66)
≥ 40	20	6	0.89	(0.35–2.27)		8	3	0.90	(0.23–3.48)	7	2	1.24	(0.27–6.68)
Ethnicity
White	375	116	Ref			163	58	Ref		88	42	Ref
Non-White	405	104	1.20	(0.89–1.63)		161	51	1.12	(0.73–1.73)	99	32	1.48	(0.86–2.54)
Education Level
Elementary School	157	41	1.151.15	(0.7777–1.70)		55	11	2.11	(1.058–4.25)	46	19	0.87	(0.45–1.69)
High School	448	134	Ref			187	79	Ref		97	35	Ref
Graduation	175	44	1.19	(0.81–1.74)		81	19	1.80	(1.02–3.17)	44	19	0.84	(0.43–1.62)
Parity
Primiparous	366	122	Ref	160	59	Ref	72	32	Ref
Multiparous	416	99	1.40	(1.04–1.89)		165	51	1.19	(0.77–1.84)	115	42	1.22	(0.70–2.10)
Hypertension
No	704	201	Ref			307	101	Ref		169	65	Ref
Yes	77	20	1.10	(0.66–1.84)		18	9	0.66	(0.29–1.51)	17	9	0.73	(0.31–1.71)
Diabetes
No	733	213	Ref			316	109	Ref		175	67	Ref
Yes	47	7	1.95	(0.87–4.38)		9	1	3.10	(0.39–24.79)	10	6	0.64	(0.22–1.82)
Planned pregnancy
Yes	391	112	Ref			170	59	Ref		94	41	Ref
No	391	108	1.04	(0.77–1.40)		155	50	1.08	(0.70–1.66)	93	33	1.23	(0.72–2.11)
Smoking
No	725	208	Ref			303	105	Ref		168	70	Ref
Yes	56	13	1.24	(0.66–2.30)		22	5	1.52	(0.56–4.13)	18	4	1.88	(0.61–5.74)
Health insurance
Private	248	71	Ref			115	34	Ref		57	26	Ref
Public	532	149	1.02			(0.74–	1.41)	209		75	0.82	(0.52–2.17)

Variables	Low/Adequate	Overweight	Obesity	OR - Overweight		OR - Obesity
Variables	n	n	n
Mode of delivery
missing data	0	1	0
Vaginal	300	127	43	Ref		Ref
C-section	351	186	118	1.25	(0.95–1.65)	2.35	(1.60–3.44)
Gestational age at birth (weeks)
missing data	6	3	6
≥ 37	612	299	143	Ref		Ref
< 37	33	12	12	0.74	(0.38–1.46)	1.56	(0.78–3.09)
Newborn weight (grs)
missing data	7	7	5
< 2500	43	14	9	0.67	(0.36–1.25)	0.88	(0.42–1.85)
2500 -3999	584	282	139	Ref		Ref
≥ 4000	17	11	8	1.34	(0.62–2.90)	1.98	(0.84–4.67)
Somatic neonatal age (weeks)
missing data	22	15	13
≥ 37	598	280	136	Ref		Ref
< 37	31	19	12	1.31	(0.73–2.36)	1.70	(0.85–3.40)
APGAR on the 1st minute
missing data	11	6	5
≥ 7	613	292	147	Ref		Ref
< 7	27	16	9	1.24	(0.66–2.34)	1.39	(0.64–3.02)
APGAR on the 5th minute
missing data	2	1	0
≥ 7	649	312	161	Ref		Ref
< 7	0	1	0	6.24	(0.25–153.50)	4.02	(0.08–203.46)
Newborn weight adequacy
missing data	13	10	11
SGA	77	18	10	0.47	(0.27–0.80)	0.55	(0.28–1.07)
AGA	543	272	128	Ref		Ref
LGA	18	14	12	1.56	(0.77–3.16)	2.86	(1.36–6.01)

Outcomes	All Sample				Women with adequate BMI in the first prenatal visit				Women with overweight BMI in the last prenatal visit
	Stag	Incr	OR (CI 95%)*		Stag	Incr	OR (CI 95%)*		Stag	Incr	OR (CI 95%)*
	n	n	OR (CI 95%)*		n	n	OR (CI 95%)*		n	n	OR (CI 95%)*
Mode of delivery
Vaginal	333	81	Ref		148	43	Ref		82	19	Ref
C-section	448	140	1.28	(0.94–1.75)	117	67	1.97	(1.25–3.10)	104	55	2.28	(1.26–4.14)
Gestational age at birth
≥ 37	741	209	ref		313	106	Ref		179	71	Ref
< 37	41	12	1.04	(0.54–2.01)	12	4	0.98	(0.31–3.12)	8	3	0.95	(0.24–3.67)
Newborn weight (g)
< 2,500	49	11	0.84	(0.43–1.64)	16	5	1.00	(0.36–2.82)	10	3	0.84	(0.22–3.14)
2500–3999	702	188	Ref		299	93	Ref		170	61	Ref
≥ 4000	49	18	1.37	(0.78–2.41)	7	9	4.13	(1.50–11.40)	2	9	12.54	(2.64–59.67)
Somatic neonatal age (weeks)
≥ 37	704	200	Ref		303	103	Ref		165	67	Ref
< 37	43	14	1.15	(0.61–2.14)	10	3	0.88	(0.24–3.27)	12	6	1.23	(0.44–3.42)
APGAR 1st minute
≥ 7	728	206	Ref		307	101	Ref		172	68	Ref
< 7	37	12	1.15	(0.59–2.24)	10	7	2.13	(0.79–5.74)	11	5	1.15	(0.39–3.43)
APGAR 5th minute
≥ 7	779	221	Ref		323	110	Ref		155	74	Ref
< 7	1	0	1.17	(0.05–28.90)	2	0	0.59	(0.03–12.29)	1	0	0.70	(0.03–17.28)
Newborn weight adequacy
SGA	74	14	0.69	(0.38–1.25)	56	9	0.49	(0.20–2.77)	8	5	1.84	(0.58–5.86)
AGA	670	184	Ref		385	126	Ref		171	58	Ref
LGA	24	19	2.88	(1.55–5.38)	9	9	3.06	(1.19–7.87)	3	10	9.83	(2.61–36.94)

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[1] Address for correspondence Fernanda Garanhani Surita, Associate Professor, Alexander Fleming 101, 13083-881, Campinas, SP, Brazil (e-mail: surita@unicamp.br).