Gestational Weight Gain and Large for Gestational Age Neonates in a Predominantly Hispanic Population Community Hospital
Abstract
To analyse changes in Gestational Weight Gain (GWG) in different Body Mass Index (BMI) categories at start of pregnancy and neonatal birth weight outcomes in a predominantly Hispanic population living in a low-income environment.
We conducted a cross sectional study of women with singleton gestation who delivered at Wyckoff Heights Medical Centre from January 1st to December 31st, 2017. BMI was categorized at first prenatal visit as normal weight (BMI= 18.5-24.9), overweight (BMI= 25-29.9) and obese (BMI >30). BMI was collected at 16-20, 24-28, and 36-38 weeks of gestation. Stratified by BMI, appropriate GWG were 25–35 pounds for normal weight (27.9%), 15–25 pounds for overweight (34.5%), and 11–20 pounds for obese (24.5%). Neonatal birth weight was categorized by Duryea percentiles and gestational age in weeks. From 831 women, normal weight (n=269), overweight (n=263), and obese (n=299) women were found. GWG was categorized as: inadequate, appropriate, or excessive based on the Institute of Medicine guidelines. The prevalence of excessive GWG was 23.1% for normal weight, 35.8% for overweight, and 37.5% for obese women. The prevalence of inadequate GWG was 48.9% for normal weight, 31.0% for overweight, and 40.6% for obese women. A significant association was found between obese women and >90 percentile neonatal birth weight (OR:2.3, 95% CI: 1.15-4.97). Obese women were more likely to have excessive GWG which is associated with maternal and neonatal adverse outcomes such as NICU admissions, gestational diabetes, hypertensive disorders in pregnancy, delivery by caesarean section, large for gestational age, and shoulder dystocia.
Keywords: Gestational weight gain; Maternal obesity; Pregnancy weight gain; Pregnancy complications
Introduction
Gestational weight gain (GWG) is the amount of weight one gains throughout the pregnancy. This weight gain can be influenced by many factors including: age, socioeconomic factors, ethnicity, and maternal comorbidities, such as pre-gestational obesity [1-4]. Excessive gestational weight can lead to numerous adverse maternal and neonatal events such as the development of gestational diabetes, gestational hypertension, and preeclampsia, delivery via caesarean section, macrosomia, neonatal hypoglycaemia and shoulder dystocia. Due to the complications that can arise, recommendations were set forth by The Institute of Medicine (IOM) designating the appropriate amount of weight women should gain based on her pre-pregnancy BMI [5]. Although these guidelines were set forth just eleven years ago in 2009, they are debatable and do not take into consideration various important factors such as: weight gain among different ethnic groups, those of low socioeconomic status and/or those with a lower education level [5].
In the United States, more than 40% of pregnant women exceed the Institute of Medicines guidelines [6]. Excessive gestational weight gain varies by ethnicity and socioeconomic status with low income populations and non-whites being at the greatest risk [1].
Hispanics are the largest minority group living in the United States. They have the highest rates of inadequate and excessive GWG and are the group with the highest birth rate [6]. Hispanic women, specifically those from the Caribbean, experience the greatest health disparity. Furthermore, this subgroup of women has the highest prevalence of maternal comorbidities including obesity and type 2 diabetes mellitus and exhibit adverse outcomes associated with poor nutrition [6].
Women who are classified as severely obese at conception have an increased risk of infant mortality, stillbirth, congenital malformations, large for gestation infants, hypertensive disorders of pregnancy, gestational diabetes, prolonged second stage of delivery, delivery via caesarean section and maternal mortality than non-obese women [7].
In our predominantly Hispanic population, we sought to determine whether the pattern of maternal gestational weight gain was associated with clinically significant changes in the neonatal birth weight.
Materials and Methods
Design and settings
We performed a single‐centre, retrospective study of patients enrolled in the prenatal service and delivered at Wyckoff Heights Medical Centre in Brooklyn, New York. The hospital is located in a community comprised of primarily Latinos living below the poverty line [8]. We enrolled women who received prenatal care and delivered a live born singleton gestation presenting to the obstetrics and gynaecology department between January 1st to December 31st, 2017 and delivered a singleton infant. This study was approved by our Institutional Review Board at Wyckoff Heights Medical Centre.
Study population
We enrolled a sample of adult women, 18 years or older, who received prenatal care and delivered at Wyckoff Heights Medical Centre. One thousand three hundred fifty-six charts were reviewed and eight hundred forty-five women met the inclusion criteria. Fourteen women who were classified as underweight at the initial prenatal visit were excluded due to inadequate sample size.
Data collection and data management
Baseline demographic data were collected on all enrolled women and neonates (Table 1). Maternal data such as maternal age at delivery, height, body weight at: first prenatal visit, 16-20 weeks’ gestation, 24-28 weeks’ gestation, 36-38 weeks’ gestation, as well as reproductive characteristics such as gravidity, parity, mode of delivery, past medical history and blood which were extracted from the hospital medical record. Neonatal data including gestational age at delivery, birth weight, and neonatal intensive care unit admission (Figure 2) as well as length of stay were collected from the hospital medical record.
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