Interpregnancy weight change and adverse pregnancy outcomes: a systematic review and meta-analysis

Abstract

Objectives: To evaluate the effect of interpregnancy body mass index (BMI) change on pregnancy outcomes, including large-for-gestational-age babies (LGA), small-for-gestational-age babies (SGA), macrosomia, gestational diabetes mellitus (GDM) and caesarean section (CS).

Design: Systematic review and meta-analysis of observational cohort studies.

Data sources: Literature searches were performed across Cochrane, MEDLINE, EMBASE, CINAHL, Global Health and MIDIRS databases.

Study selection: Observational cohort studies with participants parity from 0 to 1.

Main outcome measures: Adjusted ORs (aORs) with 95% CIs were used to evaluate the association between interpregnancy BMI change on five outcomes.

Results: 925 065 women with singleton births from parity 0 to 1 were included in the meta-analysis of 11 studies selected from 924 identified studies. A substantial increase in interpregnancy BMI (>3 BMI units) was associated with an increased risk of LGA (aOR 1.85, 95% CI 1.71 to 2.00, p<0.001), GDM (aOR 2.28, 95% CI 1.97 to 2.63, p<0.001), macrosomia (aOR 1.54, 95% CI 0.939 to 2.505) and CS (aOR 1.72, 95% CI 1.32 to 2.24, p<0.001) compared with the reference category, and a decreased risk of SGA (aOR 0.83, 95% CI 0.70 to 0.99, p=0.044). An interpregnancy BMI decrease was associated with a decreased risk of LGA births (aOR 0.70, 95% CI 0.55 to 0.90, p<0.001) and GDM (aOR 0.80, 95% CI 0.62 to 1.03), and an increased risk of SGA (aOR 1.31, 95% CI 1.06 to 1.63, p=0.014). Women with a normal BMI (<25kg/m²) at first pregnancy who have a substantial increase in BMI between pregnancies had a higher risk of LGA (aOR 2.10, 95% CI 1.93 to 2.29) and GDM (aOR 3.10, 95% CI 2.74 to 3.50) when compared with a reference than women with a BMI ≥25 kg/m² at first pregnancy.

Conclusions: Gaining weight between pregnancies increases risk of developing GDM, CS and LGA, and reduces risk of SGA in the subsequent pregnancy. Losing weight between pregnancies reduces risk of GDM and LGA and increases risk of SGA. Weight stability between first and second pregnancy is advised in order to reduce risk of adverse outcomes.

Trial registration number: CRD42016041299.

Keywords: bmi; interpregnancy; maternal medicine.

Figure 1

The 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram showing results of literature search.

Figure 2

Forest plot showing change in interpregnancy weight and the risk of large-for-gestational-age (LGA) births in all women relative to reference category (decrease in body mass index (BMI) defined as >−1 unit, moderate increase 1–3 units and substantial increase >3 units, reference category remained in same BMI category or changed by up to −2 to +2 units). aOR, adjusted OR.

Figure 3

Forest plot showing change in interpregnancy weight and the risk of gestational diabetes mellitus (GDM) in all women relative to reference category (decrease in body mass index (BMI) defined as >−1 unit, moderate increase 1–3 units and substantial increase >3 units, reference category remained in same BMI category or changed by up to −2 to +2 units). aOR, adjusted OR.

Figure 4

Forest plot showing change in interpregnancy weight and the risk of caesarean section (CS) in all women relative to reference category (decrease in body mass index (BMI) defined as >−1 unit, moderate increase 1–3 units and substantial increase >3 units, reference category remained in same BMI category or changed by up to −2 to +2 units). aOR, adjusted OR.

Figure 5

Forest plot showing change in interpregnancy weight and the risk of small-for-gestational-age (SGA) births in all women relative to reference category (decrease in body mass index (BMI) defined as >−1 unit, moderate increase 1–3 units and substantial increase >3 units, reference category remained in same BMI category or changed by up to −2 to +2 units). aOR, adjusted OR.