Association between maternal gestation weight gain and preterm birth according to pre-pregnancy body mass index and HbA1c

May 31, 2024Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology

How Weight Gain During Pregnancy Relates to Early Birth Based on Pre-Pregnancy Body Weight and Blood Sugar Levels

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Abstract

Among 23,699 pregnant women, 4.70% experienced preterm birth (PTB), with findings indicating that inadequate gestational weight gain (GWG) is linked to a higher risk of PTB.

Women with inadequate GWG had a significantly higher risk of PTB compared to those with appropriate GWG.
Excessive GWG was associated with a reduced risk of PTB.
Risk associations between GWG and PTB remained consistent across subgroups defined by glycated hemoglobin (HbA1c) and pre-pregnancy body mass index (pp-BMI).
In women with pp-BMI <18.5 kg/m, inadequate GWG significantly increased the risk of PTB compared to women with appropriate GWG and HbA1c levels of 4.6-5.0%.
The risk of PTB increased with higher HbA1c levels, even within the normal range.

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BACKGROUND: To investigate the association between gestational weight gain (GWG) and preterm birth (PTB) according to pre-pregnancy body mass index (pp-BMI) and glycated haemoglobin (HbA1c) within the normal range.

METHODS: We conducted a population-based retrospective cohort study between July 2017 and January 2020 at Women's Hospital, Zhejiang University School of Medicine. Women were classified into three groups (inadequate GWG, appropriate GWG, and excessive GWG). In addition, women were divided into different subgroups according to pp-BMI and HbA1c. We estimated the odds ratios (OR) with 95% confidence intervals (CI) to assess the associations between GWG and the risk of PTB. Meanwhile, we adjusted for possible confounding factors, including maternal age, infant sex, family history of diabetes, education, pregnancy mode, delivery mode, parity, and gravidity.

RESULTS: The study involved 23,699 pregnant women, of which 1124 (4.70%) were PTB. Women who had inadequate GWG were found to have a significantly higher risk of PTB compared to women with appropriate GWG. In contrast, women with excessive GWG had a reduced risk of PTB. Similarly, GWG and PTB had similar risk associations in the HbA1c and pp-BMI subgroups. Among women with pp-BMI <18.5 kg/m, women with inadequate GWG had a significantly increased risk of PTB compared with women in the control group (HbA1c 4.6-5.0%, appropriate GWG), and the risk increased with increasing HbA1c levels. Similar results were observed in women with normal pp-BMI. 2

CONCLUSIONS: There was a significant association between GWG and the risk of PTB, but the risk varied by pp-BMI and HbA1c levels. Reasonable weight gain during pregnancy is essential to prevent PTB. Furthermore, while HbA1c is within the normal range, the higher levels should be noticed.

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Association between maternal gestation weight gain and preterm birth according to pre-pregnancy body mass index and HbA1c

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