Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women

Research output: Contribution to journalReviewResearchpeer-review

  1. Impact of atopy on risk of glioma: a Mendelian randomisation study

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Metabonomics uncovers a reversible proatherogenic lipid profile during infliximab therapy of inflammatory bowel disease

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Late presentation of chronic viral hepatitis for medical care: a consensus definition

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Prevalence and predictors of maternal smoking prior to and during pregnancy in a regional Danish population: a cross-sectional study

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Not now but later - a qualitative study of non-exercising pregnant women's views and experiences of exercise

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Psychological adaptation after peripartum cardiomyopathy: A qualitative study

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Leisure time physical activity in 9- to 11-year-old children born moderately preterm: a cohort study

    Research output: Contribution to journalJournal articleResearchpeer-review

  • Rebecca F Goldstein
  • Sally K Abell
  • Sanjeeva Ranasinha
  • Marie L Misso
  • Jacqueline A Boyle
  • Cheryce L Harrison
  • Mary Helen Black
  • Nan Li
  • Gang Hu
  • Francesco Corrado
  • Hanne Hegaard
  • Young Ju Kim
  • Margaretha Haugen
  • Won O Song
  • Min Hyoung Kim
  • Annick Bogaerts
  • Roland Devlieger
  • Judith H Chung
  • Helena J Teede
View graph of relations

BACKGROUND: The association between Institute of Medicine (IOM) guidelines and pregnancy outcomes across ethnicities is uncertain. We evaluated the associations of gestational weight gain (GWG) outside 2009 IOM guidelines, with maternal and infant outcomes across the USA, western Europe and east Asia, with subgroup analyses in Asia. The aim was to explore ethnic differences in maternal prepregnancy body mass index (BMI), GWG and health outcomes across these regions.

METHODS: Systematic review, meta-analysis and meta-regression of observational studies were used for the study. MEDLINE, MEDLINE In-Process, Embase and all Evidence-Based Medicine (EBM) Reviews were searched from 1999 to 2017. Studies were stratified by prepregnancy BMI category and total pregnancy GWG. Odds ratio (ORs) 95% confidence intervals (CI) applied recommended GWG within each BMI category as the reference. Primary outcomes were small for gestational age (SGA), preterm birth and large for gestational age (LGA). Secondary outcomes were macrosomia, caesarean section and gestational diabetes.

RESULTS: Overall, 5874 studies were identified and 23 were included (n = 1,309,136). Prepregnancy overweight/obesity in the USA, Europe and Asia was measured at 42%, 30% and 10% respectively, with underweight 5%, 3% and 17%. GWG below guidelines in the USA, Europe and Asia was 21%, 18% and 31%, and above was 51%, 51% and 37% respectively. Applying regional BMI categories in Asia showed GWG above guidelines (51%) was similar to that in the USA and Europe. GWG below guidelines was associated with a higher risk of SGA (USA/Europe [OR 1.51; CI 1.39, 1.63]; Asia [1.63; 1.45, 1.82]) and preterm birth (USA/Europe [1.35; 1.17, 1.56]; Asia [1.06; 0.78, 1.44]) than GWG within guidelines. GWG above guidelines was associated with a higher risk of LGA (USA/Europe [1.93; 1.81, 2.06]; Asia [1.68; 1.51 , 1.87]), macrosomia (USA/Europe [1.87; 1.70, 2.06]; Asia [2.18; 1.91, 2.49]) and caesarean (USA/Europe [1.26; 1.21, 1.33]; Asia [1.37; 1.30, 1.45]). Risks remained elevated when regional BMI categories were applied for GWG recommendations. More women in Asia were categorised as having GWG below guidelines using World Health Organization (WHO) (60%) compared to regional BMI categories (16%), yet WHO BMI was not accompanied by increased risks of adverse outcomes.

CONCLUSIONS: Women in the USA and western Europe have higher prepregnancy BMI and higher rates of GWG above guidelines than women in east Asia. However, when using regional BMI categories in east Asia, rates of GWG above guidelines are similar across the three continents. GWG outside guidelines is associated with adverse outcomes across all regions. If regional BMI categories are used in east Asia, IOM guidelines are applicable in the USA, western Europe and east Asia.

Original languageEnglish
JournalBMC Medicine
Volume16
Issue number1
Pages (from-to)153
ISSN1741-7015
DOIs
Publication statusPublished - 31 Aug 2018

    Research areas

  • Adult, Female, Fetal Weight/ethnology, Humans, Infant, Newborn, Pregnancy, Pregnancy Complications, Pregnancy Outcome/ethnology, Weight Gain/ethnology

ID: 56332276