Journal Article

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

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

2018

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Analysis / Biomedicine / Birth / Body mass / Body mass index / Body size / Body weight / Categories / Confidence intervals / Continents / Diabetes mellitus / Ethnicity / Evidence-based medicine / Female / Fetal Weight - ethnology / Gestational age / Gestational diabetes / Ggestational weight gain / Guidelines / Health aspects / Humans / Infant, Newborn / Large for gestational age / Maternal and infant outcomes / Medicine / Medicine & Public Health / Meta-analysis / Minority & ethnic groups / Mother-child relations / Obesity / Outcome and process assessment (Medical care) / Overweight / Pregnancy / Pregnancy Complications / Pregnancy Outcome - ethnology / Premature birth / Regression analysis / Research Article / Reviews / Small for gestational age / Statistical analysis / Subgroups / Systematic review / Underweight / Weight gain / Weight Gain - ethnology / Weight Gain - physiology / Womens health