Maternal Anthropometry and Adverse Perinatal Outcomes in Chinese Women Público

Abstract

Low birth weight, macrosomia and cesarean delivery confer serious consequences to
mothers and infants. Epidemiological evidence associates maternal anthropometry, namely
height, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG) with the
adverse outcomes: low birth weight (LBW), macrosomia and cesarean delivery (CD) in Europoid
populations. However there is a dearth of information on these associations among Chinese
women which may not function identically as observed in Europoid populations. For example,
rates of CD in China are among the highest of any developing country at 46%. The prevalence of
LBW is uncharacteristically low for a developing country, roughly 3%. Macrosomia, at the
opposite end of the birth weight spectrum, has yet to see a large increase.

Using data from a large prospective cohort of pregnant women (n=247,831) we found
that recommendations for GWG, derived in the US population, did not adequately identify
Chinese women at risk of CD or delivering a macrosomic infant; however, they satisfactorily
identified women at risk of delivering a LBW infant. To understand why the recommendations
were not well suited for Chinese women, we undertook an examination of maternal pre-
pregnancy BMI and height and focused solely on the outcome of CD. We found that the risk for
CD increased at a considerably lower pre-pregnancy BMI than previously thought. Additionally,
the impact of GWG on CD depends on pre-pregnancy BMI, such that high GWG is more
deleterious in heavier women compared with leaner women. Maternal height was also found to
increase the risk of CD; however, we were unable to identify a threshold where risk increased
dramatically.

Adverse pregnancy outcomes are important endpoints and predictors of future health for
both mothers and infants. Development of appropriate guidelines for maternal anthropometry is a
good investment since the period prior to and during pregnancy provides an opportunity to
mitigate risk factors for adverse pregnancy outcomes. Additional research is needed to develop
adequate GWG guidelines tailored for Chinese women. Research should focus on the impact of
the changing distribution of body weight and the growing prevalence of obesity in China.

Table of Contents

Table of Contents

Acknowledgements List of Tables List of Figures Chapter 1 Introduction

Chapter 2 Literature Review: Epidemiology of Adverse Perinatal Outcomes

Low Birth Weight Macrosomia Cesarean Delivery Summary

Chapter 3 Literature Review: Epidemiology of Maternal Anthropometry and Adverse Perinatal Outcomes

Body Mass Index Gestational Weight Gain Height Effect Modification Summary Chapter 4 Methods Study Background Sample Population Data Challenges Statistical Challenges

Chapter 5 Institute of Medicine's Recommendations, Low Birth Weight, Macrosomia and Cesarean Delivery among Chinese Women

Abstract Introduction Methods Results Conclusions

Chapter 6 Maternal Anthropometry and Risk of Primary Cesarean Delivery among Chinese Women

Abstract Introduction Methods Results Discussion

Chapter 7 Maternal height and the risk of cesarean delivery in a population of Chinese women

Abstract Introduction Methods Results Discussion Chapter 8 Summary and Conclusions Main findings Limitations Strengths Challenges to Studying Pregnancy

Public Health Significance and Policy Implications

Summary References

Appendix A: Data Cleaning & Variable Definition

About this Dissertation

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School	Laney Graduate School
Department	Biological and Biomedical Sciences
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology Health Sciences, Epidemiology Health Sciences, Public Health
Palabra Clave	pre-pregnancy BMI macrosomia China gestational weight gain maternal height cesarean delivery low birth weight
Committee Chair / Thesis Advisor	Venkat Narayan, K M, Emory University
Committee Members	Correa, Adolfo , Emory University Martorell, Reynaldo, Emory University Williamson, David, Emory University Ramakrishnan, Usha, Emory University Marcus, Michele, Emory University

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