Maternal Anthropometry and Adverse Perinatal Outcomes in Chinese Women Public
Herrick, Kirsten Anne (2011)
Published
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 SummaryChapter 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 ChallengesChapter 5 Institute of Medicine's Recommendations, Low Birth Weight, Macrosomia and Cesarean Delivery among Chinese Women
Abstract Introduction Methods Results ConclusionsChapter 6 Maternal Anthropometry and Risk of Primary Cesarean Delivery among Chinese Women
Abstract Introduction Methods Results DiscussionChapter 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 PregnancyPublic Health Significance and Policy Implications
Summary ReferencesAppendix A: Data Cleaning & Variable Definition
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