The effects of prepregnancy body mass index and gestational weight gain on fetal macrosomia among American Indian/Alaskan Native women Público

Abstract

Background: The American Indian/Alaskan Native (AI/AN) population is at high health risk across many health indicators, including obesity. Fetal macrosomia can result in obstetric and long-term maternal and child complications. We investigated the effects of prepregnancy body mass index (BMI) and gestational weight gain (GWG) on macrosomia among AI/ANs.

Methods: Data came from the Pregnancy Risk Assessment Monitoring System in eight states from 2004-2011 for adult AI/ANs who delivered a live, singleton birth. Macrosomia (birthweight >=4,000 grams) and the World Health Organization's BMI categories were used. GWG enumerated the pounds women deviated from the Institute of Medicine guidelines for pregnancy weight gain. Prevalence of macrosomia by select characteristics was estimated. Multivariable logistic regression calculated adjusted odds ratios (aOR) for effects of BMI and GWG, controlling for other factors.

Results: About 30% of women were obese, and approximately 50% had excess GWG. Prevalence of macrosomia varied from 8.00-18.83% (Utah/Alaska). Characteristics with significantly high prevalence of macrosomia were obesity (16.67%), excess GWG (16.32%), multiparity (13.46%), diabetes (17.93%), no smoking (13.54%), no nausea (13.37%), post-term delivery (18.36%), and male infant (14.98%). There were significant independent effects of prepregnancy obesity (aOR:1.63; 95%Confidence Interval (CI):1.29,2.07) and excess GWG (aOR:1.16; 95%CI:1.12,1.20 per five pounds gained beyond appropriate) for macrosomia but no significant joint effects.

Conclusions: Obesity and excess GWG are independent factors for macrosomia among AI/ANs. Culturally appropriate interventions need to address these factors. Providers should target all women when counseling about GWG, emphasizing the increased risk associated with every additional pound above recommended weight gain.

Table of Contents

1. Chapter 1: Introduction/Background
   1. Definitions
   2. Risk Factors for Macrosomia
   3. Complications
      1. Table A: Maternal Short-term Complications
      2. Table B: Neonatal Short-term Complications
      3. Table C: Neonatal Long-term Complications
   4. Diagnosis of Macrosomia
   5. Cultural Context
   6. Research Aims
2. Chapter 2: Extended Methods
   1. Variable Definitions
   2. Data Analysis
3. Chapter 3: Manuscript
   1. Abstract
   2. Background
   3. Methods
   4. Results
   5. Comments
   6. Tables/Figures
      1. Table 1: Population and prevalence of macrosomia by demographic and pregnancy characteristics among American Indian/Alaskan Native women
      2. Table 2A: Average weight gained by prepregnancy body mass index category among American Indian/Alaskan Native women who gained an inadequate amount of weight
      3. Table 2B: Average weight gained by prepregnancy body mass index category among American Indian/Alaskan Native women who gained an excess amount of weight
      4. Table 3: Adjusted odds ratios of prepregnancy body mass index and gestational weight gain for macrosomia among American Indian/Alaskan Native women
      5. Table 4: Adjusted odds ratios for independent effects of prepregnancy body mass index and gestational weight gain on macrosomia among American Indian/Alaskan Native women by state of residence
4. Chapter 4: Extended Analysis
5. Chapter 5: Discussion
   1. Public Health Implications
   2. Strengths and Limitations
   3. Conclusions
6. References
7. Tables/Figures
   1. Table 1: Institute of Medicine's weight gain during pregnancy guidelines, 2009
   2. Figure 1: Flowchart for inclusion/exclusion criteria
   3. Table 2: Prevalence of demographic and pregnancy characteristics among American Indian/Alaskan Native women
   4. Figure 2: Distribution of body mass index across the entire sample of American Indian/Alaskan Native women
   5. Table 3: Prevalence of macrosomia by selected demographic and pregnancy characteristics among American Indian/Alaskan Native women who delivered a macrosomic infant
   6. Figure 3: Distribution of infant birth weight among American Indian/Alaskan Native women
   7. Figure 4: Distribution of body mass index stratified by macrosomia for American Indian/Alaskan Native women
   8. Figure 5: Distribution of gestational weight gain categories stratified by macrosomia for American Indian/Alaskan Native women
   9. Table 4. Summary statistics for maternal prepregnancy body mass index and gestational weight gain for American Indian/Alaskan Native women stratified by birth weight
   10. Table 5: Average body mass index stratified by gestational weight gain categories for all American Indian/Alaskan Native women
   11. Table 6A: Average weight gained by prepregnancy body mass index category among American Indian/ Alaskan Native women who gained an inadequate amount of weight
   12. Table 6B: Average weight gained by prepregnancy body mass index category among American Indian/ Alaskan Native women who gained an excess amount of weight
   13. Table 7: Crude associations between demographic and pregnancy characteristics and macrosomia among American Indian/Alaskan Native women
   14. Table 8. Crude associations between demographic and pregnancy characteristics and body mass index among American Indian/Alaskan Native women
   15. Table 9. Crude associations between demographic and pregnancy characteristics and gestational weight gain among American Indian/Alaskan Native women
   16. Figure 6: Directed Acyclic Graphs depicting possible causal pathways for two main exposures, body mass index and gestational weight gain, and macrosomia
   17. Table 10: Adjusted odds ratios of prepregnancy body mass index and gestational weight gain for macrosomia among American Indian/Alaskan Native women
   18. Table 11. Geographic distribution of outcome and exposures by state among American Indian/Alaskan Native women by state of residence
   19. Table 12: Adjusted odds ratios for independent effects of prepregnancy body ass index and gestational weight gain on macrosomia among American Indian/Alaskan Native women by state of residence
   20. Table 13: Adjusted odds ratios of prepregnancy body mass index and gestational weight gain on macrosomia among non-diabetic American Indian/Alaskan Native women

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Native American Studies Health Sciences, Public Health Health Sciences, Epidemiology
Palavra-chave	prenatal care body mass index GWG macrosomia BMI American Indian gestational weight gain Alaskan Native large for gestational age obesity LGA Native American
Committee Chair / Thesis Advisor	Hogue, Carol J, Emory University
Partnering Agencies	State or local health department (not in Georgia) Emory University schools, faculty or affiliated programs CDC

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