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Am J Perinatol
DOI: 10.1055/a-2565-1687
Original Article

Association of Prepregnancy Obesity versus Excessive Gestational Weight Gain with Adverse Neonatal Outcomes in the United States

Authors

  • Rodney A. McLaren Jr.

    1   Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania

  • Deepa Rastogi

    2   Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York

  • Shantanu Rastogi 

    3   Division of Neonatology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York

Funding This work was supported by the U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute (grant number: HL141849).
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Abstract

Objective

Prepregnancy obesity (PPO) and excessive gestational weight gain (eGWG) during pregnancy, both are associated with adverse neonatal outcomes. The objective of this study was to compare the independent associations of PPO and eGWG with adverse neonatal outcomes.

Study Design

This was a retrospective cohort study of singleton, live births in the United States in 2018 using National Vital Statistics System data. These were divided into four groups: 1) normal prepregnancy BMI and normal GWG, 2) normal prepregnancy BMI and eGWG, 3) prepregnancy BMI >30 kg/m2 (PPO) and normal GWG and 4) PPO and eGWG. The adverse neonatal outcomes, including preterm delivery, large for gestational age (LGA) infants, assisted neonatal ventilation, low 5-minute Apgar scores, neonatal intensive care unit (NICU) admissions, and surfactant use were studied. These outcomes were compared among groups using ANOVA and multivariable analyses.

Results

Of the 1,477,062 births included, 21.8, 41.6, 10.4, and 26.3% were in groups 1 to 4, respectively. With group 1 as the reference group after correcting for significant factors, groups 2 to 4 had a higher risk (adjusted odds ratio with 95% confidence interval), for preterm delivery of <37 weeks 1.17 (1.14–1.20), 1.05 (1.02–1.09), and 1.14 (1.11–1.18) and for LGA infants 2.38 (2.31–2.44), 2.37 (2.29–2.45), and 3.91 (3.80–4.02) in groups 2 to 4, respectively. Further, patients with PPO with and without eGWG also had increased risk of immediate assisted neonatal ventilation 1.07 (1.02–1.12) and 1.16 (1.12–1.22), for 5-minute Apgar score <3 1.40 (1.19–1.65) and 1.38 (1.20–1.58), and for NICU admission in 1.04, (1.01–1.08) and 1.12 (1.09–1.15) for groups 3 and 4, respectively.

Conclusion

Both PPO and eGWG were independently associated with preterm delivery and LGA infants. PPO with or without excessive GWG was also associated with low Apgar scores, more NICU admissions, and a higher need for immediate ventilatory support. This data supports the importance of prepregnancy weight loss to prevent or decrease adverse neonatal outcomes.

Key Points

  • Maternal obesity is associated with adverse neonatal outcomes.

  • Maternal obesity is due to PPO or eGWG.

  • To study the contribution of adverse neonatal outcomes by PPO as distinct from excessive GWG.

  • To study the increasing maternal prepregnancy BMI to the incidence of adverse neonatal outcomes.

Keywords

prepregnancy obesity - gestational weight gain - prematurity - neonatal outcomes


Publication History

Received: 22 October 2024

Accepted: 24 March 2025

Accepted Manuscript online:
25 March 2025

Article published online:
17 April 2025

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