Chelsea Lynes1, Alexander C McLain1, Edwina H Yeung2, Paul Albert2, Jihong Liu1, Nansi S Boghossian3. 1. Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Columbia. 2. Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD. 3. Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Columbia. Electronic address: nboghoss@mailbox.sc.edu.
Abstract
PURPOSE: Examine associations between interpregnancy body mass index (BMI) change (difference in the pre-pregnancy BMIs of two consecutive pregnancies) and gestational diabetes mellitus (GDM), pre-eclampsia (PE), gestational hypertension (GHtn), primary cesarean delivery, and vaginal birth after cesarean delivery (VBAC). METHODS: Modified Poisson regression models estimated adjusted associations. RESULTS: Every 1-unit increase in interpregnancy BMI increased risks of GDM (relative risk [RR]: 1.09; 95% confidence interval [CI], 1.07-1.11), PE (RR: 1.06; 95% CI, 1.04-1.09), GHtn (RR: 1.08; 95% CI, 1.06-1.10), and primary cesarean delivery (RR: 1.03; 95% CI, 1.01-1.05) and decreased the risk of a successful VBAC (RR: 0.98; 95% CI: 0.97-0.997) in the second pregnancy. A BMI increase of ≥3 units increased risks of GDM (RR: 1.71, 95% CI, 1.52-1.93), PE (RR: 1.60, 95% CI, 1.33-1.94), GHtn (RR: 1.66, 95% CI, 1.42-1.94), and primary cesarean delivery (RR: 1.29, 95% CI, 1.12-1.49) and decreased the risk of a successful VBAC (RR: 0.89; 95% CI, 0.80-0.99) compared to women with interpregnancy BMI change within -1 and +1 unit. GDM was also increased among women increasing their BMI by ≥2 but <3 units (RR: 1.40; 95% CI, 1.21-1.61) and among those gaining ≥1 but <2 units (RR: 1.23; 95% CI, 1.08-1.40). CONCLUSION: An interpregnancy BMI increase of ≥3 units is associated with an increased risk of all outcomes. These findings emphasize the importance of interpregnancy weight management.
PURPOSE: Examine associations between interpregnancy body mass index (BMI) change (difference in the pre-pregnancy BMIs of two consecutive pregnancies) and gestational diabetes mellitus (GDM), pre-eclampsia (PE), gestational hypertension (GHtn), primary cesarean delivery, and vaginal birth after cesarean delivery (VBAC). METHODS: Modified Poisson regression models estimated adjusted associations. RESULTS: Every 1-unit increase in interpregnancy BMI increased risks of GDM (relative risk [RR]: 1.09; 95% confidence interval [CI], 1.07-1.11), PE (RR: 1.06; 95% CI, 1.04-1.09), GHtn (RR: 1.08; 95% CI, 1.06-1.10), and primary cesarean delivery (RR: 1.03; 95% CI, 1.01-1.05) and decreased the risk of a successful VBAC (RR: 0.98; 95% CI: 0.97-0.997) in the second pregnancy. A BMI increase of ≥3 units increased risks of GDM (RR: 1.71, 95% CI, 1.52-1.93), PE (RR: 1.60, 95% CI, 1.33-1.94), GHtn (RR: 1.66, 95% CI, 1.42-1.94), and primary cesarean delivery (RR: 1.29, 95% CI, 1.12-1.49) and decreased the risk of a successful VBAC (RR: 0.89; 95% CI, 0.80-0.99) compared to women with interpregnancy BMI change within -1 and +1 unit. GDM was also increased among women increasing their BMI by ≥2 but <3 units (RR: 1.40; 95% CI, 1.21-1.61) and among those gaining ≥1 but <2 units (RR: 1.23; 95% CI, 1.08-1.40). CONCLUSION: An interpregnancy BMI increase of ≥3 units is associated with an increased risk of all outcomes. These findings emphasize the importance of interpregnancy weight management.
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