Overweight and obesity in pregnancy – a retrospective cohort study in Germany

Abstract

Background

Overweight and obesity are common among women of reproductive age. 43.8% of women in Germany and 50% of women in the US entering their pregnancy have a body mass index (BMI)≥25. Studies indicate that gestational overweight is associated with maternal and neonatal complications.

Methods

2034 women from 2015 until 2018 were included. Trends in BMI, gestational weight gain, pregnancy outcome, complications, neonatal weight, and outcome were analyzed. Gestational weight gain was evaluated according to the Institute of Medicine (IOM) guidelines.

Results

34% of the population were overweight with a BMI≥25. The overall weight gain was similar across BMI groups (median 11.0–14.0 kg). 44.1% gained more than recommended. These women were at higher risk of labor induction (33.1% vs. 27.0%, p=0.003), unplanned cesarean section (18.6% vs. 13.6%, p=0.004), lower incidence of spontaneous vaginal birth (54.5% vs. 59.9%, p=0.009), and higher neonatal birth weight (>90^th percentile, 14.5% vs. 5.7%, p<0.001). Gestational diabetes was linked to a lower gestational weight gain (odds ratio 0.92, confidence interval 0.90–0.95, p<0.001).

Conclusions

One third of the analyzed population was already overweight or obese at the beginning of the pregnancy. In 44.1% of cases, weight gain during pregnancy exceeded the recommended amount. This was associated with complications in pregnancy and labor as well as higher neonatal birth weight. This study highlights the importance of prenatal counseling and intervention on BMI and weight gain.

Zusammenfassung

Hintergrund

Übergewicht und Adipositas sind bei Frauen im reproduktiven Alter verbreitet. 43,8% der Frauen in Deutschland und 50% der Frauen in den USA haben zu Beginn ihrer Schwangerschaft einen Body Mass Index (BMI)≥25. Studien zeigen, dass Übergewicht in der Schwangerschaft das Risiko für maternale und neonatale Komplikationen erhöht.

Methoden

2034 Patientinnen von 2015 bis 2018 wurden eingeschlossen. Veränderungen in Gewicht (Beurteilung gemäß Institute of Medicine [IOM]), Schwangerschaftsverlauf, Geburtsmodus und Neugeborenengewicht wurden analysiert.

Ergebnisse

34% der Frauen waren übergewichtig (BMI≥25). Die durchschnittliche Gewichtszunahme in der Schwangerschaft war in allen BMI Gruppen ähnlich (Median 11,0–14,0 kg). 44,1% nahmen mehr als empfohlen zu. Diese Frauen zeigten ein höheres Risiko für eine Geburtseinleitung (33,1% vs. 27,0%, p=0,003), einen ungeplanten Kaiserschnitt (18,6% vs. 13,6%, p=0,004), eine niedrigere Rate an Spontangeburten (54,5% vs. 59.9%, p=0.009) und ein höheres Neugeborenengewicht (>90. Perzentile, 14,5% vs. 5,7%, p<0,001). Gestationsdiabetes war mit einer geringeren Gewichtszunahme assoziiert (Odds Ratio 0,92; CI 0,90 – 0,95, p<0,001).

Schlussfolgerung

Ein Drittel der Frauen war zu Beginn der Schwangerschaft übergewichtig oder adipös. In 44,1% überschritt die Gewichtszunahme die empfohlene Grenze. Dies führte vermehrt zu Komplikationen in der Schwangerschaft sowie Geburt und höherem Neugeborenengewicht. Diese Studie unterstreicht die Bedeutung pränataler Beratung und gezielte Intervention bei erhöhtem BMI und starker Gewichtszunahme.

Keywords

adipositas - foetal weight estimation - foetal macrosomia - birth weight - maternal risks - gestational diabetes

Schlüsselwörter

Adipositas - fetale Gewichtsschätzung - fetale Makrosomie - Geburtsgewicht - mütterliche Risiken - Gestationsdiabetes

Publication History

Received: 31 December 2024

Accepted after revision: 23 April 2025

Article published online:
18 June 2025

• References

• 1 Dodd JM, Turnbull D, McPhee AJ. et al. Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ 2014; 348: g1285
• 2 Chu SY, Kim SY, Bish CL. Prepregnancy obesity prevalence in the United States, 2004–2005. Matern Child Health J 2009; 13: 614-620
• 3 Bundesauswertung zum Erfassungsjahr 2020, Geburtshilfe, Qualitätsindikatoren und Kennzahlen. Institut für Qualitätssicherung und Transparenz im Gesundheitswesen (IQTIG). 2021 54.
• 4 Bundesauswertung zum Erfassungsjahr 2022, Geburtshilfe, Qualitätsindikatoren und Kennzahlen. Institut für Qualiätssicherung und Transparenz im Gesundheitswesen. 2023 112.
• 5 Harper A. Reducing morbidity and mortality among pregnant obese. Best Pract Res Clin Obstet Gynaecol 2015; 29: 427-437
• 6 Fitzsimons KJ, Modder J, Greer IA. Obesity in pregnancy: risks and management. Obstet Med 2009; 2: 52-62
• 7 Maier JT, Schalinski E, Gauger U. et al. Antenatal body mass index (BMI) and weight gain in pregnancy – its association with pregnancy and birthing complications. J Perinat Med 2016; 44: 397-404
• 8 Schellong K, Schulz S, Harder T. et al. Birth weight and long-term overweight risk: systematic review and a meta-analysis including 643,902 persons from 66 studies and 26 countries globally. PLoS One 2012; 7: e47776
• 9 Yu ZB, Han SP, Zhu GZ. et al. Birth weight and subsequent risk of obesity: a systematic review and meta-analysis. Obes Rev 2011; 12: 525-542
• 10 Reynolds RM, Allan KM, Raja EA. et al. Maternal obesity during pregnancy and premature mortality from cardiovascular event in adult offspring: follow-up of 1 323 275 person years. BMJ 2013; 347: f4539
• 11 Boney CM, Verma A, Tucker R. et al. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 2005; 115: e290-e296
• 12 Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature 2006; 444: 840-846
• 13 Nuthalapaty FS, Rouse DJ, Owen J. The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction. Obstet Gynecol 2004; 103: 452-456
• 14 Balke S, Weid P, Fangmann L. et al. Glucose levels of the oral glucose tolerance test (oGTT) can predict adverse pregnancy outcomes in women with gestational diabetes (GDM). J Clin Med 2023; 12
• 15 Koenigbauer JT, Fangmann L, Rostin P. et al. Advanced maternal age (AMA) and 75 g oGTT glucose levels are pedictors for insulin therapy in women with gestational diabetes (GDM). J Perinat Med 2023; 51: 1154-1162
• 16 Rostin P, Balke S, Sroka D. et al. The CHANGED Score – A new tool for the prediction of insulin dependency in gestational diabetes. J Clin Med 2023; 12: 7169
• 17 Bellamy L, Casas JP, Hingorani AD. et al. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373: 1773-1779
• 18 Chu SY, Kim SY, Schmid CH. et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev 2007; 8: 385-394
• 19 Wendland EM, Torloni MR, Falavigna M. et al. Gestational diabetes and pregnancy outcomes – a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth 2012; 12: 23
• 20 Wispelwey BP, Sheiner E. Cesarean delivery in obese women: a comprehensive review. J Matern Fetal Neonatal Med 2013; 26: 547-551
• 21 Goldstein RF, Abell SK, Ranasinha S. et al. Association of gestational weight gain with maternal and infant outcomes: A systematic review and meta-analysis. JAMA 2017; 317: 2207-2225
• 22 Dietz PM, Callaghan WM, Morrow B. et al. Population-based assessment of the risk of primary cesarean delivery due to excess prepregnancy weight among nulliparous women delivering term infants. Matern Child Health J 2005; 9: 237-244
• 23 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. (AWMF). Leitlinie Adipositas und Schwangerschaft. Version 1.2. Accessed: June 2019. Available online: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://register.awmf.org/assets/guidelines/015-081l_S3_Adipositas-Schwangerschaft_2020_06.pdf Stand 25.02.2025
• 24 Center for Maternal and Child Enquiries (CMACE), Royal College of Obstetricians and Gynaecologists (RCOG). CMACE/RCOG Joint Guideline Management of Women with Obesity in Pregnancy. March 2010. Available online: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.publichealth.hscni.net/sites/default/files/CMACE-RCOG%20Joint%20Guideline-Management%20of%20women%20with%20obesity%20in%20pregnancy.pdf Accessed: 25 Feb 2025
• 25 American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No 156: Obesity in Pregnancy. Obstet Gynecol. 2015. 126. e112-e126
• 26 Dudding TC, Vaizey CJ, Kamm MA. Obstetric anal sphincter injury: incidence, risk factors, and management. Ann Surg 2008; 247: 224-237
• 27 Surkan PJ, Hsieh CC, Johansson AL. et al. Reasons for increasing trends in large for gestational age births. Obstet Gynecol 2004; 104: 720-726
• 28 Santos S, Voerman E, Amiano P. et al. Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts. BJOG 2019; 126: 984-995
• 29 Metzger BE, Lowe LP, Dyer AR. et al. Hyperglycemia and adverse pregnancy outcomes. New Engl J Med 2008; 358: 1991-2002
• 30 Aune D, Saugstad OD, Henriksen T. et al. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 2014; 311: 1536-1546
• 31 Xiong C, Zhou A, Cao Z. et al. Association of pre-pregnancy body mass index, gestational weight gain with cesarean section in term deliveries of China. Sci Rep 2016; 6: 37168
• 32 International Weight Management in Pregnancy (i-WIP) Collaborative Group. Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials. BMJ 2017; 358: j3119