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Am J Perinatol 2023; 40(04): 387-393
DOI: 10.1055/s-0041-1727230
Original Article

Interpregnancy Body Mass Index Change and Offspring Mortality Risk following the Second Pregnancy

Annie M. Dude
1   Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois
,
Marcela C. Smid 
2   Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
3   Division of Maternal Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
,
D. Ware Branch
2   Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
3   Division of Maternal Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
,
Jennifer West
4   Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
,
Huong Meeks
4   Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
,
Zhe Yu
4   Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
,
Alison Fraser
4   Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
,
Ken Smith
4   Department of Population Science, Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
5   Department of Family and Consumer Studies, University of Utah, Salt Lake City, Utah
,
Deepika Reddy
6   Department of Medicine, University Diabetes and Endocrinology Center, University of Utah, Salt Lake City, Utah
› Author Affiliations Funding The authors thank the Pedigree and Population Resource of the Huntsman Cancer Institute, University of Utah (funded in part by the Huntsman Cancer Foundation) for its role in the ongoing collection, maintenance, and support of the UPDB. They also acknowledge partial support for the UPDB through grant P30 CA2014 from the National Cancer Institute, University of Utah and from the University of Utah's Program in Personalized Health and Center for Clinical and Translational Science. Additional funding was received intramural seed grant from the Diabetes and Metabolism Research Center at the University of Utah. MCS is supported by Women's Reproductive Health Research (WRHR K12, 1K12 HD085816) Career Development Program.
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Abstract

Objective The aim of the study is to examine the impact of maternal interpregnancy body mass index (BMI) change on subsequent offspring mortality risk.

Study Design This is a retrospective cohort study of women who had two consecutive live singleton deliveries of at least 20 weeks' gestation from the Utah Population Database. Our exposure was defined as interpregnancy BMI change from the date of first delivery to the conception date of subsequent pregnancy. We categorized BMI change as: < − 1, −1 to 0, 0 to <1 (reference), 1 to 2, 2 to 4, ≥4 kg/m2. Our primary outcome was all-cause age-specific mortality during four time periods: neonatal (≤28 days), infant (29 days to <1 year old), childhood ((≥1 to <5 years old), and late childhood (5 to <18 years old). We also examined mortality specifically attributed to congenital anomalies. Analyses used Cox proportional hazard models stratified by full term (≥37 weeks) and preterm (<37 weeks) deliveries. All models were adjusted for relevant confounders.

Results Of 266,752 women, among full-term deliveries, women with a BMI increase of 4 kg/m2 or more had an increased risk of neonatal mortality in their subsequent pregnancy (hazard ratio or HR = 1.72, 95% confidence interval or CI: 1.23–2.41) Women who lost 1 kg/m2 or more between deliveries also had increased neonatal mortality (HR = 1.46, 95% CI: 1.04–2.05). There were no differences in infant, early, or late childhood mortality by interpregnancy BMI change. Maternal interpregnancy interval weight loss of 1 kg/m2 or more and weight gain of ≥4 kg/m2 also had increased risk of mortality associated with congenital anomalies or conditions arising during the neonatal period following their subsequent delivery.

Conclusion Women with significant interpregnancy weight gain and modest weight loss have a significant increased risk of neonatal mortality following their subsequent pregnancy.

Key Points

  • Significant weight gain between deliveries increases the risk of neonatal death.

  • Modest weight loss between deliveries increases the risk of neonatal death.

  • This risk may be partially explained by increased risk of congenital malformations.

Keywords

neonatal mortality - weight gain - weight loss - obesity - congenital anomalies

Note

A version of this paper was presented at the 38th Annual Meeting of the Society for Maternal-Fetal Medicine, Dallas, TX, January 29, 2018 to February 3rd, 2018: abstract no.: 724.




Publication History

Received: 18 September 2020

Accepted: 02 March 2021

Article published online:
20 April 2021

© 2021. Thieme. All rights reserved.

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