Faculty member medical Science University of Babol /IRAN
Abstract
Background and purpose: This study was performed in order to determine the correlation between body mass index, maternal and fetal complications in patients admitted to Imam Hospital in sari during the year 1999.
Materials and methods:This research was a cohort study, done on 276 pregnant women (under weight 154 cases. Normal weight335 cases and over weight 237 cases). These there groups were matched by the following criteria: obstetrical history, socio-economical status and the frequency of prenatal care.
Results: In over weight women, prevalence of pre eclampsia, gestational edema, multi fetal pregnancy, multi parity, insufficient weight gaining,
mal presentation and perinatal mortality were greater than normal weight women. In under weight women prevalence of premature rupture of membranes, mal presentation was greater than normal weight women.
Conclusion: low and high BMI can contribute to the complications of pregnancy thus pregnancy in women with abnormal weigh should be considered as a high risk factor to be able to prevent complications by special cure.
Introduction
It is a long time the researchers are working on the body mass and if variation in pregnancy, and many articles are written about it. Abnormal BMI in mother plays very important role on the feature of fertility (1). In USA 20-30% of women have 20% over weight (2). Prevalence of over weight in women is varies from 7 to 46% (3). Unfortunately, the prevalence of over weight is increasing. Which is due to the life style socio economic condition (2). Different figures are available about the prevalence of under weight in women from different countries which varies from 0.2 to 35% .The purpose of Antenatal care is to have healthy neonate than healthy mother. In fact care of pregnancy starts since the birth of female neonate. She should have a normal BMI before pregnancy. Women with BMI < 19.8, BMI about 19.8 to 26 and BMI >26(till before the 18th week of pregnancy) are Considered as under weigh, normal weight and over weight respectively (4). Complications of over weight women: insufficient weight gain,hypertention, pre-eclampsia, gestational- diabete,multifetal pregnancy, Macrosomia, caesarean section,mal presentation, obstetric’s bleeding, Post- partrum,thrombophlebitis,UTI infection, dysfunctional labour, shulder distocia and fetal asfexial at birth(1,3,6,7,8,). Complications related to under weigh mothers are anemia, PROM, low Apgar score LBW, pre term delivery and in crease of perinatal mortality (5,6,9,10,11,12). There are controversial reports about the effects of pre pregnancy weight on the outcome of pregnancy (12). This study was performed in order to determine the correlation between body massmaternal and fetal complications a patient admitted to Imam Hospital in sari during the year 1999.
Material and Methods
This research was a cohort study done on 726 pregnant women in three groups of under weight (154 cases). Normal weight (335 cases) and over weight (237 persons) and were matched for medical history (BP, diabetes) abortion, still birth, LBW, pre term delivery,antenatal care and socio-economic status.The pregnant women referring to Imam khomini and Razi hospitals affiliated to Mazandaran University of medical science in case of knowing their pre pregnancy weight or the weight on the first trimester of pregnancy were selected for this study. After selection of cases, the required informations were reported in questionnaires.
Diagnosis of pre eclampsia was determined on the basis of BP 140/90 or more accompanied by proteinuria and PROM on the basis of rupture before onset of labour. Gestational age was determined on the basis of LMP or sonography in the first months of pregnancy and also with the help of dubowith’s chart. The statistical analysis was done with computer using spss.To determine of comparison was done by X2 test and Anova variation, in case of presence of significant difference between the groups with normal weight women multiple comparative test of scheffe was done.
Results
In this study the cases were matched for the medical and obstetrical history, demographic information, socio-economic condition and receipt of prenatal care. There was no significant difference between the groups on the basis of the above variables. The mean age in under weight women was 24.6 ±5.3, in the normal weight women 24,3± 5.4 and in the over weight women 25.3±5.6 years. So, there was no significant difference between these groups. In the over weight cases the numbers of gravidity and parturia, was more them the other, groups, this difference was significant (P<0.0001)
Variation of statistical analysis showed that the rate of weight gain in pregnancy in the above there groups differed significantly (P<0.0001). The mean in crease of weight gain in under weight group was 14.3 kg. While in the over weight groups was 9.5kg. There was no signification difference between these groups.
In the over weight cases the number of gravidity and parity, was more than the other groups, this difference was significant (P<0.0001).
Variance on of statistical analysis showed that the rate of weight gain in Pregnancy in the above three groups different (P<0.0001)
The mean increase of weight gain in under weight group was 14.3 kg. But in the over weight group was 9.5 kg. There was not significant difference for the variable of height, head and chest circumference, birth weight and gestational age in three groups. On the basis of pregnancy complication, pre-eclampsia disorder (RR=0.24) and pregnancy edema (RR=0.57) were more in over weight group, and there was statistically significant difference in the above said groups (P<0.0001).The premature rupture of membrane in under weight women was 27.3% (RR=0.17) Comparing to the other groups the difference was significant (P<0.001). Considering outcome of pregnancy mal presentation in the over weight group was 10.5% and in the under weight group was 13.6% which was more than the normal weight group (5.1%) this difference was statistically significant (P<0.05).
Fig .1 Complication of Pregnancy
Fetal mortality in the over weight group was 2.5% which was more than other groups this difference was significant (P<0.01) multi fetal pregnancy in over weight group was more than the other groups and this difference was significant. (P<0.01) table N0.1
Table - Outcome of pregnancy in three groups
OUT COME |
Over.wt |
Nor.wt |
Under.wt |
X2 |
Fetal distress |
27(11.4) |
26(7.8) |
11(7.3) |
N.S |
Mal presentation |
25(10.5) |
17(5.1) |
21(13.6) |
P<0.01 |
L.B.W < 2500 gr |
18(7.6) |
24(7.2) |
10(6.5) |
N.S |
Macrosomia <4000gr |
16(6.8) |
14(4.2) |
7(4.5) |
N.S |
Apgar score < 7 in fifth minute |
5(2.1) |
6(1.8) |
7(0.6) |
N.S |
NICU |
3(1.3) |
3(0.9) |
1(0.6) |
N.S |
Perinatal mortality |
6(2.5) |
2(0.6) |
0 |
P<0.05 |
Multi fetal pregnancy |
7(3.0) |
0 |
1(0.6) |
P<0.01 |
Discussion
The result of this research indicates that some pregnancy complications such as pre eclampsia and gestational edema in over weight women is observed more than the other groups. Gang etal, in korea compared two groups, it was shown that the occurrence of pre eclampsia in over weight women is more than the normal weight women (14). Drife et al, also showed that blood pressure disorder is more in over weight women, with prevalence of 7-17% (3). The percentage of pre -eclampsia in this study was 16%.
Gabaciak in his study showed that the chance of caesarean section were some what more in normal weight women, but this difference was not significant (15), which is similar to our finding. Crane et al, in their research at newyork University, showed that with increase in mother's BMI, the possibility of caesarean section is more evidence (11). Yip and cogs in USA showed that women, with high BMI have more number of parity (16). In this research the over weight women had more number of parity.
Naeyo etal, showed that in over weight women perinatal morality is more than the other groups, the fetal pregnancy and pre term delivery (10 reason is known to more increased in the number of multi).
This finding is similar to our finding, but in a similar study it was found that there is no statistically significant difference between perinatal mortality and high BMI (3).
This research indicated that the rate of mal- presentation in under and over weight women is more than the normal weight ones, which is similar to the other findings (6).
In our study, weight gaining during pregnancy in over weight women was less than the normal weight women, which is similar to the results of the other studies (17,18)
Mickey et al., in USA showed that, the premature rupture of membrane is more probable in negro and white race under weight women. Which is similar to our finding (19).
Considering findings of this research it is recommended that the women pre-pregnancy reach to normal weight condition. Since, to reduce the complications of pregnancy, Over weight pregnancy are in risk condition and need special care to avoid the complications of pregnancy.
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