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
Open accessAbstract
Objective: To assess the separate and combined associations of maternal pre‐pregnancy body mass index (BMI) and gestational weight gain with the risks of pregnancy complications and their population impact. Design: Individual participant data meta‐analysis of 39 cohorts. Setting: Europe, North America, and Oceania. Population: 265 270 births. Methods: Information on maternal pre‐pregnancy BMI , gestational weight gain, and pregnancy complications was obtained. Multilevel binary logistic regression models were used. Main outcome measures: Gestational hypertension, pre‐eclampsia, gestational diabetes, preterm birth, small and large for gestational age at birth. Results: Higher maternal pre‐pregnancy BMI and gestational weight gain were, across their full ranges, associated with higher risks of gestational hypertensive disorders, gestational diabetes, and large for gestational age at birth. Preterm birth risk was higher at lower and higher BMI and weight gain. Compared with normal weight mothers with medium gestational weight gain, obese mothers with high gestational weight gain had the highest risk of any pregnancy complication (odds ratio 2.51, 95% CI 2.31– 2.74). We estimated that 23.9% of any pregnancy complication was attributable to maternal overweight/obesity and 31.6% of large for gestational age infants was attributable to excessive gestational weight gain. Conclusions: Maternal pre‐pregnancy BMI and gestational weight gain are, across their full ranges, associated with risks of pregnancy complications. Obese mothers with high gestational weight gain are at the highest risk of pregnancy complications. Promoting a healthy pre‐pregnancy BMI and gestational weight gain may reduce the burden of pregnancy complications and ultimately the risk of maternal and neonatal morbidity. Tweetable abstract: Promoting a healthy body mass index and gestational weight gain might reduce the population burden of pregnancy complications.
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Maternal pre-pregnancy overweight/obesity increases the risks of adverse perinatal outcomes such as preterm birth, LGA, and macrosomia in non-diabetic populations.
“Accumulating evidences showed that maternal pre-pregnancy overweight/obesity increased the risks of adverse perinatal outcomes such as preterm birth, large-for-gestational age (LGA) and macrosomia, while maternal underweight was related to low birth weight and small-for-gestational age (SGA) in non-diabetic population [4–6].”
From Associations of maternal pre-pregnancy BMI and gestational weight gain with the risks of adverse pregnancy outcomes in Chinese women with gestational diabetes mellitus (2023) · cites this paper as [6]
The Results section reports that higher pre-pregnancy BMI was associated with higher risks of preterm birth and large size for gestational age. However, the paper does not report macrosomia as an outcome or establish these associations specifically in a non-diabetic population. Its Discussion also cautions that the causality of the observed associations remains unknown. (LLM, conf=0.87)
Experimental — accuracy not yet measuredMaternal underweight is related to low birth weight and SGA in non-diabetic populations.
“Accumulating evidences showed that maternal pre-pregnancy overweight/obesity increased the risks of adverse perinatal outcomes such as preterm birth, large-for-gestational age (LGA) and macrosomia, while maternal underweight was related to low birth weight and small-for-gestational age (SGA) in non-diabetic population [4–6].”
From Associations of maternal pre-pregnancy BMI and gestational weight gain with the risks of adverse pregnancy outcomes in Chinese women with gestational diabetes mellitus (2023) · cites this paper as [6]
The Results section reports that underweight mothers with low gestational weight gain had the highest risk of SGA birth. The Methods define SGA using gestational-age-adjusted birth weight, but the paper does not report low birth weight as a separate outcome or restrict this finding to a non-diabetic population. (LLM, conf=0.88)
Experimental — accuracy not yet measured
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- Authors
- Santos, S., Voerman, E., Amiano, P., Barros, H., Beilin, L., Bergström, A., Charles, M., Chatzi, L., Chevrier, C., Chrousos, G., Corpeleijn, E., Costa, O., Costet, N., Crozier, S., Devereux, G., Doyon, M., Eggesbø, M., Fantini, M., Farchi, S., Forastiere, F., Georgiu, V, Godfrey, K., Gori, D., Grote, V, Hanke, W., Hertz‐Picciotto, I., Heude, B., Hivert, M., Hryhorczuk, D., Huang, R., Inskip, H., Karvonen, A., Kenny, L., Koletzko, B., Küpers, L., Lagström, H., Lehmann, I., Magnus, P., Majewska, R., Mäkelä, J., Manios, Y., McAuliffe, F., McDonald, S., Mehegan, J., Melén, E., Mommers, M., Morgen, C., Moschonis, G., Murray, D., Ní Chaoimh, C., Nohr, E., Nybo Andersen, A., Oken, E., Oostvogels, A., Pac, A., Papadopoulou, E., Pekkanen, J., Pizzi, C., Polanska, K., Porta, D., Richiardi, L., Rifas‐Shiman, S., Roeleveld, N., Ronfani, L., Santos, A., Standl, M., Stigum, H., Stoltenberg, C., Thiering, E., Thijs, C., Torrent, M., Tough, S., Trnovec, T., Turner, S., van Gelder, M., van Rossem, L., von Berg, A., Vrijheid, M., Vrijkotte, T., West, J., Wijga, A., Wright, J., Zvinchuk, O., Sørensen, T., Lawlor, D., Gaillard, R., & Jaddoe, V.
- Affiliations
- Erasmus MC (NL)
- Biogipuzkoa Health Research Institute (ES)
- Universidade do Porto (PT)
- Medical School Royal Perth Hospital Unit The University of Western Australia Perth WA Australia
- Region Stockholm (SE)
- Inserm (FR)
- University of Southern California (US)
- National and Kapodistrian University of Athens (GR)
- University Medical Center Groningen (NL)
- Universitat Jaume I (ES)
- MRC Lifecourse Epidemiology Unit (GB)
- Liverpool School of Tropical Medicine (GB)
- Centre Hospitalier Universitaire de Sherbrooke (CA)
- Norwegian Institute of Public Health (NO)
- University of Bologna (IT)
- Regione Lazio (IT)
- University of Crete (GR)
- MRC Lifecourse Epidemiology Unit University of Southampton Southampton UK
- Ludwig-Maximilians-Universität München (DE)
- Nofer Institute of Occupational Medicine (PL)
- University of California, Davis (US)
- Harvard University (US)
- University of Illinois Chicago (US)
- The Kids Research Institute Australia (AU)
- University Hospital Southampton NHS Foundation Trust (GB)
- Finnish Institute for Health and Welfare (FI)
- Irish Centre for Fetal and Neonatal Translational Research Cork University Maternity Hospital University College Cork Cork Ireland
- Department of Epidemiology University Medical Center Groningen University of Groningen Groningen the Netherlands
- University of Turku (FI)
- Helmholtz Centre for Environmental Research (DE)
- Jagiellonian University (PL)
- Åbo Akademi University (FI)
- Department of Nutrition and Dietetics School of Health Science and Education Harokopio University Athens Greece
- UCD Perinatal Research Centre Obstetrics& Gynaecology School of Medicine National Maternity Hospital University College Dublin Dublin Ireland
- University of Calgary (CA)
- University College Dublin (IE)
- Karolinska Institutet (SE)
- Maastricht University (NL)
- National Institute of Public Health University of Southern Denmark Copenhagen Denmark
- La Trobe University (AU)
- University College Cork (IE)
- Research Unit for Gynaecology and Obstetrics Institute for Clinical Research University of Southern Denmark Odense Denmark
- Department of Public Health Section of Epidemiology University of Copenhagen Copenhagen Denmark
- Department of Public Health Amsterdam Public Health Research Institute Academic Medical Center Amsterdam the Netherlands
- University of Helsinki (FI)
- University of Turin (IT)
- Department of Environmental Epidemiology Nofer Institute of Occupational Medicine Lodz Poland
- Radboud University Medical Center (NL)
- IRCCS Materno Infantile Burlo Garofolo (IT)
- EPIUnit ‐ Instituto de Saúde Pública Universidade do Porto Porto Portugal
- Helmholtz Munich (DE)
- Ib‐salut Area de Salut de Menorca Menorca Spain
- Department of Pediatrics Cumming School of Medicine University of Calgary Calgary AB Canada
- Slovak Medical University (SK)
- Royal Aberdeen Children's Hospital (GB)
- Department for Health Evidence Radboud Institute for Health Sciences Radboud University Medical Center Nijmegen the Netherlands
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht University Utrecht the Netherlands
- Department of Pediatrics Research Institute Marien‐Hospital Wesel Wesel Germany
- Universitat Pompeu Fabra (ES)
- Bradford Royal Infirmary (GB)
- National Institute for Public Health and the Environment Bilthoven the Netherlands
- Department of Medical and Social Problems of Family Health Institute of Pediatrics, Obstetrics and Gynecology Kyiv Ukraine
- University of Copenhagen (DK)
- MRC Integrative Epidemiology Unit Oakfield House Oakfield Grove University of Bristol Bristol UK
- The Generation R Study Group Erasmus MC University Medical Center Rotterdam the Netherlands
- ORCID
- Santos, S
- Amiano, P
- Barros, H
- Bergström, A
- Charles, M‐A
- Chatzi, L
- Chevrier, C
- Corpeleijn, E
- Costet, N
- Crozier, S
- Devereux, G
- Doyon, M
- Eggesbø, M
- Forastiere, F
- Gori, D
- Grote, V
- Hanke, W
- Hertz‐Picciotto, I
- Heude, B
- Hivert, M‐F
- Hryhorczuk, D
- Inskip, H
- Koletzko, B
- Lagström, H
- Lehmann, I
- Magnus, P
- Majewska, R
- Mehegan, J
- Mommers, M
- Moschonis, G
- Oken, E
- Pac, A
- Papadopoulou, E
- Pekkanen, J
- Pizzi, C
- Porta, D
- Richiardi, L
- Roeleveld, N
- Ronfani, L
- Standl, M
- Thiering, E
- Thijs, C
- Turner, S
- Vrijheid, M
- West, J
- Wright, J
- Gaillard, R
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2019-03-20
- Volume
- 126
- Issue
- 8
- Pages
- 984-995
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- PMC
- PMC6554069
- OpenAlex
- W2916077285
- Cited by
- 591
- References
- 39
- Citations by year
- 2026: 59 · 2025: 84 · 2024: 105 · 2023: 104 · 2022: 93 · 2021: 72 · 2020: 50 · 2019: 24
- FWCI
- 9.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
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- Research Publications (Maastricht University) (acceptedVersion, other-oa)
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- PubMed Central (acceptedVersion)
- LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
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- Socio-Environmental Systems Modeling (acceptedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (acceptedVersion, other-oa)
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- WOS
- Funders
- National Institute for Health and Care Research (NF-SI-0611-10196, NF-SI-0515-10042, NIHR200286)
- British Heart Foundation (RG/15/17/31749, PG/14/33/30827)
- National Institutes of Health (UH3OD023286, UG3OD023286)
- Medical Research Council (MC_UU_12011/4, MR/K006665/1, MC_UU_00011/6, MR/K021656/1)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092924)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD034568)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- maternal body mass index, gestational weight gain, pregnancy complications, maternal obesity, gestational hypertension, preeclampsia, gestational diabetes mellitus, preterm birth, large for gestational age, small for gestational age, population attributable fraction, maternal overweight
- MeSH terms
- Gestational Weight Gain, Adult, Australia, Birth Weight, Europe, Female, Gestational Age, Humans, Infant, Newborn, North America, Pregnancy, Pregnancy Complications, Risk Factors, Cohort Studies, Body Mass Index, Odds Ratio, Overweight
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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