Excess maternal weight before and during pregnancy can result in larger babies

ScienceDaily (May 22, 2012) — Excess weight in pregnant women, both before pregnancy and gained during pregnancy, is the main predictor of whether mothers will have larger than average babies, which can result in increased risk of cesarean section or trauma during delivery, states a study published in CMAJ (Canadian Medical Association Journal).

See Also:Health & MedicinePregnancy and ChildbirthDiet and Weight LossInfant's HealthDiabetesFitnessGynecologyReferenceBirth weightBlood sugarDiabetic dietStillbirth

Women with diabetes in pregnancy or gestational diabetes are at increased risk of having a large-for-gestational-age baby. Called macrosomia, it is defined as an infant whose weight is above the 90th percentile of Canadian fetal growth curves, or more than 4 kg. Current clinical practice focuses on managing glucose levels in women with these conditions to reduce the risk of having larger babies. Recent studies have shown a link between maternal glucose levels in women without gestational diabetes and the risk of having a larger baby.

Proposed new criteria suggest lowering the glucose levels for diagnosing gestational diabetes to help identify women who might be at risk of having a large-for-gestational-age baby.

To determine the effects of a variety of maternal factors such as obesity, glucose levels and lipid levels on infant birth weight, researchers from Mount Sinai Hospital, The Hospital for Sick Children (SickKids), University of Toronto, and St. Michael's Hospital, Toronto, conducted a study with 472 women -- 368 with normal glucose tolerance and 104 with impaired glucose tolerance.

They found that excess weight before pregnancy and the amount of weight gain during pregnancy were the strongest metabolic predictors of whether a woman would have a large-for-gestational-age baby. Elevated glucose levels had a relatively modest impact as did lipid levels.

"Gestational impaired glucose tolerance was not a significant independent predictor of having a large-for-gestational-age infant," writes Dr. Ravi Retnakaran, Mount Sinai Hospital, with coauthors. "Similarly, none of the lipid measures was independently associated with birth weight or large-for-gestational-age infant. These data suggest that maternal weight and its associated circulating factors have a greater impact on infant birth weight than do mild glucose intolerance and lipid levels in women without gestational diabetes."

"In the context of the current obesity epidemic, these data support the importance of targeting healthy body weight in young women as a strategy for reducing the risk of excessive fetal growth and infant macrosomia," conclude the authors. "Furthermore, these findings suggest that, in the care of overweight or obese women in pregnancy, closer monitoring of weight gain during pregnancy may be warranted."

In a related commentary, Dr. Edmond Ryan, University of Alberta, writes, "Recently proposed criteria

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Citywide smoking ban reduced maternal smoking and preterm birth risk

ScienceDaily (May 10, 2012) — A citywide ban on public smoking in Colorado led to significant decreases in maternal smoking and preterm births, providing the first evidence in the U.S. that such interventions can impact maternal and fetal health, according to an article in Journal of Women’s Health, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers.

See Also:Health & MedicineSmokingTeen HealthMind & BrainSmoking AddictionBehaviorScience & SocietyPublic HealthSocial IssuesReferencePremature birthBreech birthBirth weightStillbirth

Prenatal exposure to tobacco smoke–whether the mother is a smoker or exposure is from environmental sources– is associated with premature births and low birth weight. The results of a “natural experiment” that compared outcomes in two cities, one with a smoking ban and one without a ban, showed reductions in both maternal smoking and premature births in the city with a smoking ban.

In the article “A Citywide Smoking Ban Reduced Maternal Smoking and Risk for Preterm, Not Low Birth Weight, Births: A Colorado Natural Experiment,” Robert Lee Page II, PharmD, MSPH, Julia Slejko, BA, and Anne Libby, PhD, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences and School of Medicine, Aurora, CO, concluded that a population-level intervention using a smoking ban improved maternal and fetal outcomes.

“Exposure to tobacco smoke is associated with not only death from lung cancer and heart disease but also risks to developing fetuses,” says Susan G. Kornstein, MD, Editor-in-Chief of Journal of Women’s Health, Executive Director of the Virginia Commonwealth University Institute for Women’s Health, Richmond, VA, and President of the Academy of Women’s Health. “The promising results of this study suggest that pregnant women and their fetuses represent an important population for further study of health and cost effects of smoke-free ordinances.”

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