Date Published: August 20, 2019
Publisher: Public Library of Science
Author(s): Marion Lecorguillé, Madalina Jacota, Blandine de Lauzon-Guillain, Anne Forhan, Marie Cheminat, Marie-Aline Charles, Barbara Heude, Kathleen Rasmussen
Abstract: BackgroundWeight-control interventions in pregnant women with overweight or obesity have limited effectiveness for fetal growth and birth outcomes. Interventions or prevention programs aiming at the pre-pregnancy period should be considered. However, how the woman’s weight change before pregnancy affects fetal growth is not known. We investigated the association between weight change over the year before pregnancy and birth weight.Methods and findingsWe used the inclusion data of 16,395 women from the ELFE French national birth cohort, a nationally representative cohort in which infants were enrolled at birth with their families in 2011. Maternal weight change was self-reported and classified into 3 groups: moderate weight variation or stable weight, weight loss > 5 kg, and weight gain > 5 kg or both weight loss and gain > 5 kg. Multiple linear regression models were used to investigate the association between pre-pregnancy weight change and a birth weight z-score calculated according to the French Audipog reference, adjusted for a large set of maternal characteristics. The analyses were stratified by maternal body mass index (BMI) at conception (<25 versus ≥25 kg/m2) and adjusted for BMI within these categories. We used the MacKinnon method to test the mediating effect of gestational weight gain (GWG) on these associations. Mother’s mean age was 30.5 years, 87% were born in France, and 26% had overweight or obesity. For women in either BMI category at conception, GWG was more than 2 kg higher, on average, for women with weight loss before pregnancy than for women with stable weight or moderate weight variation. For women with BMI < 25 kg/m2 at conception, birth weight was significantly higher with weight loss than stable weight before pregnancy (β = 0.08 [95% CI 0.02; 0.14], p = 0.01), and this total effect was explained by a significant mediating effect through GWG. For women with BMI ≥ 25 kg/m2 at conception, birth weight was not associated with pre-pregnancy weight loss during the year before pregnancy. Mediation analysis revealed that in these women, the direct effect of pre-pregnancy weight loss that would have resulted in a smaller birth weight z-score (β = −0.11 [95% CI −0.19; −0.03], p = 0.01) was cancelled out by the GWG. The mediating effect of GWG was even higher when weight loss resulted from a restrictive diet in the year before pregnancy. Weight gain before pregnancy was not associated with birth weight. Although we included a large number of women and had extensive data, the only potential cause of pre-pregnancy weight loss that was investigated was dieting for intentional weight loss. We have no information on other potential causes but did however exclude women with a history of pre-pregnancy chronic disease. Another limitation is declaration bias due to self-reported data.ConclusionsHealth professionals should be aware that GWG may offset the expected effect of weight loss before conception on fetal growth in overweight and obese women. Further studies are required to understand the underlying mechanisms in order to develop weight-control interventions and improve maternal periconceptional health and developmental conditions for the fetus.
Partial Text: Reducing adverse pregnancy and fetal outcomes for women with overweight and obesity is a public health priority. Maternal obesity is a risk factor for maternal complications during pregnancy and for infants being large for gestational age (LGA) [1–3]. Also, maternal obesity during pregnancy has been associated with long-term health consequences for the offspring, such as increased body mass index (BMI) during infancy, childhood, and later life and increased risk of type 2 diabetes in adulthood [4,5]. Excessive gestational weight gain (GWG) can also contribute to increased risk of poor maternal and birth outcomes [1,6]. The Institute of Medicine recommends GWG ranges during pregnancy, according to pre-pregnancy BMI category, that are associated with good maternal and infant outcomes [7,8].
This study is reported as per the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline (S1 STROBE guideline checklist). A brief analysis plan was written and approved before starting statistical analyses (S1 Protocol).
For women who were not overweight or obese at conception, we found a significant positive association between weight loss before pregnancy and birth weight that was totally mediated and explained by increased GWG. For women with overweight and obesity, we did not find an association between weight loss before pregnancy and birth weight. However, after taking into account GWG, weight loss before pregnancy had a negative direct effect on birth weight. GWG seemed to cancel out the expected effect on birth weight reduction of weight loss before pregnancy. For women with weight gain before pregnancy, GWG was increased during pregnancy and had a significant indirect effect on birth weight, but it did not translate into a significant total effect, and there was no direct association between weight gain before pregnancy and birth weight.
Few studies have evaluated the association between pre-pregnancy weight variation and fetal development. Our results suggest that increased GWG after weight loss before pregnancy may obscure any beneficial effect on fetal growth. These results call for increased vigilance on GWG in women who lost weight or dieted before pregnancy.