Neonatal Outcomes of Women with Pre-gestational Excess Weight

Background: An increasing trend of prevalence of overweight and obesity is noted worldwide over the past few decades. Pre-gestational excess weight has shown negative impact on neonatal outcome. Solid data are essential in formulating preventive strategies to break the viscous cycle of excess weight in pregnancy.

Objectives: To describe neonatal outcomes of women with pre-gestational excess weight delivered at a tertiary care hospital in Sri Lanka, a South Asian country.

To describe the association between maternal pre-gestational body mass index (BMI) with neonatal macrosomia and their abdominal circumference.

Methods: A hospital-based descriptive cross sectional study was conducted. A sample of 535 women with reported pre-gestational BMI >25 kg/m2 in antenatal pregnancy record delivering at postnatal wards of Colombo North Teaching Hospital were recruited using non-probability consecutive sampling method. An interviewer-administered questionnaire was used for data collection.

A sample of 155 macrsomic (>3.5 Kg) babies were recruited from the same ward settings and compared with 155 normal weight babies in a case-control analysis to ascertain maternal obesity with macrosomia.

Results: Majority of newborns were male (n=307,57.4%) compared to female babies (n=228,42.6%). A significant proportion (n=85, 15.9%) of babies were delivered premature. Birth weight was within 2.5Kg – 3.49 Kg in 55.1% (n=101), macrosomic 26% (n=139) and low birth weight 18.9% (n=295). Many 68.7% (n=307) reported neonatal morbidity and 57.4% (n=307) babies needed admission to Special Care Baby Unit. Five (1.1%) still births and 1 neonatal deaths were reported.

Increased maternal BMI is at high risk of macrosomic baby (OR=110,CI 49.21-246.47) and neonatal abdominal circumference >30cm (OR=11.8, CI 5.58-24.94).

Conclusions: Pre-gestational maternal excess weight is associated with multiple neonatal adverse outcomes; premature delivery, macrosomia, low birth weight, neonatal complications and high abdominal circumference. These can be prevented by pre-pregnancy counselling and planned pregnancies with appropriate BMI.