Integrating multiple lines of evidence to assess the effects of maternal BMI on pregnancy and perinatal outcomes.
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Borges Maria Carolina, Clayton Gemma L, Freathy Rachel M, Felix Janine F, Fernández-Sanlés Alba, Soares Ana Gonçalves, Kilpi Fanny, Yang Qian, McEachan Rosemary R C, Richmond Rebecca C, Liu Xueping, Skotte Line, Irizar Amaia, Hattersley Andrew T, Bodinier Barbara, Scholtens Denise M, Nohr Ellen A, Bond Tom A, Hayes M Geoffrey, West Jane, Tyrrell Jessica, Wright John, Bouchard Luigi, Murcia Mario, Bustamante Mariona, Chadeau-Hyam Marc, Jarvelin Marjo-Riitta, Vrijheid Martine, Perron Patrice, Magnus Per, Gaillard Romy, Jaddoe Vincent W V, Lowe William L, Feenstra Bjarke, Hivert Marie-France, Sørensen Thorkild I A, Håberg Siri E, Serbert Sylvain, Magnus Maria, Lawlor Deborah A
Аннотация
METHODS: We explored the relation of maternal pre-/early-pregnancy BMI with 20 pregnancy and perinatal outcomes by integrating evidence from three different approaches (i.e. multivariable regression, Mendelian randomisation, and paternal negative control analyses), including data from over 400,000 women.
RESULTS: All three analytical approaches supported associations of higher maternal BMI with lower odds of maternal anaemia, delivering a small-for-gestational-age baby and initiating breastfeeding, but higher odds of hypertensive disorders of pregnancy, gestational hypertension, preeclampsia, gestational diabetes, pre-labour membrane rupture, induction of labour, caesarean section, large-for-gestational age, high birthweight, low Apgar score at 1 min, and neonatal intensive care unit admission. For example, higher maternal BMI was associated with higher risk of gestational hypertension in multivariable regression (OR = 1.67; 95% CI = 1.63, 1.70 per standard unit in BMI) and Mendelian randomisation (OR = 1.59; 95% CI = 1.38, 1.83), which was not seen for paternal BMI (OR = 1.01; 95% CI = 0.98, 1.04). Findings did not support a relation between maternal BMI and perinatal depression. For other outcomes, evidence was inconclusive due to inconsistencies across the applied approaches or substantial imprecision in effect estimates from Mendelian randomisation.
CONCLUSIONS: Our findings support a causal role for maternal pre-/early-pregnancy BMI on 14 out of 20 adverse pregnancy and perinatal outcomes. Pre-conception interventions to support women maintaining a healthy BMI may reduce the burden of obstetric and neonatal complications.
FUNDING: Medical Research Council, British Heart Foundation, European Research Council, National Institutes of Health, National Institute for Health Research, Research Council of Norway, Wellcome Trust.