Background: It is unclear that how prepregnancy body mass index (BMI), gestational weight gain (GWG), and gestational diabetes mellitus (GDM) affect pregnancy outcomes in -China. Thus, we explored how BMI, GWG, and GDM affect the risks of adverse pregnancy outcomes. Methods: We performed a retrospective, population-based study included all births in Xiamen, China, 2011–2018. Demographic data and pregnancy outcomes of 73,498 women were acquired from the Medical Birth Registry of Xiamen. Women were categorized into groups on prepregnancy BMI and GWG in order to assess the risk of pregnancy outcomes. Multivariable logistic regression was performed to evaluate risk factors. Results: Overall, 6,982 (9.37%) women were obese, and 8,874 (12.07%) women were overweight. Obese women are more vulnerable to cesarean delivery, preterm birth, large-for-gestational age (LGA), and macrosomia (crude OR [cOR] 2.00, 1.89–2.12; 1.35, 1.20–1.51; 2.12, 1.99–2.26; 2.53, 2.25–2.86, respectively, adjusted ORs 1.73, 1.62–1.84; 1.25, 1.10–1.42; 2.03, 1.90–2.18; 2.77, 2.44–3.16, respectively). Similar results were observed in overweight women (cORs 1.49, 1.42–1.57; 1.02, 0.91–1.15; 1.60, 1.50–1.70; 2.01, 1.78–2.26, respectively). Furthermore, women who gain weight in excessive group were 1.43, 2.06, and 2.16 times to deliver cesarean, LGA, and macrosomia, respectively. Additionally, GDM women were easily subjected to cesarean section, preterm birth, LGA, low birth weight, and macrosamia (cORs 1.52, 1.55, 1.52, 1.37, 1.27, respectively). Conclusions: Obesity prior to pregnancy, excessive GWG, and GDM were all associated with increased odds of cesarean, LGA, and macrosomia. Blood glucose and weight control before and during pregnancy are needed that may reduce the complications of pregnancy.

1.
World Health Organization. Obesity and overweight fact sheet 2017 (accessed October 21, 2018). Available from: http://www.who.int/mediacentre/factsheets/fs311/en/.
2.
World Health Organization. Global Health Observatory (GHO) data/ overweight and obesity (accessed October 21, 2018. Available from: http://www.who.int/gho/ncd/risk_factors/overweight_obesity/obesity_adults/en/.
3.
Lu J, Bi Y, Ning G. Curbing the obesity epidemic in China.
Lancet Diabetes Endocrinol
. 2016 Jun;4(6):470–1.
4.
Leng J, Shao P, Zhang C, Tian H, Zhang F, Zhang S, et al. Prevalence of gestational diabetes mellitus and its risk factors in Chinese pregnant women: a prospective population-based study in Tianjin, China.
PLoS One
. 2015 Mar;10(3):e0121029.
5.
Qin X, Pan J. The Medical Cost Attributable to Obesity and Overweight in China: Estimation Based on Longitudinal Surveys.
Health Econ
. 2016 Oct;25(10):1291–311.
6.
Mamun AA, O’Callaghan M, Callaway L, Williams G, Najman J, Lawlor DA. Associations of gestational weight gain with offspring body mass index and blood pressure at 21 years of age: evidence from a birth cohort study.
Circulation
. 2009 Apr;119(13):1720–7.
7.
Nohr EA, Vaeth M, Baker JL, Sørensen TI, Olsen J, Rasmussen KM. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy.
Am J Clin Nutr
. 2008 Jun;87(6):1750–9.
8.
Shao Y, Qiu J, Huang H, Mao B, Dai W, He X, et al. Pre-pregnancy BMI, gestational weight gain and risk of preeclampsia: a birth cohort study in Lanzhou, China.
BMC Pregnancy Childbirth
. 2017 Dec;17(1):400.
9.
Baugh N, Harris DE, Aboueissa AM, Sarton C, Lichter E. The Impact of Maternal Obesity and Excessive Gestational Weight Gain on Maternal and Infant Outcomes in Maine: Analysis of Pregnancy Risk Assessment Monitoring System Results from 2000 to 2010.
J Pregnancy
. 2016;2016:5871313.
10.
Farrar D, Simmonds M, Bryant M, Sheldon TA, Tuffnell D, Golder S, et al. Hyperglycaemia and risk of adverse perinatal outcomes: systematic review and meta-analysis.
BMJ
. 2016 Sep;354:i4694.
11.
O’Sullivan EP, Avalos G, O’Reilly M, Dennedy MC, Gaffney G, Dunne F; Atlantic DIP collaborators. Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria.
Diabetologia
. 2011 Jul;54(7):1670–5.
12.
Huang X, Tan H, Cai M, Shi T, Mi C, Lei J. Gestational weight gain in Chinese women – results from a retrospective cohort in Changsha, China.
BMC Pregnancy Childbirth
. 2018 May;18(1):185.
13.
Yang S, Peng A, Wei S, Wu J, Zhao J, Zhang Y, et al. Pre-Pregnancy Body Mass Index, Gestational Weight Gain, and Birth Weight: A Cohort Study in China.
PLoS One
. 2015 Jun;10(6):e0130101.
14.
American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: obesity in pregnancy.
Obstet Gynecol
. 2013 Jan;121(1):213–7.
15.
Shin D, Song WO. Prepregnancy body mass index is an independent risk factor for gestational hypertension, gestational diabetes, preterm labor, and small- and large-for-gestational-age infants.
J Matern Fetal Neonatal Med
. 2015;28(14):1679–86.
16.
Graham LE, Brunner Huber LR, Thompson ME, Ersek JL. Does amount of weight gain during pregnancy modify the association between obesity and cesarean section delivery?
Birth
. 2014 Mar;41(1):93–9.
17.
Cnattingius S, Villamor E, Johansson S, Edstedt Bonamy AK, Persson M, Wikström AK, et al. Maternal obesity and risk of preterm delivery.
JAMA
. 2013 Jun;309(22):2362–70.
18.
van der Burg JW, Allred EN, McElrath TF, Fichorova RN, Kuban K, O’Shea TM, et al. Is maternal obesity associated with sustained inflammation in extremely low gestational age newborns?
Early Hum Dev
. 2013 Dec;89(12):949–55.
19.
Sun D, Li F, Zhang Y, Xu X. Associations of the pre-pregnancy BMI and gestational BMI gain with pregnancy outcomes in Chinese women with gestational diabetes mellitus.
Int J Clin Exp Med
. 2014 Dec;7(12):5784–9.
20.
Larsen CE, Serdula MK, Sullivan KM. Macrosomia: influence of maternal overweight among a low-income population.
Am J Obstet Gynecol
. 1990 Feb;162(2):490–4.
21.
Johnson JW, Longmate JA, Frentzen B. Excessive maternal weight and pregnancy outcome.
Am J Obstet Gynecol
. 1992 Aug;167(2):353–70; discussion 370–2.
22.
Bianchi C, de Gennaro G, Romano M, Aragona M, Battini L, Del Prato S, et al. Pre-pregnancy obesity, gestational diabetes or gestational weight gain: which is the strongest predictor of pregnancy outcomes?
Diabetes Res Clin Pract
. 2018 Oct;144:286–93.
23.
Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus.
Obstet Gynecol
. 2010 Mar;115(3):597–604.
24.
Ferraro ZM, Barrowman N, Prud’homme D, Walker M, Wen SW, Rodger M, et al. Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index.
J Matern Fetal Neonatal Med
. 2012 May;25(5):538–42.
25.
Amorim AR, Rössner S, Neovius M, Lourenço PM, Linné Y. Does excess pregnancy weight gain constitute a major risk for increasing long-term BMI?
Obesity (Silver Spring)
. 2007 May;15(5):1278–86.
26.
Han Z, Mulla S, Beyene J, Liao G, McDonald SD; Knowledge Synthesis Group. Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses.
Int J Epidemiol
. 2011 Feb;40(1):65–101.
27.
McDonald SD, Han Z, Mulla S, Beyene J; Knowledge Synthesis Group. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses.
BMJ
. 2010 Jul;341:c3428.
28.
Lapolla A, Dalfrà MG, Ragazzi E, De Cata AP, Fedele D. New International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommendations for diagnosing gestational diabetes compared with former criteria: a retrospective study on pregnancy outcome.
Diabet Med
. 2011 Sep;28(9):1074–7.
29.
Wong T, Ross GP, Jalaludin BB, Flack JR. The clinical significance of overt diabetes in pregnancy.
Diabet Med
. 2013 Apr;30(4):468–74.
30.
Sridhar SB, Ferrara A, Ehrlich SF, Brown SD, Hedderson MM. Risk of large-for-gestational-age newborns in women with gestational diabetes by race and ethnicity and body mass index categories.
Obstet Gynecol
. 2013 Jun;121(6):1255–62.
31.
Al-Qahtani S, Heath A, Quenby S, Dawood F, Floyd R, Burdyga T, et al. Diabetes is associated with impairment of uterine contractility and high Caesarean section rate.
Diabetologia
. 2012 Feb;55(2):489–98.
32.
Timofeev J, Huang CC, Singh J, Driggers RW, Landy HJ. Spontaneous labor curves in women with pregnancies complicated by diabetes.
J Matern Fetal Neonatal Med
. 2012 Jan;25(1):20–6.
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