TY - JOUR
T1 - Integrating multiple lines of evidence to assess the effects of maternal BMI on pregnancy and perinatal outcomes
AU - Borges, Maria Carolina
AU - Clayton, Gemma L
AU - Freathy, Rachel M
AU - Felix, Janine F
AU - Fernández-Sanlés, Alba
AU - Soares, Ana Gonçalves
AU - Kilpi, Fanny
AU - Yang, Qian
AU - McEachan, Rosemary R C
AU - Richmond, Rebecca C
AU - Liu, Xueping
AU - Skotte, Line
AU - Irizar, Amaia
AU - Hattersley, Andrew T
AU - Bodinier, Barbara
AU - Scholtens, Denise M
AU - Nohr, Ellen A
AU - Bond, Tom A
AU - Hayes, M Geoffrey
AU - West, Jane
AU - Tyrrell, Jessica
AU - Wright, John
AU - Bouchard, Luigi
AU - Murcia, Mario
AU - Bustamante, Mariona
AU - Chadeau-Hyam, Marc
AU - Jarvelin, Marjo-Riitta
AU - Vrijheid, Martine
AU - Perron, Patrice
AU - Magnus, Per
AU - Gaillard, Romy
AU - Jaddoe, Vincent W V
AU - Lowe, William L
AU - Feenstra, Bjarke
AU - Hivert, Marie-France
AU - Sørensen, Thorkild I A
AU - Håberg, Siri E
AU - Serbert, Sylvain
AU - Magnus, Maria
AU - Lawlor, Deborah A
N1 - © 2024. The Author(s).
PY - 2024
Y1 - 2024
N2 - BACKGROUND: Higher maternal pre-pregnancy body mass index (BMI) is associated with adverse pregnancy and perinatal outcomes. However, whether these associations are causal remains unclear.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.
AB - BACKGROUND: Higher maternal pre-pregnancy body mass index (BMI) is associated with adverse pregnancy and perinatal outcomes. However, whether these associations are causal remains unclear.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.
KW - Infant, Newborn
KW - Pregnancy
KW - Female
KW - Humans
KW - Cesarean Section
KW - Body Mass Index
KW - Hypertension, Pregnancy-Induced/epidemiology
KW - Diabetes, Gestational
KW - Pre-Eclampsia/epidemiology
U2 - 10.1186/s12916-023-03167-0
DO - 10.1186/s12916-023-03167-0
M3 - Journal article
C2 - 38281920
VL - 22
JO - BMC Medicine
JF - BMC Medicine
SN - 1741-7015
M1 - 32
ER -