The Effects of Prepregnancy Body Mass Index and Gestational Weight Gain on Fetal Macrosomia Among American Indian/Alaska
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The Effects of Prepregnancy Body Mass Index and Gestational Weight Gain on Fetal Macrosomia Among American Indian/ Alaska Native Women Karilynn Rockhill1,2 • Haley Dorfman1,3 • Meghna Srinath1,4 • Carol Hogue1,5
Ó Springer Science+Business Media New York 2015
Abstract Objectives The American Indian/Alaska Native (AI/AN) population is a high-risk group across many health indicators, including fetal macrosomia. We aimed to investigate the effects of prepregnancy body mass index (BMI) and gestational weight gain (GWG) on macrosomia and explore possible racial and geographical variations among AI/AN women. Methods This retrospective cohort study was conducted from the Pregnancy Risk Assessment Monitoring System in eight states (2004–2011) among live, singleton, term births to AI/AN women 20 years or older. Prevalence of macrosomia (birth weight C 4000 g) by select characteristics were estimated; differences were assessed with Chisquares. Multivariable logistic regression was conducted to calculate adjusted odds ratios (aOR) for effects on macrosomia of BMI and GWG (enumerating the pounds women deviated from the Institute of Medicine guidelines for GWG) controlling for other factors in the total sample and stratified by race and state of residence. Results The prevalence of macrosomia was 14 %, ranging from 8 to 21 % (Utah–Alaska). Among AI/AN women, 30 % were obese prepregnancy and 50 % had excess GWG. Significant independent effects were found for macrosomia of prepregnancy overweight (aOR 1.27; 95 % Confidence Interval 1.01–1.59), obesity (aOR 1.63; & Karilynn Rockhill [email protected] 1
Emory University, Atlanta, GA, USA
2
1514 Sheridan Road, Apt. 4310, Atlanta, GA 30324, USA
3
789 Hammond Drive #321, Atlanta, GA 30328, USA
4
611 East 11th Street, Apt. 4A, New York, NY 10009, USA
5
1513 Clifton Road NW, Atlanta, GA 30322, USA
1.29–2.07), and excess GWG (aOR 1.16; 1.13–1.20 per five pounds gained beyond appropriate). Adjusted estimates varied between race and state. Conclusions Prepregnancy BMI and GWG are independent factors for macrosomia among AI/AN women. Future research should prioritize development, testing, and implementation of weight management programs, which account for variations among AI/AN women, both before and during pregnancy for BMI regulation and GWG control. Keywords Macrosomia Body mass index Gestational weight gain American Indian/Alaska Native PRAMS
Significance American Indians/Alaska Natives (AI/AN) are a growing population experiencing some of the greatest health disparities. Fetal macrosomia has great risks to the mother and child. High body mass index (BMI) and excess gestational weight gain (GWG) are well-established risk factors for macrosomia in other populations. Data show high obesity rates among AI/ AN women, but population-based estimates on GWG are missing. This study aimed to provide surveillance estimates of BMI and GWG, and assess the contributions on macrosomia among AI/AN women; stratifying to explore possible racial and regional variations. We util
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