TEMPLATE DESIGN © Gestational Weight Gain and Pregnancy Outcomes in Women Who Came for Delivery in a District Hospital Hateeza Z, Noorazmi MA, Rahmah S, Balanathan K, Matthew S, Sharmini D, Yuzainov A. University of Malaya Medical Centre (UMMC) & Seberang Jaya Hospital Introduction Excessive gestational weight gain and obesity has long been regarded as a pregnancy risk factor 1-7 The upward trend in the prevalence of obesity is increasing despite its well-publicised adverse effects on health 8,9,10 Study has shown that postpartum retention of weight is proportional to weight gain during pregnancy Maternal antepartum medical complications, such as hypertension and diabetes mellitus, are significantly increased in obese mother 1,3,5,7,8 Obese patient also do poorly during the intrapartum period. Deliveries by obese women tend to have higher rates of induction of labour, caesarean section and dystocia from macrosomic babies OBJECTIVE To determine the value of total gestational weight gain, describe the association of gestational weight gain with sociodemographic background and to evaluate whether gestational weight gain has a role in predicting the pregnancy outcomes amongst the obstetrics population in Seberang Jaya Hospital in 3 months duration METHODOLOGY A cross-sectional cohort study A total of 674 pregnant women with singleton pregnancy who came to deliver vaginally in Seberang Jaya Hospital from 17 th February 2010 until 17 th May 2010 and were booked at their respective health clinic at ≤ 12 weeks period of amenorrhoea were successfully recruited Their maternal antepartum, intrapartum and postpartum event as well as neonatal outcomes were documented The data was analysed using Statistical Package for Social Science version 18 RESULTS Total deliveries in Seberang Jaya Hospital during the 3 months study period were 1865 deliveries The number of recruited patients was 674, therefore at least 36% of obstetric population of Seberang Jaya were booked at ≤ 12 weeks period of amenorrhoea Majority of the mothers were Malay (81.6%), primigravida (29.9%) and were less than 35 years old (81.5%) The mean of total gestational weight gain in the recruited sample was 10.3 ± 4.95 kg Gestational weight gain is observed to be higher in the younger age group and in women who came to deliver at more advanced period of gestation Less weight gain is observed in women with higher gravidity, parity and higher pre-pregnancy body mass index Conclusions References Women of younger age and lower parity were associated with more gestational weight gain compared to older and higher parity women. Although there is no optimum or normal amount of weight to be gained during pregnancy, this study showed significant correlations between total pregnancy weight gain to maternal and fetal complications. The results of this study emphasized the importance of educating women to know their pre-pregnancy weight and not to put on excessive weight during their pregnancy OPTIONAL LOGO HERE Gestational weight gain does not show any association with race, history of previous LSCS and miscarriage Patients with higher gestational weight gain had a longer duration of labour, higher degree of perineal tear and higher neonatal birthweight. Weight gain also shows association with different group of gestational diabetes mellitus, analgesia usage in labour, postpartum haemorrhage, Apgar score at 1 minute, shoulder dystocia and wound complications. On the other hand, it does not shows any role in predicting hypertension in pregnancy, the mode of delivery, the need for induction of labour, duration of emergency caesarean section, Apgar score at 5 minute, infection status and duration of hospital stay. Total gestational weight gain (n=674 ) Mean (sd)Median (IQR)MinMax Pre pregnancy weight (kg) (13.03) (16.60) Height (m) 1.56 (0.06)1.56 (0.07) Pre pregnancy BMI (kg/m 2 ) (5.09)23.60 (6.54) Weight at delivery (kg) (12.92) (16.0) Gestational weight gain (kg) (4.95)10.00 (6.00) Overall study population characteristics (n=674 ) Age (in years)Pre-pregnancy weight (in kg) Total weight gain(in kg) Primigravida, n=202  Mean (std dev)  Minimum  Maximum (3.85) (11.9) (5.27) Gravida 2 & 3, n=300  Mean (std dev)  Minimum  Maximum (4.44) (13.27) (4.32) Gravida 4, n=84  Mean (std dev)  Minimum  Maximum (3.83) (12.89) (4.97) Gravida 5 and above, n=88  Mean (std dev)  Minimum  Maximum (4.04) (13.61) (3.92) Age, Pre pregnancy weight and Total weight gain in different group of Gravidity (n=674 ) Age (in years) Pre-pregnancy weight (in kg) Total weight gain (in kg) Baby birth weight (in grams) No GDM, n=569  Mean (std dev)  Minimum  Maximum (5.21) (12.19) (4.93) (459.20) GDM on diet control, n=85  Mean (std dev)  Minimum  Maximum (5.38) (14.24) (4.91) (435.64) GDM on insulin, n=19  Mean (std dev)  Minimum  Maximum (6.31) (17.76) (3.63) (462.71) Age, Pre-pregnancy weight, Total weight gain and Birth weight in different group of patient with Gestational Diabetes Mellitus (n=674) Variables nWeight gain mean (sd) F (df) p-value GDM  No GDM  Diet Control  On Insulin (4.93) 9.51 (4.91) 6.12 (3.63) (2,670) <0.001 Analgesia  No Analgesia  Entonox  I/M Pethidine  Epidural (4.74) (5.81) (5.02) (5.09) (3,664) PPH  No  Yes (4.92) (5.20) (1,672) Wound Complication  Yes  No (4.94) (4.68) (1,672) Birthweight  Less than 2500g  2500g – 3599g  3600g – 3999g  More than 4000g (4.51) (4.86) (6.10) (4.11) (1.672) <0.001 Shoulder dystocia  Yes  No (-) (4.93) VariablesnCorrelation p-value Age #<0.001 Parity POG at delivery Maternal weight at delivery #<0.001 Pre-pregnancy weight #<0.001 Pre-pregnancy BMI #<0.001 Duration of labour in SVD Perineal tear Apgar score (at 1 minute) Birthweight #<0.001 Comparison in the mean of total gestational weight gain and the statistically significant categorical independent variables using ANOVA (F test) Correlation between total gestational weight gain and statistically significant continuous variable Spearman rho’s correlation, # Pearson correlation ) 1.Health implications of obesity. National Institutes of Health Consensus Development Conference Statement. Annual Internal Medicine. 1985; 103: Manson JE, Willett WC, Stampfer MJ, et al. Body weight and mortality among women. The New England Journal of Medicine. 1995; 333: Yu C, Teoh T, Robinson S. Obesity in pregnancy. BJOG. 2006;113: Gross et al. Obesity in Pregnancy: Risks and Outcome. The American College of Obstetricians and Gynecologists. October 1980; Vol.56: Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol. 2004; 103: Mamun et al. Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay. Pregnancy and Childbirth :62. 7.Kumari AS. Pregnancy outcome in women with morbid obesity. Int J Gynecol Obstet. 2001; 73: Sidik MS, Rampal L. The prevalence and factors associated with obesity among adult women in Selangor, Malaysia. Asia Pacific Family Medicine. 2009; 8:2. 9.Sebire NJ, Jolly M, Harris JP, et al. Maternal obesity and pregnancy outcome. a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord. 2001; 25: Edwards LE, Hellerstedt WL, Alton IR, Story M, Himes JH. Pregnancy complications and birth outcomes in obese and normal-weight women: effects of gestational weight change. Obstet Gynecol. 1996; 87: Lu GC, Rouse DJ, DuBard M, et al. The effect of the increasing prevalence of maternal obesity on perinatal morbidity. Am J Obstet Gynecol. 2001; 185: Bianco AT, Smilen SW, Davis Y, et al. Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol. 1998; 91: Polley BA, Wing RR, Sims CJ. Randomized controlled trial to prevent excessive gain in pregnant women. Internal Journal of Obesity and Related Disorder. 2002; 26: Eric H, Carol C.C, Shelley L.G. Trends in weight gain during pregnancy: A population study across 16 years in North Carolina. American Journal of Obstetrics and Gynecology (2006) 194, e32–e3. 15.Rossner S. Weight gain in pregnancy. Human Reproduction Volume 12 Supplement Ash et al. Maternal Weight Gain, Smoking and other factors in pregnancy as predictors of Infant Birth-Weight in Sydney Women. A.N.J.O.G Vol 29. No. 3, Abrams B, Altman SL, Pickett KE. Pregnancy weight gain: still controversial. Am J Clinical Nutrition. 2000;71:1233s- 41s.