Retrospective cohort study of the effects of obesity in early pregnancy on maternal weight gain and obstetric outcomes in an obstetric population in Africa

Chukwuemeka A Iyoke,¹ George O Ugwu,¹ Frank O Ezugwu,² Osaheni L Lawani,³ Azubuike K Onyebuchi<sup>3

1</sup>Departments of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, ²Departments of Obstetrics and Gynaecology, Enugu State University Teaching Hospital, Enugu, ³Departments of Obstetrics and Gynaecology, Federal Medical Centre, Abakaliki, Ebonyi State, Nigeria

Objective: The purpose of this study was to compare maternal weight gain in pregnancy and obstetric outcomes between women with obesity in early pregnancy and those with a normal body mass index (BMI) in early pregnancy.
Methods: This was a retrospective cohort study of women with obesity in early pregnancy and those with a normal BMI who were seen at three teaching hospitals in South-East Nigeria. Statistical analysis was performed using Statistical Package for the Social Sciences version 17.0 software, with descriptive and inferential statistics at the 95% level of confidence.
Results: The study sample consisted of 648 women (324 obese and 324 healthy-weight). The mean age of the obese women was 26.7 ± 5.1 years and that of the healthy-weight women was 26.6 ± 4.9 years. Although both excessive weight gain (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.23–0.54) and inadequate weight gain (OR 0.08, 95% CI 0.04–0.15) were less common in women with early pregnancy obesity than in healthy-weight women, a significantly higher proportion of obese women with excessive weight gain had adverse fetomaternal outcomes. Also, a significantly higher proportion of obese women had specific complications, such as premature rupture of membranes (OR 2.36, 95% CI 1.12–5.04), gestational hypertension/pre-eclampsia (OR 2.31, 95% CI 1.12–5.04), antepartum hemorrhage (OR 2.78, 95% CI 1.02–7.93), gestational diabetes (OR 4.24, 95% CI 1.62–11.74), cesarean delivery (OR 2.3, 95% CI 1.2–5.44), macrosomia (OR 4.08, 95% CI 1.06–8.41), severe birth asphyxia (OR 2.8, 95% CI 1.2–6.63), abnormal Apgar scores (OR 2.67, 95% CI 1.46–4.93), and newborn special care admissions (OR 1.18, 95% CI 1.0–3.29).
Conclusion: Early pregnancy obesity was associated with a wide range of adverse fetomaternal outcomes, and could be a genuine risk factor for increased pregnancy-related morbidity and/or mortality in this population. Interventions to reduce prepregnancy obesity could therefore be useful in this low-resource African setting.

Keywords: obesity, early pregnancy, maternal weight gain, obstetric outcomes