Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter August 12, 2014

Prepregnancy maternal obesity and fetal-perinatal death in a Mediterranean country

Eleni Papachatzi, Vassilis Papadopoulos, Gabriel Dimitriou, Spyros Paparrodopoulos, Mattheos Papadimitriou-Olivgeris and Apostolos Vantarakis

Abstract

Objective: Pre- or early-pregnancy obesity carries significant health implications. This retrospective cohort study investigates the association between pre- or early-pregnancy body mass index (BMI) and the risk of fetal and neonatal death in pregnancies implicated by obesity in a Mediterranean country.

Study design: Data on pregnancies delivered during 2003–2008 at a University hospital was linked to data from regional registry. Logistic regression models were used to determine the odds ratios of a spontaneous fetal death and perinatal death among overweight, obese, and morbid obese women.

Results: Independent predictors of fetal death were maternal prepregnancy BMI over 25, maternal age, maternal co-morbidities, and maternal residence in an island. Perinatal mortality was independently correlated to neonatal birthweight, maternal age, maternal residence in towns and villages, and maternal BMI over 40. Overall, maternal residence in an island, maternal autoimmune disease, and maternal prepregnancy BMI (over 25) were independent risk factors predicting offspring death (both intrauterine and perinatal).

Conclusions: Maternal obesity is correlated to offspring’s mortality during fetal and/or perinatal period. This is one of the very few studies in a Mediterranean country. This study underlines the need for public health interventions to prevent obesity in young women.


Corresponding author: Dr. Apostolos Vantarakis, Department of Public Health, Medical School, University of Patras 26500, Patras, Greece, Tel./Fax: +302610969875, E-mail:

Acknowledgments

The authors would like to express gratitude and appreciation to the University of Patras for access services in online libraries and journals. Additionally they would like to thank employees in the office patient flow of the University Hospital of Patras, for their help in classification of patient files.

References

[1] Bonaccio M, Di Castelnuovo A, Bonanni A, Costanzo S, De Lucia F, Pounis G, et al. Adherence to a Mediterranean diet is associated with a better health-related quality of life: a possible role of high dietary antioxidant content. Br Med J Open. 2013;3:pii:e003003.10.1136/bmjopen-2013-003003Search in Google Scholar

[2] Catalano PM, Presley L, Minium J, Hauguel-de Mouzon S. Fetuses of obese mothers develop insulin resistance in utero. Diabetes Care. 2009;32:1076–80.10.2337/dc08-2077Search in Google Scholar

[3] Chen A, Feresu SA, Fernandez C, Rogan WJ. Maternal obesity and the risk of infant death in the United States. Epidemiology. 2009;20:74–81.10.1097/EDE.0b013e3181878645Search in Google Scholar

[4] Chibber R. Unexplained antepartum fetal deaths: what are the determinants? Arch Gynecol Obstet. 2005;271:286–91.10.1007/s00404-004-0606-1Search in Google Scholar

[5] Cresswell JA, Campbell OM, De Silva MJ, Filippi V. Effect of maternal obesity on neonatal death in sub-Saharan Africa: multivariable analysis of 27 national datasets. Lancet. 2012;380:1325–30.10.1016/S0140-6736(12)60869-1Search in Google Scholar

[6] Cundy T, Gamble G, Townend K, Henley PG, MacPherson P, Roberts AB. Perinatal mortality in Type 2 diabetes mellitus. Diabet Med. 2000;17:33–9.10.1046/j.1464-5491.2000.00215.xSearch in Google Scholar

[7] Denison FC, Roberts KA, Barr SM, Norman JE. Obesity, pregnancy, inflammation, and vascular function. Reproduction. 2010;140:373–85.10.1530/REP-10-0074Search in Google Scholar

[8] Doak CM, Wijnhoven TM, Schokker DF, Visscher TL, Seidell JC. Age standardization in mapping adult overweight and obesity trends in the WHO European Region. Obes Rev. 2012;13:174–91.10.1111/j.1467-789X.2011.00943.xSearch in Google Scholar

[9] European health for all database (HFA-DB) [database on the Internet] Updated: July 2013.Search in Google Scholar

[10] Farajian P, Risvas G, Karasouli K, Pounis GD, Kastorini CM, Panagiotakos DB, et al. Very high childhood obesity prevalence and low adherence rates to the Mediterranean diet in Greek children: the GRECO study. Atherosclerosis. 2011;217:525–30.10.1016/j.atherosclerosis.2011.04.003Search in Google Scholar

[11] Filippidis FT, Tzavara C, Dimitrakaki C, Tountas Y. Compliance with a healthy lifestyle in a representative sample of the Greek population: preliminary results of the Hellas Health I study. Public Health. 2011;125:436–41.10.1016/j.puhe.2011.03.009Search in Google Scholar

[12] Galliano D, Bellver J. Female obesity: short- and long-term consequences on the offspring. Gynecol Endocrinol. 2013;29:626–31.10.3109/09513590.2013.777420Search in Google Scholar

[13] Gouveri ET, Tzavara C, Drakopanagiotakis F, Tsaoussoglou M, Marakomichelakis GE, Tountas Y, et al. Mediterranean diet and metabolic syndrome in an urban population: the Athens Study. Nutr Clin Pract. 2011;26:598–606.10.1177/0884533611416821Search in Google Scholar

[14] Hirose A, Borchert M, Niksear H, Alkozai AS, Gardiner J, Filippi V. The role of care-seeking delays in intrauterine fetal deaths among ‘near-miss’ women in Herat, Afghanistan. Paediatr Perinat Epidemiol. 2012;26:388–97.10.1111/j.1365-3016.2012.01299.xSearch in Google Scholar

[15] Huang DY, Usher RH, Kramer MS, Yang H, Morin L, Fretts RC. Determinants of unexplained antepartum fetal deaths. Obstet Gynecol. 2000;95:215–21.Search in Google Scholar

[16] Kim SY, Dietz PM, England L, Morrow B, Callaghan WM. Trends in pre-pregnancy obesity in nine states, 1993–2003. Obesity (Silver Spring). 2007;15:986–93.10.1038/oby.2007.621Search in Google Scholar

[17] Kocijancic DM, Plesinac S, Plecas D, Aksam S, Kocijancic A. Correlation of biochemical parameters and neonatal outcome in patients with gestational hypertension. Clin Exp Hypertens. 2013;35:6–10.10.3109/10641963.2012.685533Search in Google Scholar

[18] Kothari CL, Wendt A, Liggins O, Overton J, Sweezy Ldel C. Assessing maternal risk for fetal-infant mortality: a population-based study to prioritize risk reduction in a healthy start community. Matern Child Health J. 2011;15:68–76.10.1007/s10995-009-0561-3Search in Google Scholar

[19] Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ. Pre-pregnancy weight and the risk of stillbirth and neonatal death. Br J Obstet Gynaecol. 2005;112:403–8.10.1111/j.1471-0528.2005.00437.xSearch in Google Scholar

[20] Leung TY, Leung TN, Sahota DS, Chan OK, Chan LW, Fung TY, et al. Trends in maternal obesity and associated risks of adverse pregnancy outcomes in a population of Chinese women. Br J Obstet Gynaecol. 2008;115:1529–37.10.1111/j.1471-0528.2008.01931.xSearch in Google Scholar

[21] Ma Y, Yang Y, Wang F, Zhang P, Shi C, Zou Y, et al. Obesity and risk of colorectal cancer: a systematic review of prospective studies. PLoS One. 2013;8:e53916.10.1371/journal.pone.0053916Search in Google Scholar

[22] Moran LJ, Norman RJ. The obese patient with infertility: a practical approach to diagnosis and treatment. Nutr Clin Care. 2002;5:290–7.10.1046/j.1523-5408.2002.05604.xSearch in Google Scholar

[23] National Statistic Service of Greece, ELSTAT, University of Thessalia (e-Demography)-Hellenic Statistic Authority.Search in Google Scholar

[24] Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i–xii, 1–253.Search in Google Scholar

[25] OECD Health Data 2013, Definitions, Sources and Methods. Eurostat-Hellenic Statistic Authority.Search in Google Scholar

[26] Paletas K, Athanasiadou E, Sarigianni M, Paschos P, Kalogirou A, Hassapidou M, et al. The protective role of the Mediterranean diet on the prevalence of metabolic syndrome in a population of Greek obese subjects. J Am Coll Nutr. 2010;29:41–5.10.1080/07315724.2010.10719815Search in Google Scholar

[27] Raatikainen K, Heiskanen N, Heinonen S. Transition from overweight to obesity worsens pregnancy outcome in a BMI-dependent manner. Obesity (Silver Spring). 2006;14:165–71.10.1038/oby.2006.20Search in Google Scholar

[28] Ramsay JE, Ferrell WR, Crawford L, Wallace AM, Greer IA, Sattar N. Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J Clin Endocrinol Metab. 2002;87:4231–7.10.1210/jc.2002-020311Search in Google Scholar

[29] Romaguera D, Bamia C, Pons A, Tur JA, Trichopoulou A. Food patterns and Mediterranean diet in western and eastern Mediterranean islands. Public Health Nutr. 2009;12:1174–81.10.1017/S1368980008003674Search in Google Scholar

[30] Sebastian Manzanares G, Angel Santalla H, Irene Vico Z, Lopez Criado MS, Alicia Pineda L, Jose Luis Gallo V. Abnormal maternal body mass index and obstetric and neonatal outcome. J Matern Fetal Neonatal Med. 2012;25:308–12.10.3109/14767058.2011.575905Search in Google Scholar

[31] Silva-del Valle MA, Sanchez-Villegas A, Serra-Majem L. Association between the adherence to the Mediterranean diet and overweight and obesity in pregnant women in Gran Canaria. Nutr Hosp. 2013;28:654–9.Search in Google Scholar

[32] Tennant PW, Rankin J, Bell R. Maternal body mass index and the risk of fetal and infant death: a cohort study from the North of England. Hum Reprod. 2011;26:1501–11.10.1093/humrep/der052Search in Google Scholar

[33] Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348:2599–608.10.1056/NEJMoa025039Search in Google Scholar

[34] Walsh CA, McMenamin MB, Foley ME, Daly SF, Robson MS, Geary MP. Trends in intrapartum fetal death, 1979–2003. Am J Obstet Gynecol. 2008;198:47. e1–7.10.1016/j.ajog.2007.06.018Search in Google Scholar

[35] World Health Organization, Global Health Observatory (GHO), Noncommunicable diseases, “Prevalence of obesity, ages 20+, age standardized, Females, 2008”. Available at: http://gamapserver.who.int/mapLibrary/Files/Maps/Global_Obesity_Females_2008.png. Accessed on 28 July 2014.Search in Google Scholar

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2014-2-6
Accepted: 2014-7-15
Published Online: 2014-8-12
Published in Print: 2015-5-1

©2015 by De Gruyter