Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter October 26, 2021

The impact of parity and maternal obesity on the fetal outcomes of a non-selected Lower Saxony population

Lars Brodowski EMAIL logo , Niels Rochow , Efrah I. Yousuf , Fabian Kohls , Constantin S. von Kaisenberg , Silvia Berlage and Manfred Voigt



Maternal obesity during pregnancy is associated with adverse intrauterine events and fetal outcomes and may increase the risk of obesity and metabolic disease development in offspring. Higher parity, regardless of socioeconomic status, is associated with increased maternal body mass index (BMI). In this study, we examined the relationship between parity, maternal obesity, and fetal outcomes in a large sample of mother-neonate pairs from Lower Saxony, Germany.


This retrospective cohort study examined pseudonymized data of a non-selected singleton cohort from Lower Saxony’s statewide quality assurance initiative. 448,963 cases were included. Newborn outcomes were assessed in relation to maternal BMI and parity.


Maternal obesity was associated with an increased risk of placental insufficiency, chorioamnionitis, and fetal distress while giving birth. This effect was present across all parity groups. Fetal presentation did not differ between BMI groups, except for the increased risk of high longitudinal position and shoulder dystocia in obese women. Maternal obesity was also associated with an increased risk of premature birth, low arterial cord blood pH and low 5-min APGAR scores.


Maternal obesity increases the risk of adverse neonatal outcomes. There is a positive correlation between parity and increased maternal BMI. Weight-dependent fetal risk factors increase with parity, while parity-dependent outcomes occur less frequently in multipara. Prevention and intervention programs for women planning to become pregnant can be promising measures to reduce pregnancy and birth complications.

Corresponding author: Dr. med. Lars Brodowski, Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1 30625 Hannover, Germany, E-mail:


The authors greatly appreciate the support of the obstetric hospitals in Lower Saxony and the Ärztekammer Niedersachsen in recruiting participants and providing data.

  1. Research funding: None declared.

  2. Author contributions: Conceived and concepted the study: LB CVK MV FK. Study design: LB NR MV. Supervision: LB FK CVK FK SB MV. Analyzed the data: MV NR. Contributed patient information/analysis tools: SB MV NR. Contributed to the writing of the manuscript: LB NR EIY. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: This is a retrospective analysis of birth data from the Lower Saxony Perinatal Survey under the Ethical Approval of the Ethics Committee of the Lower Saxony Medical Association.


1. Bianco, AT, Smilen, SW, Davis, Y, Lopez, S, Lapinski, R, Lockwood, CJ. Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol 1998;91:97–102. in Google Scholar

2. Barker, DJ. Fetal programming of coronary heart disease. Trends Endocrinol Metabol 2002;13:364–8. in Google Scholar

3. LifeCycle Project-Maternal, O, Childhood Outcomes Study, G, Voerman, E, Santos, S, Inskip, H, Amiano, P, et al.. Association of gestational weight gain with adverse maternal and infant outcomes. JAMA 2019;321:1702–15. in Google Scholar PubMed PubMed Central

4. Drake, AJ, Reynolds, RM. Impact of maternal obesity on offspring obesity and cardiometabolic disease risk. Reproduction 2010;140:387–98. in Google Scholar

5. Nelson, SM, Matthews, P, Poston, L. Maternal metabolism and obesity: modifiable determinants of pregnancy outcome. Hum Reprod Update 2010;16:255–75. in Google Scholar PubMed PubMed Central

6. O’Tierney-Ginn, PPL, Minium, J, Hauguel deMouzon, S, Catalano, PM. Sex-specific effects of maternal anthropometrics on body composition at birth. Am J Obstet Gynecol 2014;356:1–9. in Google Scholar PubMed PubMed Central

7. Stothard, KJ, Tennant, PW, Bell, R, Rankin, J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. J Am Med Assoc 2009;301:636–50. in Google Scholar PubMed

8. Aune, D, Saugstad, OD, Henriksen, T, Tonstad, S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 2014;311:1536–46. in Google Scholar PubMed

9. Kappel-Latif, S, Zacherl, J, Hejna, M, Westerhoff, M, Tamandl, D, Ba-Ssalamah, A, et al.. * Pancho trial, p53-adapted neoadjuvant chemotherapy for resectable esophageal cancer completed-mutation rate of the marker higher than expected. Eur Surg ACA Acta chirurgica Austriaca 2018;50:160–6. in Google Scholar PubMed PubMed Central

10. Rooney, BL, Schauberger, CW. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol 2002;100:245–52. in Google Scholar

11. Villamor, E, Cnattingius, S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet 2006;368:1164–70. in Google Scholar

12. Kehl, S, Dotsch, J, Hecher, K, Schlembach, D, Schmitz, D, Stepan, H, et al.. Intrauterine growth restriction. Guideline of the German Society of Gynecology and Obstetrics (S2k-level, AWMF registry No. 015/080, October 2016. Geburtshilfe Frauenheilkd 2017;77:1157–73. in Google Scholar PubMed PubMed Central

13. Ayres-de-Campos, D, Arulkumaran, S, Panel, FIFMEC. FIGO consensus guidelines on intrapartum fetal monitoring: Introduction. Int J Gynaecol Obstet 2015;131:3–4. in Google Scholar PubMed

14. ACOG Committee Opinion No 579. Definition of term pregnancy. Obstet Gynecol 2013;122:1139–40. in Google Scholar PubMed

15. 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

16. Wolfe, H. High prepregnancy body-mass index – a maternal-fetal risk factor. N Engl J Med 1998;338:191–2. in Google Scholar PubMed

17. Devlieger, R. Maternal obesity in Europe: where do we stand and how to move forward?: a scientific paper commissioned by the European Board and College of Obstetrics and Gynaecology, EBCOG. Eur J Obstet Gynecol Reprod Biol 2016;201:203–8. in Google Scholar PubMed

18. R Development Core Team. A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2019.Search in Google Scholar

19. McIntyre, HD. Overweight and obesity in Australian mothers: epidemic or endemic? Med J Aust 2012;196:184–8. in Google Scholar PubMed

20. Cunningham, CE, Teale, GR. A profile of body mass index in a large rural Victorian obstetric cohort. Med J Aust 2013;198:39–42. in Google Scholar PubMed

21. Callaway, LK. The prevalence and impact of overweight and obesity in an Australian obstetric population. Med J Aust 2006;184:56–9. in Google Scholar PubMed

22. Magann, EF. The effects of an increasing gradient of maternal obesity on pregnancy outcomes. Aust N Z J Obstet Gynaecol 2013;53:250–7. in Google Scholar PubMed

23. Athukorala, C. The risk of adverse pregnancy outcomes in women who are overweight or obese. BMC Pregnancy Childbirth 2010;10:56. in Google Scholar PubMed PubMed Central

24. Usha Kiran, TS. Outcome of pregnancy in a woman with an increased body mass index. BJOG 2005;112:768–72. in Google Scholar PubMed

25. Han, Z. Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol 2011;40:65–101. in Google Scholar PubMed

26. Gunderson, EP. Childbearing and obesity in women: weight before, during, and after pregnancy. Obstet Gynecol Clin North Am 2009;36:317–32. ix. in Google Scholar PubMed PubMed Central

27. Cnattingius, S, Lambe, M. Trends in smoking and overweight during pregnancy: prevalence, risks of pregnancy complications, and adverse pregnancy outcomes. Semin Perinatol 2002;26:286–95. in Google Scholar PubMed

28. Oken, E. Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol 2007;196:322.e1–8. in Google Scholar PubMed PubMed Central

29. Oken, E. Maternal gestational weight gain and offspring weight in adolescence. Obstet Gynecol 2008;112:999–1006. in Google Scholar PubMed PubMed Central

30. Mamun, AA. Associations of gestational weight gain with offspring body mass index and blood pressure at 21 years of age: evidence from a birth cohort study. Circulation 2009;119:1720–7. in Google Scholar PubMed

31. Celi, F. Epidemiology of overweight and obesity among school children and adolescents in three provinces of central Italy, 1993-2001: study of potential influencing variables. Eur J Clin Nutr 2003;57:1045–51. in Google Scholar PubMed

32. Hyatt, MA. Maternal parity and its effect on adipose tissue deposition and endocrine sensitivity in the postnatal sheep. J Endocrinol 2010;204:173–9. in Google Scholar

Supplementary Material

The online version of this article offers supplementary material (

Received: 2020-12-31
Accepted: 2021-10-05
Published Online: 2021-10-26
Published in Print: 2022-02-23

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 27.1.2023 from
Scroll Up Arrow