Effects of Maternal Prepregnancy Nutritional Status on Pregnancy Outcomes
This article is part of Special Issue:
Yejuan Jiang,
Xue Wang,
Lilong Wu,
Xiaoge Huang,
Xingru Cao,
Yejuan Jiang
Department of Obstetrics and Gynecology , The Affiliated Yixing Hospital of Jiangsu University , Yixing , Jiangsu, China , ujs.edu.cn
Search for more papers by this authorXue Wang
Department of Obstetrics and Gynecology , Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University , Jinan , Shandong, China
Search for more papers by this authorLilong Wu
Department of Obstetrics and Gynecology , Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University , Jinan , Shandong, China
Search for more papers by this authorXiaoge Huang
Department of Obstetrics and Gynecology , Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University , Jinan , Shandong, China
Search for more papers by this authorCorresponding Author
Xingru Cao
Department of Obstetrics and Gynecology , Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University , Jinan , Shandong, China
Search for more papers by this authorYejuan Jiang,
Xue Wang,
Lilong Wu,
Xiaoge Huang,
Xingru Cao,
Yejuan Jiang
Department of Obstetrics and Gynecology , The Affiliated Yixing Hospital of Jiangsu University , Yixing , Jiangsu, China , ujs.edu.cn
Search for more papers by this authorXue Wang
Department of Obstetrics and Gynecology , Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University , Jinan , Shandong, China
Search for more papers by this authorLilong Wu
Department of Obstetrics and Gynecology , Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University , Jinan , Shandong, China
Search for more papers by this authorXiaoge Huang
Department of Obstetrics and Gynecology , Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University , Jinan , Shandong, China
Search for more papers by this authorCorresponding Author
Xingru Cao
Department of Obstetrics and Gynecology , Jinan Maternity and Child Care Hospital Affiliated to Shandong First Medical University , Jinan , Shandong, China
Search for more papers by this authorFirst published: 30 May 2025
Academic Editor: Jincheng Wang
Abstract
Background: The influence of prepregnancy body mass index (BMI) and dietary patterns on pregnancy outcomes remains unclear. This study examines the sociodemographic factors affecting the prepregnancy BMI and dietary health, as well as their impact on maternal and neonatal complications.
Methods: A total of 1064 women were enrolled at the Jinan Maternal and Child Health Hospital (Shandong, China) from January 2021 to December 2023. The China pregnancy healthy diet index (CHDI-P) was used to assess dietary health. Regression analyses were conducted to evaluate the relationship between sociodemographic characteristics, the BMI, CHDI-P scores, and adverse pregnancy outcomes.
Results: Higher education and moderate income were protective factors for maintaining a normal BMI, while older maternal age was linked to dietary patterns. Prepregnancy obesity significantly increased the risk of gestational diabetes and hypertension, while overweight and obesity were associated with a lower risk of small-for-gestational-age (SGA) births. Additionally, suboptimal dietary patterns were linked to a higher risk of large-for-gestational-age (LGA) infants and macrosomia.
Conclusion: Prepregnancy overweight, obesity, and unhealthy dietary patterns contribute to adverse pregnancy outcomes, including gestational diabetes, hypertension, LGA, and macrosomia. These findings highlight the importance of weight management and nutritional guidance before and during pregnancy, particularly for women with lower educational attainment.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
- 1 Ikedionwu C. A., Dongarwar D., Yusuf K. K., Ibrahimi S., Salinas-Miranda A. A., and Salihu H. M., Pre-Pregnancy Maternal Obesity, Macrosomia, and Risk of Stillbirth: A Population-Based Study, European Journal of Obstetrics & Gynecology and Reproductive Biology. (2020) 252, 1–6, https://doi.org/10.1016/j.ejogrb.2020.06.004.
- 2 Nilsen R. M., Strandberg R. B., Yaya Y. et al., Pre-Pregnancy Obesity Among Immigrant and Non-Immigrant Women in Norway: Prevalence, Trends, and Subgroup Variations, Acta Obstetricia et Gynecologica Scandinavica. (2024) 103, no. 10, 2081–2091, https://doi.org/10.1111/aogs.14923.
- 3 Wang Y., Ma H., Feng Y. et al., Association Among Pre-Pregnancy Body Mass Index, Gestational Weight Gain and Neonatal Birth Weight: A Prospective Cohort Study in China, BMC Pregnancy and Childbirth. (2020) 20, no. 1, https://doi.org/10.1186/s12884-020-03323-x.
- 4 Lagiou P., Tamimi R. M., Mucci L. A., Adami H.-O., Hsieh C.-C., and Trichopoulos D., Diet During Pregnancy in Relation to Maternal Weight Gain and Birth Size, European Journal of Clinical Nutrition. (2004) 58, no. 2, 231–237, https://doi.org/10.1038/sj.ejcn.1601771, 2-s2.0-1342332341.
- 5
Reyes-López M. A.,
González-Leyva C. P.,
Rodríguez-Cano A. M. et al., Diet Quality is Associated With a High Newborn Size and Reduction in the Risk of Low Birth Weight and Small for Gestational Age in a Group of Mexican Pregnant Women: An Observational Study, Nutrients. (2021) 13, no. 6, https://doi.org/10.3390/nu13061853.
10.3390/nu13061853 Google Scholar
- 6 Starling A. P., Sauder K. A., Kaar J. L., Shapiro A. L., Siega-Riz A. M., and Dabelea D., Maternal Dietary Patterns During Pregnancy are Associated With Newborn Body Composition, The Journal of Nutrition. (2017) 147, no. 7, 1334–1339, https://doi.org/10.3945/jn/117.248948.
- 7 Bhowmik B., Siddique T., Majumder A. et al., Maternal BMI and Nutritional Status in Early Pregnancy and its Impact on Neonatal Outcomes at Birth in Bangladesh, BMC Pregnancy and Childbirth. (2019) 19, no. 1, https://doi.org/10.1186/s12884-019-2571-5.
- 8 Young M. F., Nguyen P. H., Addo O. Y. et al., The Relative Influence of Maternal Nutritional Status Before and During Pregnancy on Birth Outcomes in Vietnam, European Journal of Obstetrics & Gynecology and Reproductive Biology. (2015) 194, 223–227, https://doi.org/10.1016/j.ejogrb.2015.09.018, 2-s2.0-84945913345.
- 9
Delgado Y.,
Gaytan C.,
Perez N.,
Miranda E.,
Morales B. C., and
Santos M., Association of Congenital Heart Defects (CHD) With Factors Related to Maternal Health and Pregnancy in Newborns in Puerto Rico, CHD. (2024) 19, no. 1, 19–31, https://doi.org/10.32604/chd.2024.046339.
10.32604/chd.2024.046339 Google Scholar
- 10 Bianchi C., de Gennaro G., Romano M. et al., Pre-Pregnancy Obesity, Gestational Diabetes or Gestational Weight Gain: Which is the Strongest Predictor of Pregnancy Outcomes?, Diabetes Research and Clinical Practice. (2018) 144, 286–293, https://doi.org/10.1016/j.diabres.2018.08.019, 2-s2.0-85054021374.
- 11 González-Plaza E., Bellart J., Martínez-Verdú M. Á., Arranz Á., Luján-Barroso L., and Seguranyes G., Pre-Pregnancy Overweight and Obesity Prevalence and Relation to Maternal and Perinatal Outcomes, Enfermería Clínica (English Edition). (2022) 32, S23–S30, https://doi.org/10.1016/j.enfcle.2021.04.006.
- 12
Lewandowska M.,
Więckowska B., and
Sajdak S., Pre-Pregnancy Obesity, Excessive Gestational Weight Gain, and the Risk of Pregnancy-Induced Hypertension and Gestational Diabetes Mellitus, Journal of Clinical Medicine. (2020) 9, no. 6, https://doi.org/10.3390/jcm9061980.
10.3390/jcm9061980 Google Scholar
- 13 Liu C., Liu C.-C., and Sones L., Reversal of Maternal Obesity Attenuates Hypoxia and Improves Placental Development in the Preeclamptic-Like BPH/5 Mouse Model, Biocell. (2023) 47, no. 9, 2051–2058, https://doi.org/10.32604/biocell.2023.029644.
- 14 Han Z., Mulla S., Beyene J., Liao G., McDonald S. D., and On Behalf of the Knowledge Synthesis Group, Maternal Underweight and the Risk of Preterm Birth and Low Birth Weight: a Systematic Review and Meta-Analyses, International Journal of Epidemiology. (2011) 40, no. 1, 65–101, https://doi.org/10.1093/ije/dyq195, 2-s2.0-79952049834.
- 15 Khanam R., Lee A. C., Mitra D. K. et al., Maternal Short Stature and Under-Weight Status are Independent Risk Factors for Preterm Birth and Small for Gestational Age in Rural Bangladesh, European Journal of Clinical Nutrition. (2019) 73, no. 5, 733–742, https://doi.org/10.1038/s41430-018-0237-4, 2-s2.0-85048884666.
- 16
Lefizelier E.,
Misbert E.,
Brooks M.,
Le Thuaut A.,
Winer N., and
Ducarme G., Preterm Birth and Small-for-Gestational Age Neonates Among Prepregnancy Underweight Women: A Case-Controlled Study, Journal of Clinical Medicine. (2021) 10, no. 24, https://doi.org/10.3390/jcm10245733.
10.3390/jcm10245733 Google Scholar
- 17
Bhattacharya S.,
Campbell D. M.,
Liston W. A., and
Bhattacharya S., Effect of Body Mass Index on Pregnancy Outcomes in Nulliparous Women Delivering Singleton Babies, BMC Public Health. (2007) 7, no. 1, https://doi.org/10.1186/1471-2458-7-168, 2-s2.0-34547660216.
10.1186/1471-2458-7-168 Google Scholar
- 18
Khan M. N.,
Rahman M.,
Shariff A. A.,
Rahman M.,
Rahman M. S., and
Rahman M. A., Maternal Undernutrition and Excessive Body Weight and Risk of Birth and Health Outcomes, Archives of Public Health. (2017) 75, no. 1, https://doi.org/10.1186/s13690-017-0181-0, 2-s2.0-85011391093.
10.1186/s13690-017-0181-0 Google Scholar
- 19 Bonakdar S. A., Dorosty Motlagh A. R., Bagherniya M. et al., Pre-Pregnancy Body Mass Index and Maternal Nutrition in Relation to Infant Birth Size, Clinical Nutrition Research. (2019) 8, no. 2, 129–137, https://doi.org/10.7762/cnr.2019.8.2.129.
- 20 Mahanta L. B., Choudhury M., Devi A., and Bhattacharya A., On the Study of Pre-Pregnancy Body Mass Index (BMI) and Weight Gain as Indicators of Nutritional Status of Pregnant Women Belonging to Low Socio-Economic Category: A Study from Assam, Indian Journal of Community Medicine. (2015) 40, no. 3, 198–202, https://doi.org/10.4103/0970-0218.158870, 2-s2.0-84934273177.
- 21
Uno K.,
Takemi Y.,
Hayashi F., and
Hosokawa M., Nutritional Status and Dietary Intake Among Pregnant Women in Relation to Pre-Pregnancy Body Mass Index in Japan, Nihon Koshu Eisei Zasshi. (2016) 63, no. 12, 738–749, https://doi.org/10.11236/jph.63.12_738, 2-s2.0-85043378725.
10.11236/jph.63.12_738 Google Scholar
- 22 Yang M., Feng Q., Chen C. et al., Healthier Diet Associated With Reduced Risk of Excessive Gestational Weight Gain: A Chinese Prospective Cohort Study, Maternal and Child Nutrition. (2023) 19, no. 3, https://doi.org/10.1111/mcn.13397.
- 23
Zhang J.,
Wang X.,
Zhu P.,
Huang X.,
Cao X., and
Li J., Exploring the Relationships Between Pre-Pregnancy BMI, Gestational Weight Gain, and Nutritional Intake: a Real-World Investigation in Shandong, China, PeerJ. (2024) 12, https://doi.org/10.7717/peerj.17099.
10.7717/peerj.17099 Google Scholar
- 24 Doherty D. A., Magann E. F., Francis J., Morrison J. C., and Newnham J. P., Pre-Pregnancy Body Mass Index and Pregnancy Outcomes, International Journal of Gynecology & Obstetrics. (2006) 95, no. 3, 242–247, https://doi.org/10.1016/j.ijgo.2006.06.021, 2-s2.0-33750841527.
- 25 Who Expert Consultation, Appropriate Body-Mass Index for Asian Populations and its Implications for Policy and Intervention Strategies, Lancet (London, England). (2004) 363, no. 9403, 157–163, https://doi.org/10.1016/S0140-6736(03)15268-3, 2-s2.0-85066456886.
- 26 Yang Y. X., Wang X. L., Leong P. M. et al., New Chinese Dietary Guidelines: Healthy Eating Patterns and Food-Based Dietary Recommendations, Asia Pacific Journal of Clinical Nutrition. (2018) 27, no. 4, 908–913, https://doi.org/10.6133/apjcn.072018.03, 2-s2.0-85050828186.
- 27
Garovic V. D.,
Dechend R.,
Easterling T. et al., Hypertension in Pregnancy: Diagnosis, Blood Pressure Goals, and Pharmacotherapy: A Scientific Statement from the American Heart Association, Hypertension, 79, no. 2, e21–e41, https://doi.org/10.1161/HYP.0000000000000208.
10.1161/HYP.0000000000000208 Google Scholar
- 28 Cosson E., Vicaut E., Sandre-Banon D. et al., Performance of a Selective Screening Strategy for Diagnosis of Hyperglycaemia in Pregnancy as Defined by IADPSG/WHO Criteria, Diabetes & Metabolism. (2020) 46, no. 4, 311–318, https://doi.org/10.1016/j.diabet.2019.09.002.
- 29 Ghafoor S., Current and Emerging Strategies for Prediction and Diagnosis of Prelabour Rupture of the Membranes: A Narrative Review, MJMS. (2021) 28, no. 3, 5–17, https://doi.org/10.21315/mjms2021.28.3.2.
- 30 Peace J. M. and Banayan J. M., Anemia in Pregnancy: Pathophysiology, Diagnosis, and Treatment, International Anesthesiology Clinics. (2021) 59, no. 3, 15–21, https://doi.org/10.1097/AIA.0000000000000320.
- 31 Black R. E., Victora C. G., Walker S. P. et al., Maternal and Child Undernutrition and Overweight in Low-Income and Middle-Income Countries, The Lancet. (2013) 382, no. 9890, 427–451, https://doi.org/10.1016/S0140-6736(13)60937-X, 2-s2.0-84881182352.
- 32 Gaillard R., Durmuş B., Hofman A., Mackenbach J. P., Steegers E. A. P., and Jaddoe V. W. V., Risk Factors and Outcomes of Maternal Obesity and Excessive Weight Gain during Pregnancy, Obesity. (2013) 21, no. 5, 1046–1055, https://doi.org/10.1002/oby.20088, 2-s2.0-84879398102.
- 33 Kramer M. S., Séguin L., Lydon J., and Goulet L., Socio-Economic Disparities in Pregnancy Outcome: Why Do the Poor Fare So Poorly?, Paediatric & Perinatal Epidemiology. (2000) 14, no. 3, 194–210, https://doi.org/10.1046/j.1365-3016.2000.00266.x, 2-s2.0-0033898243.
- 34 Jwa S. C., Fujiwara T., Hata A., Arata N., Sago H., and Ohya Y., BMI Mediates the Association between Low Educational Level and Higher Blood Pressure During Pregnancy in Japan, BMC Public Health. (2013) 13, no. 1, https://doi.org/10.1186/1471-2458-13-389, 2-s2.0-84876957930.
- 35 Emond J. A., Karagas M. R., Baker E. R., and Gilbert-Diamond D., Better Diet Quality During Pregnancy is Associated With a Reduced Likelihood of an Infant Born Small for Gestational Age: An Analysis of the Prospective New Hampshire Birth Cohort Study, The Journal of Nutrition. (2018) 148, no. 1, 22–30, https://doi.org/10.1093/jn/nxx005, 2-s2.0-85044505779.
- 36 Liu X. and Zhang W., Effect of Maternal Age on Pregnancy: a Retrospective Cohort Study, Chinese Medical Journal. (2014) 127, no. 12, 2241–2246, https://doi.org/10.3760/cma.j.issn.0366-6999.20133118, 2-s2.0-84902500211.
- 37 Londero A. P., Rossetti E., Pittini C., Cagnacci A., and Driul L., Maternal Age and the Risk of Adverse Pregnancy Outcomes: a Retrospective Cohort Study, BMC Pregnancy and Childbirth. (2019) 19, no. 1, https://doi.org/10.1186/s12884-019-2400-x, 2-s2.0-85069789411.
- 38 Segura J. and Ruilope L. M., Obesity, Essential Hypertension and Renin–Angiotensin System, Public Health Nutrition. (2007) 10, no. 10A, 1151–1155, https://doi.org/10.1017/S136898000700064X, 2-s2.0-36049008829.
- 39 Shams E., Kamalumpundi V., Peterson J., Gismondi R. A., Oigman W., and de Gusmão Correia M. L., Highlights of Mechanisms and Treatment of Obesity-Related Hypertension, Journal of Human Hypertension. (2022) 36, no. 9, 785–793, https://doi.org/10.1038/s41371-021-00644-y.
- 40 Eid S., Sas K. M., Abcouwer S. F. et al., New Insights into the Mechanisms of Diabetic Complications: Role of Lipids and Lipid Metabolism, Diabetologia. (2019) 62, no. 9, 1539–1549, https://doi.org/10.1007/s00125-019-4959-1, 2-s2.0-85069682431.
- 41 Bogaerts A., Ameye L., Martens E., and Devlieger R., Weight Loss in Obese Pregnant Women and Risk for Adverse Perinatal Outcomes, Obstetrics & Gynecology. (2015) 125, no. 3, 566–575, https://doi.org/10.1097/AOG.0000000000000677, 2-s2.0-84923595202.
- 42 Cedergren M., Effects of Gestational Weight Gain and Body Mass Index on Obstetric Outcome in Sweden, International Journal of Gynecology & Obstetrics. (2006) 93, no. 3, 269–274, https://doi.org/10.1016/j.ijgo.2006.03.002, 2-s2.0-33747067717.
- 43
Sun Y.,
Shen Z.,
Zhan Y. et al., Effects of Pre-Pregnancy Body Mass Index and Gestational Weight Gain on Maternal and Infant Complications, BMC Pregnancy and Childbirth. (2020) 20, no. 1, https://doi.org/10.1186/s12884-020-03071-y.
10.1186/s12884-020-03071-y Google Scholar
- 44 Simas T. A. M., Waring M. E., Liao X. et al., Prepregnancy Weight, Gestational Weight Gain, and Risk of Growth Affected Neonates, Journal of Women’s Health. (2012) 21, no. 4, 410–417, https://doi.org/10.1089/jwh.2011.2810, 2-s2.0-84859837208.
- 45 Yancey L. M., Withers E., Bakes K., and Abbott J., Postpartum Preeclampsia: Emergency Department Presentation and Management, Journal of Emergency Medicine. (2011) 40, no. 4, 380–384, https://doi.org/10.1016/j.jemermed.2008.02.056, 2-s2.0-79954630139.
- 46 Abdelwahab M. F., Frey H. A., Lynch C. D., Klebanoff M. A., Thung S. F., Costantine M. M., Landon M. B., and Venkatesh K. K., Association between Diabetes in Pregnancy and Shoulder Dystocia by Infant Birth Weight in an Era of Cesarean Delivery for Suspected Macrosomia, American Journal of Perinatology. (2023) 40, no. 9, 929–936, https://doi.org/10.1055/s-0043-1764206.
- 47 Nasrullah A., Herrera M., Garbinski A., DuMont T., and Alhajhusain A., Medical Emergencies in the Pregnant Patient, Critical Care Nursing Quarterly. (2023) 46, no. 4, 403–416, https://doi.org/10.1097/CNQ.0000000000000476.
- 48 Kibret K. T., Chojenta C., Gresham E., Tegegne T. K., and Loxton D., Maternal Dietary Patterns and Risk of Adverse Pregnancy (Hypertensive Disorders of Pregnancy and Gestational Diabetes Mellitus) and Birth (Preterm Birth and Low Birth Weight) Outcomes: A Systematic Review and Meta-Analysis, Public Health Nutrition. (2019) 22, no. 3, 506–520, https://doi.org/10.1017/S1368980018002616, 2-s2.0-85054974180.
- 49
Lindsay K. L.,
Buss C.,
Wadhwa P. D., and
Entringer S., The Effect of a Maternal Mediterranean Diet in Pregnancy on Insulin Resistance is Moderated by Maternal Negative Affect, Nutrients. (2020) 12, no. 2, https://doi.org/10.3390/nu12020420.
10.3390/nu12020420 Google Scholar
