Acta Obstetricia et Gynecologica.

2006; 85: 269
/276

ORIGINAL ARTICLE

Impact of prepregnant body mass index and maternal weight gain on

the risk of pregnancy complications in Japanese women

KOYA WATABA, TAKAHIRO MIZUTANI, KENSHI WASADA, MIKIO MORINE,

TAKASHI SUGIYAMA & NORIYUKI SUEHARA
Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan

Abstract
Background. To analyze the association of pregnancy complications with prepregnant body mass index and weight gain
during pregnancy in Japanese women. Methods. A retrospective cohort study was conducted with 21,718 Japanese women
with a singleton pregnancy. Pregnant women were grouped by prepregnant body mass index and evaluated for association
with pregnancy complications using multivariate logistic regression analysis. The women in each body mass index group
were then divided into groups by weight gain during pregnancy using intervals of 0.05 kg/week to analyze the relationship
between the weight gain and pregnancy complications by multivariate logistic regression association analysis. Results. In
both nulliparous and parous women, the least pregnancy complications were found among women with medium
prepregnant body mass indexes (18
/23.9). Significant risks of pregnancy complications were associated with low (B/18) and
high (]/24) prepregnant body mass indexes, particularly high prepregnant body mass indexes. In nulliparous women, the
optimal weight gain was 0.25
/0.4 kg/week for low (B/18) prepregnant body mass index, 0.20
/0.30 kg/week for medium
(18
/23.9) prepregnant body mass index, and ]/0.05 kg/week for high (]/24) prepregnant body mass index. In parous
women, the corresponding values were ]/0.20, 0.20
/0.30, and 0.05
/0.30 kg/week. Conclusions. Japanese women with
prepregnant body mass indexes from 18 to 23.9 are least associated with pregnancy complications, although there is a broad
range of prepregnant body mass indexes associated with few pregnancy complications. Optimal weight gain is roughly
inversely related to prepregnant body mass index.

Key words: Prepregnant BMI, pregnancy complication, weight gain

Abbreviations: BMI: body mass index, SGA: small-for-gestational-age infants, LGA: large-for-gestational-age infants,
NICU: neonatal intensive care unit

It has been reported that lean prepregnant women

have an increased risk of delivering small-for-gestational-age infants (SGA) (1,2), while prepregnant
obesity is associated with gestational diabetes, preeclampsia, eclampsia, cesarean delivery, labor complications, and macrosomia (3
/6). Excessive weight
gain during pregnancy has also been reported to be
associated with an increased risk of pre-eclampsia,
gestational diabetes, and other complications (6
/
10). Therefore, attempts have been made to categorize prepregnant body mass index (BMI) (3,11)
and maternal weight gain in relation to the risk
of pregnancy complications and adverse birth

outcomes (6,8,9). However, these studies have so

far been mostly on Caucasian women and little
information is available on Japanese women. In this
study, we addressed the issue of pregnancy complications in relation to prepregnant BMI and weight
gain during pregnancy among Japanese women in a
retrospective cohort study.
Material and methods
Subjects and database
We conducted a retrospective cohort study with
21,718 women with a singleton pregnancy who

Correspondence: Takahiro Mizutani, Department of Obstetrics and Gynecology, Mizuho Ladies Clinic, 5-72 Mizuho-cho, Itami, Hyogo 664-0013, Japan.
E-mail: ta000ka@mb1.kisweb.ne.jp

Received 19 May 2005; accepted 30 November 2005

ISSN 0001-6349 print/ISSN 1600-0412 online # 2006 Taylor & Francis
DOI: 10.1080/00016340500502044

270

K. Wataba et al.

delivered the baby at term in Osaka Medical

Center and Research Institute for Maternal and
Child Health in 1981
/1999. All pregnancies and
deliveries were registered in the hospital database,
which carried demographic characteristics, and
antepartum, intrapartum and neonatal complications, filled out prospectively. Demographic characteristics included prepregnant BMI, age, weight
gain during pregnancy, and gestational age at
delivery. Antepartum complications included preeclampsia and severe pre-eclampsia. Intrapartum
complications included blood loss of more than
1,000 ml at delivery, vacuum extraction, elective
cesarean delivery (cesarean delivery), and emergent
cesarean delivery. Neonatal complications included
SGA, large-for-gestational-age infants (LGA), 1-min
Apgar B/4, 1-min Apgar score B/7, and neonatal
intensive care unit (NICU) admission. Pre-eclampsia was diagnosed by blood pressure of ]/140/
90 mmHg or a sustained rise (]/30 mmHg in systolic blood pressure and 15 mmHg in diastolic
blood pressure) or proteinuria of ]/300 mg per
24 h after the 20th week of gestation. Severe
pre-eclampsia was diagnosed by systolic blood pressure of ]/160 mmHg, diastolic blood pressure of
]/110 mmHg, or proteinuria of ]/5 g per 24 h. SGA
and LGA were defined as infants whose birth
weights were below and above the tenth percentile
of birth weights of infants of the same sex delivered
at the same gestational age, respectively. The weight
gain during pregnancy (kg/week) was calculated by
dividing the difference between body weight at
delivery and prepregnant body weight by the number
of gestational weeks at delivery.

Methods
First, we performed multivariate logistic regression
analysis for the association of prepregnant BMIs
with antepartum, intrapartum, or neonatal complications among nulliparous and parous women.
Second, we divided women into groups by an
increase in prepregnant BMI of 2 kg/m2, and analyzed each group for the association with specific
pregnancy complications identified in the above
analysis using multivariate logistic regression analysis with dummy variable. Relative risks of complications of various prepregnant BMI groups were
evaluated using an adjusted odds ratio (OR). An
association was considered significant when statistic
analysis showed a p value less than 0.05 and OR was
more than 1.5. Third, we analyzed women with
low (B/18), medium (18
/23.9), and high ( ]/24)
prepregnant BMIs for an association of weight gain
during pregnancy with antepartum, intrapartum, or

neonatal complications using multivariate logistic

regression analysis. Each prepregnant BMI group
was then analyzed for an association between weight
gain of 0.05 kg/week and specific pregnancy complications associated with maternal weight gain
using multivariate logistic regression analysis with
dummy variable.

Statistical analysis
The statistical analysis was performed using Stat
Flex (Version 5) and a p value less than 0.05 was
regarded as significant.
Results
Table I presents maternal and neonatal demographic
and outcome data for the 21,718 Japanese women.
A significant difference between nulliparous and
parous women was observed in a number of demographic variables, including not only prepregnant
BMI, age, weight gain during pregnancy, and gestational age, but also many pregnancy complications
like pre-eclampsia, blood loss of more than 1,000 ml
at delivery, vacuum extraction, cesarean delivery,
emergent cesarean delivery, SGA, and 1-min Apgar
score B/4.
Then the association of prepregnant BMI with
antepartum, intrapartum, and neonatal complications among women with various prepregnant BMIs
was evaluated using multivariate logistic regression
analysis in both nulliparous and parous women
(data not shown). In nulliparous women, high
prepregnant BMIs showed significant association
with a number of complications, including preeclampsia, blood loss at delivery of more than
1,000 ml, cesarean delivery, emergent cesarean
delivery, LGA, and 1-min Apgar score B/7. On the
other hand, low prepregnant BMIs were significantly
associated with SGA. Similarly, in parous women,
high prepregnant BMIs were associated with preeclampsia, severe pre-eclampsia, blood loss at
delivery of more than 1,000 ml, cesarean delivery,
LGA, 1-min Apgar B/4 and 7, and NICU admission, whereas low prepregnant BMIs showed significant association with SGA.
We divided the women into 7 groups by prepregnant BMI and examined each BMI group for an
association with pregnancy complications listed
above (Table II). Nulliparous women with prepregnant BMIs 18
/19.9, 20
/21.9, and 22
/23.9 showed
the least association with pregnancy complications.
On the other hand, prepregnant BMI B/18 was
associated with only SGA, while prepregnant
BMI ]/24 was associated with pre-eclampsia, blood

BMI and optimal weight gain 271

Table I. Demographic characteristics and complications between nulliparous and parous women (1981
/1999)

Demographic characteristics
Prepregnant BMI (kg/m2, mean 9/SD)
Age (y, mean 9/SD)
Weight gain (kg/wk, mean 9/SD)
Gestational age (wk, mean 9/SD)
Preeclampsia
Severe preeclampsia
Blood loss/1000 ml at delivery
Vacuum extraction
Cesarean delivery
Emergent cesarean delivery
SGA
LGA
1-min Apgar score B/4
1-min Apgar score B/7
NICU admission

Nulliparaous
(n/10413)
20.59/2.6
27.89/4.1
0.259/0.09
39.89/1.2
415 (4.0)
59 (0.6)
63 (0.6)
552 (5.3)
1409 (13.5)
776 (7.5)
560 (5.4)
537 (5.2)
122 (1.2)
99 (1.0)
271 (2.6)

Parous women
(n /11305)

21.19/3.0
30.459/3.9
0.249/0.09
39.39/1.2
259 (2.3)
47 (0.4)
120 (1.1)
175 (1.5)
2342 (20.7)
428 (3.8)
729 (6.5)
584 (5.2)
187 (1.7)
83 (0.7)
284 (2.5)

B/.01
B/.01
B/.01
B/.01
B/.01
NS
B/.01
B/.01
B/.01
B/.01
B/.01
NS
B/.01
NS
NS

NS/not significant; SD /standard deviation; SGA/small-for-gestational-age infants; LGA/large-for-gestational-age infants; NICU/

neonatal intensive care unit.
Data are presented as n (%).

loss of more than 1,000 ml at delivery, cesarean

delivery, emergent cesarean delivery, and LGA.
Similar results were obtained with parous women.
Next, we classified the women into three prepregnant BMI groups, low (B/18), medium (18
/23.9),
and high ( ]/24), and examined whether weight gains
were associated with pregnancy and neonatal complications in each group using multivariate logistic
regression analysis (data not shown). Among nulliparous women, the low prepregnant BMI group
showed significant association between weight
gain during pregnancy and pre-eclampsia, cesarean
delivery, SGA, LGA, and 1-min Apgar score B/4. In
the medium prepregnant BMI group, weight gain
during pregnancy was associated with pre-eclampsia,
severe pre-eclampsia, cesarean delivery, SGA, and
LGA. In the high prepregnant BMI group, weight
gain during pregnancy was associated with preeclampsia, emergent cesarean delivery, SGA, and
NICU admission. Among parous women, weight
gain during pregnancy showed significant association with SGA and LGA in the low prepregnant BMI group; with cesarean delivery, SGA,
LGA, 1-min Apgar score B/4, and NICU admission
in the medium prepregnant BMI group; and with
pre-eclampsia, severe pre-eclampsia, SGA, LGA,
and 1-min Apgar score B/4 in the high prepregnant
BMI group.
Each prepregnant BMI group was classified by
weight gain of 0.05 kg/week and examined for the
association with pregnancy complications listed
above. In the case of nulliparous women, few
complications were associated with weight gains of
0.25
/0.40 kg/week in the low prepregnant BMI

group, 0.20
/0.30 kg/week weight gain in the medium prepregnant BMI group, and ]/0.05 kg/week
weight gain in the high prepregnant BMI group
(Table III). In the case of parous women, increases
]/0.20 kg/week in the low prepregnant BMI group,
0.20
/0.30 kg/week in the medium prepregnant
BMI group, and 0.05
/0.30 kg/week in the high
prepregnant BMI group were considered as low-risk
weight gains (Table IV).
Discussion
This is the first analysis of prepregnant BMI and
weight gain during pregnancy in relation to pregnancy complications and adverse neonatal outcomes
among Japanese women. We found that the incidence of antepartum, intrapartum, and neonatal
complications varied depending on prepregnant
BMI among both nulliparous and parous women.
Similar associations have been reported with nonJapanese women (1,2,6
/8,12
/19).
As there were significant differences between
nulliparous and parous women in prepregnant
BMI, age, weight gain during pregnancy, gestational
age, and frequency of complications, these two
groups of women were separately analyzed in the
following study.
We found that women with prepregnant BMI 18
/
23.9 showed few associations with pregnancy complications studied. Women with prepregnant BMI
B/18 were associated with SGA in both nulliparous
and parous groups. Women with prepregnant BMI
]/24 were associated with pre-eclampsia, blood loss
of more than 1,000 ml at delivery, cesarean delivery,

272
K. Wataba et al.

Table II. Adjusted odds ratios for selected complications associated with prepregnant BMI among nulliparous and parous women
BMI

Nulliparous women
Complication
Preeclampsia
Blood loss/1000 ml at delivery
Cesarean delivery
Emergent cesarean delivery
SGA
LGA
1-min Apgar score B/7
Parous women
Complication
Preeclampsia
Severe preeclampsia
Blood loss/1000 ml at delivery
Cesarean delivery
SGA
LGA
1-min Apgar score B/4
1-min Apgar score B/7
NICU admission

B/18

18
/19.9

20
/21.9

22
/23.9

24
/25.9

26
/27.9

28/

(n /1292)

(n /3849)

(n/3123)

(n/1317)

(n/472)

(n /167)

(n/193)

0.50
0.76
0.72
0.78
1.71
0.39
1.02

(0.32
/0.77)
(0.55
/1.13)
(0.56
/1.08)
(0.56
/1.03)
(1.30
/ 2.26)
(0.27
/0.57)
(0.53
/1.96)

(n /1067)

0.26
0.87
0.88
0.79
2.48
0.39
1.13
0.97
0.93

(0.10
/0.59)
(0.24
/3.14)
(0.66
/1.17)
(0.57
/1.11)
(1.94
/ 3.16)
(0.25
/0.61)
(0.51
/2.39)
(0.51
/1.84)
(0.61
/1.43)

Data are presented as odds ratio (95% confidence interval).

Underlined data: pB/0.05 and odds ratio /1.5.
*:pB/0.05 and odds ratio B/1.5.

0.56
0.86
0.78
0.77
1.33
0.77
0.69

(0.42
/0.75)
(0.70
/1.07)
(0.67
/0.90)
(0.63
/0.93)
(1.07
/1.67)*
(0.66
/0.91)
(0.53
/0.92)

(n /3461)

0.56
0.92
1.02
1.05
1.18
0.59
1.28
1.84
0.76

(0.38
/0.82)
(0.39
/2.20)
(0.85
/1.23)
(0.81
/1.35)
(0.97
/1.43)
(0.46
/0.77)
(0.82
/1.99)
(0.99
/3.74)
(0.55
/1.06)

1.00
1.00
1.00
1.00
1.00
1.00
1.00
(n/3521)

1.00
1.00
1.00
1.00
1.00
1.00
1.00
1.00
1.00

1.14
1.15
1.28
1.12
0.87
1.14
1.16

(0.82
/1.60)
(0.89
/1.48)
(1.07
/1.53)*
(0.90
/1.42)
(0.63
/1.21)
(0.93
/1.40)
(0.84
/1.61)

2.16
1.55
1.54
1.20
1.05
1.09
1.12

(n/1829)

1.21
2.13
1.27
1.29
0.61
1.16
1.58
2.08
0.64

(0.83
/1.74)
(0.91
/4.98)
(1.03
/1.56)*
(0.98
/1.77)
(0.47
/0.81)
(0.89
/1.54)
(0.97
/2.57)
(0.92
/4.69)
(0.41
/1.01)

(1.45
/ 3.22)
(1.10
/ 2.18)
(1.20
/ 1.99)
(0.86
/1.68)
(0.67
/1.65)
(0.80
/1.48)
(0.70
/1.79)

2.59
2.66
2.97
1.82
0.86
2.10
0.70

(1.35
/ 3.22)
(0.56
/6.01)
(1.07
/1.89)*
(1.00
/2.13)*
(0.27
/0.64)
(1.35
/ 2.59)
(1.39
/ 4.45)
(2.37
/ 12.42)
(0.42
/1.41)

5.74
1.60
3.65
3.98
0.80
1.79
1.67

(n /337)

(n/717)

2.08
1.85
1.42
1.46
0.42
1.87
2.49
5.43
0.77

(1.41
/ 4.74)
(1.70
/ 4.14)
(2.09
/ 4.23)
(1.15
/ 2.90)
(0.41
/1.81)
(1.39
/ 3.17)
(0.30
/1.64)

2.96
3.78
1.26
1.46
0.35
3.77
3.58
3.92
2.49

(1.75
/ 5.01)
(1.19
/ 11.97)
(0.86
/1.85)
(0.98
/2.38)
(0.19
/0.64)
(2.58
/ 5.52)
(1.82
/ 7.02)
(1.29
/ 11.97)
(1.47
/ 4.23)

(3.58
/ 9.21)
(1.01
/ 2.53)
(2.46
/ 5.43)
(2.55
/ 6.42)
(0.41
/1.55)
(1.02
/ 3.14)
(0.93
/2.95)
(n/373)

4.74
2.22
1.95
2.59
0.26
5.09
3.85
6.67
1.77

(3.22
/ 7.00)
(0.61
/8.04)
(1.55
/ 2.99)
(1.15
/ 4.08)
(0.12
/0.48)
(3.18
/ 7.88)
(1.80
/ 8.70)
(3.16
/ 13.40)
(1.03
/ 3.05)

Table III. Adjusted odds ratios for selected complications associated with weight gain during pregnancy in each BMI group among nulliparous women
Weight gain (kg/w)

Low BMI Group

Complication
Preeclampsia
Cesarean delivery
SGA
LGA
1-min Apgar score B/4

1.06
0.49
6.20
0.76
12.24

B/0.15

0.15
/0.20

0.20
/0.25

0.25
/0.30

0.30
/0.35

0.35
/0.40

0.40/

(n /79)

(n/132)

(n/259)

(n/311)

(n /252)

(n/147)

(n/112)

(0.21
/5.46)
(0.17
/1.39)
(2.72
/ 14.09)
(0.25
/2.31)
(2.04
/ 73.43)

0.57
0.91
2.58
1.75
2.93

(0.11
/2.90)
(0.43
/1.89)
(1.14
/ 5.87)
(0.86
/3.56)
(0.45
/19.14)

0.84
0.86
2.46
1.36
2.49

(0.25
/2.80)
(0.46
/1.60)
(1.19
/ 5.08)
(0.73
/2.54)
(0.44
/14.2)

1.00
1.00
1.00
1.00
1.00

0.22
0.87
1.55
1.73
1.41

(0.03
/1.87)
(0.43
/1.74)
(0.67
/3.58)
(0.91
/3.28)
(0.19
/10.59)

2.72
1.10
1.03
1.26

(0.84
/8.74)
(0.48
/2.54)
(0.34
/3.12)
(0.53
/3.00)

/

3.45
2.30
2.02
2.25
1.18

(1.04
/ 11.50)
(1.06
/ 4.98)
(0.74
/5.52)
(1.03
/ 4.94)
(0.10
/14.24)

Weight gain (kg/w)

Medium BMI Group

Complication
Preeclampsia
Severe preeclampsia
Cesarean delivery
SGA
LGA

B/0.15

0.15
/0.20

0.20
/0.25

0.25
/0.30

0.30
/0.35

0.35
/0.40

0.40/

(n/753)

(n /1236)

(n/2051)

(n /2046)

(n/1222)

(n/588)

(n/393)

0.61
1.39
1.28
2.64
1.40

(0.35
/1.05)
(0.40
/4.99)
(0.98
/1.66)
(1.88
/ 3.71)
(0.86
/2.79)

0.46
2.01
0.86
1.60
1.16

(0.28
/0.78)
(0.69
/5.81)
(0.68
/1.10)
(1.15
/ 2.23)
(0.89
/1.51)

0.73
0.17
0.84
1.39
1.41

(0.49
/1.08)
(0.02
/1.42)
(0.68
/1.05)
(1.03
/1.87)*
(1.31
/1.76)*

1.00
1.00
1.00
1.00
1.00

1.17
1.98
1.10
0.96
1.76

(0.78
/1.74)
(0.66
/5.90)
(0.87
/1.39)
(0.66
/1.39)
(1.38
/ 2.23)

1.92
7.21
1.61
0.84
2.34

(1.24
/ 2.98)
(2.68
/ 19.40)
(1.21
/ 2.14)
(0.51
/1.37)
(1.77
/ 3.10)

3.53
9.58
1.68
0.34
2.58

(2.31
/ 5.39)
(3.44
/ 26.64)
(1.22
/ 2.30)
(0.16
/0.76)
(1.71
/ 3.89)

Weight gain (kg/w)

Complication
Preeclampsia
Emergent cesarean delivery
SGA
NICU admission

0.61
0.53
7.06
0.61

0.05
/0.10

0.10
/0.15

0.15
/0.20

0.20
/0.25

0.25
/0.30

0.30/

(n /67)

(n/84)

(n /87)

(n/134)

(n /153)

(n/112)

(n/195)

(0.21
/1.82)
(0.21
/1.29)
(2.11
/ 23.61)
(0.12
/3.13)

Data are presented as odds ratio (95% confidence interval).

Underlined data: pB/0.05 and the odds ratio /1.5.
*:pB/0.05 and the odds ratioB/1.5.

0.30 (0.08
/1.14)

0.58 (0.24
/1.40)
0.70 (0.13
/3.85)

/

0.21
0.83
1.51
1.18

(0.04
/1.01)
(0.37
/1.87)
(0.38
/6.03)
(0.30
/4.62)

1.00
1.00
1.00
1.00

0.82
0.94
2.03
0.31

(0.34
/1.98)
(0.47
/1.88)
(0.64
/6.43)
(0.06
/1.63)

1.54
1.05
2.03
1.34

(0.66
/3.58)
(0.50
/2.21)
(0.60
/6.86)
(0.40
/4.56)

1.82
1.13
0.56
1.61

(0.86
/3.89)
(0.58
/2.19)
(0.14
/2.26)
(0.53
/4.83)

BMI and optimal weight gain 273

High BMI Group

B/0.05

274

Weight gain (kg/w)

B/0.15

0.15
/0.20

0.20
/0.25

0.25
/0.30

0.30
/0.35

0.35
/0.40

0.40/

(n /69)

(n/114)

(n/245)

(n/268)

(n/202)

(n /100)

(n/69)

5.42 (2.86
/ 10.27)

/

2.78 (1.53
/ 5.06)

/

1.39 (0.82
/2.42)

0.35 (0.09
/1.31)

1.00
1.00

0.47 (0.22
/1.01)

0.65 (0.18
/2.01)

0.37 (0.12
/1.09)

1.37 (0.46
/4.69)

1.00 (0.41
/2.42)

2.16 (0.63
/7.44)

Low BMI Group

Complication
SGA
LGA

Weight gain (kg/w)

Medium BMI Group

Complication
Cesarean delivery
SGA
LGA
1-min Apgar score B/4
NICU admission

0.57
2.21
0.43
0.86
1.57

B/0.15

0.15
/0.20

0.20
/0.25

0.25
/0.30

0.30
/0.35

0.35
/0.40

0.40/

(n/857)

(n /1418)

(n/2201)

(n/2176)

(n/1340)

(n /544)

(n /275)

(0.34
/0.83)
(1.67
/ 2.93)
(0.26
/0.75)
(0.27
/2.52)
(0.96
/2.56)

1.01
1.68
0.68
0.76
1.32

(0.71
/1.44)
(1.23
/ 2.07)
(0.46
/1.01)
(0.38
/1.52)
(0.84
/2.10)

1.00
1.00
1.00
1.00
1.00

1.49
0.85
1.48
1.35
1.11

(1.09
/2.04)*
(0.65
/1.11)
(1.15
/2.33)*
(0.78
/2.34)
(0.72
/1.72)

1.21
0.71
1.64
1.41
1.29

(0.84
/1.74)
(0.51
/0.98)
(1.18
/ 2.27)
(0.76
/2.62)
(0.80
/2.08)

1.43
0.48
2.23
2.21
1.54

(0.89
/2.29)
(0.29
/0.81)
(1.51
/ 3.31)
(1.08
/ 4.53)
(0.84
/2.82)

1.34
0.34
3.94
2.26
1.79

(0.68
/2.65)
(0.15
/0.79)
(2.56
/ 6.03)
(0.96
/5.71)
(0.86
/3.74)

Weight gain (kg/w)

High BMI Group

Complication
Preeclampsia
Severe preeclampsia
SGA
LGA
1
/min Apgar score B/4

B/0.05

0.05
/0.10

0.10
/0.15

0.15
/0.20

0.20
/0.25

0.25
/0.30

0.30/

(n/155)

(n/147)

(n/240)

(n/287)

(n/252)

(n /185)

(n /161)

0.55 (0.23
/1.33)

/
2.82 (1.17
/ 6.78)
0.38 (0.18
/0.77)
0.55 (0.13
/2.18)

0.36 (0.12
/1.07)

/
1.17 (0.37
/3.29)
0.52 (0.27
/1.01)
0.71 (0.18
/2.75)

0.38 (0.16
/0.93)

5.14(0.56
/46.9)
1.07 (0.44
/2.64)
0.69 (0.41
/1.14)
0.67 (0.23
/1.99)

1.00
1.00
1.00
1.00
1.00

Data are presented as odds ratio (95% confidence interval).

Underlined data: pB/0.05 and the odds ratio /1.5.
*: pB/0.05 and the odds ratio B/1.5.

0.60
3.69
0.48
1.22
1.13

(0.27
/1.33)
(0.37
/36.00)
(0.16
/1.42)
(0.71
/2.09)
(0.42
/2.97)

1.07
5.36
0.65
1.25
1.77

(0.51
/2.28)
(0.54
/52.66)
(0.15
/1.79)
(0.69
/2.27)
(0.65
/4.83)

1.11
2.07
0.39
2.27
1.77

(0.51
/2.41)
(0.12
/33.95)
(0.19
/1.45)
(1.31
/ 3.95)
(0.64
/4.87)

K. Wataba et al.

Table IV. Adjusted odds ratios for selected complications associated with weight gain during pregnancy in each BMI group among parous women

BMI and optimal weight gain 275

emergent cesarean delivery, and LGA in the nulliparous group, and pre-eclampsia, severe pre-eclampsia, blood loss of more than 1,000 ml at delivery,
cesarean delivery, LGA, 1-min Apgar score B/4,
1-min Apgar score B/7, and NICU admission in the
parous group. These results indicate that deviation
from prepregnant BMI 18
/23.9, particularly above
this range, poses a risk of pregnancy complications.
In this study, we classified prepregnant BMIs for
Japanese women in relation to the incidence of
pregnancy complications and adverse neonatal outcomes. Our classification differs from that for
Caucasian women in which prepregnant BMIs less
than 19.8 and more than 26 were defined as underweight and overweight, respectively, based on the
quartile range of BMI of women at reproductive
age (11).
Our results suggest that optimal weight gains
during pregnancy in nulliparous women were
0.25
/0.40 kg/week in the low prepregnant BMI
(B/18) group, 0.20
/0.30 kg/week in the medium
prepregnant BMI (18
/23.9) group, and ]/0.05 kg/
week in the high prepregnant BMI (]/24) group.
Among parous women, the corresponding values
were ]/0.20, 0.20
/0.30, and 0.05
/0.30 kg/week.
On the basis of 40 weeks of gestation, optimal weight
gains during pregnancy in nulliparous women were
10
/16 kg in the low prepregnant BMI group, 8
/
12 kg in the medium prepregnant BMI group, and
]/2 kg in the high prepregnant BMI group. For
parous women, the corresponding values were ]/8,
8
/12, and 2
/12 kg. Our results indicated that
weight gains less than the optimal in the nulliparous
women were associated with SGA in all three
prepregnant BMI groups, and 1-min Apgar score
B/4 in the low prepregnant BMI group, while weight
gain larger than the optimal was associated with
pre-eclampsia, cesarean delivery, and LGA in the
low and medium prepregnant BMI groups, and
severe pre-eclampsia in the medium prepregnant
BMI group. On the other hand, in parous women,
weight gains less than the optimal were associated
with only SGA in all three prepregnant BMI groups,
while weight gains larger than the optimal were
linked to LGA in the medium and high prepregnant
BMI groups, and 1-min Apgar score B/4 in the
medium prepregnant BMI group.
Several groups studied weight gains during pregnancy (6,8,9) and two groups recommended weight
gains on the basis of prepregnant BMI. One indicated that optimal weight gains for Caucasian
women were 12
/18 kg for low prepregnant BMI
(B/19.8), 11.5
/16 kg for moderate prepregnant
BMI (19.8
/26), and 7
/11.5 kg for high prepregnant
BMI (/26) (11). The other reported that recom-

mended weight gains for Chinese women were 13
/

16.7, 11
/16.4, and 7.1
/14.4 kg for low (B/19),
moderate (19
/23.5), and high (/23.5) prepregnant
BMIs, respectively (20), indicating a similarity
between Caucasian and Chinese women. In comparison, our study showed that optimal weight
gains for Japanese women were generally smaller,
which may be attributable to differences in the
BMI classification, lifestyle, and management of
delivery, such as infrequent use of obstetric anesthesia in Japan.
The present study suggests that control of weight
gain during pregnancy depending on prepregnant
BMI as classified in relation to the incidence of
adverse pregnancy outcome and neonatal complications would lead to better obstetric management for
Japanese women.

References
1. Institute of Medicine. Nutrition during pregnancy and lactation: an implementation guide. Washington, DC: National
Academy Press; 1992.
2. Rantakallio P, Laara E, Koiranen M, Sarpola A. Maternal
build and pregnancy outcome. J Clin Epidemiol. 1995;48:
199
/207.
3. Cnattingius S, Bergstrom R, Lipworth L, Kramer MS.
Prepregnancy weight and the risk of adverse pregnancy
outcomes. N Engl J Med. 1998;338:147
/52.
4. Crane SS, Wojtowycz MA, Dye TD, Aubry RH, Artal R.
Association between pre-pregnancy obesity and the risk of
cesarean delivery. Obstet Gynecol. 1997;89:213
/6.
5. Jensen H, Agger AO, Rasmussen KL. The influence of
prepregnancy body mass index on labor complications. Acta
Obstet Gynecol Scand. 1999;78:799
/802.
6. 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.
7. 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;87:389
/94.
8. Witter FR, Caulfield LE, Stoltzfus RJ. Influence of maternal
anthropometric status and birth weight on the risk of cesarean
delivery. Obstet Gynecol. 1995;85:947
/51.
9. Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ.
1987;65:663
/737.
10. Harrison GG, Udall JN, Morrow G, 3rd. Maternal obesity,
weight gain in pregnancy, and infant birth weight. Am J
Obstet Gynecol. 1980;136:411
/2.
11. Institute of Medicine. Nutrition during pregnancy. Part I.
Weight gain. Washington, DC: National Academy Press;
1990.
12. Galtier-Dereure F, Montpeyroux F, Boulot P, Bringer J,
Jaffiol C. Weight excess before pregnancy: complications
and cost. Int J Obes Relat Metab Disord. 1995;19:443
/8.
13. Ruge S, Andersen T. Obstetric risks in obesity. An analysis of
the literature. Obstet Gynecol Surv. 1985;40:57
/60.
/

276

K. Wataba et al.

14. Johnson SR, Kolberg BH, Varner MW, Railsback LD.

Maternal obesity and pregnancy. Surg Gynecol Obstet.
1987;164:431
/7.
15. Garbaciak JA, Jr., Richter M, Miller S, Barton JJ. Maternal
weight and pregnancy complications. Am J Obstet Gynecol.
1985;152:238
/45.
16. Perlow JH, Morgan MA. Massive maternal obesity and
perioperative cesarean morbidity. Am J Obstet Gynecol.
1994;170:560
/5.
17. Edwards LE, Dickes WF, Alton IR, Hakanson EY. Pregnancy in the massively obese: course, outcome, and obesity
/

prognosis of the infant. Am J Obstet Gynecol. 1978;131:479
/

83.
18. Baeten JM, Bukusi EA, Lambe M. Pregnancy complications
and outcomes among overweight and obese nulliparous
women. Am J Public Health. 2001;91:436
/40.
19. Wolfe HM, Zador IE, Gross TL, Martier SS, Sokol RJ. The
clinical utility of maternal body mass index in pregnancy. Am
J Obstet Gynecol. 1991;164:1306
/10.
20. Wong W, Nelson LS, Tang NLS, Lau TK, Wong TW. A new
recommendation for maternal weight gain in Chinese women.
J Am Diet Assoc. 2000;100:791
/6.
/