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Epidemiology and Population Health

Racial differences in contribution of prepregnancy obesity and excessive gestational weight gain to large-for-gestational-age neonates

International Journal of Obesity volume 44, pages 1521–1530 (2020)Cite this article

Subjects

Abstract

Objectives

To examine the racial differences in the population attributable fraction (PAF) of prepregnancy obesity and excessive gestational weight gain to large-for-gestational-age (LGA) neonates.

Methods

We conducted a population-based retrospective cohort study among all women who had prenatal screening and had a singleton live birth in a hospital (1 April 2016–31 March 2017) using data from Ontario birth registry in Canada. We used multivariable log-binomial regression models to estimate the PAF and 95% confidence interval (CI) of LGA neonates due to prepregnancy obesity and excessive gestational weight gain. All models were stratified by race (White, Asian, and Black).

Results

Of the 74,402 eligible women, the prevalence of prepregnancy obesity, excessive gestational weight gain, and LGA neonate was 21.1%, 60.0%, and 11.3%, respectively, for Whites; 9.3%, 45.9%, and 5.4%, respectively, for Asians; and 28.6%, 52.4%, and 7.9%, respectively, for Blacks. The association of prepregnancy obesity was greater than that of excessive gestational weight gain on LGA for all racial groups. Excessive gestational weight gain contributed more than prepregnancy obesity in Whites (PAF 32.9%, 95% CI [30.3–35.5%] and 16.6%, 95% CI [15.3–17.9%], respectively, for excessive gestational weight gain and prepregnancy obesity) and in Asians (PAF 32.1%, 95% CI [27.2–36.7%] and 11.8%, 95% CI [9.5–14.1%], respectively, for excessive gestational weight gain and prepregnancy obesity). Prepregnancy obesity (PAF 22.8%, 95% CI [17.1–28.1%]) and excessive gestational weight gain (PAF 20.1%, 95% CI [4.7–33.0%]) contributed to LGA neonates almost the same in Blacks.

Conclusions

Excessive gestational weight gain contributed more to LGA neonates than prepregnancy obesity in Whites and Asians, while there was no difference between excessive gestational weight gain and prepregnancy obesity in their contributions to the LGA neonates in Blacks. The differences are mostly driven by the differential prevalence of the two risk factors across racial groups.

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Fig. 1: Prevalence of LGA at the 90th percentile, obesity and excessive GWG by race.
Fig. 2: Adjusted risk ratios (aRRs) for LGA neonate due to prepregnancy obesity and excessive GWG by race.
Fig. 3: Adjusted population attributable fractions (PAFs) for LGA neonates due to prepregnancy obesity and excessive GWG by race.

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Data availability

The data analyzed during this study are held securely at the prescribed registry BORN Ontario. Data sharing regulations prevent these data from being made available publicly due to the personal health information in the datasets. Enquiries regarding BORN data must be directed to BORN Ontario (Science@BORNOntario.ca).

Code availability

The analysis code for adjusted population attributable faction could be available in Appendix B.

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Acknowledgements

This study was supported by a Canadian Institutes of Health Research (CIHR) grant (Number FDN-148438).

Author information

Author notes

  1. These authors contributed equally: Yanfang Guo, Laura M. Gaudet

Authors and Affiliations

  1. Better Outcomes Registry & Network Ontario, Ottawa, ON, Canada

    Yanfang Guo, Qun Miao, Tianhua Huang & Mark C. Walker

  2. Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada

    Yanfang Guo, Qun Miao & Deshayne B. Fell

  3. OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Yanfang Guo, Katherine Muldoon, Shi-Wu Wen, Mark C. Walker & Laura M. Gaudet

  4. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada

    Yanfang Guo, Qun Miao, Deshayne B. Fell, Shi-Wu Wen, Mark C. Walker & Laura M. Gaudet

  5. Genetics Program, North York General Hospital, Toronto, ON, Canada

    Tianhua Huang

  6. Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada

    Tianhua Huang

  7. Department of Obstetrics, Gynecology, and Newborn Care, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Shi-Wu Wen & Mark C. Walker

  8. Department of Obstetrics and Gynecology, Queen’s University, Kingston, ON, Canada

    Laura M. Gaudet

  9. Department of Obstetrics and Gynecology, Kingston Health Sciences Center, Kingston, ON, Canada

    Laura M. Gaudet

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Correspondence to Yanfang Guo or Laura M. Gaudet.

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The authors declare that they have no conflict of interest.

Ethical approval

This study received ethical approvals from the Children’s Hospital of Eastern Ontario Research Ethics Board (16/119X) and the Ottawa Health Science Network Research Ethics Board (20160780-01H).

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Guo, Y., Miao, Q., Huang, T. et al. Racial differences in contribution of prepregnancy obesity and excessive gestational weight gain to large-for-gestational-age neonates. Int J Obes 44, 1521–1530 (2020). https://doi.org/10.1038/s41366-020-0543-5

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