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Placental weight mediates the effects of prenatal factors on fetal growth: the extent differs by preterm status.

Abstract

OBJECTIVE

Elevated pre-pregnancy BMI, excessive gestational weight gain (GWG), and gestational diabetes mellitus (GDM) are known determinants of fetal growth. The role of placental weight is unclear. We aimed to examine the extent to which placental weight mediates the associations of pre-pregnancy BMI, GWG, and GDM with birth weight-for-gestational age, and whether the relationships differ by preterm status.

DESIGN AND METHODS

We examined 1,035 mother-infant pairs at birth from the Boston Birth Cohort. Data were collected by questionnaire and clinical measures. Placentas were weighed without membranes or umbilical cords. We performed sequential models excluding and including placental weight, stratified by preterm status.

RESULTS

We found that 21% of mothers were obese, 42% had excessive GWG, and 5% had GDM. Forty-one percent were preterm. Among term births, after adjustment for sex, gestational age, maternal age, race, parity, education, smoking, and stress during pregnancy, birth weight-for-gestational age z-score was 0.55 (0.30, 0.80) units higher for pre-pregnancy obesity vs. normal weight. It was 0.34 (0.13, 0.55) higher for excessive vs. adequate GWG, 0.67 (0.24, 1.10) for GDM vs. no DM, with additional adjustment for pre-pregnancy BMI. Adding placental weight to the models attenuated the estimates for pre-pregnancy obesity by 20%, excessive GWG by 32%, and GDM by 21%. Among preterm infants, GDM was associated with 0.67 (0.34, 1.00) higher birth weight-for-gestational age z-score, but pre-pregnancy obesity and excessive GWG were not. Attenuation by placental weight was 36% for GDM.

CONCLUSIONS

These results suggest that placental weight partially mediates the effects of pre-pregnancy obesity, GDM, and excessive GWG on fetal growth among term infants.

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  • Authors+Show Affiliations

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    MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

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    Source

    Obesity (Silver Spring, Md.) 21:3 2013 Mar pg 609-20

    MeSH

    Adolescent
    Adult
    Birth Weight
    Body Mass Index
    Body Weight
    Boston
    Cohort Studies
    Diabetes, Gestational
    Female
    Fetal Development
    Gestational Age
    Humans
    Infant
    Infant, Newborn
    Male
    Maternal Age
    Obesity
    Parity
    Placenta
    Pregnancy
    Risk Factors
    Socioeconomic Factors
    Surveys and Questionnaires
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    23592670

    Citation

    Ouyang, Fengxiu, et al. "Placental Weight Mediates the Effects of Prenatal Factors On Fetal Growth: the Extent Differs By Preterm Status." Obesity (Silver Spring, Md.), vol. 21, no. 3, 2013, pp. 609-20.
    Ouyang F, Parker M, Cerda S, et al. Placental weight mediates the effects of prenatal factors on fetal growth: the extent differs by preterm status. Obesity (Silver Spring). 2013;21(3):609-20.
    Ouyang, F., Parker, M., Cerda, S., Pearson, C., Fu, L., Gillman, M. W., ... Wang, X. (2013). Placental weight mediates the effects of prenatal factors on fetal growth: the extent differs by preterm status. Obesity (Silver Spring, Md.), 21(3), pp. 609-20. doi:10.1002/oby.20254.
    Ouyang F, et al. Placental Weight Mediates the Effects of Prenatal Factors On Fetal Growth: the Extent Differs By Preterm Status. Obesity (Silver Spring). 2013;21(3):609-20. PubMed PMID: 23592670.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Placental weight mediates the effects of prenatal factors on fetal growth: the extent differs by preterm status. AU - Ouyang,Fengxiu, AU - Parker,Margaret, AU - Cerda,Sandra, AU - Pearson,Colleen, AU - Fu,Lingling, AU - Gillman,Matthew W, AU - Zuckerman,Barry, AU - Wang,Xiaobin, PY - 2011/07/21/received PY - 2012/03/23/accepted PY - 2013/4/18/entrez PY - 2013/4/18/pubmed PY - 2013/12/24/medline SP - 609 EP - 20 JF - Obesity (Silver Spring, Md.) JO - Obesity (Silver Spring) VL - 21 IS - 3 N2 - OBJECTIVE: Elevated pre-pregnancy BMI, excessive gestational weight gain (GWG), and gestational diabetes mellitus (GDM) are known determinants of fetal growth. The role of placental weight is unclear. We aimed to examine the extent to which placental weight mediates the associations of pre-pregnancy BMI, GWG, and GDM with birth weight-for-gestational age, and whether the relationships differ by preterm status. DESIGN AND METHODS: We examined 1,035 mother-infant pairs at birth from the Boston Birth Cohort. Data were collected by questionnaire and clinical measures. Placentas were weighed without membranes or umbilical cords. We performed sequential models excluding and including placental weight, stratified by preterm status. RESULTS: We found that 21% of mothers were obese, 42% had excessive GWG, and 5% had GDM. Forty-one percent were preterm. Among term births, after adjustment for sex, gestational age, maternal age, race, parity, education, smoking, and stress during pregnancy, birth weight-for-gestational age z-score was 0.55 (0.30, 0.80) units higher for pre-pregnancy obesity vs. normal weight. It was 0.34 (0.13, 0.55) higher for excessive vs. adequate GWG, 0.67 (0.24, 1.10) for GDM vs. no DM, with additional adjustment for pre-pregnancy BMI. Adding placental weight to the models attenuated the estimates for pre-pregnancy obesity by 20%, excessive GWG by 32%, and GDM by 21%. Among preterm infants, GDM was associated with 0.67 (0.34, 1.00) higher birth weight-for-gestational age z-score, but pre-pregnancy obesity and excessive GWG were not. Attenuation by placental weight was 36% for GDM. CONCLUSIONS: These results suggest that placental weight partially mediates the effects of pre-pregnancy obesity, GDM, and excessive GWG on fetal growth among term infants. SN - 1930-739X UR - https://www.unboundmedicine.com/medline/citation/23592670/Placental_weight_mediates_the_effects_of_prenatal_factors_on_fetal_growth:_the_extent_differs_by_preterm_status_ L2 - https://doi.org/10.1002/oby.20254 DB - PRIME DP - Unbound Medicine ER -