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The association between gestational weight gain z-score and stillbirth: a case-control study.
BMC Pregnancy Childbirth 2019; 19(1):451BP

Abstract

BACKGROUND

There is limited information on potentially modifiable risk factors for stillbirth, such as gestational weight gain (GWG). Our purpose was to explore the association between GWG and stillbirth using the GWG z-score.

METHODS

We analyzed 479 stillbirths and 1601 live births from the Stillbirth Collaborative Research Network case-control study. Women with triplets or monochorionic twins were excluded from analysis. We evaluated the association between GWG z-score (modeled as a restricted cubic spline with knots at the 5th, 50th, and 95th percentiles) and stillbirth using multivariable logistic regression with generalized estimating equations, adjusting for pre - pregnancy body mass index (BMI) and other confounders. In addition, we conducted analyses stratified by pre - pregnancy BMI category (normal weight, overweight, obese).

RESULTS

Mean GWG was 18.95 (SD 17.6) lb. among mothers of stillbirths and 30.89 (SD 13.3) lb. among mothers of live births; mean GWG z-score was - 0.39 (SD 1.5) among mothers of cases and - 0.17 (SD 0.9) among control mothers. In adjusted analyses, the odds of stillbirth were elevated for women with very low GWG z-scores (e.g., adjusted odds ratio (aOR) and 95% Confidence Interval (CI) for z-score - 1.5 SD versus 0 SD: 1.52 (1.30, 1.78); aOR (95% CI) for z-score - 2.5 SD versus 0 SD: 2.36 (1.74, 3.20)). Results differed slightly by pre - pregnancy BMI. The odds of stillbirth were slightly elevated among women with overweight BMI and GWG z-scores ≥1 SD (e.g., aOR (95% CI) for z-score of 1.5 SD versus 0 SD: 1.84 (0.97, 3.50)).

CONCLUSIONS

GWG z-scores below - 1.5 SD are associated with increased odds of stillbirth.

Authors+Show Affiliations

Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA. cassandra.pickens@gmail.com. Laney Graduate School, Emory University, 201 Dowman Dr, Atlanta, GA, 30307, USA. cassandra.pickens@gmail.com.Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.Department of Gynecology and Obstetrics, School of Medicine, Emory University, 1648 Pierce Dr NE, Atlanta, GA, 30307, USA.Department of Obstetrics and Gynecology, School of Medicine, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA.Department of Obstetrics and Gynecology, School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA.Department of Obstetrics and Gynecology, Columbia University Medical Center, 630 W 168th St, New York, NY, 10032, USA.Department of Pathology and Laboratory Medicine, Brown University, 222 Richmond St, Providence, RI, 02903, USA.Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX, 77555, USA.Department of Obstetrics and Gynecology, School of Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA.Medical School, University of Texas Health Science Center at Houston, 7000 Fannin St #1200, Houston, TX, 77030, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31783735

Citation

Pickens, Cassandra M., et al. "The Association Between Gestational Weight Gain Z-score and Stillbirth: a Case-control Study." BMC Pregnancy and Childbirth, vol. 19, no. 1, 2019, p. 451.
Pickens CM, Hogue CJ, Howards PP, et al. The association between gestational weight gain z-score and stillbirth: a case-control study. BMC Pregnancy Childbirth. 2019;19(1):451.
Pickens, C. M., Hogue, C. J., Howards, P. P., Kramer, M. R., Badell, M. L., Dudley, D. J., ... Stoll, B. J. (2019). The association between gestational weight gain z-score and stillbirth: a case-control study. BMC Pregnancy and Childbirth, 19(1), p. 451. doi:10.1186/s12884-019-2595-x.
Pickens CM, et al. The Association Between Gestational Weight Gain Z-score and Stillbirth: a Case-control Study. BMC Pregnancy Childbirth. 2019 Nov 29;19(1):451. PubMed PMID: 31783735.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association between gestational weight gain z-score and stillbirth: a case-control study. AU - Pickens,Cassandra M, AU - Hogue,Carol J, AU - Howards,Penelope P, AU - Kramer,Michael R, AU - Badell,Martina L, AU - Dudley,Donald J, AU - Silver,Robert M, AU - Goldenberg,Robert L, AU - Pinar,Halit, AU - Saade,George R, AU - Varner,Michael W, AU - Stoll,Barbara J, Y1 - 2019/11/29/ PY - 2018/04/29/received PY - 2019/11/12/accepted PY - 2019/12/1/entrez PY - 2019/12/1/pubmed PY - 2019/12/1/medline KW - Fetal death KW - Gestational weight gain KW - Obesity KW - Stillbirth SP - 451 EP - 451 JF - BMC pregnancy and childbirth JO - BMC Pregnancy Childbirth VL - 19 IS - 1 N2 - BACKGROUND: There is limited information on potentially modifiable risk factors for stillbirth, such as gestational weight gain (GWG). Our purpose was to explore the association between GWG and stillbirth using the GWG z-score. METHODS: We analyzed 479 stillbirths and 1601 live births from the Stillbirth Collaborative Research Network case-control study. Women with triplets or monochorionic twins were excluded from analysis. We evaluated the association between GWG z-score (modeled as a restricted cubic spline with knots at the 5th, 50th, and 95th percentiles) and stillbirth using multivariable logistic regression with generalized estimating equations, adjusting for pre - pregnancy body mass index (BMI) and other confounders. In addition, we conducted analyses stratified by pre - pregnancy BMI category (normal weight, overweight, obese). RESULTS: Mean GWG was 18.95 (SD 17.6) lb. among mothers of stillbirths and 30.89 (SD 13.3) lb. among mothers of live births; mean GWG z-score was - 0.39 (SD 1.5) among mothers of cases and - 0.17 (SD 0.9) among control mothers. In adjusted analyses, the odds of stillbirth were elevated for women with very low GWG z-scores (e.g., adjusted odds ratio (aOR) and 95% Confidence Interval (CI) for z-score - 1.5 SD versus 0 SD: 1.52 (1.30, 1.78); aOR (95% CI) for z-score - 2.5 SD versus 0 SD: 2.36 (1.74, 3.20)). Results differed slightly by pre - pregnancy BMI. The odds of stillbirth were slightly elevated among women with overweight BMI and GWG z-scores ≥1 SD (e.g., aOR (95% CI) for z-score of 1.5 SD versus 0 SD: 1.84 (0.97, 3.50)). CONCLUSIONS: GWG z-scores below - 1.5 SD are associated with increased odds of stillbirth. SN - 1471-2393 UR - https://www.unboundmedicine.com/medline/citation/31783735/The_association_between_gestational_weight_gain_z-score_and_stillbirth:_a_case-control_study L2 - https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2595-x DB - PRIME DP - Unbound Medicine ER -