European Journal of Cardiovascular Medicine

Unfavourable pregnancy outcomes can be anticipated based on variables such as early pregnancy, elevated body mass index, and weight gain. Low BMI used to be more associated with pregnancy difficulties, but as lifestyles change, obesity is becoming more prevalent, particularly in urban areas, and could eventually become a major public health concern [1, 2, 3].

Studies have shown that mothers who are obese or overweight have an increased risk of large for gestational age (LGA), emergency caesarean sections, postpartum haemorrhage, wound infections, and gestational diabetes in addition to other conditions. On the other hand, women who were underweight had a higher risk of anaemia and adverse neonatal

outcomes, including preterm birth and intrauterine growth retardation (IUGR) [3,4].

The nutritional status of the mother has a major impact on the health and quality of life of both the unborn child and the pregnant woman. Since the BMI and patterns of weight gain during pregnancy are controllable risk factors for adverse pregnancy outcomes, they should be given high priority. It is important to be aware of the signs and symptoms of unfavourable pregnancy outcomes. A deeper comprehension of the complex interactions between mother and foetus has led to a significant improvement in antenatal recommendations. The Institute of Medicine (IOM) released guidelines controlling weight gain during pregnancy based on pre-pregnancy BMI in order to achieve optimal pregnancy outcomes [4,5].

Asian populations have been the subject of fewer studies than those undertaken in Western nations. The aim of this study is to evaluate the relationship between body weight and pregnancy outcomes in our Indian population. It would be feasible to evaluate the relationship between BMI and its detrimental effects on pregnancy outcomes by conducting this study. It would also be feasible to investigate the connection between BMI and increased gestational weight in our Indian environment. Additionally, this study would allow for the evaluation of the relative risk of different pregnancy outcomes that a patient with excessive BMI may encounter [5, 6].

During the first 12 weeks of gestation, between May 2023 to April 2024, 150 pregnant women with singleton, uncomplicated pregnancies who had been scheduled at Rangaraya Medical College, Kakinada, Andhra Pradesh, India undertook a prospective observational study.

Inclusion criteria:

1. All 1^st trimester pregnant women.
2. Singleton Pregnancy.
3. Medical disorder complicating pregnancy, overt diabetes mellitus, thyroid disorders complicating pregnancy.

Exclusion criteria:

1. Multiple Gestation
2. Overt Hypoglycemia &Thyroid Disorders
3. Pregnant woman who were detected after first trimester as first visit.

Methodology

Women who had appointments at Govt General Hospital, Kakinada throughout the first 12 weeks of pregnancy and who had singletons without difficulties were the subjects of our study. Consent in writing was acquired. Using a pre-made questionnaire, basic exam information such as weight and

height was obtained, and BMI was calculated accordingly.

Using the weight (kg) / height (m2) formula (QUETELET'S Index), patients were divided into 4 groups according to their BMI: underweight (18.5 kg/m 2), normal (18.5-24.9), overweight (25-29.9), and obese (30 and beyond). Weight gain was tracked at each appointment, and any pregnancy-related problems were documented. Following delivery, data on postnatal issues, the neonate's Apgar score, birth weight, and gestational age at delivery were collected from the case sheets. To maintain the sample size at 150, patients who did not follow up were eliminated from the experiment and new participants were enrolled [6,7].

Table 1: Frequency and distribution of BMI At First Visit

In the table above, frequency and percentage distribution are displayed. 68.6% of the participants had a normal BMI. A total of 26% of the participants were overweight. 1.3% of the participants were classified as obese. 4% of the female population was underweight.

Table2: Distribution of subjects based on Weight Gain In Pregnancy

Table 3: Weight gain in Association To BMI

Table4:Association between BMI and Birth weight

The findings were examined. In comparison to women with normal BMI, it was shown that obese mothers gave birth to the majority of LGA newborns. Similarly, the majority of SGA babies were delivered by underweight women. There was a Pearson Chi square analysis. It revealed a meaningful correlation between BMI and birth weight. (X2 =38.598, p<0.001).

150 pregnant ladies were prospectively observed by us. women scheduled at Government General Hospital, Kakinada who were expecting a singleton pregnancy without complications. There had been hospital deliveries within 12 weeks of gestation. The experiment's subjects were between the ages of 18 and 40. The average subject age was 28. Of the research population, nulliparas made up 53.8%. Multiparagraph sentences make up 46.2% of sentences. 92.1 percent of patients were on term. 7.9% of babies were born before 37–40 weeks. 37 weeks or shorter. 17.4% of people had weight issues. incorporating 0–7 kg. 53% gained eight to ten pounds. 13 kg while carrying a child. Overweight was identified in 29.6% of women who acquired more than 13 kg. The study included four groups of women. BMI ranges that are derived from early pregnancy BMI. The population's average weight was 18.5 kg/m2 with a BMI of 13.4%. For 55.3 percent of females, the BMI ranged from 18.5 to 24.9 kg/m2. For 24.5 percent of females, the BMI ranged from 25.0 to 29.9 kg/m2. 6.7% of the female population had a BMI of 30 kg/m2 or higher. Of the individuals in the study, 31.2% had a normal BMI, and 55.3% were overweight or obese. It's crucial. As lifestyles change, obesity is becoming more common, especially among young people living in cities, and it could be quite harmful to one's health [7,8,9].

Many obese persons gained the greatest weight, whereas underweight people gained the least. Weight gain was found to be associated with gestational weight gain (p 0.01) using Chi-square testing on early pregnancy BMI. In a related investigation, Ihunnya O. Frederick et al. found that pregnant underweight women lost less weight than obese ones (p = 0.001.2). Research found that underweight women gave birth to neonates with lower birth weights and obese women gave birth to large babies in a different analysis by J.E. Brown et al. Consequently, it is imperative to maintain a healthy weight throughout pregnancy as anything less can result in complications. Because of this, it's critical to motivate pregnant mothers to follow the IOM's guidelines for overall weight increase based on pre-pregnancy. BMI 10.7% of the normal patients in this study had a problem. Within the BMI range, diabetes was evident. Of those with diabetes, 25.8% are overweight. In people with an obese BMI, diabetes struck 35.3% of them. DM developed in just 1% of the underweight BMI group. Obese patients made up the largest proportion of diabetic patients (35.3%) and the smallest proportion of underweight patients (1%), respectively [10,11].

BMI and diabetes mellitus were linked using chi-square analysis, which revealed that BMI rises with diabetes (p 0.01). Dohertya discovered that 188 of the 331 women in her D.A. (6.6%) were obese and had a greater chance of getting gestational diabetes. Relative risk indicated the worst hazard. Obese women had a threefold increased risk of diabetes, overweight women a twofold increase, and underweight women no increased risk compared to women with normal BMI. In this study, 0.7% of individuals were obese. Individuals with normal BMIs experienced PIH. 5.9% of preeclampsia cases involved underweight people. Compared to 17.6% of the group with an obese BMI, 9.7% of the group with an overweight BMI experienced PIH. The largest prevalence of preeclampsia was seen in obese individuals (17.6%), compared to women with a normal BMI (0.7%). A significant correlation (p 0.01) between rising BMI and preeclampsia was found using Chi-square analysis. A similar study by Meenakshi, according to Srivastava Reena (FOGSI), revealed that obese women were more likely to be obese and were linked to unfavourable outcomes such preeclampsia at p 0.05 [12,13].

After computing relative risk, which is the highest risk relative to a normal BMI, obese women had a preeclampsia that was 25 times higher. preeclampsia is thirteen times more common in overweight women and eight times more common in underweight women compared to women with normal BMIs. Anaemia and diabetes were diagnosed in 8.6% of people with a normal BMI. Anaemia affected 11.3% of the overweight individuals. Anaemia did not occur in obese people. Twenty.6% of patients who were underweight had anaemia. The frequency of underweight women is 20.6%. Overweight women (11.3%) experienced anaemia development compared to 8.6% of women with a normal BMI. Anaemia and low BMI were found to be strongly correlated in a chi-square analysis study. (p < 0.05). According to Adam, 46's 1136 research, 26.5% were found. Anaemia and low BMI were strongly correlated (p 0.05) in the population of underweight girls. In this trial, no obese subject got diabetes. Relative risk could not be calculated due to anaemia. It seems that the chance of anaemia in women who were overweight was doubled. Nonetheless, underweight women had a twofold increased incidence of

anaemia compared to those with a normal BMI [14,15,16].

We have to pay attention to this because we are changing. Anaemia is more common in rural areas of the nation. 5.9% of participants who were obese had a BMI that was 0.7% lower than that of normal people, and 6.5% of overweight participants had polyhydraminos. Patients with oligohydraminos were more likely to be underweight (14.7%) than those with polyhydraminos, who did not exhibit underweight symptoms. a 4.3% BMI. Most individuals with more severe Polyhydraminos predominated in underweight individuals, and they were also found in those with high BMIs and oligohydraminos. Liquor volume and BMI had an association (p 0.05) according to the chi-square test. Individuals who were obese exhibited a higher relative risk, with overweight women nine times more likely to have polyhydramnios than women with a normal BMI. Polyhydraminos were absent in underweight patients. The oligohydraminos risk was found to be three times higher in the underweight group compared to those with a normal BMI, although the relative risk could not be estimated. Findings revealed that 13.6% of PROM patients had a normal BMI, compared to 5.9% of obese patients and 12.9% of overweight individuals. 11.8% of people in the population are underweight. Individuals with PROM women (13.6%) had a BMI that was lower than average. The results did not differ in any noticeable way. PROM differences (p=0.05) between BMI categories. Meenakshi and Srivastava Reena's (FOGSI) similar investigation showed that obese individuals were not exceptional. PROM when p > 0.05 in females. PPROM data showed that 3.2% of obese individuals had 11.8% of the PPROM. Among the patients with a normal BMI, only 1.4% experienced PPROM. group of underweight PPROM patients[17,18].

The statistics indicated which people were the most obese when compared to other BMI groups. The results of the chi square analysis showed that there was no meaningful correlation between ROM and BMI. (p = 0.351) According to a comparative risk analysis, women who were overweight, obese, or underweight did not exhibit an increased risk. While PPROM risk is seven times higher than normal BMI risk, most obese persons are at risk of PROM. The association between PPROM and obesity in women was not statistically significant (p=0.35). a growth of seven times. It was discovered that 61.8% of the experiment participants were underweight, while 56.4% were normal. straightforward vaginal births against overweight (41.9%) and obese (47.1%). A BMI is substantially linked with vaginal delivery, according to chi square analysis (p 0.05). However, the obese group saw a decrease in the number of patients who experienced difficult vaginal births, and the majority of people in the overweight (54.8%) and obese (41.2%) groups did not experience compared to the other two groups, respectively [19, 20]. In a research of 215 women, Meenakshi and Srivastava Reena (FOGSI) found that 18 of the obese women had problematic vaginal deliveries (p 0.05). Obese women were one-fold more likely to acquire complex conditions than women with a normal BMI. According to a study, women with normal BMI were more likely than overweight or underweight women to experience a difficult vaginal delivery. In comparison to the general population, the percentage of obese (41.1%) and overweight (54.8%) individuals in our study who had emergency or elective C sections is significantly greater. Chi square analysis revealed a significant connection (p 0.05) between Caesarean section and BMI. In a study including 215 women, Meenakshi and Srivastava Reena (FOGSI) found that 79 out of 170 obese women had a p-value of 0.01. In comparison to women with a normal BMI, the risk is one-fold higher for all three categories in our study. While obese and underweight women did not suffer problems, overweight women (4.8%) did, in contrast to pyrexia linked to a normal BMI (2.1%). Chi square analysis revealed that there was no relationship (p = 0.407) between BMI and pyrexia in our investigation. Our findings showed that overweight women are twice as likely to have diabetes as women with a normal BMI. It was not able to determine the danger for women who were overweight or underweight. These women suffered from pyrexia. In our study, PPH rates were greater in obese (23.5%) and overweight (23.5%) women than in normal weight (3.6%) and underweight (2.9%) women. A substantial relationship was established using chi square analysis. (p<0.05) BMI and PPH. A study by Meenakshi and Srivastava Reena (FOGSI) 1 showed that there was no significant link between PPH and BMI, with only 5 out of 170 obese and overweight women having PPH. Our study found a significant relationship between PPH and BMI. (P less than 0.05). The results of this study show that women with an obesity-related BMI had a six-fold increased risk of developing PPH. Compared to women with a normal BMI, those who are overweight or underweight do not have an increased risk of PPH. Compared to other groups, obese women had an 11.8% delay in

wound healing [20,21].

Meenakshi and Srivastava Reena (FOGSI) 1 conducted a study on 215 women and found that 25 out of 170 obese and overweight women had delayed wound healing. The p-value for this result was 0.05. This was found using the Chi square test. According to the current study, women with an obesity-related BMI are five times more likely to experience delayed wound healing than women with an overweight or underweight BMI. The rate of thromboembolism in patients with an obese BMI was just 5.9%. Chi square analysis revealed a substantial correlation between thromboembolism and BMI. (p

< 0.005), X 2 = 13.937 [21, 22].

It is impossible to determine the relative risk of thromboembolism in the 253 obese BMI patients because the disorder only affected one patient. The p-value indicates a relationship between thromboembolism and BMI. Compared to women with a normal BMI, obese women gave birth to 17.6% more LGAs. Forty-eight percent of SGA infants were born to underweight mothers. Obesity and high birth weight were related, although low BMI and low birth weight were not. (p<0.001). J.E. Brown et al. and Ihunnaya O Frederick et al. saw similar outcomes with p0.001 and 0.0009, respectively. Meenakshi, Srivastava Reena (FOGSI) 1 found that 56 of the 120 obese and overweight women who were investigated gave birth to children with poor Apgar ratings. In comparison to the group with a normal BMI, underweight women in our study had a three times higher chance of giving birth to an SGA baby than either overweight or obese women did. Compared to patients who were overweight or underweight, who showed a one-fold greater risk, obese patients had a 28-fold increased likelihood of giving birth to LGA children [22,23].

Our study showed that babies born to underweight (35.3%) and obese (64.7%) mothers had poor Apgar scores, in contrast to women in the normal BMI category, who had a significantly higher proportion of children with good Apgar ratings. 88.6% (Apgar greater than 7). Pearson Chi square analysis revealed a highly significant (p 0.001) correlation between Apgar score and BMI. Women who are obese are five times more likely to give birth to babies with low Apgar scores than women who are underweight, overweight women are not at risk, and women with a normal BMI. A pregnant woman's nutritional status affects both her unborn child's health and her own. Weight gain and BMI in the early stages of pregnancy are indicators of poor pregnancy outcomes. We examined the relationship between low mother and foetal outcomes and severe early pregnancy BMI in our study. Low BMI was substantially associated with unfavourable maternal outcomes (p<0.05). Overweight and obese women were more likely to experience poor maternal outcomes, including gestational diabetes, pregnancy-induced hypertension, increased alcohol consumption, PPROM, a higher rate of instrumental deliveries and caesarean sections, postpartum complications like haemorrhage, delayed wound healing, having LGA babies, and low Apgar scores. decreased volume of liquid, elevated risk of anaemia in female underweights, etc. Additionally examined were BMI and weight increase throughout pregnancy. Women who were underweight acquired the least weight, whereas women who were obese or overweight gained more weight than those whose BMI was normal. In this study, we examined the relationship between early pregnancy BMI and weight gain and various pregnancy outcomes [24, 25].

Several studies have demonstrated the substantial influence that early pregnancy BMI and increased gestational weight have on adverse outcomes for both the mother and the infant. The current study's findings indicate a clear link between low BMI and unfavourable maternal outcomes. Underweight moms have been linked to anaemia, reduced fluid volume, an increase in caesarean sections, and SGA deliveries with low Apgar scores. Overweight and obese women were found to have a significantly higher risk of adverse maternal outcomes, including gestational diabetes, pregnancy-induced hypertension, increased alcohol volume, PPROM, rates of instrumental delivery and caesarean sections, postpartum complications, including delayed wound healing and postpartum haemorrhage, and having low Apgar scores for live births. It was demonstrated that while underweight women gained the least amount of weight, obese and overweight women gained more weight than women with normal BMIs. The outcomes made sense. It was also determined what the relative risk of different pregnancy outcomes was for a patient with a high or low BMI. Pregnancy outcomes that can be modified, such as BMI and patterns of weight increase, emphasise the importance of paying close attention to these aspects. It is important to be aware of the warning signs and symptoms of unfavourable pregnancy outcomes. A better knowledge of the

complex interplay between mother and foetus has led to improvements in antenatal guidelines.

Compared to the amount of research done in Western countries, relatively less has been studied on the population of Asia. Low BMI used to be more frequently linked to pregnancy problems in India, but as lifestyles change, obesity is becoming more prevalent, particularly in urban areas, and could soon become a major public health concern. This study allowed for the evaluation of the relationship between BMI and the unfavourable effects it has on pregnancy outcomes. The results of this study, which examined the relative risk of different pregnancy outcomes that a patient with excessive BMI may experience, were compelling. It was also feasible to examine the association between BMI and gestational weight rise in our Indian setting, and the findings are all noteworthy.

Funding support:

Nil

Conflict of interest:

Nil

1. Srivastava Reena.Sharma NeelaRai.Kushwaha K.P. AdityaVani Obstetric Behaviour and Pregnancy Outcome in Overweight and Obese Women. Federation of Obstetric and Gynaecology Society of India (FOGSI)(2012)
2. Ihunnaya Frederick; Michelle A. Williams; Anne E. Sales, et al (2007).Pre-pregnancy Body Mass Index, Gestational Weight Gain and other Maternal Characteristics in Relation to Infant Birth Weight. Acta Obstet. GynaecolScand; 82: 813-819.
3. Institute of Medicine (1990). Nutrition during pregnancy: Part I: weight gain, Part II: nutrient supplements. Washington, DC: National Academy
4. Cogswell ME, Serdule MK, Hungerford DW, Yip R (1995) Gestational weight gain among average-weight and overweight women – what isexcessive? Am J Obstetgynecol; 172: 705-12.
5. Witter FR, Caulfield LE, Stoltzfus (1995) Influence of maternal anthropometric status and birth weight on the risk of caesarean delivery.ObstetGynecol; 85:947-51.
6. Young TK, Woodmansee B. (2002) Factors that are associated with caesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain. Am J ObstetGynecol; 187:312-8.
7. Cnattingius S, Bergstrom R, Lipworth L, Kramer (1998) Pre pregnancy weight and the risk of adverse pregnancy outcomes, N Engl J Med; 338:147-52
8. Nohr EA, Bech BH, Varth M, Rasmussen KM, Henribsen TB, Olsen (2007) Obesity, gestational weight gain and preterm birth: a study within the Danish National Birth Cohort. Paediatr Perinet Epideniol; 21: 5-14.
9. Stotland NE, Caughey AB, Lahiff M, Abrams (2006) Weight gain and spontaneous preterm birth: the role of race or ethnicity and previous pretermbirth. ObstetGynaecol; 108: 1448-55.
10. Cedergren M. (2006) Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Int J Gynaecol Obstet; 93:269-