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Size for gestational age at birth according to offspring sex and gestational weight gain in underweight women

  • Y. Kasuga (a1), D. Shigemi (a2), M. Tamagawa (a1), T. Suzuki (a1), S.-H. Kim (a1), T. Higuchi (a1), H. Yasunaga (a2) and S. Nakada (a1)...


Although maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are related to fetal growth, there is a paucity of data regarding how offspring sex affects the relationship between maternal BMI in underweight mothers (pre-pregnancy BMI <18.5 kg/m2) and size for gestational age at birth. The aim of this study was to investigate the effect of offspring sex on the relationships among maternal pre-pregnancy BMI, GWG and size for gestational age at birth in Japanese underweight mothers. Records of women with full-term pregnancies who underwent perinatal care at Kawasaki Municipal Hospital (Kawasaki, Japan) between January 2013 and December 2017 were retrospectively reviewed. The study cohort included underweight (n=566) and normal-weight women (18.5 kg/m2⩽pre-pregnancy BMI<25 kg/m2; n=2671). The incidence of small for gestational age (SGA) births in the underweight group was significantly higher than that in the normal-weight group (P<0.01). Additionally, SGA incidence in the underweight group was significantly higher than that in the normal-weight group (P<0.01) in female, but not male (P=0.30) neonates. In the women with female neonates, pre-pregnancy underweight was associated with a significantly increased probability of SGA (odds ratio [OR]: 1.80; P<0.01), but inadequate GWG was not (OR: 1.38; P=0.11). In contrast, in women with male neonates, inadequate GWG was associated with a significantly increased probability of SGA (OR: 1.53; P=0.03), but not with pre-pregnancy underweight (OR: 1.30; P=0.10). In conclusion, the present results suggest that pre-pregnancy underweight is associated with SGA in female offspring but not in male offspring.


Corresponding author

Address for correspondence: Y. Kasuga, Department of Obstetrics and Gynecology, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawa-Dori, Kawasaki-ku, Kawasaki, Kanagawa 210-0013, Japan. E-mail:


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1.Jeric, M, Roje, D, Medic, N, Strinic, T, Mestrovic, Z, Vulic, M. Maternal pre-pregnancy underweight and fetal growth in relation to institute of medicine recommendations for gestational weight gain. Early Hum Dev. 2013; 89, 277281.
2.Fujiwara, K, Aoki, S, Kurasawa, K, Okuda, M, Takahashi, T, Hirahara, F. Associations of maternal pre-pregnancy underweight with small-for-gestational-age and spontaneous preterm birth, and optimal gestational weight gain in Japanese women. J Obstet Gynaecol Res. 2014; 40, 988994.
3.Yu, Z, Han, S, Zhu, J, Sun, X, Ji, C, Guo, X. Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis. PLoS One. 2013; 8, e61627.
4.Barker, DJ, Winter, PD, Osmond, C, Margetts, B, Simmonds, SJ. Weight in infancy and death from ischaemic heart disease. Lancet. 1989; 2, 577580.
5.Boney, CM, Verma, A, Tucker, R, Vohr, BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005; 115, e290e296.
6.Morisaki, N, Kawachi, I, Oken, E, Fujiwara, T. Parental characteristics can explain why Japanese women give birth to the smallest infants in the United States. Paediatr Perinat Epidemiol. 2016; 30, 473478.
7.Enomoto, K, Aoki, S, Toma, R, Fujiwara, K, Sakamaki, K, Hirahara, F. Pregnancy outcomes based on pre-pregnancy body mass index in Japanese women. PLoS One. 2016; 11, e0157081.
8.Melby, MK, Yamada, G, Surkan, PJ. Inadequate gestational weight gain increases risk of small-for-gestational-age term birth in girls in Japan: a population-based cohort study. Am J Hum Biol. 2016; 28, 714720.
9.Pugh, SJ, Albert, PS, Kim, S, et al. Patterns of gestational weight gain and birthweight outcomes in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons: a prospective study. Am J Obstet Gynecol. 2017; 217, 346 e1e11.
10.Waters, TP, Huston-Presley, L, Catalano, PM. Neonatal body composition according to the revised institute of medicine recommendations for maternal weight gain. J Clin Endocrinol Metab. 2012; 97, 36483654.
11.Nomura, K, Kido, M, Tanabe, A, Nagashima, K, Takenoshita, S, Ando, K. Investigation of optimal weight gain during pregnancy for Japanese women. Sci Rep. 2017; 7, 2569.
12.O’Tierney-Ginn, P, Presley, L, Minium, J, Hauguel deMouzon, S, Catalano, PM. Sex-specific effects of maternal anthropometrics on body composition at birth. Am J Obstet Gynecol. 2014; 211, 292 e1292 e9.
13.Sojo, L, Garcia-Patterson, A, Maria, MA, et al. Are birth weight predictors in diabetic pregnancy the same in boys and girls? Eur J Obstet Gynecol Reprod Biol. 2010; 153, 3237.
14.Mando, C, Calabrese, S, Mazzocco, MI, et al. Sex specific adaptations in placental biometry of overweight and obese women. Placenta. 2016; 38, 17.
15.Minakami, H, Maeda, T, Fujii, T, et al. Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2014 edition. J Obstet Gynaecol Res. 2014; 40, 14691499.
16.Morisaki, N, Nagata, C, Jwa, SC, et al. Pre-pregnancy BMI-specific optimal gestational weight gain for women in Japan. J Epidemiol. 2017; 27, 492498.
17.Rasmussen, KM, Yaktine, AL, Institute of Medicine (U.S.). Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines. 2009. National Academies Press: Washington, DC.
18.Itabashi, K, Miura, F, Uehara, R, Nakamura, Y. New Japanese neonatal anthropometric charts for gestational age at birth. Pediatr Int. 2014; 56, 702708.
19.Macdonald, EM, Natale, R, Regnault, TR, Koval, JJ, Campbell, MK. Obstetric conditions and the placental weight ratio. Placenta. 2014; 35, 582586.
20.Goldstein, RF, Abell, SK, Ranasinha, S, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017; 317, 22072225.
21.Lampl, M, Gotsch, F, Kusanovic, JP, et al. Sex differences in fetal growth responses to maternal height and weight. Am J Hum Biol. 2010; 22, 431443.
22.Simon, L, Borrego, P, Darmaun, D, Legrand, A, Roze, JC, Chauty-Frondas, A. Effect of sex and gestational age on neonatal body composition. Br J Nutr. 2013; 109, 11051108.
23.Murai, U, Nomura, K, Kido, M, Takeuchi, T, Sugimoto, M, Rahman, M. Pre-pregnancy body mass index as a predictor of low birth weight infants in Japan. Asia Pac J Clin Nutr. 2017; 26, 434437.
24.Hull, HR, Dinger, MK, Knehans, AW, Thompson, DM, Fields, DA. Impact of maternal body mass index on neonate birthweight and body composition. Am J Obstet Gynecol. 2008; 198, 416 e1416 e6.
25.Badfar, G, Shohani, M, Soleymani, A, Azami, M. Maternal anemia during pregnancy and small for gestational age: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2018; 17, doi:10.1080/14767058.2017.1411477.
26.Wallace, JM, Horgan, GW, Bhattacharya, S. Placental weight and efficiency in relation to maternal body mass index and the risk of pregnancy complications in women delivering singleton babies. Placenta. 2012; 33, 611618.


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Size for gestational age at birth according to offspring sex and gestational weight gain in underweight women

  • Y. Kasuga (a1), D. Shigemi (a2), M. Tamagawa (a1), T. Suzuki (a1), S.-H. Kim (a1), T. Higuchi (a1), H. Yasunaga (a2) and S. Nakada (a1)...


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