We investigated the association between 2009 IOM recommendations and adverse infant outcomes by maternal prepregnancy body mass index (BMI). Birth outcomes for 570,672 women aged 18-40 years with a singleton full-term live-birth were assessed using 2004-2007 Florida live-birth certificates. Outcomes included large-for-gestational-age (LGA) and small-for-gestational-age (SGA). Associations between gestational weight change and outcomes were assessed for 10 BMI groups by calculating proportions, and logistic regression modeling was used to produce adjusted odds ratios (aORs) to account for the effect of confounders. We created comparison categories below and above recommendations using 2009 IOM recommendations as a reference. Of importance, 41.6% of women began pregnancy as overweight and obese and 51.2% gained weight excessively during pregnancy on the basis of 2009 IOM recommendations. Proportions of LGA were higher among obese women and increased with higher weight gain. Compared with recommended weight gain, aORs for LGA were lower with less than recommended gain (aOR range: 0.27-0.77) and higher with more than recommended gain (aOR range: 1.27-5.99). However, SGA was less prevalent among obese women, and the proportion of SGA by BMI was similar with higher weight gain. Gain less than recommended was associated with increased odds of SGA (aOR range: 1.11-2.97), and gain greater than recommended was associated with decreased odds of SGA (aOR range: 0.38-0.83). Gestational weight gain influenced the risk for LGA and SGA in opposite directions. Minimal weight gain or weight loss lowered risk for LGA among obese women. Compared with 1990 IOM recommendations, 2009 recommendations include weight gain ranges that are associated with lower risk of LGA and higher risk of SGA. Awareness of these tradeoffs may assist with clinical implementation of the 2009 IOM gestational weight gain recommendations. However, our results did not consider other maternal and infant outcomes related to gestational weight gain; therefore, the findings should be interpreted with caution.
To investigate the reliability and validity of weight, height, and body mass index (BMI) from birth certificates with directly measured values from the Women, Infants, and Children (WIC) Program. Florida birth certificate data were linked and compared with first trimester WIC data for women with a live birth during the last quarter of calendar year 2005 (n = 23,314 women). Mean differences for weight, height, and BMI were calculated by subtracting birth certificate values from WIC values. Reliability was estimated by Pearson's correlation. Validity was measured by sensitivity and specificity using WIC data as the reference. Overall mean differences plus or minus standard error (SE) were 1.93 ± 0.04 kg for weight, -1.03 ± 0.03 cm for height, and 1.07 ± 0.02 kg/m(2) for BMI. Pearson's correlation ranged from 0.83 to 0.95, which indicates a strong positive association. Compared with other categories, women in the second weight group (56.7-65.8 kg), the highest height group (≥167.6 cm), or BMI < 18.5 had the greatest mean differences for weight (2.2 ± 0.08 kg), height (-2.4 ± 0.05 cm), and BMI (1.5 ± 0.06), respectively. Mean differences by maternal characteristics were similar, but statistically significant, likely in part from the large sample size. The sensitivity for birth certificate data was 77.3% (±1.42) for underweight (BMI < 18.5) and 76.4% (±0.51) for obesity (BMI ≥ 30). Specificity was 96.8% (±0.12) for underweight and 97.5% (±0.12) for obesity. Birth certificate data had higher underweight prevalence (6 vs. 4%) and lower obesity prevalence (24 vs. 29%), compared with WIC data. Although birth certificate data overestimated underweight and underestimated obesity prevalence, the difference was minimal and has limited impact on the reliability and validity for population-based surveillance and research purposes related to recall or reporting bias.
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