Association Between Gestational Weight Gain and Perinatal Outcomes

Abstract

OBJECTIVE: To evaluate the association between gestational weight gain and maternal and neonatal outcomes in a large, geographically-diverse cohort. METHODS: Trained chart abstractors at 25 hospitals obtained maternal and neonatal data for all deliveries on randomly selected days over 3 years (2008–2011). Gestational weight gain was derived using weight at delivery minus pre-pregnancy or first-trimester weight and categorized as below, within or above the Institute of Medicine (IOM) guidelines in this retrospective cohort study. Maternal (primary or repeat cesarean birth, 3rd or 4th degree lacerations, severe postpartum hemorrhage, hypertensive disease of pregnancy) and neonatal (preterm birth, shoulder dystocia, macrosomia, hypoglycemia) outcomes were compared among women in the gestational weight gain categories in unadjusted and adjusted analyses with ORs and 95%CI reported. Covariates included age, race-ethnicity, tobacco use, insurance type, parity, prior cesarean birth, pregestational diabetes, hypertension, and hospital type. RESULTS: Of the 29,861 women included, 51% and 21% had gestational weight gain above and below the guidelines, respectively. There was an association between gestational weight gain above the IOM guidelines and cesarean birth in both nulliparous women (aOR 1.44, 95%CI 1.31–1.59) and multiparous women (aOR 1.26, 95%CI 1.13–1.41) and hypertensive diseases of pregnancy in nulliparous and multiparous women combined (aOR 1.84, 95%CI 1.66–2.04). For the neonatal outcomes, gestational weight gain above the IOM guidelines was associated with shoulder dystocia (aOR 1.74, 95%CI 1.41-.2.14), macrosomia (aOR 2.66, 95%CI 2.03–3.48), and neonatal hypoglycemia (aOR 1.60, 95%CI 1.16–2.22). Gestational weight gain below the guidelines was associated with spontaneous (aOR 1.50, 95%CI 1.31–1.73) and indicated (aOR 1.34, 95%CI 1.12–1.60) preterm birth. CONCLUSIONS: In a large, diverse cohort with prospectively collected data, gestational weight gain below or above guidelines is associated with a variety of adverse pregnancy outcomes.

Gestational Weight Gain and Pregnancy Outcomes among Nulliparous Women

“…This finding is consistent with prior studies, in which between 40 and 73% of women gained excessive weight. 4,5,25,26 Our results are also consistent with estimates of inadequate gestational weight gain, which occurs in 10 to 30% of women. 25 Gestational weight gain represents a potentially modifiable risk factor for adverse pregnancy outcomes.…”

Effect of gestational Mediterranean diet intervention on newborn fat mass and cord blood leptin level

“…For women within the excessive gestational weight gain category, infants born to normal-weight mothers had lower %fat (11.8%) than infants born to overweight mothers (13.7%, P .019) and obese mothers (14.2%, P .011). Moreover, gestational weight gain above the figures of the Institute of Medicine (IOM) guidelines was found to be associated with both macrosomia, and neonatal hypoglycemia in the study of Kominiarek et al [16].…”

Gestational weight gain and adverse pregnancy outcomes: a prospective cohort study

“…A study of 29 861 women from 25 hospitals in USA showed that early weight gain over the 2009 IOM recommendation was shown to be associated with the development of gestational hypertension. 31 In a study of 101 259 women with chronic hypertension, women who gained the amount of weight above the GWG range recommended by IOM guidelines were at increased risks of eclampsia. 32 Given the known vascular permeability and decreased plasma oncotic pressure that accompanies pre-eclampsia and its association with rapid weight gain, 33 excessive GWG may be a cause of hypertensive disease of pregnancy.…”