Evaluating the application of the 2009 Institute of Medicine gestational weight gain guidelines on pregnant Chinese women

Abstract

Background The 2009 Institute of Medicine (IOM) gestational weight gain (GWG) guidelines were initially developed for pregnant women in the United States. Objective This study aimed to investigate whether the IOM guidelines were suitable for pregnant Chinese women. Methods A retrospective cohort study comprising 20,593 singleton pregnant women was conducted at the Beijing Obstetrics and Gynaecology Hospital (1 January 2018 to 31 December 2019). Applicability was evaluated by comparing the GWG corresponding to the lowest point of the predicted composite risk curve with the 2009 IOM GWG Guidelines. The IOM Guidelines serve as the standard for the GWG categories and the pre-pregnancy body mass index. An exponential function model was used to fit the weight gain during pregnancy and the probability of caesarean section, preterm birth, small for gestational age, and large for gestational age. A quadratic function model was used to fit the combined probability of the above-mentioned adverse pregnancy outcomes. The applicability of the IOM guidelines was evaluated by comparing the weights corresponding to the lowest predicted probability with the GWG range recommended by the IOM guidelines. Results According to the 2009 IOM GWG Guidelines, 43% of the women achieved adequate weight, almost 32% gained excessive weight, and 25% gained inadequate weight. The GWG range proposed by the IOM included the lowest predicted probability value for underweight women and exceeded the lowest predicted probability for normal weight, overweight, and obese women. Conclusions The 2009 IOM guidelines were suitable for Chinese women whose pre-pregnancy body mass index was classified as underweight. The guidelines were not suitable for normal, overweight, or obese pre-pregnancy body mass index classifications. Therefore, based on the above evidence, the 2009 IOM guidelines are not suitable for all Chinese women.

High pre-pregnancy body mass index and gestational weight gain among women belonging to upper SES from Delhi, India

“…2 . Similar comparisons (based on nation-specific BMI criteria and IOM guidelines) have also been carried out in other studies [13] , [25] , [26] . In the present study, findings showed that overall, 62.78 % of subjects had gained inappropriate weight out of which nearly half of the subjects (48.12 %) had gained weight more than recommendations and 14.66 % subjects had gained less than recommended GWG limits.…”

“…Hence, in the present study, the BMI criteria based on the Asian Indians (2009) [20] , was used to classify the pregnant women. Since, there are no national guidelines available for optimum GWG for obese and overweight Indian pregnant women, current study was aimed to assess the pattern of GWG w.r.t IOM guidelines-2009 among the subjects with BMI categories specified for (Asian-Indians,2009) as reported in earlier studies from China and India [13] , [25] , [26] .…”

Optimal range of gestational weight gain for singleton pregnant women: a cohort study based on Chinese specific body mass index categories

“…Even studies using the same statistical method recommend a completely different range of body mass, which may be related to the different inclusion outcomes. In terms of the outcome of the study, outcomes related to neonatal weight, such as SGA, LGA, low birth weight infants and macrosomia, are the most commonly used outcome indicators to calculate the range of weight gain during pregnancy, and pregnancy induced hypertension or preeclampsia are the most commonly used outcome indicators to minimize its risk [7,21,32,[34][35][36].…”

“…However, in view of the differences in race, environment, economic development level, medical service level, living habits, etc., the applicability of IOM 2009 GWG guidelines to pregnancy weight gain in other countries is controversial [7,[31][32][33]. This guideline has been demonstrated unsuitable for all Chinese women [34]. Many researches in different countries continued to explore appropriate gestational weight gain based on national data on pregnant women [31-33, 35, 36], and the statistical methods used and the GWG range recommended were also different.…”