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

Abstract

ObjectiveTo assess the associations of gestational weight gain (GWG) in early and late pregnancy with subsequent risks of adverse pregnancy outcomes in Chinese women.DesignProspective cohort study.SettingShanghai, China.ParticipantsWe studied 2630 nulliparous singleton pregnant women with complete data on weight gain in early (≤17 weeks of gestation) and late (>17 weeks) pregnancy in the Shanghai Birth Cohort.MethodsGWG was standardised into z-scores by gestational age and categorised as low (z-score <−1), normal (−1 to +1) and high (>1). The adjusted relative risks (aRRs) and 95%CIs were estimated through log-binomial regression models. Interaction effects between GWG and some other adjustment factors were tested, further stratified analyses were performed separately where interaction terms were significant.Outcome measuresAdverse maternal and neonatal outcomes.ResultsIndependent from GWG in late pregnancy, higher GWG in early pregnancy was associated with higher risks of gestational diabetes mellitus (aRR: 1.66; 95% CI: 1.11 to 2.48), caesarean section (aRR: 1.21; 95% CI: 1.05 to 1.39) and prolonged hospitalisation (aRR: 1.56; 95% CI: 1.03 to 2.38). Higher GWG in late pregnancy was independently associated with higher risks of caesarean section (aRR: 1.24; 95% CI: 1.09 to 1.41), large for gestational age (aRR: 2.01; 95% CI: 1.50 to 2.7) and macrosomia (aRR: 1.90; 95% CI: 1.30 to 2.78). In addition, the risk of gestational hypertension increased significantly with increased total GWG (aRR: 1.78; 95% CI: 1.14 to 2.76). The effects of GWG in late pregnancy on maternal and neonatal outcomes were significantly different between the women bearing a female and the women bearing male fetus.ConclusionThe GWG associations with adverse pregnancy outcomes differ at early and late pregnancy, and there may be effect modification by fetal sex in the association of GWG in late pregnancy with some pregnancy outcomes.

Normal Gestational Weight Gain Protects From Large-for-Gestational-Age Birth Among Women With Obesity and Gestational Diabetes

“…Also the timing of GWG has been reported relevant to fetal growth (18)(19)(20). Though excessive GWG early in pregnancy has been reported to have the strongest effect on fetal overgrowth (18,19), also controversial results has been presented (20). Thus, another limitation of the study is that we were able to study only the total GWG during pregnancy, not weight gain in different trimesters of pregnancy or after GDM diagnosis.…”

“…This is common in similar studies, and as mothers are measured at the first antenatal visit, substantial reporting error is unlikely. Also the timing of GWG has been reported relevant to fetal growth (18)(19)(20). Though excessive GWG early in pregnancy has been reported to have the strongest effect on fetal overgrowth (18,19), also controversial results has been presented (20).…”

Maternal obesity, pregnancy weight gain, and birth weight and risk of colorectal cancer

“…We used these two measures of pregnancy weight gain based on evidence that the timing of weight gain has different consequences for fetal growth and development. [33][34][35][36]…”

Association between Prenatal Care and Gestational Weight Gain: Cross-Sectional Study in a Low-Income Area of Rio de Janeiro

“…10 No entanto, há uma grande variação na prevalência de GPG inadequado e excessivo entre diferentes estudos e populações. 2,31 Além disso, a literatura sugere que o IMC pré-gestacional está positivamente associado ao GPG, e mulheres com sobrepeso e obesas têm maior probabilidade de ganhar peso excessivamente durante a gravidez. 13,30 Cheney et al 30 verificaram que gestantes com sobrepeso e obesidade tiveram maiores chances de ganhar peso excessivo em comparação com mulheres com peso normal.…”

“…O ganho de peso excessivo durante a gravidez aumenta o risco de desenvolvimento de síndromes hipertensivas, diabetes mellitus gestacional e macrossomia fetal, enquanto o ganho de peso insuficiente está relacionado ao baixo-peso ao nascer e ao crescimento intrauterino restrito. [1][2][3] Fatores socioeconômicos, como educação, paridade, estilo de vida materno e a atenção no pré-natal encontram-se entre os determinantes do ganho de peso gestacional (GPG). [4][5][6] O Institute of Medicine (IOM) 7 sugere que mulheres com índice de massa corporal (IMC) normal anterior ao período gestacional devem ganhar entre 11,5 e 16 kg ao longo da gravidez.…”