Gestational Weight Gain and Neonatal Biometry during the COVID-19 Pandemic: A Multicenter Observational Cohort

Abstract

Objective: To assess whether being pregnant and delivering during the COVID-19 pandemic was associated with changes in gestational weight gain (GWG) or frequency of small- (SGA) or large-for-gestational-age (LGA) neonates. Study Design: Secondary analysis of a multicenter observational cohort comparing pregnant people who delivered during the COVID-19 pandemic (June-December 2020) to people who delivered prior to the pandemic (March-December 2019). Those with multiple gestations, fetuses with major congenital anomalies, implausible GWG values, unavailable body mass index (BMI), or who were SARS-CoV-2 positive were excluded. The primary outcome was frequency of optimal recommended GWG based on pre-pregnancy BMI. Neonatal outcomes included birthweight, ponderal index, and frequency of SGA, LGA and small head circumference for livebirths. Multivariable regression analysis was used to assess associations between exposure to the pandemic and outcomes. Results: The 4,225 pregnant people exposed to the pandemic were older and more likely to have gestational diabetes compared with the 6,492 people who delivered prior to the COVID-19 pandemic. The frequency of appropriate GWG was 28.0% during the pandemic and 27.6% before the pandemic (aOR 1.02, 95% CI 0.93-1.11). Excessive GWG was more likely (aOR 1.08, 95% CI 1.001-1.17) and inadequate GWG was less likely during the pandemic (aOR 0.86, 95% CI 0.77-0.95). The frequency of SGA was 5.4% during the pandemic and 6.1% before the pandemic (aOR 0.90, 95% CI 0.76-1.06), and the frequency of LGA was 16.0% during the pandemic vs 15.0% before the pandemic (aOR 1.06, 95% CI 0.95-1.18). Other neonatal outcomes including birthweight percentile (62.1 vs 60.2), ponderal index (2.6 g/cm3 in both groups), and small head circumference for livebirths (8.2% vs 8.1%) were similar between groups as well. Conclusion: Being pregnant and delivering during the COVID-19 pandemic was associated with a higher likelihood of excessive GWG and a lower likelihood of inadequate GWG.