Gestational Weight Gain and Severe Maternal Morbidity at Delivery Hospitalization

Abstract

has been reviewed by the Editorial Board and by special expert referees. Although it is judged not acceptable for publication in Obstetrics & Gynecology in its present form, we would be willing to give further consideration to a revised version. If you wish to consider revising your manuscript, you will first need to study carefully the enclosed reports submitted by the referees and editors. Each point raised requires a response, by either revising your manuscript or making a clear and convincing argument as to why no revision is needed. To facilitate our review, we prefer that the cover letter include the comments made by the reviewers and the editor followed by your response. The revised manuscript should indicate the position of all changes made. We suggest that you use the "track changes" feature in your word processing software to do so (rather than strikethrough or underline formatting).

Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004–2013

“…The excess weight gain was more common in overweight and obese women (61% and 53%, respectively), which is consistent with the literature [29,30]. Previous studies underscored increases in SMM only among women with excess weight gain [14,16]; however, our results show an increase in maternal death/SMM also in women with low gestational weight gain. Prior studies were smaller and were often restricted to women with term pregnancy [14,16].…”

“…Previous studies underscored increases in SMM only among women with excess weight gain [14,16]; however, our results show an increase in maternal death/SMM also in women with low gestational weight gain. Prior studies were smaller and were often restricted to women with term pregnancy [14,16]. Our sensitivity analyses show that such restriction provides different results for perinatal outcomes, as women with low and excess weight gain are more likely to deliver preterm.…”

“…Prior reports were relatively small and showed an elevated risk of cesarean delivery, preeclampsia, and blood transfusions among women who had excess weight gain during pregnancy [5,14,15]. One study reported an overall increased risk of SMM during hospital admission for delivery among women who had excess gestational weight gain; however, similarly to studies of perinatal outcomes, these findings pertained only to term deliveries [16]. None of the prior studies included all serious adverse birth outcomes, including death and severe maternal and fetal/infant morbidity.…”

“…The IOM/ACOG guidelines provide the same optimal weight gain recommendation for women with pre-pregnancy obesity regardless of the obesity class [1,3]. However, suboptimal weight gain likely differs with increasing BMI in these women [6,16], and this lack of specific recommendations by obesity class signifies an important knowledge gap.…”

Understanding maternal mortality in women with obesity and the role of care they receive: a national case-control study

“…Nevertheless, a recent meta-analysis showed that self-reported weight of women of reproductive age differs only slightly from direct measures [35]. Finally, beyond BMI, gestational weight gain, a recently highlighted risk factor for adverse pregnancy outcomes [36], was not taken into account in our analysis, because related data were not available. Nonetheless, a noteworthy study from the state of Washington did not show any substantial modification in the associations between BMI and maternal outcomes after controlling for gestational weight gain [11].…”