Gestational Weight Gain: Association with Adverse Pregnancy Outcomes

Hannaford, Karen; Tuuli, Methodius G.; Odibo, Linda; Macones, George A.

doi:10.1055/s-0036-1584583

Cited by 11 publications

(9 citation statements)

References 9 publications

(20 reference statements)

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“…However, in studies applying ethnic-specific regional BMI categories, women in Asia had similar rates of GWG above guidelines. The prevalence of GWG above guidelines is consistent with observational studies [47–50]. Excess GWG increases adverse pregnancy outcomes, independent of BMI, as demonstrated here, and also increases postpartum weight retention and obesity [45, 51].…”

Section: Discussionsupporting

confidence: 87%

Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women

Goldstein

Abell

Ranasinha

et al. 2018

BMC Med

336

334

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BackgroundThe association between Institute of Medicine (IOM) guidelines and pregnancy outcomes across ethnicities is uncertain. We evaluated the associations of gestational weight gain (GWG) outside 2009 IOM guidelines, with maternal and infant outcomes across the USA, western Europe and east Asia, with subgroup analyses in Asia. The aim was to explore ethnic differences in maternal prepregnancy body mass index (BMI), GWG and health outcomes across these regions.MethodsSystematic review, meta-analysis and meta-regression of observational studies were used for the study. MEDLINE, MEDLINE In-Process, Embase and all Evidence-Based Medicine (EBM) Reviews were searched from 1999 to 2017. Studies were stratified by prepregnancy BMI category and total pregnancy GWG. Odds ratio (ORs) 95% confidence intervals (CI) applied recommended GWG within each BMI category as the reference. Primary outcomes were small for gestational age (SGA), preterm birth and large for gestational age (LGA). Secondary outcomes were macrosomia, caesarean section and gestational diabetes.ResultsOverall, 5874 studies were identified and 23 were included (n = 1,309,136). Prepregnancy overweight/obesity in the USA, Europe and Asia was measured at 42%, 30% and 10% respectively, with underweight 5%, 3% and 17%. GWG below guidelines in the USA, Europe and Asia was 21%, 18% and 31%, and above was 51%, 51% and 37% respectively. Applying regional BMI categories in Asia showed GWG above guidelines (51%) was similar to that in the USA and Europe.GWG below guidelines was associated with a higher risk of SGA (USA/Europe [OR 1.51; CI 1.39, 1.63]; Asia [1.63; 1.45, 1.82]) and preterm birth (USA/Europe [1.35; 1.17, 1.56]; Asia [1.06; 0.78, 1.44]) than GWG within guidelines. GWG above guidelines was associated with a higher risk of LGA (USA/Europe [1.93; 1.81, 2.06]; Asia [1.68; 1.51 , 1.87]), macrosomia (USA/Europe [1.87; 1.70, 2.06]; Asia [2.18; 1.91, 2.49]) and caesarean (USA/Europe [1.26; 1.21, 1.33]; Asia [1.37; 1.30, 1.45]). Risks remained elevated when regional BMI categories were applied for GWG recommendations. More women in Asia were categorised as having GWG below guidelines using World Health Organization (WHO) (60%) compared to regional BMI categories (16%), yet WHO BMI was not accompanied by increased risks of adverse outcomes.ConclusionsWomen in the USA and western Europe have higher prepregnancy BMI and higher rates of GWG above guidelines than women in east Asia. However, when using regional BMI categories in east Asia, rates of GWG above guidelines are similar across the three continents. GWG outside guidelines is associated with adverse outcomes across all regions. If regional BMI categories are used in east Asia, IOM guidelines are applicable in the USA, western Europe and east Asia.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1128-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 87%

Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women

Goldstein

Abell

Ranasinha

et al. 2018

BMC Med

336

334

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“…The 13 studies included a total of 156,170 participants. All included studies were cohort studies; seven were retrospective [ 15 , 16 , 18 , 19 , 24 – 26 ], three were prospective [ 20 , 21 , 23 ], two were retrospective analyses of prospectively collected data [ 17 , 27 ] and one was a secondary analysis of a multicenter, placebo-controlled randomized double-blind trial [ 22 ]. Four studies included multiethnic populations [ 20 , 22 , 23 , 27 ], seven studies were performed on Asian populations [ 15 – 19 , 25 , 26 ], one study was performed on a population of Latinas [ 21 ] and one study was performed on an African population [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

“…Pre-pregnancy weight was self-reported in five studies [ 15 – 17 , 21 , 26 ] and measured at the first prenatal visit in five studies [ 18 , 20 , 22 , 23 , 25 ]; three studies did not mention their data-collection methods [ 19 , 24 , 27 ]. Seven studies with complete data for GWG with normal pre-gestational BMI used the IOM recommendations [ 15 – 17 , 19 , 23 , 25 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…First, using self-reported pre-pregnancy weight or the weight and height data recorded at the first prenatal visit within the first 12 weeks of pregnancy is one limitation of this study. In our report, pre-pregnancy weight was self-reported by five studies [ 15 – 17 , 21 , 26 ] and measured at the first prenatal visit by five studies [ 18 , 20 , 22 , 23 , 25 ]; three studies did not mention their data collection methods [ 19 , 24 , 27 ]. Self-reported pre-pregnancy weight is subject to recall bias, and the weight recorded at the first prenatal visit is difference from pre-pregnancy weight, which might lead to under- or overestimations of GWG, a common problem among gestational weight gain studies.…”

Section: Discussionmentioning

confidence: 99%

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Excessive gestational weight gain in accordance with the IOM criteria and the risk of hypertensive disorders of pregnancy: a meta-analysis

Ren

Cai

et al. 2018

BMC Pregnancy Childbirth

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BackgroundExcessive gestational weight gain (GWG) is a potential risk factor for hypertensive disorders of pregnancy (HDP).MethodsWe systematically reviewed three electronic databases for relevant articles published in English: PubMed, EMBASE and Web of Science. The Newcastle-Ottawa Scale was used to assess study quality. Random-effects meta-analyses were performed to supply a pooled estimation of the OR comparing the risk of HDP among healthy pregnant women with and without excessive GWG.ResultsThe pooled estimation for the association between excessive GWG and the risk of HDPs yielded an odds ratio (OR) of 1.79 (95% CI: 1.61–1.99). A subgroup analysis showed that women who had excessive GWG were more likely to have an HDP (OR 1.82; 95% CI 1.53–2.17), preeclampsia (OR 1.92; 95% CI 1.36–2.72), or gestational hypertension (OR 1.67; 95% CI 1.43–1.95). The pooled estimation for the association between excessive GWG and the risk of HDPs among pregestational normal weight women yielded an OR of 1.57 (95% CI 1.26–1.96). A subgroup analysis showed that women who had excessive GWG were more likely to have HDP (OR 1.45; 95% CI 1.09–1.92) or gestational hypertension (OR 1.51; 95% CI 1.22–1.86). The summary ORs of pre-gestational underweight women and pre-gestational overweight and obese women were 2.17 (95% CI 1.56–3.02) and 1.32 (95% CI 1.08–1.63), respectively.ConclusionsThe findings of this study suggest that excessive GWG in accordance with the IOM recommendations influences the rate of HDP.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1922-y) contains supplementary material, which is available to authorized users.

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“…Previous studies have shown conflicting results regarding the GDM association with GWG. Some have suggested that the inadequate GWG is associated with GDM [10], but others have demonstrated that the GWG is not associated with GDM [22]. These conflicting results might be related to the fact that women who are diagnosed with GDM during the second trimester of pregnancy may try to maintain appropriate weight during the remainder of pregnancy by exercising and having a healthy diet.…”

Section: Discussionmentioning

confidence: 99%

Is it appropriate for Korean women to adopt the 2009 Institute of Medicine recommendations for gestational weight gain?

et al. 2017

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BackgroundThe 2009 Institute of Medicine (IOM) guidelines for gestational weight gain (GWG) are intended for use among women in the United States. Little data are available on whether the 2009 IOM recommendations can be applied to Asian women. This study aimed to evaluate whether the recommendations are related to adverse pregnancy outcomes in Korean pregnant women.Methods and findingsA retrospective cohort study was conducted for all singleton-pregnant women at a university hospital in Korea. After classifying the enrolled women into four Korean pre-pregnancy body mass index (BMI) categories, the risk of adverse pregnancy outcomes were analyzed for women who gained inadequate or excessive GWG based on 2009 IOM recommendations. Of 7,843 pregnancies, 64.0% of women had normal pre-pregnancy BMI and 42.7% achieved optimal GWG. Across all BMI categories, adverse pregnancies outcomes such as small for gestational age (SGA), large for gestational age (LGA), preterm birth, preeclampsia, and cesarean due to dystocia were significantly associated with GWG (all P ≤ 0.001).Women with normal BMI who gained inadequate weight were more likely to develop SGA and preterm birth and less likely to develop LGA (adjusted odds ratio (aOR) 2.21, 1.33, and 0.54, respectively). Whereas, women with normal BMI who gained excessive weight were more likely to develop LGA, preterm birth, preeclampsia, and cesarean section due to dystocia (aOR 2.10, 1.33, 1.37, and 1.37, respectively) and less likely to develop SGA (aOR 0.60).ConclusionsIt is tolerable for Korean women to follow recommended GWG from the 2009 IOM guidelines to decrease adverse pregnancy outcomes. This will be helpful for antenatal care on GWG not only for Korean pregnant women, but also other Asian women who have lower BMI criteria than Caucasian women.

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Gestational Weight Gain: Association with Adverse Pregnancy Outcomes

Cited by 11 publications

References 9 publications

Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women

Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women

Excessive gestational weight gain in accordance with the IOM criteria and the risk of hypertensive disorders of pregnancy: a meta-analysis

Is it appropriate for Korean women to adopt the 2009 Institute of Medicine recommendations for gestational weight gain?

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