Gestational weight gain charts for different body mass index groups for women in Europe, North America, and Oceania

Santos, Susana; Eekhout, Iris; Voerman, Ellis; Gaillard, Romy; Barros, Henrique; Munier, Charles; Chatzi, Leda; Chevrier, Cécile; Chrousos, George P.; Corpeleijn, Eva; Costet, Nathalie; Crozier, Sarah; Doyon, Myriam; Eggesbø, Merete; Fantini, Maria Pia; Farchi, Sara; Forastiére, Francesco; Gagliardi, Luigi; Georgiu, Vagelis; Godfrey, Keith M.; Gori, Davide; Grote, Veit; Hanke, Wojciech; Hertz‐Picciotto, Irva; Heude, Barbara; Hivert, Marie‐France; Hryhorczuk, Daniel O.; Huang, Rae‐Chi; Inskip, Hazel; Jusko, Todd A.; Karvonen, Anne M.; Koletzko, Berthold; Küpers, Leanne K.; Lagström, Hanna; Lawlor, Debbie A.; Lehmann, Irina; Lopez-Espinosa, Maria-José; Magnus, Per; Majewska, Renata; Mäkelä, Johanna; Μanios, Yannis; McDonald, Sheila; Mommers, Monique; Morgen, Camilla Schmidt; Moschonis, George; Murínová, Ľubica Palkovičová; Newnham, John P.; Nøhr, Ellen Aagaard; Andersen, Anne‐Marie Nybo; Oken, Emily; Oostvogels, Adriëtte J. J. M.; Pac, Agnieszka; Papadopoulou, Eleni; Pekkanen, Juha; Pizzi, Costanza; Polańska, Kinga; Porta, Daniela; Richiardi, Lorenzo; Rifas‐Shiman, Sheryl L.; Roeleveld, Nel; Santa‐Marina, Loreto; Santos, Ana Cristina; Smit, Henriëtte A.; Sørensen, Thorkild I A; Standl, Marie; Stanislawski, Maggie A.; Stoltenberg, Camilla; Thiering, Elisabeth; Thijs, Carel; Torrent, Maties; Tough, Suzanne; Trnovec, T.; Gelder, Marleen M.H.J. van; Rossem, Lenie van; Berg, Andrea von; Vrijheid, Martine; Vrijkotte, Tanja G. M.; Zvinchuk, Alexander; Buuren, Stef van; Jaddoe, Vincent W. V.

doi:10.1186/s12916-018-1189-1

Cited by 87 publications

(99 citation statements)

References 34 publications

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“…However, a large systematic review showed that reporting error did not bias associations between pregnancy‐related weight and birth outcomes . We used maternal pre‐pregnancy BMI‐specific weight gain for gestational age z ‐scores, which classify weight gain independently of gestational age . This approach allows assessment of the unbiased associations between gestational weight gain and pregnancy outcomes that are highly correlated with gestational age at birth.…”

Section: Discussionmentioning

confidence: 99%

“…We calculated maternal pre‐pregnancy BMI‐specific weight gain for gestational age z ‐scores based on reference charts created using data from this collaboration (Supporting Information Appendix S1). These z ‐scores were categorised into six categories [<−2.0 standard deviation (SD), −2.0 to −1.1 SD, −1.0 to −0.1 SD, 0–0.9 SD, 1.0–1.9 SD and ≥2.0 SD) and into low (≤−1.1 SD), medium (−1.0 to 0.9 SD) and high (≥1.0 SD) weight gain.…”

Section: Methodsmentioning

confidence: 99%

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Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta‐analysis of European, North American and Australian cohorts

Santos

Voerman

Amiano

et al. 2019

BJOG

402

320

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Obesity is one of the biggest challenges facing global reproductive health. Women in the UK and USA are today more likely to be obese or overweight at booking than normal weight, and many low-and middle-income countries (LMICs) seem destined to follow suit (Poston et al. Lancet Diabetes Endocrinol 2016;4:1025-36). Understanding how, and to what extent, maternal body mass index (BMI) and weight gain during pregnancy contribute to adverse outcomes for mothers and their offspring is therefore vital to informing future health policy.In an individual participant data meta-analysis of over 265 000 births, Santos et al. (BJOG 2019;126:984-95) confirm strong correlations between pre-pregnancy maternal BMI and the risks of gestational hypertension, preeclampsia and gestational diabetes. Over one-third of such complications in the study population were considered attributable to maternal overweight and obesity. The risk of large size for gestational age (LGA) at birth increased similarly across all categories of pre-pregnancy BMI and gestational weight gain, although these data should be interpreted in the context of a continuing debate regarding the customisation of fetal growth charts. It remains uncertain how maternal height and weight influence fetal growth potential, and whether LGA babies born to mothers who are obese or mothers with excessive weight gain carry the same short-and long-term health risks as LGA babies born to mothers who are normal weight. Preterm birth was also more common among women who are obese and past literature has suggested that this association is strongest for extremely preterm delivery (Cnattingius et al. JAMA 2013;309:2362-70), whether spontaneous or iatrogenic.Whereas women who are obese or have high weight gain are consistently shown to be at greatest risk, there is clear evidence of a continuum of risk across the full BMI range, which is emphasised by the authors' use of population attributable risk (PAR). Notably, the overall burden of pregnancy complications is similar in overweight and obese groups (PAR 11.4 and 12.5%, respectively). This calls into question traditional models of care targeting women with a booking BMI above 30 kg/m 2 or even higher thresholds. Minimising gestational weight gain in these women ameliorates but does not remove the excess risk, and ultimately may have less impact on outcomes at a population level than previously hoped.The authors acknowledge that the data were derived from cohorts who were largely white; however, comparable findings have been reported in LMICs with varied ethnic populations (Rahman et al. Obes Rev 2015;16:758-70).Being healthy entails more than just not being obese, and the study also draws important attention to the risks of small size for gestational age and preterm birth, particularly amongst underweight women with inadequate weight gain during pregnancy. These findings strengthen the argument for novel public health approaches to optimise maternal health with a shift in focus towards pre-conception and interpregnancy intervent...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta‐analysis of European, North American and Australian cohorts

Santos

Voerman

Amiano

et al. 2019

BJOG

402

320

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“…Pre-pregnancy nutritional status versus maternal weight gain and neonatal size Similar tendencies have been observed also in other regions of the world. In the USA, excess weight gain was reported for 50% of all pregnant women [8,12], and as many as 64-66% for women with pre-pregnancy overweight or obesity [6,19]. Weight gain below recommendations was found in 20% of the subjects [12].…”

Section: Nomentioning

confidence: 99%

“…The maximum recommended weight gain for obese women is 7 kg lower than for women with normal BMI. For that reason, most sources report that the percentage of women with pre-pregnancy obesity/ overweight whose weight gain during pregnancy is above recommendations -even despite lower weight gain in kilograms -is higher than the percentage of women with normal pre-pregnancy BMI but excess gestational weight gain [1,19,33].…”

Section: Nomentioning

confidence: 99%

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Pre-pregnancy nutritional status versus maternal weight gain and neonatal size

Wierzejska

Wojda

2019

Rocz Panstw Zakl Hig

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Background. Maternal weight during pregnancy may affect both, the course of pregnancy and the anthropometric parameters of the newborn. The steadily growing problem of excessive weight in reproductive-age women is associated with the risk for gestational obesity and its negative consequences for the infant. Objectives. The aims of the study were to analyze the following: (i) maternal weight gain as compared to the pre-pregnancy BMI, and (ii) the link between maternal weight and other environmental factors versus neonatal size. Material and methods. The study was conducted among 94 women in singleton term pregnancy, who delivered at the Department of Obstetrics, Gynecology and Oncology, Medical University of Warsaw. The American Institute of Medicine criteria for the recommended weight gain were followed. Multivariate logistic regression model and multiple regression analysis were used for statistical analysis. Results. Normal weight gain was observed in only one-third of the subjects, while excess weight gain was detected in as many as 42.5% of the women. Active smokers were at a 4-fold higher risk for excess weight gain as compared to nonsmokers (OR 4.13, 95% CI 1.19 - 14.34, p = 0.026). Infants born to mothers with insufficient weight gain (24.5% of the mothers) were lighter by 302 g (p=0.0405) and shorter by 2.4 cm (p=0.0025) as compared to those born to mothers with normal weight gain. Conclusions. Maternal weight gain in most of our subjects was not compliant with the current recommendations, regardless of the pre-pregnancy BMI. Inadequate pregnancy weight gain negatively affects the anthropometric parameters of the newborn.

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Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes

Obesity¹,

Voerman

Santos

et al. 2019

JAMA

Self Cite

388

208

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IMPORTANCE Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all prepregnancy weight ranges. OBJECTIVES To examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories. DESIGN, SETTING, AND PARTICIPANTS Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample). Optimal gestational weight gain ranges were estimated for each prepregnancy body mass index (BMI) category by selecting the range of gestational weight gain that was associated with lower risk for any adverse outcome. Individual participant-level data from 3505 participants within 4 separate hospital-based cohorts were used as a validation sample. Data were collected between 1989 and 2015. The final date of follow-up was December 2015. EXPOSURES Gestational weight gain. MAIN OUTCOMES AND MEASURES The main outcome termed any adverse outcome was defined as the presence of 1 or more of the following outcomes: preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, and small or large size for gestational age at birth. RESULTS Of the 196 670 women (median age, 30.0 years [quartile 1 and 3, 27.0 and 33.0 years] and 40 937 were white) included in the main sample, 7809 (4.0%) were categorized at baseline as underweight (BMI <18.5); 133 788 (68.0%), normal weight (BMI, 18.5-24.9); 38 828 (19.7%), overweight (BMI, 25.0-29.9); 11 992 (6.1%), obesity grade 1 (BMI, 30.0-34.9); 3284 (1.7%), obesity grade 2 (BMI, 35.0-39.9); and 969 (0.5%), obesity grade 3 (BMI, Ն40.0). Overall, any adverse outcome occurred in 37.2% (n = 73 161) of women, ranging from 34.7% (2706 of 7809) among women categorized as underweight to 61.1% (592 of 969) among women categorized as obesity grade 3. Optimal gestational weight gain ranges were 14.0 kg to less than 16.0 kg for women categorized as underweight; 10.0 kg to less than 18.0 kg for normal weight; 2.0 kg to less than 16.0 kg for overweight; 2.0 kg to less than 6.0 kg for obesity grade 1; weight loss or gain of 0 kg to less than 4.0 kg for obesity grade 2; and weight gain of 0 kg to less than 6.0 kg for obesity grade 3. These gestational weight gain ranges were associated with low to moderate discrimination between those with and those without adverse outcomes (range for area under the receiver operating characteristic curve, 0.55-0.76). Results for discriminative performance in the validation sample were similar to the corresponding results in the main study sample (range for area under the receiver operating characteristic curve, 0.51-0.79). CONCLUSIONS AND RELEVANCE In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational wei...

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Gestational weight gain charts for different body mass index groups for women in Europe, North America, and Oceania

Cited by 87 publications

References 34 publications

Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta‐analysis of European, North American and Australian cohorts

Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta‐analysis of European, North American and Australian cohorts

Pre-pregnancy nutritional status versus maternal weight gain and neonatal size

Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes

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