Gestational weight gain disparities in South Carolina: Temporal trends, 2004‐2015

Abstract

Background Few studies have examined secular trends in gestational weight gain (GWG) and findings are inconsistent. Parallel to increasing trends in pre‐pregnancy obesity, we hypothesised similar increasing GWG trends. Objectives The study examined trends in GWG in South Carolina (SC), using methods to reduce bias. We also examined whether the 12‐year trends in GWG varied according to race/ethnicity and pre‐pregnancy weight. Methods Data came from SC birth certificates, 2004 to 2015. We calculated standardised GWG z‐scores (GWGZ), using smoothed reference values to account for gestational age and pre‐pregnancy body mass index. Quantile regression was used to examine trends in GWGZ, adjusting for pre‐pregnancy weight status, race/ethnicity, parity, WIC participation, smoking during pregnancy, residence, age, and birth cohort. Results Among 615 093 women, the mean GWGZ was −0.4 (SD = 1.3), which increased from −0.4 in 2004‐2005 to −0.2 in 2014‐2015. GWGZ increased at the 5th, 10th, 25th, 50th, and 75th percentiles (ranging 0.04 to 0.73 units), with differential trends observed in sub‐groups by pre‐pregnancy weight and racial/ethnic group. Notably, non‐Hispanic White women showed larger increasing trends (0.89 units) compared to non‐Hispanic Black (0.55 units) and Hispanic (0.76 units) women in the 5th percentile. Decreasing trends were seen overall for the 90th (−0.02) and 95th percentile (−0.06 units) but positive trends were not seen among women experiencing obese class 1 (no change in 90th and 95th), and 2 (0.01 units in 90th, −0.02 units in 95th). Conclusions This study shows increasing GWGZ trends from the 5th to the 75th percentiles and decreasing trends in 90th and 95th percentiles in SC for the last decade. Racial/ethnic and pre‐pregnancy weight disparities did not improve over the study period. Future research is needed to confirm these findings in other states and to develop strategies to narrow racial and pre‐pregnancy weight disparities at the highest and lowest percentiles.

Risk of large for gestational age births at early, full and late term in relation to pre‐pregnancy body mass index: Mediation by gestational diabetes status

“…Missing data included race/ethnicity (0.9%), education (1.3%), parity (0.3%), pre‐pregnancy BMI (2.1%), gestational diabetes (0.1%), gestational age (0.1%) and birthweight (0.1%). Deletion due to missing data can be influential if it is missing not at random, but the percentage of missing data in our study was small (4.9%), and multiple imputation was not necessary 36 . Characteristics of women and infants with and without missing data in the study sample are displayed in Table .…”

A Behavioral Lifestyle Intervention to Limit Gestational Weight Gain in Pregnant Women with Overweight and Obesity

“…CLINICAL TRIALS AND INVESTIGATIONS times more likely to exceed IOM gestational weight gain (GWG) guidelines than women with normal weight (4), and the trend of gaining excessive weight during pregnancy appears to be rising over time (5)(6)(7). Women with overweight and obesity who exceed IOM guidelines further increase their risk for adverse perinatal outcomes (8).…”

“…Half of pregnant women in the United States exceed the Institute of Medicine (IOM)'s recommended weight gain (3). Women with overweight and obesity are two to three times more likely to exceed IOM gestational weight gain (GWG) guidelines than women with normal weight (4), and the trend of gaining excessive weight during pregnancy appears to be rising over time (5‐7). Women with overweight and obesity who exceed IOM guidelines further increase their risk for adverse perinatal outcomes (8).…”

Effects of a lifestyle intervention on postpartum weight retention among women with elevated weight

“…Excessive pregnancy‐related weight gain and weight retention after delivery appear to contribute to the obesity epidemic among women (2,6–8). Given that the proportion of women entering pregnancy with overweight (BMI ≥ 25 kg/m 2 ) or obesity (BMI ≥ 30 kg/m 2 ) has been rising in the United States over the past three decades (9,10) and the trend of gaining excessive weight during pregnancy also appears to be rising over time (11–13), it is important to limit postpartum weight retention among at‐risk women through reducing GWG and/or promoting postpartum weight loss.…”