Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: A systematic review

Faucher, Mary Ann; Barger, Mary K.

doi:10.1016/j.wombi.2015.03.006

Cited by 93 publications

(98 citation statements)

References 25 publications

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“…36 While our results generally agree with these conclusions, we extended previous research by evaluating dose-response associations across a wide distribution of gestational weight gain. Our finding that risk of these outcomes is essentially uniform until a weight gain threshold is reached may be important for determining safe lower limits of gestational weight gain.…”

Section: Discussionsupporting

confidence: 89%

Low Gestational Weight Gain and Risk of Adverse Perinatal Outcomes in Obese and Severely Obese Women

et al. 2016

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Background Our objective was to estimate associations between gestational weight gain z-scores and preterm birth, neonatal intensive care unit admission, large- and small-for-gestational age birth (LGA, SGA), and cesarean delivery among grade 1, 2, and 3 obese women. Methods Singleton infants born in Pennsylvania (2003–2011) to grade 1 (body mass index (BMI) 30–34.9 kg/m2, n=148,335), grade 2 (35–39.9 kg/m2, n=72,032), or grade 3 (≥40 kg/m2, n=47,494) obese mothers were included. Total pregnancy weight gain (kg) was converted to gestational age-standardized z-scores. Multivariable Poisson regression models stratified by obesity grade were used to estimate associations between z-scores and outcomes. A probabilistic bias analysis, informed by an internal validation study, evaluated the impact of BMI and weight gain misclassification. Results Risks of adverse outcomes did not substantially vary within the range of z-scores equivalent to 40-week weight gains of −4.3 to 9 kg for grade 1 obese, −8.2 to 5.6 kg for grade 2 obese, and −12 to −2.3 kg for grade 3 obese women. As gestational weight gain increased beyond these z-score ranges, there were slight declines in risk of SGA but rapid rises in cesarean delivery and LGA. Risks of preterm birth and neonatal intensive care unit admission were weakly associated with weight gain. The bias analysis supported the validity of the conventional analysis. Conclusions Gestational weight gain below national recommendations for obese mothers (5–9 kg) may not adversely affect fetal growth, gestational age at delivery, or mode of delivery.

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Section: Discussionsupporting

confidence: 89%

Low Gestational Weight Gain and Risk of Adverse Perinatal Outcomes in Obese and Severely Obese Women

et al. 2016

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“…However a proportion of the initially overweight/obese women are also at increased risk of substantial weight-loss between successive parities. In support recent studies report wider variability in gestational weight-gain in overweight/obese women and while ~70% of obese women exceed current pregnancy weight-gain recommendations, gestational weight-loss is also more common in this group, and increasingly prevalent as the severity of obesity increases [18,19]. Greater variability in weight-change between parities has also been reported for women who had a high BMI or were heavier than normal at the first baseline pregnancy [13,20].…”

Section: Discussionmentioning

confidence: 99%

Weight change across the start of three consecutive pregnancies and the risk of maternal morbidity and SGA birth at the second and third pregnancy

2017

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BackgroundWeight-change across parities and/or current BMI may influence maternal and fetal morbidity and requires to be differentiated to better inform weight-management guidance.MethodsDirection, pattern and magnitude of weight-change across three consecutive parities and thereby two inter-pregnancy periods was described in 5079 women. The association between inter-pregnancy weight-change versus current BMI and adverse maternal events, SGA-birth and preterm delivery at second and third pregnancy were investigated by logistic regression.ResultsMore women gained weight across the defined childbearing period than lost it, with ~35% of normal and overweight women gaining sufficient weight to move up a BMI-category. Nine patterns of weight-change were defined across two inter-pregnancy periods and 50% of women remained weight-stable throughout (within 2BMI units/period). Women who were overweight/obese at first pregnancy had higher risk of substantial weight-gain and loss (>10kg) during each of two inter-pregnancy periods. Inter-pregnancy weight-gain (> 2BMI units) between first and second pregnancy increased the risk of maternal morbidity (1or more event of hypertensive disease, caesarean-section, thromboembolism) at second pregnancy, while weight-loss (>2BMI units) increased the risk of SGA-birth. Similarly, increased risk of maternal morbidity at the third pregnancy was influenced by weight-gain during both inter-pregnancy periods but not by current BMI-category. Both weight-gain between first and second pregnancy, and being overweight/obese by third pregnancy protected the fetus against SGA-birth whereas weight-loss between second and third pregnancy doubled the SGA risk.ConclusionHalf the women studied exhibited significant weight-fluctuations. This influenced their risk of maternal morbidity and SGA-birth at second and third pregnancy.

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“…In relation to obese pregnant women, gestational diabetes and pre-eclampsia, that is, two of the most common adverse outcomes, were not considered by the IOM due DOI: 10.1159/000496471 to the lack of available evidence. Recent studies have also questioned the IOM recommendations for weight gain in obese pregnant women, suggesting that these should be modified according to obesity classes I, II and III (BMI 30-34.9, 35-39.9, and > 40 kg/m 2 ) [61]. The most convincing evidence for avoidance of excessive GWG in all BMI categories is the strong association with postpartum weight retention.…”

Section: Recommendations On Nutrition Of Pregnant Womenmentioning

confidence: 99%

Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations

et al. 2019

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Background: A considerable body of evidence accumulated especially during the last decade, demonstrating that early nutrition and lifestyle have long-term effects on later health and disease (“developmental or metabolic programming”). Methods: Researchers involved in the European Union funded international EarlyNutrition research project consolidated the scientific evidence base and existing recommendations to formulate consensus recommendations on nutrition and lifestyle before and during pregnancy, during infancy and early childhood that take long-term health impact into account. Systematic reviews were performed on published dietary guidelines, standards and recommendations, with special attention to long-term health consequences. In addition, systematic reviews of published systematic reviews on nutritional interventions or exposures in pregnancy and in infants and young children aged up to 3 years that describe effects on subsequent overweight, obesity and body composition were performed. Experts developed consensus recommendations incorporating the wide-ranging expertise from additional 33 stakeholders. Findings: Most current recommendations for pregnant women, particularly obese women, and for young children do not take long-term health consequences of early nutrition into account, although the available evidence for relevant consequences of lifestyle, diet and growth patterns in early life on later health and disease risk is strong. Interpretation: We present updated recommendations for optimized nutrition before and during pregnancy, during lactation, infancy and toddlerhood, with special reference to later health outcomes. These recommendations are developed for affluent populations, such as women and children in Europe, and should contribute to the primary prevention of obesity and associated non-communicable diseases.

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Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: A systematic review

Abstract: Gestational weight gain guidelines may need modification for severity of obesity.

Cited by 93 publications

References 25 publications

Low Gestational Weight Gain and Risk of Adverse Perinatal Outcomes in Obese and Severely Obese Women

Low Gestational Weight Gain and Risk of Adverse Perinatal Outcomes in Obese and Severely Obese Women

Weight change across the start of three consecutive pregnancies and the risk of maternal morbidity and SGA birth at the second and third pregnancy

Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations

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