Gestational weight gain standards based on women enrolled in the Fetal Growth Longitudinal Study of the INTERGROWTH-21^stProject: a prospective longitudinal cohort study

Abstract

ObjeCtiveTo describe patterns in maternal gestational weight gain (GWG) in healthy pregnancies with good maternal and perinatal outcomes. DesignProspective longitudinal observational study. Main OutCOMe MeasuresMaternal weight measured with standardised methods and identical equipment every five weeks (plus/minus one week) from the first antenatal visit (<14 weeks' gestation) to delivery. After confirmation that data from the study sites could be pooled, a multilevel, linear regression analysis accounting for repeated measures, adjusted for gestational age, was applied to produce the GWG values. results 13 108 pregnant women at <14 weeks' gestation were screened, and 4607 met the eligibility criteria, provided consent, and were enrolled. The variance within sites (59.6%) was six times higher than the variance between sites (9.6%). The mean GWGs were 1.64 kg, 2.86 kg, 2.86 kg, 2.59 kg, and 2.56 kg for the gestational age windows 14-18 +6 weeks, 19-23 +6 weeks, 24-28 +6 weeks, 29-33 +6 weeks, and 34-40 +0 weeks, respectively. Total mean weight gain at 40 weeks' gestation was 13.7 (SD 4.5) kg for 3097 eligible women with a normal BMI in the first trimester. Of all the weight measurements, 71.7% (10 639/14 846) and 94.9% (14 085/14 846) fell within the expected 1 SD and 2 SD thresholds, respectively. Data were used to determine fitted 3rd, 10th, 25th, 50th, 75th, 90th, and 97th smoothed GWG centiles by exact week of gestation, with equations for the mean and standard deviation to calculate any desired centiles according to gestational age in exact weeks. COnClusiOnsWeight gain in pregnancy is similar across the eight populations studied. Therefore, the standards generated in this study of healthy, well nourished women may be used to guide recommendations on optimal gestational weight gain worldwide.

Gestational Weight Gain in Japanese Women With Favorable Perinatal Outcomes

“…At last, the optimal GWG found in this study seems to be smaller than the recently reported standards generated in the healthy and well-nourished women (13.7 kg) from different continents, i.e., Asia, Europe, North America, South America and Africa [2]. The average physique of Japanese women is certainly short and slender in comparison to that of the women in other countries; however, a larger prospective study will be required to assess the optimal range of GWG for Japanese women.…”

“…Therefore, examinations concerning optimal GWG are very important. To date, the goals of the previous studies concerning the GWG have seemed to set the recommended ranges of GWG in women of various physiques [2-4]. However, optimal GWG has not yet been clearly defined and remains one of the most controversial issues in modern perinatal medicine.…”

Maternal Supplementation with Small-Quantity Lipid-Based Nutrient Supplements Compared with Multiple Micronutrients, but Not with Iron and Folic Acid, Reduces the Prevalence of Low Gestational Weight Gain in Semi-Urban Ghana: A Randomized Controlled Trial

“…The outcome measures evaluated at 36 wk of gestation (last laboratory visit before delivery) were as follows: total gestational weight (kilograms), midupper arm circumference (MUAC; centimeters), and triceps skinfold (TSF) thickness (millimeters) gain; GWG per week; percentage adequacy of GWG achieved; percentage of women whose GWG was inadequate (less than the lower cutoff of recommendations), adequate (within the recommended range), or excessive (more than the upper cutoff of recommendations) according to the IOM GWG recommendations (13); and the percentage of normal-weight (in kg/m 2 ; 18.5 < BMI < 25.0) women whose estimated GWG was less than the third centile or >97th centile of the INTERGROWTH-21st standards (14). Outcomes evaluated at 6 mo postpartum (maternal endpoint of the study) were weight, MUAC, TSF thickness, and BMI; change in weight, MUAC, TSF thickness, and BMI from prepregnancy; and the percentage of women who became overweight or obese out of those who were not overweight or obese at prepregnancy.…”

“…More recently, the International Fetal and Newborn Growth (INTERGROWTH-21st) Consortium for the 21st Century published GWG standards by using data from more diverse populations compared with the IOM recommendations (14). However, unlike the IOM recommendations, the INTERGROWTH-21st standards are appropriate for normal-weight women only, and therefore the former recommendations may have greater applicability.…”

International standards for symphysis-fundal height based on serial measurements from the Fetal Growth Longitudinal Study of the INTERGROWTH-21stProject: prospective cohort study in eight countries

“…The project has already generated international standards for ultrasound dating of early pregnancy30 and assessment of fetal growth,4 maternal weight gain,31 newborn size for gestational age and sex,32 33 and preterm postnatal growth 34…”