Gestational Weight Gain Trend and Population Attributable Risks of Adverse Fetal Growth Outcomes in Ohio

Abstract

Background The trend of gestational weight gain (GWG) in relation to the Institute of Medicine (IOM) guidelines and population attributable risks (PARs) of GWG on fetal growth outcomes remain unclear. Methods We analyzed Ohio birth certificates from 2006 to 2012 to examine GWG trend by prepregnancy body mass index, to calculate the risk of small- and large-for-gestational-age (SGA and LGA), and macrosomia (birthweight >4000 g or >4500 g) infants, and to estimate the PARs of GWG below or above the guidelines. Results Of 869,531 women who delivered singleton live births at 22–44 weeks of gestation, 4.5% were underweight, 48.9% were normal weight, 23.9% were overweight, and 22.7% were obese before pregnancy. About 36.5% of underweight, 52.6% of normal weight, 72.5% of overweight, and 62.4% of obese women gained weight above the guidelines, with only slight changes from 2006 to 2012. Also, 34.9% of underweight, 20.1% of normal weight, 16.3% of overweight, and 27.0% of obese women gained weight below the guidelines. The PAR of GWG below or above the guidelines was −13% for SGA, 32.6% for LGA, 28.1% for macrosomia >4000 g, and 48.3% for macrosomia >4500 g, mostly driven by currently GWG above the guidelines in normal weight, overweight, and obese women. Conclusions A high percentage of pregnant women gained weight outside of the current IOM GWG guidelines; however, changes from 2006 to 2012 were small. GWG above the IOM guidelines significantly contributed to a large proportion of LGA and macrosomic infants in the general population.

Maternal Body Mass Index and Regional Anaesthesia Use at Term: Prevalence and Complications

“…Increasing BMI is often considered a risk factor for the majority of obstetric outcomes in a more dose–response fashion across the BMI spectrum (e.g. post‐partum haemorrhage, large for gestational age infants), while we found increased odds of regional anaesthesia complications only in primiparous women with morbid obesity and super obesity, and in multiparous women with super obesity. It is worth noting that non‐monotonic relationship observed between BMI and adverse regional anaesthesia outcomes is also observed with some other outcomes (e.g.…”

Exercise during pregnancy has a preventative effect on excessive maternal weight gain and gestational diabetes. A randomized controlled trial

“…11,12 Current trends for weight gain among women of reproductive age are alarming. 13,14 Precise estimates of GDM prevalence are not clear. A recent meta-analysis reported that the prevalence of GDM in Europe is 5.4%.…”

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

“…Only three published studies 11‐13 have examined GWG trends in the United States. Harris et al (2014) 12 found average GWG fell by 0.24 lbs/year and inadequate GWG increased by 0.4%/year in Maine from 2000 to 2010.…”

“…Harris et al (2014) 12 found average GWG fell by 0.24 lbs/year and inadequate GWG increased by 0.4%/year in Maine from 2000 to 2010. Chen et al (2015) 11 concluded a slight change in Ohio in the percentages of GWG below, within or above the IOM guidelines without discussing directions 11 . Johnson et al (2015) 13 used the 14‐state data from the Pregnancy Risk Assessment Monitoring System (PRAMS) and concluded that average GWG and the percentage with GWG below IOM recommendations stayed about the same over time, but there was a biennial 1.0% GWG decrease within and 0.8% GWG increase above IOM recommendations.…”

“…Two studies 11,12 did not account for pre‐pregnancy BMI, and none of them accounted for gestational age, thus introducing bias 14‐16 . Existing studies used linear or logistic regression methods to examine GWG time changes, which ignores more extreme ends of the population distribution 11‐13 . Non‐parametric methods, which are robust to outliers and track GWG percentiles, are better suited to determine GWG trends.…”