Factors that influence excessive gestational weight gain: moving beyond assessment and counselling

One in four Canadian adults is obese, and more women are entering pregnancy with a higher body mass index (BMI) than in the past. Pregnant women who are overweight or obese have a higher risk of pregnancy-related complications than women of normal weight. Gestational weight gain (GWG) is also associated with childhood obesity. Although the factors influencing weight gain during pregnancy are multifaceted, little is known about the social inequality of GWG. This review will address some of the socioeconomic factors and maternal characteristics influencing weight gain and the impact that excessive GWG has on health outcomes such as post-partum weight retention. The effects of an overweight or obese pre-pregnancy BMI on GWG and neonatal outcomes will also be addressed. The timing of weight gain is also important, as recommendations now include trimester-specific guidelines. While not conclusive, preliminary evidence suggests that excessive weight gain during the first trimester is most detrimental.     

Trimester-Specific and Total Gestational Weight Gain in Two Consecutive Pregnancies

ObjectiveThis retrospective study aimed to characterize trimester-specific and total gestational weight gain (GWG) over the course of two consecutive pregnancies, as well as maternal determinants associated with interpregnancy weight change (IPWC) and excessive GWG in the second pregnancy.MethodsWe analyzed the electronic medical records of women who delivered their first two consecutive infants at term between 2001 and 2017.ResultsWeight gain trajectories differed between the first and second pregnancy for the 1497 women included in this study, with lower second- and third-trimester weight gain in the second pregnancy. Respectively, 53% and 41% of women had excessive GWG in the first and second pregnancies, with a higher proportion of excessive GWG found in women with a higher body mass index (BMI). Most women (55%) experienced interpregnancy weight gain. Maternal determinants of IPWC were BMI before first pregnancy, first-trimester and total GWG in the first pregnancy, and interpregnancy interval (P < 0.0001). Maternal risk factors associated with excessive GWG in the second pregnancy were excessive total GWG in the first pregnancy (OR 6.23; 95% CI 4.67–8.32), interpregnancy weight gain (OR 1.58; 95% CI 1.19–2.09), and interpregnancy interval (OR 1.18; 95% CI 1.07–1.29) as well as BMI before the second pregnancy (OR 1.04, 95% CI 1.02–1.07).ConclusionWeight gain trajectories differ between consecutive pregnancies. GWG in the first pregnancy is a key determinant for IPWC and GWG in the second pregnancy.     

The relationship between antenatal body attitudes,pre-pregnancy body mass index,and gestational weight gain

Objectivesan estimated 50% of women experience excessive gestational weight gain (GWG). Maternal body attitudes are associated with GWG, however this relationship is complex and may differ based on pre-pregnancy body mass index (BMI) or gestational age. The aim of this study was to explore the moderating role of maternal pre-pregnancy BMI on the relationship between body attitudes in early-to-mid and late pregnancy and GWG.Design/Participantspregnant women less than 18 weeks gestation were recruited for a postal questionnaire study via Australian pregnancy online forums, pregnancy and parenting magazines, and antenatal clinics. In early-mid pregnancy (Time 1; mean (M) = 16.81 weeks gestation, standard deviation (SD) = 1.18), participants reported demographics, pre-pregnancy weight, height, and body attitudes (salience of weight and shape, attractiveness, strength and fitness and feeling fat). In late pregnancy, body attitudes (Time 2; M = 32.65 weeks gestation, SD = 0.91) and weight (Time 3; M = 37.15 weeks gestation, SD = 1.55) were reported. Pre-pregnancy BMI and total GWG were calculated. Moderation analyses were conducted.Findingsin early-mid pregnancy, pre-pregnancy BMI moderated the relationship between feeling fat and GWG. Pre-pregnancy BMI did not moderate the relationship between body attitudes and GWG for salience of weight and shape, attractiveness or strength and fitness in early-mid pregnancy. In late pregnancy, pre-pregnancy BMI moderated the relationship between all four body attitude facets (salience of weight and shape, attractiveness, feeling fat and strength and fitness) and GWG.Conclusion/Implications for practicethe relationship between body attitudes and GWG was moderated by pre-pregnancy BMI, particularly in late pregnancy. It is recommended that antenatal health care providers monitor women's body attitudes throughout pregnancy to aid in the management of healthy GWG and promote positive maternal and infant health outcomes. This is particularly important for women entering pregnancy with an underweight/normal weight BMI.     

A conceptual model of psychosocial risk and protective factors for excessive gestational weight gain

Objective

nearly half of all women exceed the guideline recommended pregnancy weight gain for their Body Mass Index (BMI) category. Excessive gestational weight gain (GWG) is correlated positively with postpartum weight retention and is a predictor of long-term, higher BMI in mothers and their children. Psychosocial factors are generally not targeted in GWG behaviour change interventions, however, multifactorial, conceptual models that include these factors, may be useful in determining the pathways that contribute to excessive GWG. We propose a conceptual model, underpinned by health behaviour change theory, which outlines the psychosocial determinants of GWG, including the role of motivation and self-efficacy towards healthy behaviours. This model is based on a review of the existing literature in this area.

Assessment and conclusion

there is increasing evidence to show that psychosocial factors, such as increased depressive symptoms, anxiety, lower self-esteem and body image dissatisfaction, are associated with excessive GWG. What is less known is how these factors might lead to excessive GWG. Our conceptual model proposes a pathway of factors that affect GWG, and may be useful for understanding the mechanisms by which interventions impact on weight management during pregnancy. This involves tracking the relationships among maternal psychosocial factors, including body image concerns, motivation to adopt healthy lifestyle behaviours, confidence in adopting healthy lifestyle behaviours for the purposes of weight management, and actual behaviour changes.

Implications for practice

health-care providers may improve weight gain outcomes in pregnancy if they assess and address psychosocial factors in pregnancy.     

孕前体质指数及孕期体重增长对妊娠过程及结局的影响

目的:探讨孕前体质指数(BMI)及孕期体重增长(GWG)与妊娠合并疾病及不良结局的关系。方法:回顾分析于复旦大学附属妇产科医院产科门诊定期产前检查并住院分娩的3541例足月单胎初产妇的临床资料。将产妇按孕前体质指数(BMI)和不同孕期体重增长(GWG)分组,采用logistic多因素回归分析孕前体质指数及孕期体重增长与妊娠合并疾病及结局的关系。结果:孕妇孕期体重平均增加(16.0±4.9)kg,新生儿平均出生体重(3341.6±425.9)g,低出生体重儿和巨大儿分别占2.1%及5.1%。根据IOM推荐孕期GWG分组,GWG过低、过高组孕妇与正常孕妇的巨大儿、剖宫产数、早产发生率比较,差异有统计学意义(P0.05)。孕前超重、肥胖能增加妊娠期糖尿病(OR=2.7,2.3)、妊娠期高血压疾病(OR=5.4,OR=7.7)、巨大儿(OR=1.6,OR=8.9)、剖宫产(OR=1.4,OR=1.7)的发生风险,而GWG过高增加剖宫产的发生风险(OR=1.5)。结论:孕前BMI不仅影响妊娠合并疾病的发生,也与妊娠结局密切相关。临床上应特别重视孕前宣教及体检,建议育龄期妇女达到合适的体质指数后怀孕。孕期过度体重增长增大了不良妊娠结局(巨大儿、剖宫产)的发生率,临床上可参照IOM推荐体重增长范围进行孕妇体重控制,加强孕期的健康教育和体重随访。同时建议利用大数据多方调研,得出适合中国各地区的孕期体重参考标准。     

Effects of gestational weight gain and body mass index on obstetric outcome in Sweden.

OBJECTIVE: The objective of this study was to estimate the effects of low and high gestational weight gain, in different maternal Body Mass Index (BMI) classes, on obstetric and neonatal outcomes. METHOD: A prospective population-based cohort study of 245,526 singleton term pregnancies. Women were grouped in five categories of BMI and in three gestational weight gain categories; < 8 kg (low weight gain), 8-16 kg and >16 kg (high weight gain). Obstetric and neonatal outcomes were evaluated after adjustments for maternal age, parity, smoking, year of birth. RESULT: Obese women with low gestational weight gain had a decreased risk for the following outcomes (adjusted odds ratio; 95% confidence interval): preeclampsia (0.52; 0.42-0.62), cesarean section (0.81; 0.73-0.90), instrumental delivery (0.75; 0.63-0.88), and LGA births (0.66; 0.59-0.75). There was a 2-fold increased risk for preeclampsia and LGA infants among average and overweight women with excessive weight gain. High gestational weight gain increased the risk for cesarean delivery in all maternal BMI classes. CONCLUSION: The effects of high or low gestational weight gain differ depending on maternal BMI and the outcome variable studied. Obese women may benefit from a low weight gain during pregnancy.     

Protocol for the immediate delivery versus expectant care of women with preterm prelabour rupture of the membranes close to term (PPROMT) Trial [ISRCTN44485060]

Background

Nutritional status of women has been considered an important prognostic indicator of pregnancy outcomes. Few studies have evaluated patterns of weight gain and pre-pregnancy body mass index in developing regions where malnutrition and poor weight gain as well as maternal obesity have significant influences on the pregnancy outcome. This study aims to show effect of pregnancy body mass index and the corresponding gestational weight gain on the outcome of pregnancy.

Methods

On a prospective cross sectional study, two hundred and seventy women from urban areas of Northwest Iran were recruited for participation during their first eight weeks of pregnancy. Body mass index (BMI) was categorized and gestational weight gain was divided into two groups of normal and abnormal based on recommendations of Institute of Medicine (IOM) published in 1990. Chi square and one way ANOVA were used in the univariate analysis of the association between weight gain and corresponding adverse outcomes including cesarean, preterm labor and low neonatal birth weight. Adjusted odds ratios for adverse outcomes were determined by multiple logistic regression models, while controlling for the following factors: maternal age, parity, and education.

Results

Both pre-pregnancy BMI < 19 and abnormal weight gain during pregnancy were found to be associated with low neonatal birth weight defined as < 2500 g. Abnormal weight gain, during pregnancy was not related to an increased risk of preterm labor or cesarean delivery but it was highly associated with low birth weight (LBW)(P < 0.05).

Conclusion

Low pre-pregnancy BMI is an established risk factor for LBW. Abnormal gestational weight gain may further complicate the pregnancy as an additional risk factor for neonatal LBW. All women, regardless of their pre-pregnancy BMI may be at risk for abnormal weight gain and hence low birth weight. Pre-pregnancy and gestation nutritional assessments remain significant part of all prenatal visits.     

Psychosocial predictors of gestational weight gain and the role of mindfulness

ObjectiveTo identify the psychosocial factors (i.e., stress, anxiety, depression, social support) that are associated with gestational weight gain (GWG) and the relationship of mindfulness with GWG during each trimester of pregnancy.DesignIn this cross-sectional study, an online survey that assessed physical and mental health and wellness practices was administered to pregnant women.ParticipantsPregnant women ≥8 weeks gestation, ≥18 years old, and could read and write in English.Measurement and findingsWomen who responded to the survey (N=1,073) were on average 28.7±4.6 years old. Findings from a regression analysis suggest that increased levels of depression may be predictive of increased GWG in the second trimester and decreased levels of mindfulness may be predictive of increased GWG in the first trimester. Anxiety, stress, and overall social support were not associated with GWG in any trimester.Key conclusionsMindfulness-based strategies (e.g., yoga) may have the potential to manage both depression and excessive GWG and may beneficial for and preferred by pregnant women. More research is warranted to determine clear relationships between psychosocial health, mindfulness, and GWG.Implications for practiceHealth care providers are encouraged to screen for depression in early pregnancy (i.e., first or second trimester) and provide resources to manage symptoms of depression and GWG to promote optimal birth outcomes. Health care providers may want to counsel patients on how to manage depression and/or GWG by suggesting mindfulness-based approaches.     

Prepregnancy body mass index and gestational weight gain with the outcome of pregnancy: a 13-year study of 292,568 cases in China

Purpose

We aimed to investigate the combined associations of prepregnancy body mass index (BMI) and gestational weight gain (GWG) with pregnancy outcomes in Chinese women.

Methods

Data for 292,568 singleton term pregnancies were selected from 1993 to 2005 based on the Perinatal Health Care Surveillance System, with anthropometric measurements being collected prospectively. Prepregnancy BMI was categorized according to the definitions of the World Health Organization (WHO). Total GWG was categorized into four groups. Adjusted associations of prepregnancy BMI and GWG with outcomes of interest were estimated using logistic regression analyses. GWG was categorized as below, within and above the Institute of Medicine (IOM) (2009) recommendations.

Results

Maternal overweight and high GWG or GWG above the IOM recommendation were associated with hypertensive disorders complicating pregnancy, cesarean delivery, macrosomia and large-for-gestational-age (LGA) infants. Maternal underweight and low GWG or GWG below the IOM recommendation were risk factors for low-birth-weight (LBW) and small-for-gestational-age (SGA) infants. Moreover, being overweight [odds ratio (OR) 1.2, 95?% confidence interval (CI) 1.0–1.3) and having a low weight gain (OR 1.1, 95?% CI 1.0–1.1) increased the risk of newborn asphyxia.

Conclusion

Being overweight/obese and having a high weight gain, as well as being underweight and having a low weight gain, were associated with increased risks for adverse pregnancy outcomes in Chinese women.     

Maternal obesity and gestational weight gain are modestly associated with umbilical cord DNA methylation

IntroductionMaternal obesity (OB) and excessive gestational weight gain (GWG) are strong independent contributors that augment obesity risk in offspring. However, direct evidence of epigenetic changes associated with maternal habitus remains sparse.MethodsWe utilized Bisulfite Amplicon Sequencing (BSAS) to conduct targeted DNA methylation association analysis of maternal obesity and excessive GWG with DNA methylation of select metabolism-related and imprinted genes. Umbilical cord (UC) tissue from infants born to normal weight and overweight/obese women from the Glowing study were utilized (n = 78).ResultsIn multivariable linear regression adjusted for relevant confounders, Institute on Medicine (IOM) GWG category and infant sex were significantly associated with UC IGFBP1 methylation, while gestation length was significantly associated with UC PRKAA1 methylation. In addition, infant fat mass (%) at 2 weeks of age was significantly associated with umbilical cord methylation of RAPTOR. While regression tree analysis confirmed findings from multivariable models demonstrating that maternal early pregnancy BMI and IOM GWG category are associated with fetal UC DNA methylation patterns for select metabolic and imprinted genes, in general, effect sizes were quite small and statistical significance was not maintained when accounting for multiple testing.DiscussionOur findings suggest that maternal obesity and excessive GWG are weakly correlated with offspring DNA methylation patterns at birth.     

The effect of gestational weight gain on likelihood of referral to obstetric care for women eligible for primary,midwife-led care after antenatal booking

Objectiveto examine the effect of gestational weight gain (GWG) on likelihood of referral from midwife-led to obstetrician-led care during pregnancy and childbirth for women in primary care at the outset of their pregnancy.Designsecondary analysis of data from a prospective cohort study.SettingDutch midwife-led practices.Participantsa cohort of 1288 women of Northern European descent, with uncomplicated, singleton pregnancy at antenatal booking who consequently were eligible for primary, midwife-led care.Measurementsbecause of the absence of an established GWG guideline in the Netherlands, we compared the effect of inadequate and excessive GWG according to two GWG guidelines: the criterion traditionally used, which is based on knowledge of the physiological components of GWG, advising 10–15 kg as a normal GWG irrespective of a woman׳s BMI category, and the 2009 Institute of Medicine recommendations (IOMr) on GWG, which provide BMI related advice. Outcome measures were: number of women referred from midwife-led to obstetrician-led care during pregnancy and during childbirth; indications of referral and birth outcomes.FindingsGWG above traditional criteria (Tc; >15 kg between 12 and 36 weeks) was associated with increased odds for referral during childbirth (adjusted odds ratio (aOR) 1.88; 95% confidence interval (CI) 1.22–2.90), but had no effect on referral during pregnancy (aOR .86; 95% CI .57–1.30). No associations were established between GWG below Tc (<10 kg) and referral during pregnancy (aOR 1.08; 95% CI .78–1.50) or childbirth (aOR 1.08; 95% CI .74–1.56). No associations were found between GWG below and above the IOMr and referral during pregnancy (below IOMr: aOR 1.01; 95% CI .71–1.45; above IOMr: aOR .89; 95% CI .61–1.28) or childbirth (below IOMr: aOR .85; 95% CI .57–1.25; above IOMr: aOR 1.09; 95% CI .73–1.63). With regard to the effect of GWG according to both recommendations on indications for referral and birth outcomes, GWG above Tc was associated with higher rates of referral for hypertensive disorders (aOR 1.91; 95% CI 1.04–3.50) and for meconium stained liquor (aOR 2.22; CI 1.33–3.71) after adjusting for BMI and parity.ConclusionsGWG above Tc – irrespective of BMI category – was associated with doubled odds of referral to specialist care during childbirth. GWG below or above IOMR and GWG below TC were not associated with adverse obstetric outcomes in women who were eligible for primary care at the outset of their pregnancy.Implications for practiceweight gain <15 kg between 12 and 36 weeks is advised for women in all BMI categories in this population. It is important to validate GWG guidelines in a target population before implementing them.     

Gestational weight gain and adverse pregnancy outcomes in a nulliparous cohort

Objective

Excessive gestational weight gain (GWG) is an important contributing factor to the obesity epidemic in women and is associated with pregnancy complications. We investigated the relationship between GWG and caesarean delivery in labour, large for gestational age (LGA), small for gestational age (SGA) infants and pregnancy-induced hypertension by maternal pre-pregnancy body mass index (BMI) in a contemporary nulliparous cohort.

Study design

Using 2009 Institute of Medicine guidelines, participants in the SCOPE study (from Cork, Ireland, Auckland, New Zealand and Adelaide, Australia) were classified into GWG categories (low, normal and high) according to pre-pregnancy BMI. Maternal characteristics and pregnancy outcomes were compared between weight gain categories. SGA and LGA were defined as <10th and >90th customised birthweight centile. Multivariable analysis adjusted for confounding factors that impact on GWG including BMI.

Results

Of 1950 participants, 17.2% (n = 335) achieved the recommended GWG, 8.6% (n = 167) had low and 74.3% (n = 1448) had high GWG. Women with high GWG had increased rates of LGA infants [adjusted OR 4.45 (95% CI 2.49–7.99)] and caesarean delivery in labour [aOR 1.46 (1.03–2.07)]. SGA was increased in women with low GWG [aOR 1.79 (1.06–3.00)].

Conclusion

Three quarters of participants had high GWG, which was associated with an independent risk of LGA infants and caesarean in labour. Low GWG was associated with SGA infants. These adverse outcomes are potentially modifiable by achievement of normal GWG, which should be an important focus of antenatal care.     

Gestational weight gain and the risk of infant mortality amongst women with normal prepregnancy BMI: the Friedmann-Balayla model

Objective: The study of the association between gestational weight gain (GWG) and infant mortality is riddled with methodological concerns, particularly with limitations in accounting for gestational age-specific weight gain. In our study, we developed a new model, which accounts for gestational age, to determine whether insufficient or excessive GWG is associated with an increased risk of infant death amongst women with normal prepregnancy BMI (18.5–24.9?kg/m²).

Methods: We developed and implemented the Friedmann-Balayla model to mitigate gestational age-related biases in our assessment, and conducted a population-based cohort study using the CDC’s 2013 Period-Linked Birth-Infant Death data. The impact of GWG according to the 2009 IOM guidelines on the risk of infant mortality was estimated using logistic regression analysis, adjusting for relevant confounders.

Results: Our cohort consisted of 1,517,525 singleton deliveries and 6138 infant deaths. Overall, relative to women achieving adequate GWG, neither women gaining insufficient nor excessive weight had greater odds of infant death during the first year of life (OR [95%CI]): 1.06 [0.97–1.17] (p?=?0.174), and 0.98 [0.91–1.04] (p?=?0.523), respectively. This relationship did not change when restricting our analysis to term or preterm deliveries or when conducting sensitivity analyses accounting for maternal morbidities (p?>?0.05).

Conclusion: Using this novel analytic approach, there does not appear to be an increased risk of infant mortality if GWG falls outside of the IOM guidelines in women with normal prepregnancy BMI. Future studies should apply this methodology to other BMI categories.     

The Institute of Medicine recommendation for gestational weight gain is probably not optimal among non-American pregnant women: a retrospective study from China

Purpose: To investigate whether the Institute of Medicine (IOM) recommended gestational weight gain (GWG) range is optimal among Chinese singleton pregnant women.

Methods: For the purpose of a retrospective observational study, data on 8209 mature singleton deliveries in Shanghai from January 2014 to December 2016 were extracted from medical records in terms of clinical performance. All cases were categorized as undergainers, appropriate-gainers, and above-gainers according to IOM recommended gestational weight gain range after stratification of maternal BMI and proportions of three categories were calculated. Comparisons of maternal and neonatal outcome were conducted among three categories and the associations of those outcome including risks of low birth weight (LBW) and macrosomia (MAC) with GWG were estimated by logistic regression analysis. To examine the applicability of IOM recommendation for Chinese pregnant women, the accumulated risk of LBW and MAC was displayed by stacked column chart and comparison was made among GWG category. The joint predicted risk (JPR) curve of both LBW and MAC in relation to GWG (continuous measurement) was plotted to demonstrate the relation of lowest JPR corresponding GWG with IOM range.

Results: The IOM recommended weight gain was achieved only by 3502 (42.7%) pregnant women and 41.6% gained excessive weight during pregnancy, especially for the overweight and obese women, the proportions of above-gainers mounting to 65.7 and 75.9%, respectively. By multivariate analysis GWG significantly influenced the risk of MAC and caesarean section. Although the association between the risk of LBW and GWG was not significant, p value reached .051. The risk of delivering macrosomia and caesarean section doubled when GWG exceeded the IOM rang. Appropriate gainers did not always gain the lowest joint risk of low birth weight and macrosomia from stacked column chart and it is obvious that the GWG point according to the lowest JPR was always located left to the IOM recommended range for each BMI category from the JPR curve chart in relation to GWG.

Conclusions: The IOM recommended GWG range is possibly too much for Chinese singleton pregnant population for each BMI category. It is necessary to build different gestational weight gain standards for specific ethnic population.     

Total gestational weight change and rate of change in pregnant Taiwanese women

Objective: The purpose of this study was to estimate and compare total gestational weight gain (GWG) and the trimester-specific mean rate of GWG based on pre-pregnancy body mass index (BMI) as recommended by the Institute of Medicine (IOM).Materials and methods: The medical records of 470 participants who had received antenatal care at medical teaching hospitals in northern Taiwan and who delivered after 37 weeks of pregnancy were analyzed.

Pregnancy weight gain and premenopausal breast cancer risk

OBJECTIVE: To investigate whether excessive weight gain during pregnancy alters a woman's risk of developing premenopausal breast cancer. STUDY DESIGN: We conducted a nested case-control study within a cohort composed of 22,610 Finnish women (mean age, 40; SD 6.4) who responded to a questionnaire requesting information on breast cancer diagnosis and on adult and pregnancy weight gain as part of a study of a hormone-releasing intrauterine device. One hundred fourteen of these women reported having been diagnosed with breast cancer, and 98 were eligible for analysis. Four matched controls were selected for each case (n = 392). Mean age at the time the women were diagnosed with breast cancer was 41.3 years (SD 5.46) and at the time they returned the questionnaire, 46.7 years (SD 5.55). RESULTS: We found no evidence that pregnancy weight gain, unadjusted or adjusted for prepregnancy body weight or other covariates (educational status, age at menarche and first pregnancy, and family history of breast cancer), had an effect on breast cancer risk. However, pregnancy weight gain was linked to an inverse association between change in body mass index (BMI) during adult life and premenopausal breast cancer. Women who gained an excessive amount of weight during pregnancy (> 16 kg) were at a significantly reduced risk of developing premenopausal breast cancer (p = 0.043, OR 0.28, 95% CI 0.08-0.96) if their BMI increased > 7 m/kg(-2) after age 20. BMI increase was not associated with breast cancer risk in women whose pregnancy weight gain remained within the recommended range (< 16 kg). CONCLUSION: Since our previous findings show that women who gain an excessive amount of weight during pregnancy are at an increased breast cancer risk after menopause, regardless of adult BMI, an excessive pregnancy weight gain may provide a short-term protective but cause a long-term breast cancer-promoting effect. It remains to be determined why BMI and pregnancy weight gain differently affect premenopausal and postmenopausal breast cancer risk.     

Gestational Weight Gain of Pregnant African American Adolescents Affects Body Mass Index 18 Years Later

ObjectiveTo determine if gestational weight gain (GWG) in adolescents is associated with long‐term weight increases 12 years and 18 years after delivery of a first child and the differential effects of weight gain during pregnancy that is inadequate, the appropriate amount, and excessive based on the 2009 Institute of Medicine (IOM) recommendations.DesignSecondary data analysis of data from a randomized controlled trial.SettingMemphis, Tennessee.ParticipantsTwo hundred ninety‐eight (298) primiparous low‐income Black women who were adolescents at the time of their first pregnancies.MethodLinear regression was used to examine the relationship between body mass index (BMI) at 12 and 18 years postdelivery and GWG, parity, prepregnancy BMI, and smoking.ResultsThe total sample experienced a significant BMI increase from prepregnancy to 12 years and 18 years postdelivery. More than 50% of the women had a BMI increase greater than 10 kg/m². By 18 years postdelivery, 85% were overweight or obese. Prepregnancy BMI and GWG had a positive significant effect on BMI 12 and 18 years later, whereas smoking had a negative effect. Those who gained excessive weight based on the IOM recommendations had a significantly higher BMI compared with those who gained appropriately.ConclusionGestational weight gain had long‐term effects on BMI in a minority adolescent population. Excessive pregnancy weight gain is likely to contribute to long‐term weight retention, especially if adolescents are overweight or obese when they become pregnant with their first children. Intervention during pregnancy to limit GWG has the potential of limiting long‐term negative health consequences that result from overweight and obesity in minority women.     

Assessing the Accuracy of Pregnant Women in Recalling Pre-Pregnancy Weight and Gestational Weight Gain

ObjectiveMaternity care providers can use pre-pregnancy weight (PPW) and gestational weight gain (GWG) as markers for difficult delivery, and frequently obtain this information directly from the patient. The goal of this study was to determine whether women report their PPW and GWG correctly at the end of pregnancy.MethodsWe performed a prospective cohort study of 189 women delivering between June 1,2011, and July 31,2011, at the Saint John Regional Hospital or the Moncton Hospital in New Brunswick. Self- reported PPW and GWG were compared with measured weights obtained from the antenatal chart and upon presentation for delivery. Patient characteristics, BMI classification, and accuracy and degree of error in recall were assessed.ResultsThe majority of respondents were under 30 years of age (63.4%) and were delivering at term (96.3%). Ninety women (47.6%) were having their first baby. A record of weight measured in the first trimester was available for 98 respondents (51.9%); using this information, 44 women (44.9%) were determined to be overweight or obese at delivery. Approximately one third of women with a normal BMI were not able to recall their PPW or GWG accurately (± 1 kg). Among all BMI classes, there was a consistent pattern of under-reporting of PPW (by a mean of 1.52 kg) and over-reporting of GWG (by a mean of 1.61 kg), but several extreme outliers were identified.ConclusionAt the time of delivery, under-reporting of PPW and over-reporting of GWG are common and difficult to predict. Maternity care providers should be aware of this discrepant reporting of PPW and GWG and recognize the implications for intrapartum management and postpartum weight loss.     

Impact of Gestational Weight Gain on Cesarean Delivery Risk,Perinatal Birth Weight and Gestational Age in Women with Normal Pre-pregnancy BMI

Background

Gestational weight gain (GWG) proportional to body mass index before pregnancy is one of the factors on maternal and neonatal outcomes. The aim of the current study was to assess association between GWG, and cesarean section, birth weight and gestational age at birth in women with normal BMI prior to pregnancy.

Methods

This was a cross-sectional study carried out in 103 hospitals in Tehran, the capital of Iran, from July 6 to 21, 2015. The data were extracted by 103 trained midwives. Finally, 2394 pregnant women with normal BMI before pregnancy and singleton birth were examined. GWG was categorized based on Institute of Medicine (IOM) recommendations.

Results

Prevalence of low birth weight (LBW) was 5.41% and prevalence of macrosomia was 2.18%. The prevalence of LBW in women with GWG less than the weight gain recommended by IOM was 2.13 times [95% confidence interval (CI) 1.13–4.02, P = 0.019] more than in women with GWG equal to the weight gain recommended by IOM. There was no statistically significant difference in the prevalence of LBW between women with GWG more than recommended weight gain by IOM and women with GWG equal to the weight gain recommended by IOM (OR = 1.21, 95% CI 0.61–2.38, P = 0.580).

Conclusion

After controlling for confounding variables, the prevalence of cesarean section and preterm birth had no significant difference at various levels of GWG. Accordingly, the prevalence of LBW among women with GWG less than the recommended weight gain by IOM was significantly 2.13 more than that among women with GWG equal to the recommended weight gain by IOM.

     

The mutual effect of pregestational body mass index,maternal hyperglycemia and gestational weight gain on adverse pregnancy outcomes

Objective: To investigate the mutual effect of obesity, gestational diabetes (GDM) and gestational weight gain (GWG) on adverse pregnancy outcomes.

Methods: Charts of patients who delivered in our hospital between June 2001 and June 2006 singleton, live births >24 weeks gestation were reviewed. Univariate and multivariate logistic regression were used to assess pregnancy outcomes defined as large for gestational age (LGA), primary cesarean section (PCS) and a composite outcome of LGA and/or PCS.

Results: A total of 8595 women were included. Frequency of composite outcome increased with increasing body mass index (BMI), increasing hyperglycemia and above-recommended GWG. In the multivariate logistic regression analysis compared to women with normal BMI, odds ratio (OR) for composite outcome was 1.23 (95% confidence interval [CI] 1.06–1.44) in overweight women, OR?=?1.86 (1.51–2.31) in obese women and in severe obesity OR?=?2.97 (2.15–4.11).

Compared to normoglycemic women, odds for composite outcome in women with abnormal glucose challenge test OR?=?1.46 (1.20–1.79), impaired glucose tolerance OR?=?1.65 (1.14–2.4) and GDM OR?=?1.56 (1.16–2.10). Women with GWG above recommended had OR?=?1.58, (1.37–1.81) for composite outcome.

Conclusions: Higher pregestational BMI, maternal hyperglycemia and above-recommended GWG independently contribute to adverse pregnancy outcomes. Furthermore, there is mutual effect between these three factors and adverse outcomes. Appropriate pregestational weight and adequate GWG might reduce risk of adverse pregnancy outcomes.