Racial differences in contribution of prepregnancy obesity and excessive gestational weight gain to large-for-gestational-age neonates

2020 ◽  
Vol 44 (7) ◽  
pp. 1521-1530 ◽  
Author(s):  
Yanfang Guo ◽  
Qun Miao ◽  
Tianhua Huang ◽  
Deshayne B. Fell ◽  
Katherine Muldoon ◽  
...  
Keyword(s):  
Weight Gain ◽  
Racial Differences ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Gestational Weight ◽  
Excessive Gestational Weight Gain ◽  
Prepregnancy Obesity

scholarly journals Gestational Weight Gain and Pregnancy Outcomes among Nulliparous Women

2019 ◽  
Author(s):  
Annie M. Dude ◽  
William Grobman ◽  
David Haas ◽  
Brian M. Mercer ◽  
Samuel Parry ◽  
...  
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Pregnancy Outcomes ◽  
Large For Gestational Age ◽  
Gestational Weight ◽  
Excessive Gestational Weight Gain ◽  
Hypertensive Disorders

Abstract Objective To determine the association between total gestational weight gain and perinatal outcomes. Study Design Data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be (NuMoM2b) study were used. Total gestational weight gain was categorized as inadequate, adequate, or excessive based on the 2009 Institute of Medicine guidelines. Outcomes examined included hypertensive disorders of pregnancy, mode of delivery, shoulder dystocia, large for gestational age or small for-gestational age birth weight, and neonatal intensive care unit admission. Results Among 8,628 women, 1,666 (19.3%) had inadequate, 2,945 (34.1%) had adequate, and 4,017 (46.6%) had excessive gestational weight gain. Excessive gestational weight gain was associated with higher odds of hypertensive disorders (adjusted odds ratio [aOR] = 2.05, 95% confidence interval [CI]: 1.78–2.36) Cesarean delivery (aOR = 1.24, 95% CI: 1.09–1.41), and large for gestational age birth weight (aOR = 1.49, 95% CI: 1.23–1.80), but lower odds of small for gestational age birth weight (aOR = 0.59, 95% CI: 0.50–0.71). Conversely, inadequate gestational weight gain was associated with lower odds of hypertensive disorders (aOR = 0.75, 95% CI: 0.62–0.92), Cesarean delivery (aOR = 0.77, 95% CI: 0.65–0.92), and a large for gestational age birth weight (aOR = 0.72, 95% CI: 0.55–0.94), but higher odds of having a small for gestational age birth weight (aOR = 1.64, 95% CI: 1.37–1.96). Conclusion Both excessive and inadequate gestational weight gain are associated with adverse maternal and neonatal outcomes.

scholarly journals Increasing Prepregnancy Obesity Is Associated with Large-for-Gestational Age Infants Among a Diverse, Contemporary Cohort (P11-018-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Amy Nichols ◽  
Monique Hedderson ◽  
Fei Xu ◽  
Elizabeth Widen
Keyword(s):  
Weight Gain ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Kaiser Permanente ◽  
Obesity Class ◽  
Gestational Weight ◽  
Prepregnancy Obesity ◽  
Class 1 ◽  
Iom Recommendations

Abstract Objectives The Institute of Medicine (IOM) gestational weight gain (GWG) recommendations do not differentiate by severity of obesity. Among a large, diverse cohort of women with obesity, we assessed gestational weight gain and neonatal size outcomes between prepregnancy obesity classes. Methods Electronic health records from 25,017 women with obesity who delivered singleton term births (37-42 weeks) at Kaiser Permanente Northern California between 2008–2013 were abstracted. We examined associations between BMI obesity class (class 1 30–34.9 kg/m2; class 2 35–39.9 kg/m2; class 3 ≥ 40 kg/m2), total GWG, adherence to IOM recommendations (below, within, or above), infant birthweight and large-for-gestational age (LGA, > 90th percentile for weight) using analysis of variance or chi2. Multivariable linear and logistic regression models were used to examine associations between obesity class, total GWG, and neonatal size, adjusting for maternal height, infant sex, race/ethnicity, parity, gestational age at delivery, and total GWG in neonatal models. Results Before pregnancy, 60.9% of women had class 1 obesity, 24.6% class 2, and 14.5% class 3. Adherence to IOM recommendations varied by obesity class (P < 0.001); overall, a majority (59.0%) of women showed excessive GWG (64.3% class 1; 53.7% class 2; 45.7% class 3) with a smaller proportion (21.0%) gaining within IOM recommendations (20.9% class 1; 21.5% class 2; 20.5% class 3). In adjusted models, compared to women with class 1 obesity, estimated total GWG was 1.89 kg lower among women with class 2 obesity (P < 0.001), and 3.4 kg lower among women with class 3 obesity (P < 0.001). A total of 3933 neonates were born LGA (14.4% class 1; 16.9% class 2; and 19.5% class 3). In adjusted models, compared to women with class 1 obesity, neonates born to women with class 2 or class 3 obesity were heavier (class 2: b = 58.3g, 95% CI (45.1, 71.5), P < 0.001; class 3: b = 121.5g, 95% CI (105.1, 137.8), P < 0.001) and at higher risk for LGA infants (class 2 AOR 1.50, CI: 1.28, 1.77; P < 0.001; class 3 AOR 2.38, 95% CI: 2.01, 2.82; P < 0.001). Conclusions Prepregnancy class 2 and class 3 obesity were associated with lower gestational weight gain, but higher infant birthweight and risk for LGA. The optimal range of maternal weight gain that balances risk for mothers and infants may vary by severity of obesity. Funding Sources Kaiser Permanente Community Benefit Grant to Monique Hedderson, PhD.

scholarly journals Patterns of Gestational Weight Gain in Women with Overweight or Obesity and Risk of Large for Gestational Age

Obesity Facts ◽  
2019 ◽  
Vol 12 (4) ◽  
pp. 407-415 ◽  
Author(s):  
Wei Zheng ◽  
Wenyu Huang ◽  
Zhi Zhang ◽  
Li Zhang ◽  
Zhihong Tian ◽  
...  
Keyword(s):  
Weight Gain ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Gestational Weight ◽  
Overweight Or Obesity

scholarly journals Gestational Weight Gain Influences Neonatal Outcomes in Women With Obesity and Gestational Diabetes

2021 ◽  
Author(s):  
Ana M Ramos-Levi ◽  
Gemma Rodriguez-Carnero ◽  
Cristina Garcia-Fontao ◽  
Antia Fernandez-Pombo ◽  
Paula Andújar-Plata ◽  
...  
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Gestational Diabetes ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Large For Gestational Age ◽  
Gestational Weight ◽  
Increased Risk ◽  
The Impact

Abstract Background. Obesity and gestational diabetes mellitus (GDM) are associated to increased risk of perinatal complications and obesity in the offspring. However, the impact of gestational weight gain (GWG) on maternal and fetal outcomes has led to controversial results. Research design and methods. Retrospective study of 220 women with GDM and pre-pregnancy body mass index (BMI) ≥ 30 kg/m2. Pregnant women were classified according to the Institute of Medicine (IOM) recommendations regarding prior BMI and GWG. We evaluated the impact of GWG on birth weight and perinatal outcomes. Results. Mean maternal age was 34.7±5.3 years. Pre-pregnancy obesity was classified as grade I in 55.3% of cases, grade II in 32.0%, and grade III in 12.7%. GWG was adequate (5-9kg) in 24.2%, insufficient (< 5kg) in 41.8% and excessive (> 9kg) in 34.2%. Birthweight was within normal range in 81.9%, 3.6% were small for gestational age (SGA) and 14.4% were large for gestational age (LGA). Insufficient GWG was associated to a higher rate of SGA offspring, excessive GWG was associated to LGA and adequate GWG to normal birth weight. Conclusion. GWG in women with pre-pregnancy obesity and GDM impacts neonatal birthweight. Insufficient GWG is associated to SGA and excessive GWG is associated to LGA. Women with adequate GWG according to IOM guidelines obtained better perinatal outcomes.

scholarly journals Patterns of Gestational Weight Gain and Infants Born Large-for-Gestational Age Across Consecutive Pregnancies

2019 ◽  
Vol 29 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Elizabeth L. Adams ◽  
Michele E. Marini ◽  
Krista S. Leonard ◽  
Danielle Symons Downs ◽  
Ian M. Paul ◽  
...  
Keyword(s):  
Weight Gain ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Gestational Weight

scholarly journals Weight gain in pregnancy: is less truly more for mother and infant?

2012 ◽  
Vol 5 (2) ◽  
pp. 58-64 ◽  
Author(s):  
Linda A Barbour
Keyword(s):  
Weight Gain ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Neonatal Morbidity ◽  
Current Data ◽  
Large For Gestational Age ◽  
Institute Of Medicine ◽  
Gestational Weight ◽  
The Relationship ◽  
In Pregnancy

SUMMARY Although more than 50% of women gain weight above the Institute of Medicine (IOM) guidelines for weight gain in pregnancy and excessive weight gain is an independent risk factor for significant maternal and neonatal morbidity and offspring obesity, there is little consensus over the ideal weight gain during pregnancy. Surprisingly, the 2009 IOM guidelines varied minimally from the 1990 IOM guidelines, and many critics advocate lower weight gain recommendations. This review explores the energy costs of pregnancy, the relationship between gestational weight gain and birth weight, and considers what gestational weight gain minimizes both large-for-gestational age as well as small-for-gestational age infants. An extensive examination of the current data leads this author to question whether the current weight gain recommendations are too liberal, especially for obese pregnant women.

scholarly journals Comparison between American Institute of Medicine Guidelines and Local Recommendation for Gestational Weight Gain in Taiwanese Primiparous Women

2020 ◽  
Author(s):  
Alexander Waits ◽  
Chao-Yu Guo ◽  
Li-Yin Chien
Keyword(s):  
Weight Gain ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Future Research ◽  
Institute Of Medicine ◽  
Weight Retention ◽  
American Institute ◽  
Discriminative Performance ◽  
Gestational Weight

Abstract Background : American Institute of Medicine (IOM) recommends different ranges of gestational weight gain (GWG) based on pre-pregnancy body mass index (BMI). In Taiwan, IOM guidelines are implemented concurrently with the local recommendation for GWG (10–14 kg). This study compared between the two sets of guidelines in relation to adverse perinatal outcomes.Methods : We analyzed 31653 primiparas with singletons from 2011-2016 annual National Breastfeeding Surveys. Logistic regressions for preterm birth, small for gestational age (SGA), large for gestational age (LGA), cesarean section and excessive postpartum weight retention (PWR) were fitted separately for GWG categorized according to IOM and Taiwan ranges. Areas under the receiver-operator curves (AUC) and the predicted probabilities for each outcome were compared in each BMI group.Results : AUC for both guidelines ranged within 0.51 – 0.73. Compared to Taiwan recommendation, IOM ranges showed lower probabilities of SGA for underweight (0.11–0.15 versus 0.14–0.18), of LGA for obese (0.12–0.15 versus 0.15–0.18), of excessive PWR for overweight (0.19–0.30 versus 0.27–0.39), and obese (0.15–0.22 versus 0.25-0.36); and higher probabilities of excessive PWR for underweight (0.17-0.33 versus 0.14-0.22).Conclusions : Discriminative performance of IOM and Taiwan recommendations was poor for the five adverse birth outcomes, and no preference for either set of recommendations could be inferred from our results. In the absence of specific GWG guidelines, health care workers may provide inconsistent information to their patients. Future research is needed to explore optimal GWG ranges that can reliably predict locally relevant perinatal outcomes for mother and child.

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