Association between Gestational Weight Gain Adequacy and Adverse Maternal and Neonatal Outcomes

Objectives To estimate the prevalence of gestational weight gain (GWG) adequacy according to the 2009 guidelines, and to examine the association between GWG adequacy and the adverse outcomes, stratified by prepregnancy body mass index (BMI). Study Design A retrospective cohort study, using the 2011 to 2013 U.S. linked birth/infant death datasets, restricted to nonanomalous singleton live births at 37 to 41 weeks. The adverse outcomes included composite maternal morbidity (CMM), composite neonatal morbidity (CNM), and neonatal and infant mortalities. We used multivariable Poisson's regression models with robust error variance to examine the association between GWG adequacy and adverse outcomes. Results Of 8,656,791 singleton live births, 20, 32, and 48% had inadequate, adequate, and excessive GWG, respectively. After multivariable regression adjustment, compared with adequate GWG, excessive GWG had 1.10 (1.08–1.13) and 1.12 (1.10–1.14) times higher risk of CMM and CNM, respectively; similar findings were observed in BMI subgroups. Compared with adequate GWG, inadequate GWG had 1.14 (1.03–1.26) and 1.12 (1.07–1.18) times higher risk of neonatal and infant mortalities, respectively. Similar results were noted among women with normal weight. Conclusion Excessive GWG was associated with an increased risk of CMM and CNM, while inadequate GWG was associated with a higher risk of neonatal and infant mortalities.

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Association between maternal gestational weight gain and preterm birth according to body mass index and maternal age in Quzhou, China

Scientific Reports ◽

10.1038/s41598-020-72949-w ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Ying Hu ◽

Qi Wu ◽

Luyang Han ◽

Yuqing Zou ◽

Die Hong ◽

...

Keyword(s):

Body Mass Index ◽

Weight Gain ◽

Preterm Birth ◽

Gestational Weight Gain ◽

Body Mass ◽

Maternal Age ◽

Preterm Births ◽

Normal Weight ◽

Live Births ◽

Gestational Weight

Abstract The aim of this study is to investigate the association between maternal gestational weight gain (GWG) and preterm birth according to pre-pregnancy body mass index (BMI) and maternal age. We did a cohort, hospital-based study in Quzhou, South China, from 1 Jan 2018 to 30 June 2019. We selected 4274 singleton live births in our analysis, 315 (7.4%) of which were preterm births. In the overall population, excess GWG was significantly associated with a decreased risk of preterm birth compared with adequate GWG (adjusted OR 0.81 [95% CI 0.72–0.91]), and the risk varied by increasing maternal age and pre-pregnancy BMI. Interestingly, underweight women who older than 35 years with excess GWG had significantly increased odds of preterm birth compared with adequate GWG in underweight women aged 20–29 years (2.26 [1.06–4.85]) and normal weight women older than 35 years (2.23 [1.13–4.39]). Additionally, low GWG was positively and significantly associated with preterm birth overall (1.92 [1.47–2.50]). Among normal weight women category, compared with adequate GWG women aged 20–29 years did, those older than 20 years with low GWG, had significantly higher odds of preterm birth, which increased with maternal age (1.80 [1.16–2.79] in 20–29 years, 2.19 [1.23–3.91] in 30–34 years, 3.30 [1.68–6.46] in ≫ 35 years). In conclusion, maternal GWG was significantly associated with the risk of preterm birth, but the risk varied by pre-pregnancy BMI and maternal age.

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Independent effect of gestational weight gain and prepregnancy obesity on pregnancy outcomes among Saudi women: A sub-cohort analysis from Riyadh mother and baby cohort study (RAHMA)

PLoS ONE ◽

10.1371/journal.pone.0262437 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262437

Author(s):

Amel Fayed ◽

Hayfaa A. Wahabi ◽

Samia Esmaeil ◽

Roaa Elkouny ◽

Hala Elmorshedy ◽

...

Keyword(s):

Cohort Study ◽

Weight Gain ◽

Gestational Weight Gain ◽

Pregnancy Outcomes ◽

Cohort Analysis ◽

Adverse Outcomes ◽

Independent Effect ◽

Gestational Weight ◽

Increased Risk ◽

Prepregnancy Obesity

Background Gestational weight gain (GWG) and prepregnancy obesity are garnering more attention as determining factors of pregnancy outcomes when it comes to the wellbeing of both the mother and her baby. This study was conducted to describe the pattern of GWG among participants of Riyadh Mother and Baby Multicenter Cohort Study (RAHMA) and to investigate the detrimental effects of excessive GWG and prepregnancy obesity on pregnancy outcomes. Methods RAHMA is a multicentre cohort study conducted in three hospitals in Riyadh, Saudi Arabia. Participants were categorized according to the Institute of Medicine into inadequate, adequate, and excessive GWG, and stratified by body mass index (BMI) into under/normal weight, overweight, and obese. To examine the independent effect of maternal prepregnancy obesity and GWG, a multivariate regression model was used and adjusted odds ratio (AOR) and 95% Confidence Interval (CI) for each outcome were calculated. Results A total of 7029 participants were included in this study; 31.8% had adequate GWG, 25.9% had excessive GWG and 42.3% had inadequate GWG, while 29.7% had normal BMI, 33.3% were overweight, 34.8% were obese, and 2.2% were underweight. Excessive GWG was independently associated with increased risk of hypertensive events, (AOR = 1.77, 95% CI 1.20–2.63). Obesity was associated with higher risk of gestational diabetes (AOR 2.11, 95% CI 1.76–2.53), hypertensive events (AOR 2.06, 95% CI 1.48–3.01), and delivery by emergency caesarean section (AOR = 1.63, 95% CI 1.35–1.97). Infants of obese women had increased odds of macrosomia (AOR 3.11, 95% CI 1.94–4.99) and lower odds of low birth weight (AOR = 0.68, 95% CI 0.53–0.88). Conclusion In comparison to excessive GWG, which increases the risk of hypertensive events during pregnancy, prepregnancy obesity is associated with more adverse outcomes including GDM, hypertensive events in pregnancy and emergency CS.

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Pre-Pregnancy Body Mass Index and Gestational Weight Gain are Associated with the Maternal-Infant Adverse Outcomes in Chinese Women with Gestation Diabetes

10.21203/rs.3.rs-611560/v1 ◽

2021 ◽

Author(s):

Qing-Xiang Zheng ◽

Hai-Wei Wang ◽

Xiu-Min Jiang ◽

Yan Lin ◽

Gui-Hua Liu ◽

...

Keyword(s):

Body Mass Index ◽

Weight Gain ◽

Cesarean Delivery ◽

Gestational Weight Gain ◽

Body Mass ◽

Chinese Women ◽

Normal Weight ◽

Adverse Outcomes ◽

Large For Gestational Age ◽

Gestational Weight

Abstract The gestational weight gain (GWG) range of Chinese women with gestational diabetes mellitus (GDM) still remains unclear. Our objective was to identify the ranges of GWG in Chinese women with GDM, and to investigate the associations between pre-pregnancy body mass index (BMI), GWG and maternal-infant adverse outcomes. GDM Women delivering singleton from 2013 to 2018 in a tertiary public hospital were collected. Logistic regression analysis was used to assess the joint effects of pre-pregnancy BMI and GWG on maternal-infant adverse outcomes. Finally, 14,578 women were collected. The ranges of GWG of Chinese women with GDM in the underweight, normal weight, overweight and obese groups were 5.95-21.95kg, 4.23-21.83kg, 0.88-21.12kg and-1.76-19.95kg, respectively. The risks of large for gestational age (LGA), macrosomia and cesarean delivery were significantly increased with the increase of pre-pregnancy BMI. Furthermore, the risks of LGA, macrosomia and cesarean delivery were significantly higher in normal weight group with GWG higher than the National Academy of Medicine’s (NAM) recommendation. Similarly, in overweight group with GWG higher than NAM recommendation, the risks of LGA were significantly higher, while, the risks of macrosomia were significantly lower. In conclusion, the ranges of GWG in GDM women were different with NAM recommendation.

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Associations Between Pre-Pregnancy Body Mass Index, Gestational Weight Gain and Preterm Birth: a Cohort Study in Wuhan, China

10.21203/rs.3.rs-49045/v1 ◽

2020 ◽

Author(s):

Yiyang Guo ◽

Chao Xiong ◽

Aifen Zhou ◽

Ronghua Hu ◽

Rong Yang ◽

...

Keyword(s):

Cohort Study ◽

Weight Gain ◽

Preterm Birth ◽

Gestational Weight Gain ◽

Early Pregnancy ◽

Tracking System ◽

Normal Weight ◽

Elevated Risk ◽

Gestational Weight ◽

Increased Risk

Abstract Background Preterm birth (PTB) is the leading cause of neonatal mortality and morbidity worldwide. Methods This cohort study was designed to investigate the associations between pre-pregnancy BMI, total gestational weight gain (GWG), and GWG during early pregnancy with PTB utilizing data of 83,096 Chinese women from the Maternal and Children Healthcare Information Tracking System of Wuhan, China. Results Women who were underweight, overweight or obese prior to pregnancy had an overall elevated risk of PTB, compared to their normal weight counterparts. Women with total GWG below the IOM recommendation had an increased risk of PTB compared to women who had GWG within the recommendation, whereas an increasing risk of PTB was observed asweekly early pregnancy GWGincreased. When stratified by subtypes of PTB, pre-pregnancy underweight was associated with higher risk of spontaneous PTB, and pre-pregnancy overweight /obese increased the risk of both spontaneous PTB and medically indicated PTB. Women with total GWG below the IOM recommendation had elevated risk for spontaneous PTB and PROM, and women with GWG above the recommendation had decreased risk for all three subtypes of PTB, whereas risk for the three subtypes of PTB increased along with increasing weekly GWG of early pregnancy. Conclusions Maternal underweight, overweight/obesity, total GWG, and GWG during early pregnancy should be considered in combination to reduce the risk of PTB, women should modify their weight gains during pregnancy according to the results.

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Gestational weight gain in a migration context: are migrant women more at risk of inadequate or excessive weight gain during pregnancy?

Journal of Epidemiology & Community Health ◽

10.1136/jech-2021-216619 ◽

2021 ◽

pp. jech-2021-216619

Author(s):

Lorraine Poncet ◽

Henri Panjo ◽

Thomas Schmitz ◽

Dominique Luton ◽

Laurent Mandelbrot ◽

...

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Multinomial Logistic Regression ◽

Normal Weight ◽

Sub Saharan Africa ◽

Migrant Women ◽

Gestational Weight ◽

Increased Risk ◽

Sub Saharan ◽

Inadequate Prenatal Care

BackgroundInadequate or excessive gestational weight gain (GWG) is associated with adverse maternal and neonatal outcomes. Little is known on adequacy of GWG in migrant women. This study investigates whether migrant women in France are at higher risk of inadequate or excessive GWG, and what characteristics are associated with GWG in migrant and non-migrant groups.MethodsWe used data from the PreCARE multicentric prospective cohort (N=10 419). The study includes 5403 women with singleton deliveries, with non-migrant (n=2656) and migrant (n=2747) status. We used multinomial logistic regression, adjusting for maternal age and parity, to investigate the association of migrant status, socioeconomic status-related variables and GWG. In stratified analyses, we identified factors associated with GWG in both groups.ResultsCompared with non-migrant women, migrant women had increased risk of inadequate GWG (adjusted odds ratio (aOR) 1.18; 95% CI 1.03 to 1.34). Non-migrant women with foreign origins had increased risk of excessive GWG (aOR 1.58; 95% CI 1.30 to 1.92). Women born in Sub-Saharan Africa had increased risk of both inadequate and excessive GWG. Regardless of migration status, women with lower education and women who did not start pregnancy with a normal weight were less likely to gain adequately. Inadequate prenatal care was associated with inadequate GWG only among non-migrant women.ConclusionMigrant women are at higher risk of inadequate GWG.

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The Effects of Pre-Pregnancy Body Mass Index and Gestational Weight Gain on the Risk of Preeclampsia at a Tertiary Referral Hospital, Northern Tanzania

10.21203/rs.3.rs-114602/v1 ◽

2020 ◽

Author(s):

Nelago Tukondjeni Amagulu ◽

Bariki Mchome ◽

Julius Pius Alloyce ◽

Kingsly Tobi ◽

Eusebius Maro

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Multinomial Logistic Regression ◽

Normal Weight ◽

Excessive Weight Gain ◽

Gestational Weight ◽

Excessive Weight ◽

Northern Tanzania ◽

Increased Risk ◽

In Pregnancy

Abstract Background: Pre/eclampsia and other hypertensive disorders of pregnancy contributed to 18% of the maternal mortality reported in Northern Tanzanian. There is increasing prevalence of obesity in Tanzania which is related to excessive weight gain in pregnancy. Both high BMI and excessive gestation weight gain are identified to increase risk of PE and subtypes, however this is still inconclusive and little is known about the joint effect of pre-pregnancy BMI and GWG on risk of PE and its subtypes in Africa. We evaluated the independent and joint effects of pre-pregnancy BMI and GWG on the risk of pre-eclampsia and its subtypes among women who delivered at Kilimanjaro Christian Medical Center (KCMC) from October 2018 to May 2019, Northern Tanzania.Methods: We performed a retrospective birth cohort study from October 2018 to May 2019 at KCMC, Tanzania. Pre-pregnancy BMI was categorized using WHO categories into Underweight (˂ 18.5kg/m²), Normal weight (18.5-24.9kg/m²), Overweight (25-29.9kg/m²) and Obese (≥ 30kg/m²). Gestational Weight Gain (GWG) was categorized using the 2009 Institute of Medicine (IOM) guidelines into Inadequate, Adequate and Excessive weight gain in pregnancy. Multinomial logistic regression analysis was used to adjust for confounders using relative risk, 95% confidence interval for the risk ratios (RR) that did not cross 1 and p<0.05 were regarded statistically significant.Results: Among the 1309 women analysed, 5.3% were Underweight, 51.1% Normal weight, 26.9% Overweight and 16.7% were Obese. About 43.5% had excessive GWG. Women with PE were 9.5%. Both obesity and excessive GWG independently increased risk of PE with adjusted RR=2.42, 95%CI: 1.48-3.96 and RR=1.77, 95%CI: 1.16-2.69 when compared to normal BMI and adequate GWG respectively. Jointly, Obesity and Excessive GWG had the highest risk of PE (ARR=4.95, 95%CI: 2.21-11.10). The increased risk was similar for Mild PE (MPE), Severe PE or eclampsia (SP/E) and Late Onset PE (LOPE). No association was found for Early Onset PE (EOPE).Conclusion: Pre-pregnancy Obesity and Excessive GWG independently and jointly increases risk for PE and the risk varies by PE subtype.

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Obesity as a Predictor of Delayed Lactogenesis II

Journal of Human Lactation ◽

10.1177/0890334417727716 ◽

2017 ◽

Vol 33 (4) ◽

pp. 684-691 ◽

Cited By ~ 27

Author(s):

Irma Preusting ◽

Jessica Brumley ◽

Linda Odibo ◽

Diane L. Spatz ◽

Judette M. Louis

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Singleton Pregnancy ◽

Targeted Interventions ◽

Gestational Weight ◽

Prepregnancy Bmi ◽

Increased Risk ◽

Prepregnancy Obesity ◽

Observational Cohort ◽

Breastfeeding Cessation

Background: Lactogenesis II is the onset of copious milk production. A delay in this has been associated with an increased risk of formula supplementation and early cessation of breastfeeding. Prepregnancy obesity has also been associated with decreased breastfeeding rates and early cessation. Research aim: This study aimed to evaluate the effect of prepregnancy obesity on self-reported delayed lactogenesis II. Methods: We conducted a prospective observational cohort study of 216 women with a singleton pregnancy and who planned to breastfeed. We compared the onset of lactogenesis II between women with a body mass index (BMI) < 30 kg/m2 and women with a BMI ≥ 30 kg/m2. Using multivariate logistic regression analyses, we assessed the relationship between maternal BMI and delay of lactogenesis II. Results: The prevalence of delayed lactogenesis II among women with prepregnancy BMI < 30 kg/m2 and BMI ≥ 30 kg/m2 was 46.4% and 57.9%, respectively. Delayed lactogenesis II occurred more frequently among women who were obese at the time of delivery ( p < .05). After controlling for the covariates, age, prepregnancy BMI, and gestational weight gain were positively associated with delayed lactogenesis II. Conclusion: Prepregnancy obesity and excessive gestational weight gain are associated with an increased risk of delayed lactogenesis II. Women who are at risk for delay in lactogenesis II and early breastfeeding cessation will need targeted interventions and support for them to achieve their personal breastfeeding goals.

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The influence of pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes in two-child women

10.21203/rs.2.16978/v1 ◽

2019 ◽

Author(s):

Hanqing Chen ◽

Suhua Zou ◽

Zhuyu Li ◽

Jianbo Yang ◽

Jian Cai ◽

...

Keyword(s):

Body Mass Index ◽

Weight Gain ◽

Gestational Weight Gain ◽

Body Mass ◽

Perinatal Outcomes ◽

Normal Weight ◽

Excessive Weight Gain ◽

Gestational Weight ◽

Excessive Weight ◽

Weight Gain During Pregnancy

Abstract Background Pre-pregnancy body mass index and gestational weight gain were related to perinatal outcomes. It was not know the changes of pre-pregnancy body mass index, weight gain during pregnancy and its effect on perinatal outcomes in two-child women.Methods This was a retrospective study. Data of single term women delivered in the First Affiliated Hospital of Sun Yat-sen University were collected from July 2017 to June 2018. Gestational weight gain criteria of the American Institute of Medical Research and pre-pregnancy body mass index classes were used to evaluate the effects on pregnancy outcomes.Results A total of 3049 cases were enrolled in the study. Overweight cases was 9.0% and obesity was 2.4%. The weight gain of the two-child women was less than that of primipara(12.4±3.9vs13.3±4.0kg, P<0.001). The proportion of primipara with excessive weight gain was higher compared to two-child women(20.1%versus17.3%, P<0.001). There were 40.0% overweight primipara and 55.2% of two-child women had excessive weight gain. And 40.5% primipara and 54.5% two-child women of obesity had excessive weight gain during pregnancy. Obese primipara increased the risk of pre-eclampsia (aOR2.38, 95%CI 0.76-7.46). And the odds of diabetes mellitus and large for gestational age also increased in this group (aOR3.49, 95%CI 1.46-8.35 and aOR7.65, 95%CI 1.83-31.97, respectively). Two-child women had similar results. Underweight primipara with excessive weight gain increased the pre-eclampsia risk (aOR2.26, 95%CI 0.29-17.46). Normal weight and overweight/obese primipara also had similar results. But in two-child women, only overweight/obesity increased the risk of pre-eclampsia (aOR2.01, 95%CI 0.41-9.98). Underweight two-child women with less weight gain increased the risk of diabetes(aOR2.06, 95%CI 0.43-9.8). Two-child women with overweight/obese increased the odds of LGA even if they had less weight gain(aOR2.58, 95%CI 0.11-63.22). Normal weight primipara and two-child women with overweight and obese with excessive weight gain had similar results. On the other way, underweight primipara with less weight gain increased the risk of SGA(aOR1.74, 95%CI 0.81-3.76).Conclusions Gestational weight gain of two-child women was less than primipara. Overweight/obese women with excessive weight gain of two-child women increased the risk of adverse outcomes.

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Examining the Effection of Second-and Third-trimester Rate of Gestational Weight Gain on Perinatal Outcomes Among Chinese Twin Gestations Based on the Provisional Guidelines: A Retrospective Cohort Study

10.21203/rs.3.rs-114603/v1 ◽

2020 ◽

Author(s):

Li-hua Lin ◽

Yi-lin Weng ◽

Ying-ying Lin ◽

Xiu-xian Huang ◽

Yang Lin ◽

...

Keyword(s):

Regression Analysis ◽

Weight Gain ◽

Gestational Weight Gain ◽

Normal Weight ◽

Premature Delivery ◽

Third Trimester ◽

Gestational Weight ◽

Gain Rate ◽

Twin Pregnancies ◽

Weight Gain Rate

Abstract Background: This paper investigated how second and third trimester gestational weight gain relates toperinatal outcomes among normal weight women with twin pregnancies in Fujian, China. Methods: A retrospective study on the medical records of 931 normal weight twin pregant women was conducted in Fujian Maternity and Child Health Hospital from 2014 to 2018.The 2nd and 3rd trimester weekly weight gain rate were calculated and categorized women as gaining below, within, or above the 2009 Institute of Medicine (IOM) recommended rates . The association between trimester-specific weight gain rate and perinatal outcome was performed by traditional regression analysis among groups.Results:A total of 931 pregnant women and 1862 neonates were included for analysis. 25.9% ,19.8% and 54.3%% of women had less than, greater than and within the recommended rates of gain in the 2nd and 3rd trimester, respectively. Multivariate Logistic regression analysis showed that greater than recommended rates of weight gain in 2nd trimester decreased the risks of preeclampsia (adjusted OR:0.458,95% CI:0.255~0.824). Less than recommended rates of weight gain in 3rd trimester increased the risk of premature delivery（adjusted OR=1.926,95%CI:1.403~2.644）, gestational diabetes mellitus (adjusted OR = 2.052,95%CI:1.417~2.972), intrahepatic cholestasis syndrome (adjusted OR = 3.016,95%CI:1.057~8.606), premature rupture of the membrane (adjusted OR = 1.722,95%CI:1.180~2.512) and neonatal respiratory distress syndrome (adjusted OR = 5.135,95%CI:1.701~15.498) and decreased the risk of cesarean section (adjusted OR = 0.587,95%CI:0.385~0.893) .In addition, greater than recommended rates of weight gain in 3rd trimester was associated with increased risks in premature delivery (adjusted OR=1.818,95%CI:1.307~2.527), and gestational hypertension (adjusted OR=2.098,95%CI:1.018~4.324) as well as preeclampsia(adjusted OR:2.029, 95%CI:1.331~3.093). The stratified analysis of weight gain in 3rd trimester showed that there was no significant difference in the incidence of adverse pregnancy outcomes compared to weight gain rate groups in 2nd trimester.Conclusions: While this study showed gestational weight gain rate less than or greater than in 3rd trimester were associated with some adverse maternal and neonatal outcomes, further studies of prospective and multi-center researches are required to explore alternate ranges of gestational weight gain rate in twin pregnancies.

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Total gestational weight gain and the risk of preeclampsia by pre-pregnancy body mass index categories: a population-based cohort study from 2013 to 2017

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0008 ◽

2019 ◽

Vol 47 (6) ◽

pp. 585-591 ◽

Cited By ~ 3

Author(s):

Tanja Premru-Srsen ◽

Zorana Kocic ◽

Vesna Fabjan Vodusek ◽

Ksenija Geršak ◽

Ivan Verdenik

Keyword(s):

Body Mass Index ◽

Weight Gain ◽

Gestational Weight Gain ◽

Body Mass ◽

Odds Ratio ◽

Protective Factor ◽

Population Based ◽

Normal Weight ◽

Obese Women ◽

Gestational Weight

Abstract Background Identifying the risk factors for preeclampsia (PE) is essential for the implementation of preventive actions. In the present study, we aimed at exploring the association between total gestational weight gain (GWG) and PE. Methods We performed a population-based cohort survey of 98,820 women with singleton pregnancies who delivered in Slovenia from 2013 to 2017. Aggregated data were obtained from the National Perinatal Information System (NPIS). The main outcome measure was the incidence of PE. The main exposure variable was total GWG standardized for the gestational duration by calculating the z-scores. The associations between total GWG and PE stratified by pre-pregnancy body mass index (BMI) categories adjusted for a variety of covariates were determined using multivariable logistic regression. We calculated the crude odds ratio (OR) and adjusted odds ratio (aOR) with a 95% confidence interval using a two-way test. Results Excessive GWG was associated with increased odds of PE in all pre-pregnancy BMI categories. The increase in the odds of PE by 445% was the highest in underweight women and by 122% was the lowest in obese women. Low GWG was associated with decreased odds of PE in all pre-pregnancy BMI categories except in normal-weight women with a GWG below −2 standard deviation (SD) and underweight women. The decrease in the odds of PE by 67% was the highest in obese women and by 41% was the lowest in normal-weight women. Conclusion Excessive GWG is a significant risk factor for PE, especially in underweight women, while low GWG is an important protective factor against PE, especially in obese women.

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