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 Gestational weight gain, birthweight and early-childhood obesity: between- and within-family comparisons

2020 ◽  
Vol 49 (5) ◽  
pp. 1682-1690
Author(s):  
Sylvia E Badon ◽  
Charles P Quesenberry ◽  
Fei Xu ◽  
Lyndsay A Avalos ◽  
Monique M Hedderson
Keyword(s):  
Early Childhood ◽  
Weight Gain ◽  
Childhood Obesity ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Gestational Weight ◽  
Childhood Weight ◽  
Familial Environment ◽  
Iom Recommendations

Abstract Background Associations of excessive gestational weight gain (GWG) with greater birthweight and childhood obesity may be confounded by shared familial environment or genetics. Sibling comparisons can minimize variation in these confounders because siblings grow up in similar environments and share the same genetic predisposition for weight gain. Methods We identified 96 289 women with live births in 2008–2014 at Kaiser Permanente Northern California. Fifteen percent of women (N = 14 417) had at least two births during the study period for sibling analyses. We assessed associations of GWG according to the Institute of Medicine (IOM) recommendations with birthweight and obesity at age 3 years, using conventional analyses comparing outcomes between mothers and sibling analyses comparing outcomes within mothers, which control for stable within-family unmeasured confounders such as familial environment and genetics. We used generalized estimating-equations and fixed-effects models. Results In conventional analyses, GWG above the IOM recommendations was associated with 88% greater odds of large-for-gestational age birthweight [95% confidence interval (CI): 1.80, 1.97] and 30% greater odds of obesity at 3 years old (95% CI: 1.24, 1.37) compared with GWG within the IOM recommendations. In sibling analyses, GWG above the IOM recommendations was also associated with greater odds of large-for-gestational age [odds ratio (OR): 1.36; 95% CI: 1.20, 1.54], but was not associated with obesity at 3 years old (OR = 0.98; 95% CI: 0.84, 1.15). Conclusions GWG likely has a direct impact on birthweight; however, shared environmental and lifestyle factors within families may play a larger role in determining early-childhood weight status and obesity risk than GWG.

scholarly journals Evaluation of Institute of Medicine Guidelines for Gestational Weight Gain in Women with Chronic Hypertension

2017 ◽  
Vol 07 (03) ◽  
pp. e145-e150 ◽  
Author(s):  
Anne Siegel ◽  
Alan Tita ◽  
Hannah Machemehl ◽  
Joseph Biggio ◽  
Lorie Harper
Keyword(s):  
Weight Gain ◽  
Gestational Weight Gain ◽  
Gestational Age ◽  
Large For Gestational Age ◽  
Stepwise Logistic Regression ◽  
Chronic Hypertension ◽  
Institute Of Medicine ◽  
Gestational Weight ◽  
Iom Recommendations ◽  
The Impact

Objective To assess the impact of gestational weight gain (GWG) outside the Institute of Medicine (IOM) recommendations on perinatal outcomes in pregnancies complicated by chronic hypertension (HTN). Methods The study consisted of a retrospective cohort of all singletons with HTN from 2000 to 2014. Maternal outcomes examined were superimposed preeclampsia and cesarean delivery. Neonatal outcomes were small for gestational age (SGA), large for gestational age (LGA), and preterm birth (PTB). Groups were compared using analysis of variance and chi-squared test for trend. Backward stepwise logistic regression was adjusted for confounding factors. Results Of 702 subjects, 106 (15.1%) gained within, 176 (25.0%) gained less, and 420 (59.8%) gained more weight than the IOM recommendations. After adjusting for confounders, GWG above IOM recommendations remained associated with LGA (adjusted odds ratio [AOR]: 2.53, confidence interval [CI] 95%:1.29–4.95). Weight gain less than recommended was associated with a decreased risk of superimposed preeclampsia (AOR: 0.49, CI 95%: 0.26–0.93) without increasing the risk of SGA (AOR: 1.03, CI 95%: 0.57–1.86). Conclusion Women with pregnancies complicated by chronic HTN should be counseled regarding the association of LGA with excessive GWG. Additionally, they should be counseled that weight gain below recommendations may be associated with a decreased risk of superimposed preeclampsia; however, this association deserves further investigation.

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 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 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 Higher Peripheral Cholesterol and a Positive Correlation With Risk for Large-For-Gestational-Age Neonates in Pre-Pregnancy Underweight Women

2021 ◽  
Vol 12 ◽  
Author(s):  
Dongyu Wang ◽  
Wenjing Ding ◽  
Chengcheng Ding ◽  
Haitian Chen ◽  
Weihua Zhao ◽  
...  
Keyword(s):  
Weight Gain ◽  
Gestational Age ◽  
Subgroup Analysis ◽  
Pregnancy Outcomes ◽  
Normal Weight ◽  
Large For Gestational Age ◽  
Overweight Women ◽  
Gestational Weight ◽  
Adverse Pregnancy ◽  
Iom Recommendations

ObjectiveAs the high proportion of underweight pregnant women, omission of their weight gain and blood lipids management during gestation might lead to adverse pregnancy outcomes. This study aimed to determine the relationship between lipid profile and risks for adverse pregnancy outcomes in pre-pregnancy underweight women.MethodsThis study was part of an ongoing cohort study including Chinese gravidas delivered from January 2015 to December 2016. Included subjects were grouped into underweight, normal-weight, and overweight by BMI before conception. Logistic regression was used to assess the association between lipid profiles during second trimester and adverse obstetric outcomes in each group. A subgroup analysis according to the gestational weight gain, in which subjects in each group were divided into above and within the Institute of Medicine (IOM) recommendations, was performed.ResultsA total of 6, 223 women were included. The proportion of underweight (19.3%) was similar to that of overweight women (19.4%) in South China. Peripheral total cholesterol (TC) level in underweight women was significantly higher than that in overweight women (P &lt;0.001). After adjusting maternal age, TC level was positively correlated to the risk for large-for-gestational-age (LGA) [aOR =2.24, 95%CI (1.08, 4.63)], and negatively related to the risk for small-for-gestational age (SGA) [aOR =0.71, 95%CI (0.59, 0.85)] in underweight women, but not in normal-weight or overweight women. The subgroup analysis showed that maternal TC level was positively correlated with the risk of LGA only in underweight women who gained weight more than the IOM recommendations.ConclusionUnderweight pregnant women with high TC levels had a higher risk for LGA, especially among women whose gestational weight gain were above the IOM recommendations. Therefore, clinical management of lipids and weight gain during gestation should also be recommended for underweight women.

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 Diet, Physical Activity and Gestational Weight Gain Patterns among Pregnant Women Living with Obesity in the North East of England: The GLOWING Pilot Trial

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1981
Author(s):  
Nicola Heslehurst ◽  
Angela C. Flynn ◽  
Lem Ngongalah ◽  
Catherine McParlin ◽  
Kathryn V. Dalrymple ◽  
...  
Keyword(s):  
Physical Activity ◽  
Weight Gain ◽  
Pregnant Women ◽  
Gestational Weight Gain ◽  
Pilot Trial ◽  
Institute Of Medicine ◽  
Obesity Class ◽  
Gestational Weight ◽  
North East ◽  
Class 1

Maternal diet, physical activity (PA) behaviours, and gestational weight gain (GWG) are important for optimum health of women and their babies. This secondary analysis of the GLOWING pilot cluster trial explored these among women living with obesity in high deprivation. Pregnant women completed food frequency, PA and psychosocial questionnaires. Weights were retrieved from medical records and measured during routine appointments with midwives. Descriptive and regression analyses were stratified by obesity class. A total of 163 women were recruited; 54.0% had class 1 obesity, 25.8% class 2, 20.2% class 3, and 76.1% lived in the two most deprived quintiles. Women had suboptimal dietary intake, particularly for oily fish, fruit and vegetables. PA was predominantly light intensity, from household, care and occupational activities. Most women gained weight outside of Institute of Medicine (IOM) guideline recommendations (87.8%); women in class 3 obesity were most likely to have inadequate GWG below IOM recommendations (58.3%, p < 0.01) and reduced odds of excessive GWG compared with class 1 (AOR 0.13, 95% 0.04–0.45). Deprived women with obesity have a double inequality as both increase pregnancy risks. This population requires support to meet guideline recommendations for diet, PA and GWG. Further research exploring obesity classes would inform policies and care to achieve the best pregnancy outcomes.

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