Suggested Gestational Weight Gain for Chinese Women and Comparison with Institute of Medicine Criteria: A Large Population-Based Study

Objective: To establish suggested gestational weight gain (GWG) using several distinct methods in a Chinese population. Methods: This study analyzed data from the medical records of singleton pregnancy women during 2011–2017 in Beijing, China. Suggested GWG was calculated using four distinct methods. In method 1, suggested GWG was identified by the interquartile method. Subsequently, risk models for small for gestational age (SGA) and large for gestational age (LGA) with respect to GWG were constructed. GWG was treated as a continuous variable in method 2, and as a categorized variable in methods 3 and 4. Results: An average GWG of 15.78 kg with a prevalence of LGA at 19.34% and SGA at 2.12% was observed among the 34,470 participants. Methods 1 and 2 did not yield clinically applicable results. The suggested GWGs were 11–17/11–16 kg, 9–19/9–15 kg, 4–12/4–10 kg, and 0–12/0–6 kg by method 3/method 4 for underweight, normal-weight, overweight, and obese women, respectively. The GWG range suggested by method 3 resulted in a larger proportion of participants (62.03%) within range, while the suggested GWG range by method 4 was associated with a lower risk of LGA compared to that conferred by the Institute of Medicine (IOM) criteria. Conclusion: This study suggests a modest GWG goal compared to IOM recommendations based on a large Chinese cohort.

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

Obstetric Medicine ◽

10.1258/om.2012.120004 ◽

2012 ◽

Vol 5 (2) ◽

pp. 58-64 ◽

Cited By ~ 10

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.

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

10.21203/rs.3.rs-15498/v1 ◽

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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Paternal weight prior to conception and infant birthweight: a prospective cohort study

Nutrition and Diabetes ◽

10.1038/s41387-021-00172-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ravi Retnakaran ◽

Shi Wu Wen ◽

Hongzhuan Tan ◽

Shujin Zhou ◽

Chang Ye ◽

...

Keyword(s):

Cohort Study ◽

Weight Gain ◽

Gestational Weight Gain ◽

Gestational Age ◽

Weight Status ◽

Large For Gestational Age ◽

Maternal Weight ◽

Singleton Pregnancy ◽

Gestational Weight ◽

Unit Increase

Abstract Background/Objective Previous studies have consistently demonstrated that maternal weight status both before and during pregnancy is associated with infant birthweight. However, a fundamental limitation across this literature remains that previous studies have not evaluated the concomitant impact of paternal weight at conception, owing to the paucity of studies in which fathers were assessed prior to pregnancy. Thus, we established a cohort of preconception couples to prospectively evaluate the associations of maternal and paternal weight prior to pregnancy with infant birthweight at delivery. Methods In this prospective observational cohort study, 1292 newly-married women and their partners in Liuyang, China, were assessed at median of 23.3 weeks before a singleton pregnancy, thereby enabling concomitant assessment of preconception maternal and paternal body mass index (BMI) in relation to infant birthweight. Results Mean birthweight was 3294 ± 450 g with 147 neonates (11.4%) born large-for-gestational-age (LGA) and 94 (7.3%) small-for-gestational-age (SGA). After adjustment for maternal and paternal factors prior to conception (age, education, smoking, BMI, household income), length of gestation, total gestational weight gain, gestational diabetes, preeclampsia, and infant sex, it was noted that infant birthweight increased by 42.2 g (95% CI 29.5–54.8; p < 0.0001) per unit increase in maternal pregravid BMI and 10.7 g (95% CI 0.5–20.9; p = 0.04) per unit increase in paternal pregravid BMI. Maternal pregravid BMI explained 6.2% of the variance in birthweight whereas paternal BMI explained only 0.7%. Independent predictors of LGA delivery were maternal pregravid BMI (aOR = 1.91, 95% CI 1.50–2.44), maternal age (aOR = 1.48, 95% CI 1.09–2.00), and gestational weight gain (aOR = 1.80, 95% CI 1.40–2.30). Paternal pregravid BMI was not independently associated with LGA or SGA. Conclusion Paternal BMI prior to conception is associated with infant birthweight but only modestly so, in contrast to the dominant impact of maternal weight.

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Associations between gestational weight gain adequacy and neonatal outcomes in Tanzania

10.1101/2021.08.19.21262273 ◽

2021 ◽

Author(s):

Nandita Perumal ◽

Dongqing Wang ◽

Anne Marie Darling ◽

Molin Wang ◽

Enju Liu ◽

...

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Gestational Age ◽

Low Birthweight ◽

Perinatal Death ◽

Sub Saharan Africa ◽

Large For Gestational Age ◽

Institute Of Medicine ◽

Gestational Weight ◽

Newborn Outcomes

Introduction: Gestational weight gain (GWG) is associated with fetal and newborn health; however, data from sub-Saharan Africa are limited. Methods: We used data from a prenatal micronutrient supplementation trial among a cohort of HIV-negative pregnant women in Dar es Salaam, Tanzania to estimate the relationships between GWG and newborn outcomes. GWG adequacy was defined as the ratio of the total observed weight gain over the recommended weight gain based on the Institute of Medicine body mass index (BMI)-specific guidelines. Newborn outcomes assessed were: stillbirth, perinatal death, preterm birth, low birthweight, macrosomia, small-for-gestational age (SGA), large-for-gestational age (LGA), stunting at birth, and microcephaly. Modified Poisson regressions with robust standard error were used to estimate the relative risk of newborn outcomes as a function of GWG adequacy. Results: Of 7561 women included in this study, 51% had severely inadequate (<70%) or inadequate GWG (70-90%), 31% had adequate GWG (90-125%), and 18% had excessive GWG (≥125%). Compared to adequate GWG, severely inadequate GWG was associated with a higher risk of low birthweight, SGA, stunting at birth, and microcephaly; whereas excessive GWG was associated with a higher risk of LGA and macrosomia. Conclusion: Interventions to support optimal gestational weight gain are needed and are likely to improve newborn outcomes.

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Application of Japanese guidelines for gestational weight gain to multiple pregnancy outcomes and its optimal range in 101,336 Japanese women

Scientific Reports ◽

10.1038/s41598-019-53809-8 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Kyoko Nomura ◽

Kengo Nagashima ◽

Shunji Suzuki ◽

Hiroaki Itoh

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Multiple Pregnancy ◽

Large For Gestational Age ◽

Obese Women ◽

Operating Characteristics ◽

Gestational Weight ◽

Japanese Guidelines

AbstractThis study was performed to investigate whether the Japanese guidelines for gestational weight gain (GWG) can be used to determine the risks of multiple pregnancy outcomes and estimate optimal GWG in 101,336 women with singleton pregnancies in 2013. Multivariable logistic regression analyses indicated that the risks associated with low birth weight, small for gestational age, and preterm birth increased significantly with weight gain below the Japanese guidelines, and the risks of macrosomia and large for gestational age increased with weight gain above the guidelines regardless of Asian-specific pre-pregnancy body mass index (BMI). The GWG cutoff points estimated from the adjusted area under the receiver operating characteristics curve >0.6 corresponded to 10–13.8 kg in underweight women with pre-pregnancy BMI < 18.5 kg/m2; 10–13.7 kg in normal weight women with pre-pregnancy BMI 18.5–22.9 kg/m2; 8.5–11.4 kg in overweight women with pre-pregnancy BMI 23–24.9 kg/m2, 5–13.3 kg in obese women with pre-pregnancy BMI 25–29.9 kg/m2; and 4.7 kg in obese women with pre-pregnancy BMI ≥ 30 kg/m2. The optimal GWG ranges proposed by the present study are slightly higher than those recommended by the current Japanese guidelines.

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THE ASSOCIATION OF GESTATIONAL WEIGHT GAIN AND ADVERSE PREGNANCY OUTCOMES IN WOMEN WITH GESTATIONAL DIABETES MELLITUS

Endocrine Practice ◽

10.4158/ep-2019-0011 ◽

2019 ◽

Vol 25 (11) ◽

pp. 1137-1150 ◽

Cited By ~ 2

Author(s):

Qianyue Xu ◽

Zhijuan Ge ◽

Jun Hu ◽

Shanmei Shen ◽

Yan Bi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Weight Gain ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Gestational Diabetes Mellitus ◽

Gestational Weight Gain ◽

Gestational Age ◽

Large For Gestational Age ◽

Institute Of Medicine ◽

Gestational Weight

Objective: To explore the association of excessive gestational weight gain (GWG) defined by the Institute of Medicine (IOM) targets and adverse perinatal outcomes in gestational diabetes mellitus (GDM) pregnancies, and whether a modified target might be related to a lower rate of adverse perinatal outcomes for GDM. Methods: This retrospective cohort study involved 1,138 women of normal glucose tolerance (NGT) and 1,200 women with GDM. Based on the IOM target, pregnancies were classified to appropriate GWG (aGWG), inadequate GWG, and excessive GWG (eGWG). Modified GWG targets included: upper limit of IOM target minus 1 kg (IOM-1) or 2 kg (IOM-2), both upper and lower targets minus 1 kg (IOM-1-1) or 2 kg (IOM-2-2). Results: The proportions of women achieving eGWG were 26.3% in NGT and 31.2% in GDM ( P = .036); in comparison, for aGWG NGT, the risks of large for gestational age (LGA) were significantly higher in eGWG NGT (adjusted odds ratio [OR] 1.47; 95% confidence interval [CI] 1.02 to 2.13), aGWG GDM (adjusted OR 1.42; 95% CI 1.03 to 1.95), and eGWG GDM (adjusted OR 2.70; 95% CI 1.92 to 3.70). GDM pregnancies gaining aGWG based on the modified GWG targets (IOM-2, IOM-1-1, and IOM-2-2) had a lower prevalence of LGA and macrosomia delivery than that for similar pregnancies using the original IOM target (all P<.05). Conclusion: For aGWG GDM according to the IOM target, adhering to a more stringent weight control was associated with decreased adverse outcomes. A tighter IOM target might help to reduce the prevalence of adverse pregnancy outcomes. Abbreviations: aGWG = appropriate gestational weight gain; BG = blood glucose; BMI = body mass index; CI = confidence interval; eGWG = excessive gestational weight gain; GDM = gestational diabetes mellitus; GW = gestational weeks; GWG = gestational weight gain; HbA1c = hemoglobin A1c; iGWG = inadequate gestational weight gain; IOM = Institute of Medicine; LGA = large for gestational age; NGT = normal glucose tolerance; NICU = neonatal intensive care unit; OGTT = oral glucose tolerance test; OR = odds ratio; PARp = partial population attributable risks; SGA = small for gestational age

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Short maternal stature and gestational weight gain among refugee and migrant women birthing appropriate for gestational age term newborns: a retrospective cohort on the Myanmar-Thailand border, 2004–2016

BMJ Global Health ◽

10.1136/bmjgh-2020-004325 ◽

2021 ◽

Vol 6 (2) ◽

pp. e004325

Author(s):

Sue J Lee ◽

Ahmar H Hashmi ◽

Aung Myat Min ◽

Mary Ellen Gilder ◽

Nay Win Tun ◽

...

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Gestational Age ◽

Retrospective Cohort ◽

First Trimester ◽

Large For Gestational Age ◽

Obese Women ◽

Gestational Weight ◽

Appropriate For Gestational Age ◽

Term Newborns

IntroductionTo examine the interactions between short maternal stature, body mass index (BMI) and gestational weight gain (GWG) among appropriate for gestational age (AGA) term newborns in a population of refugees and migrants in Southeast Asia.MethodsThis is a retrospective cohort study from 2004 to 2016, including women delivering term, singleton newborns, with first trimester height, weight and gestation dated by ultrasound and a last body weight measured within 4 weeks of birth. AGA newborns were those not classified as small for gestational age or large for gestational age by either INTERGROWTH-21st or Gestation Related Optimal Weight standards. The influence of maternal stature on GWG in delivering an AGA newborn was analysed, with GWG compared with existing National Academy of Medicine (NAM) recommendations.Results4340 women delivered AGA newborns. Mean maternal height (SD) was 151.5 cm (5.13), with 58.5% of women considered too short by INTERGROWTH-21st standards. Only one in four women (26.5%, 1150/4340) had GWG within NAM recommendations. Women of shorter stature had a significantly lower mean GWG compared with taller women in underweight and normal BMI categories (p<0.001 for both BMI categories). Mean GWG of overweight and obese women did not differ by height (p=1.0 and p=0.85, respectively) and fell within the lower range of NAM recommendations.ConclusionThese results suggest that short maternal stature can be an important predictor of GWG and should be considered with prepregnancy BMI. Limited-resource settings and special populations need robust GWG recommendations that reflect height and BMI.

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

American Journal of Perinatology Reports ◽

10.1055/s-0037-1604076 ◽

2017 ◽

Vol 07 (03) ◽

pp. e145-e150 ◽

Cited By ~ 4

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.

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