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

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 <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.

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Gestational weight gain and adverse pregnancy outcomes: a prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-038187 ◽

2020 ◽

Vol 10 (9) ◽

pp. e038187

Author(s):

Yuelin Wu ◽

Sheng Wan ◽

Shengyi Gu ◽

Zhengqian Mou ◽

Lingling Dong ◽

...

Keyword(s):

Cohort Study ◽

Weight Gain ◽

Caesarean Section ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Late Pregnancy ◽

Adverse Pregnancy Outcomes ◽

Gestational Weight ◽

Maternal And Neonatal Outcomes ◽

Adverse Pregnancy

ObjectiveTo assess the associations of gestational weight gain (GWG) in early and late pregnancy with subsequent risks of adverse pregnancy outcomes in Chinese women.DesignProspective cohort study.SettingShanghai, China.ParticipantsWe studied 2630 nulliparous singleton pregnant women with complete data on weight gain in early (≤17 weeks of gestation) and late (>17 weeks) pregnancy in the Shanghai Birth Cohort.MethodsGWG was standardised into z-scores by gestational age and categorised as low (z-score <−1), normal (−1 to +1) and high (>1). The adjusted relative risks (aRRs) and 95%CIs were estimated through log-binomial regression models. Interaction effects between GWG and some other adjustment factors were tested, further stratified analyses were performed separately where interaction terms were significant.Outcome measuresAdverse maternal and neonatal outcomes.ResultsIndependent from GWG in late pregnancy, higher GWG in early pregnancy was associated with higher risks of gestational diabetes mellitus (aRR: 1.66; 95% CI: 1.11 to 2.48), caesarean section (aRR: 1.21; 95% CI: 1.05 to 1.39) and prolonged hospitalisation (aRR: 1.56; 95% CI: 1.03 to 2.38). Higher GWG in late pregnancy was independently associated with higher risks of caesarean section (aRR: 1.24; 95% CI: 1.09 to 1.41), large for gestational age (aRR: 2.01; 95% CI: 1.50 to 2.7) and macrosomia (aRR: 1.90; 95% CI: 1.30 to 2.78). In addition, the risk of gestational hypertension increased significantly with increased total GWG (aRR: 1.78; 95% CI: 1.14 to 2.76). The effects of GWG in late pregnancy on maternal and neonatal outcomes were significantly different between the women bearing a female and the women bearing male fetus.ConclusionThe GWG associations with adverse pregnancy outcomes differ at early and late pregnancy, and there may be effect modification by fetal sex in the association of GWG in late pregnancy with some pregnancy outcomes.

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Gestational Weight Gain and Pregnancy Outcomes among Nulliparous Women

American Journal of Perinatology ◽

10.1055/s-0039-1696640 ◽

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.

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Pregnancy Outcomes after Preeclampsia: The Effects of Interpregnancy Weight Change

American Journal of Perinatology ◽

10.1055/s-0040-1713000 ◽

2020 ◽

Author(s):

Maya Tabet ◽

Soumya Banna ◽

Lan Luong ◽

Russell Kirby ◽

Jen Jen Chang

Keyword(s):

Weight Loss ◽

Weight Gain ◽

Cesarean Delivery ◽

Gestational Age ◽

Weight Change ◽

Pregnancy Outcomes ◽

Normal Weight ◽

Large For Gestational Age ◽

Obese Women ◽

Increased Risk

Objective This study aimed to examine the effects of interpregnancy weight change on pregnancy outcomes, including recurrent preeclampsia, preterm birth, small-for-gestational age (SGA), large-for-gestational age (LGA), and cesarean delivery, among women with a history of preeclampsia. We also evaluated whether these associations were modified by prepregnancy body mass index (BMI) category in the first pregnancy (BMI < 25 vs. ≥25 kg/m2) and if associations were present among women who maintained a healthy BMI category in both pregnancies. Study Design We conducted a population-based retrospective cohort study including 15,108 women who delivered their first two nonanomalous singleton live births in Missouri (1989–2005) and experienced preeclampsia in the first pregnancy. We performed Poisson regression with robust error variance to estimate relative risks and 95% confidence intervals for outcomes of interest after controlling for potential confounders. Results Interpregnancy weight gain was associated with increased risk of recurrent preeclampsia, LGA, and cesarean delivery. These risks increased in a “dose–response” manner with increasing magnitude of interpregnancy weight gain and were generally more pronounced among women who were underweight or normal weight in the first pregnancy. Interpregnancy weight loss exceeding 1 BMI unit was associated with increased risk of SGA among underweight and normal weight women, while interpregnancy weight loss exceeding 2 BMI units was associated with reduced risk of recurrent preeclampsia among overweight and obese women. Conclusion Even small changes in interpregnancy weight may significantly affect pregnancy outcomes among formerly preeclamptic women. Appropriate weight management between pregnancies has the potential to attenuate such risks. Key Points

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Prognosis Associated with Sub-Types of Hyperglycaemia in Pregnancy

Journal of Clinical Medicine ◽

10.3390/jcm10173904 ◽

2021 ◽

Vol 10 (17) ◽

pp. 3904

Author(s):

Emmanuel Cosson ◽

Sid Ahmed Bentounes ◽

Charlotte Nachetergaele ◽

Narimane Berkane ◽

Sara Pinto ◽

...

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Insulin Requirement ◽

Large For Gestational Age ◽

Gestational Weight ◽

Hypertensive Disorders ◽

Increased Risk ◽

In Pregnancy

We aimed to compare pregnancy outcomes in 4665 women according to the following types of hyperglycaemia in pregnancy sub-types: (i) normoglycaemia, (ii) gestational diabetes mellitus (GDM), (iii) diabetes in pregnancy (DIP), (iv) early-diagnosed (i.e., <22 weeks of gestation) GDM (eGDM), and (v) early-diagnosed DIP (eDIP). The prevalence of normoglycaemia, eGDM, eDIP, GDM, and DIP was 76.4%, 10.8%, 0.6%, 11.7%, and 0.6%, respectively. With regard to pregnancy outcomes, gestational weight gain (11.5 ± 5.5, 9.0 ± 5.4, 8.3 ± 4.7, 10.4 ± 5.3, and 10.1 ± 5.0 kg, p < 0.0001) and insulin requirement (none, 46.0%, 88.5%, 25.5%, and 51.7%; p < 0.001) differed according to the glycaemic sub-types. eGDM and eDIP were associated with higher rates of infant malformation. After adjustment for confounders, with normoglycaemia as the reference, only GDM was associated with large-for-gestational-age infant (odds ratio 1.34 (95% interval confidence 1.01–1.78) and only DIP was associated with hypertensive disorders (OR 3.48 (1.26–9.57)). To conclude, early-diagnosed hyperglycaemia was associated with an increased risk of malformation, suggesting that it was sometimes present at conception. Women with GDM, but not those with eGDM, had an increased risk of having a large-for-gestational-age infant, possibly because those with eGDM were treated early and therefore had less gestational weight gain. Women with DIP might benefit from specific surveillance for hypertensive disorders.

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

International Journal of Epidemiology ◽

10.1093/ije/dyaa110 ◽

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.

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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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Normal Gestational Weight Gain Protects From Large-for-Gestational-Age Birth Among Women With Obesity and Gestational Diabetes

Frontiers in Public Health ◽

10.3389/fpubh.2021.550860 ◽

2021 ◽

Vol 9 ◽

Author(s):

Sanna Mustaniemi ◽

Hilkka Nikkinen ◽

Aini Bloigu ◽

Anneli Pouta ◽

Risto Kaaja ◽

...

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Gestational Diabetes ◽

Gestational Weight Gain ◽

Gestational Age ◽

Reference Group ◽

Normal Weight ◽

Large For Gestational Age ◽

Lower Birth Weight ◽

Gestational Weight

Background: Pre-pregnancy obesity, excess gestational weight gain (GWG), and gestational diabetes (GDM) increase fetal growth. Our aim was to assess whether normal GWG is associated with lower risk for a large-for-gestational-age (LGA; over the 90th percentile of birth weight for sex and gestational age) infant and lower birth weight standard deviation (SD) score in the presence of GDM and maternal obesity.Methods: This multicenter case-control study is part of the Finnish Gestational Diabetes (FinnGeDi) Study and includes singleton pregnancies of 1,055 women with GDM and 1,032 non-diabetic controls. Women were divided into 12 subgroups according to their GDM status, pre-pregnancy body mass index (BMI; kg/m2), and GWG. Non-diabetic women with normal BMI and normal GWG (according to Institute of Medicine recommendations) served as a reference group.Results: The prevalence of LGA birth was 12.2% among women with GDM and 6.2% among non-diabetic women (p < 0.001). Among all women, normal GWG was associated with lower odds of LGA [odds ratio (OR) 0.57, 95% CI: 0.41–0.78]. Among women with both obesity and GDM, the odds for giving birth to a LGA infant was 2.25-fold (95% CI: 1.04–4.85) among those with normal GWG and 7.63-fold (95% CI: 4.25–13.7) among those with excess GWG compared with the reference group. Compared with excess GWG, normal GWG was associated with 0.71 SD (95% CI: 0.47–0.97) lower birth weight SD score among women with GDM and obesity. Newborns of normal weight women with GDM and normal GWG had 0.28 SD (95% CI: 0.05–0.51) lower birth weight SD scores compared with their counterparts with excess GWG. In addition, in the group of normal weight non-diabetic women, normal GWG was associated with 0.46 SD (95% CI: 0.30–0.61) lower birth weight SD scores compared with excess GWG.Conclusion: GDM, obesity, and excess GWG are associated with higher risk for LGA infants. Interventions aiming at normal GWG have the potential to lower LGA rate and birth weight SD scores even when GDM and obesity are present.

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Investigation of optimal gestational weight gain based on the occurrence of adverse pregnancy outcomes for Chinese women: a prospective cohort study

Reproductive Biology and Endocrinology ◽

10.1186/s12958-021-00797-y ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Yin Sun ◽

Zhongzhou Shen ◽

Yongle Zhan ◽

Yawen Wang ◽

Shuai Ma ◽

...

Keyword(s):

Cohort Study ◽

Weight Gain ◽

Pregnant Women ◽

Gestational Weight Gain ◽

Pregnancy Outcomes ◽

Chinese Women ◽

Normal Weight ◽

Adverse Pregnancy Outcomes ◽

Gestational Weight ◽

Adverse Pregnancy

Abstract Objective To investigate recommendations for appropriate gestational weight gain (GWG) of Chinese females. Methods In total of 3,172 eligible women in the first trimester were recruited into the Chinese Pregnant Women Cohort Study (CPWCS) project. Pregnancy complications and outcomes were collated using the hospital medical records system. The method of occurrence of participants with adverse pregnancy outcomes (Occurrence Method) was conducted to calculate the recommended total GWG for each participant’s pre-pregnancy BMI. Occurrence Method data were judged against the Institute of Medicine (IOM) and Japanese recommended criteria in terms of the total occurrence of adverse pregnancy outcomes of pregnant women with appropriate weight gain. Results The most frequent GWG was ≥ 14 kg and < 16 kg (19.4%), followed by ≥ 10 kg and < 12 kg (15.5%) and ≥ 12 kg and < 14 kg (15.2%). The most frequently occurring adverse pregnancy outcomes were cesarean sections for underweight (30.0%), normal weight (40.4%), overweight (53.6%) and obese (53.7%) women. A large for gestational age (LGA) accounted for 18.0% of the overweight and 20.9% of the obesity group. Gestational diabetes mellitus (GDM) occurred in 16.9% of overweight and 23.1% of obese women. The recommended total GWG in a Chinese women population is ≥ 8 and < 12 kg if underweight, ≥ 12 and < 14 kg for normal weight, ≥ 8.0 and < 10.0 kg if overweight, and < 8 kg for women with obesity. Conclusions Current Chinese recommendations provide the optimal ranges of GWG to minimize the occurrence of undesirable pregnancy outcomes for each group of pre-pregnancy BMIs in a Chinese population. Trial registration Registered with ClinicalTrials (NCT03403543).

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Gestational Weight Gain During the Second and Third Trimesters and Adverse Pregnancy Outcomes, Results From a Prospective Pregnancy Cohort in Urban Tanzania

10.21203/rs.3.rs-563740/v1 ◽

2021 ◽

Author(s):

Jiaxi Yang ◽

Molin Wang ◽

Deirdre K. Tobias ◽

Janet W. Rich-Edwards ◽

Anne Marie Darling ◽

...

Keyword(s):

Weight Gain ◽

Preterm Birth ◽

Pregnant Women ◽

Gestational Weight Gain ◽

Early Pregnancy ◽

Gestational Age ◽

Pregnancy Outcomes ◽

Gestational Weight ◽

Pregnancy Cohort ◽

Adverse Pregnancy

Abstract Background Appropriate gestational weight gain (GWG) is important for optimal pregnancy outcomes. This study prospectively evaluated the associations between GWG during the second and third trimesters of pregnancy and adverse pregnancy outcomes in an urban Tanzanian pregnancy cohort. Methods We used data from a randomized clinical trial conducted among pregnant women recruited by 27 weeks of gestation in Dar es Salaam, Tanzania (N = 1,230). Women’s gestational weight was measured at baseline and at monthly antenatal visits. Weekly GWG rate during the second and third trimesters was calculated and characterized as inadequate, adequate, or excessive, in conjunction with measured or imputed early-pregnancy BMI status according to the 2009 Institute of Medicine (IOM) GWG guidelines. We used multivariable Poisson regression with a sandwich variance estimator to calculate risk ratios (RR) for associations of GWG with low birth weight, preterm birth, small for gestational age (SGA), and large for gestational age (LGA). Degree of appropriate GWG defined using additional metrics (i.e., percentage of adequacy, z-score) and potential effect modification by maternal BMI were additionally evaluated. Results According to the IOM guidelines, 517 (42.0%), 270 (22.0%), and 443 (36.0%) women were characterized as having inadequate, adequate, and excessive GWG, respectively. Overall, compared to women with adequate GWG, women with inadequate GWG had a lower risk of LGA births (RR=0.54, 95% CI: 0.36 - 0.80) and a higher risk of SGA births (RR=1.32, 95% CI: 0.95 - 1.81). Women with inadequate GWG as defined by percentage of GWG adequacy had a higher risk of LBW (OR=1.93, 95% CI: 1.03 - 3.63). In stratified analyses by early-pregnancy BMI, excessive GWG among women with normal BMI was associated with a higher risk of preterm birth (RR=1.59, 95% CI: 1.03 - 2.44). Conclusions A comparatively high percentage of excessive GWG was observed among healthy pregnant women in Tanzania. Both inadequate and excessive GWGs were associated with elevated risks of poor pregnancy outcomes. Future studies among diverse SSA populations are warranted to confirm our findings, and clinical recommendations on optimal GWG should be developed to promote healthy GWG in SSA settings. Trial registration This trial was registered as “Prenatal Iron Supplements: Safety and Efficacy in Tanzania” (NCT01119612; http://clinicaltrials.gov/show/NCT01119612).

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Gestational Weight Gain Particularly Affects the Risk of Large for Gestational Age Infants in Non-obese Mothers

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-0891-0919 ◽

2019 ◽

Vol 79 (11) ◽

pp. 1183-1190 ◽

Cited By ~ 1

Author(s):

Friederike Weschenfelder ◽

Thomas Lehmann ◽

Ekkehard Schleussner ◽

Tanja Groten

Keyword(s):

Risk Factor ◽

Weight Gain ◽

Gestational Weight Gain ◽

Gestational Age ◽

Significant Risk ◽

Normal Weight ◽

Large For Gestational Age ◽

Excessive Weight Gain ◽

Gestational Weight ◽

Excessive Weight

Abstract Introduction The birth of a large for gestational age (LGA) infant is a significant risk factor for birth complications and maternal morbidity and an even higher risk factor for offspring obesity, metabolic syndrome and cardiovascular disease in later life. Relevant factors affecting the risk of delivering an LGA infant are maternal pre-gravid obesity, excessive gestational weight gain exceeding the recommendations of the Institute of Medicine (IOM) and diabetes in pregnancy. We aimed to determine what matters most in terms of the risk of fetal overgrowth. Materials and Methods We performed a database analysis of 12 701 singleton term deliveries documented in our university hospital birth registry from 2003 to 2014. Multivariate logistic regression analysis was used to determine the adjusted odds ratios. Results Excessive weight gain had the strongest impact on LGA (OR: 1.249 [95% CI: 1.018 – 1.533]) compared to maternal pre-gravid body mass index (BMI) (OR: 1.083 [95% CI: 1.066 – 1.099]) and diabetes (OR: 1.315 [95% CI: 0.997 – 1.734]). Keeping gestational weight gain within the recommendations of the IOM resulted in a risk reduction for LGA of 20% (OR: 0.801 [95% CI: 0.652 – 0.982]). The risk for LGA increases by 6.9% with each kg weight gain. Normal weight women (BMI 18.5 – 24.9 kg/m2) and moderately overweight women (BMI 25 – 29.9 kg/m2) showed the highest increase in LGA rates per kg weight gain during pregnancy (OR: 1.078 [95% CI: 1.052 – 1.104] and OR: 1.058 [95% CI: 1.026 – 1.09], resp.). Only in underweight (< 18.5 kg/m2) and normal weight women the risk of LGA birth is strongly influenced by diabetes (OR 11.818 [95% CI: 1.156–120.782] and 1.564 [95% CI: 1.013–2.415]). Conclusion Excessive weight gain is particularly important for non-obese women. These women are therefore a target cohort for intervention, as each prevented additional kilogram weight gain reduces the risk of LGA by more than 5%.

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