RSS-Feed abonnieren
DOI: 10.1055/s-0036-1579650
Impact of Gestational Weight Gain on Perinatal Outcomes in Obese Women
Publikationsverlauf
14. Januar 2016
22. Januar 2016
Publikationsdatum:
09. März 2016 (online)
![](https://www.thieme-connect.de/media/ajp/201609/lookinside/thumbnails/10-1055-s-0036-1579650_160022-1.jpg)
Abstract
Objective This study aims to evaluate perinatal outcomes, according to gestational weight gain (GWG) in obese women.
Study Design A retrospective cohort of perinatal outcomes in obese women who gained below, within, or above the 2009 Institute of Medicine guidelines and delivered ≥ 36 weeks. Additionally, outcomes, according to the rate of GWG (kg/week; minimal [< 0.16], moderate [0.16–0.49], or excessive [> 0.49]) were compared among women delivering preterm.
Results Overall, 5,651 obese women delivered ≥ 36 weeks. GWG above guidelines was associated with increased cesarean section (adjusted odds ratio [aOR]: 1.44, 95% confidence interval [CI]: 1.21–1.72), gestational hypertension (aOR: 1.58, 95% CI: 1.21–2.06), and macrosomia (birth weight ≥ 4,000 g) (aOR: 2.08, 95% CI: 1.62–2.67). GWG below recommendations was associated with less large for gestational age infants (aOR: 0.60, 95% CI: 0.47–0.75). A total of 6,663 women delivered ≥ 20 weeks. Minimal weekly GWG was associated with increased spontaneous preterm birth (aOR: 1.56, 95% CI: 1.23–1.98) and more small for gestational age (SGA) infants (aOR: 1.55, 95% CI: 1.19–2.01). Excessive weekly GWG was associated with increased indicated preterm birth (aOR: 1.61, 95% CI: 1.29–2.01), cesarean section (aOR: 1.39, 95% CI: 1.20–1.61), preeclampsia (aOR: 1.83, 95% CI: 1.49–2.26), neonatal intensive care unit admission (aOR: 1.33, 95% CI: 1.08–1.63), and macrosomia (aOR: 2.40, 95% CI: 1.94–2.96).
Conclusions Obese women with excessive GWG had worse outcomes than women with GWG within recommendations. Limited GWG was associated with increased spontaneous preterm birth and SGA infants.
Note
This study was presented in part at the 33rd Annual Meeting of the Society of Maternal-Fetal Medicine; February 11–16, 2013; San Francisco, CA.
-
References
- 1 Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012; 307 (5) 491-497
- 2 Bennett JC, Wang H, Schirmer BD, Northup CJ. Quality of life and resolution of co-morbidities in super-obese patients remaining morbidly obese after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2007; 3 (3) 387-391
- 3 Arrowsmith S, Wray S, Quenby S. Maternal obesity and labour complications following induction of labour in prolonged pregnancy. BJOG 2011; 118 (5) 578-588
- 4 Baeten JM, Bukusi EA, Lambe M. Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health 2001; 91 (3) 436-440
- 5 Joy S, Istwan N, Rhea D, Desch C, Stanziano G. The impact of maternal obesity on the incidence of adverse pregnancy outcomes in high-risk term pregnancies. Am J Perinatol 2009; 26 (5) 345-349
- 6 Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004; 103 (2) 219-224
- 7 Myles TD, Gooch J, Santolaya J. Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol 2002; 100 (5 Pt 1) 959-964
- 8 American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: obesity in pregnancy. Obstet Gynecol 2013; 121 (1) 213-217
- 9 Stothard KJ, Tennant PWG, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 2009; 301 (6) 636-650
- 10 Chen M, McNiff C, Madan J, Goodman E, Davis JM, Dammann O. Maternal obesity and neonatal Apgar scores. J Matern Fetal Neonatal Med 2010; 23 (1) 89-95
- 11 Chen A, Feresu SA, Fernandez C, Rogan WJ. Maternal obesity and the risk of infant death in the United States. Epidemiology 2009; 20 (1) 74-81
- 12 Nohr EA, Vaeth M, Bech BH, Henriksen TB, Cnattingius S, Olsen J. Maternal obesity and neonatal mortality according to subtypes of preterm birth. Obstet Gynecol 2007; 110 (5) 1083-1090
- 13 Catalano PM, Ehrenberg HM. The short- and long-term implications of maternal obesity on the mother and her offspring. BJOG 2006; 113 (10) 1126-1133
- 14 Vesco KK, Dietz PM, Rizzo J , et al. Excessive gestational weight gain and postpartum weight retention among obese women. Obstet Gynecol 2009; 114 (5) 1069-1075
- 15 Herring SJ, Oken E, Rifas-Shiman SL , et al. Weight gain in pregnancy and risk of maternal hyperglycemia. Am J Obstet Gynecol 2009; 201 (1) 61.e1-61.e7
- 16 Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol 2010; 115 (3) 597-604
- 17 Siega-Riz AM, Viswanathan M, Moos MK , et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol 2009; 201 (4) 339.e1-339.e14
- 18 Institute of Medicine. Weight Gain during Pregnancy: Reexamining the Guidelines. Washington, DC: National Academies Press; 2009
- 19 Brenner WE, Edelman DA, Hendricks CH. A standard of fetal growth for the United States of America. Am J Obstet Gynecol 1976; 126 (5) 555-564
- 20 Einerson BD, Huffman JK, Istwan NB, Rhea DJ, Joy SD. New gestational weight gain guidelines: an observational study of pregnancy outcomes in obese women. Obesity (Silver Spring) 2011; 19 (12) 2361-2364
- 21 Johnson J, Clifton RG, Roberts JM , et al; Eunice Kennedy Shriver National Institute of Child Health; Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Pregnancy outcomes with weight gain above or below the 2009 Institute of Medicine guidelines. Obstet Gynecol 2013; 121 (5) 969-975
- 22 Swank ML, Marshall NE, Caughey AB , et al. Pregnancy outcomes in the super obese, stratified by weight gain above and below institute of medicine guidelines. Obstet Gynecol 2014; 124 (6) 1105-1110
- 23 Durie DE, Thornburg LL, Glantz JC. Effect of second-trimester and third-trimester rate of gestational weight gain on maternal and neonatal outcomes. Obstet Gynecol 2011; 118 (3) 569-575
- 24 Bodnar LM, Siega-Riz AM, Simhan HN, Himes KP, Abrams B. Severe obesity, gestational weight gain, and adverse birth outcomes. Am J Clin Nutr 2010; 91 (6) 1642-1648
- 25 Blomberg M. Maternal and neonatal outcomes among obese women with weight gain below the new Institute of Medicine recommendations. Obstet Gynecol 2011; 117 (5) 1065-1070
- 26 Kominiarek MA, Seligman NS, Dolin C , et al. Gestational weight gain and obesity: is 20 pounds too much?. Am J Obstet Gynecol 2013; 209 (3) 214.e1-214.e11