Am J Perinatol 2021; 38(02): 182-190
DOI: 10.1055/s-0039-1696640
Original Article

Gestational Weight Gain and Pregnancy Outcomes among Nulliparous Women

Annie M. Dude
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
,
William Grobman
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
,
David Haas
2   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Brian M. Mercer
3   Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Samuel Parry
4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
,
Robert M. Silver
5   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
Ronald Wapner
6   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Deborah Wing
7   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California-Irvine, Irvine, California
,
George Saade
8   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch–Galveston, Galveston, Texas
,
Uma Reddy
9   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, Yale University, New Haven, Connecticut
,
Jay Iams
10   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Michelle A. Kominiarek
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
› Author Affiliations
Funding Support for the NuMoM2b study was provided by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development: U10 HD063036, RTI International; U10 HD063072, Case Western Reserve University; U10 HD063047, Columbia University; U10 HD063037, Indiana University; U10HD063041, University of Pittsburgh; U10 HD063020, Northwestern University; U10 HD063046, University of California Irvine; U10 HD063048, University of Pennsylvania; and U10 HD063053, University of Utah. In addition, support was provided by respective Clinical and Translational Science Institutes to Indiana University (UL1TR001108) and University of California Irvine (UL1TR000153).

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.

Note

A version of this paper was presented at the 66th Annual Meeting of the Society for Reproductive Investigation, Paris, France, March 12 to 16, 2019.




Publication History

Received: 08 June 2019

Accepted: 22 July 2019

Article published online:
06 September 2019

© 2019. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Harvey MW, Braun B, Ertel KA, Pekow PS, Markenson G, Chasan-Taber L. prepregnancy body mass index, gestational weight gain, and odds of cesarean delivery in hispanic women. Obesity (Silver Spring) 2018; 26 (01) 185-192
  • 2 Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol 2010; 115 (03) 597-604
  • 3 Masho SW, Urban P, Cha S, Ramus R. Body mass index, weight gain, and hypertensive disorders in pregnancy. Am J Hypertens 2016; 29 (06) 763-771
  • 4 Simas TA, Waring ME, Liao X. et al. Prepregnancy weight, gestational weight gain, and risk of growth affected neonates. J Womens Health (Larchmt) 2012; 21 (04) 410-417
  • 5 Goldstein RF, Abell SK, Ranasinha S. et al. Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women. BMC Med 2018; 16 (01) 153
  • 6 Rooney BL, Schauberger CW. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol 2002; 100 (02) 245-252
  • 7 Oken E, Taveras EM, Kleinman KP, Rich-Edwards JW, Gillman MW. Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol 2007; 196 (04) 322.e1-322.e8
  • 8 Chasan-Taber L, Silveira M, Waring ME. et al. Gestational weight gain, body mass index, and risk of hypertensive disorders of pregnancy in a predominantly puerto rican population. Matern Child Health J 2016; 20 (09) 1804-1813
  • 9 Fortner RT, Pekow P, Solomon CG, Markenson G, Chasan-Taber L. Prepregnancy body mass index, gestational weight gain, and risk of hypertensive pregnancy among Latina women. Am J Obstet Gynecol 2009; 200 (02) 167.e1-167.e7
  • 10 Vesco KK, Dietz PM, Rizzo J. et al. Excessive gestational weight gain and postpartum weight retention among obese women. Obstet Gynecol 2009; 114 (05) 1069-1075
  • 11 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 (06) 1642-1648
  • 12 Cheng YW, Eden KB, Marshall N, Pereira L, Caughey AB, Guise JM. Delivery after prior cesarean: maternal morbidity and mortality. Clin Perinatol 2011; 38 (02) 297-309
  • 13 van Oostwaard MF, Langenveld J, Schuit E. et al. Recurrence of hypertensive disorders of pregnancy: an individual patient data metaanalysis. Am J Obstet Gynecol 2015; 212 (05) 624.e1-624.e17
  • 14 Kominiarek MA, Seligman NS, Dolin C. et al. Gestational weight gain and obesity: is 20 pounds too much?. Am J Obstet Gynecol 2013; 209 (03) 214.e1-214.e11
  • 15 Park S, Sappenfield WM, Bish C, Salihu H, Goodman D, Bensyl DM. Assessment of the Institute of Medicine recommendations for weight gain during pregnancy: Florida, 2004-2007. Matern Child Health J 2011; 15 (03) 289-301
  • 16 Grimes DA. Epidemiologic research using administrative databases: garbage in, garbage out. Obstet Gynecol 2010; 116 (05) 1018-1019
  • 17 Haas DM, Parker CB, Wing DA. et al; NuMoM2b study. A description of the methods of the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (nuMoM2b). Am J Obstet Gynecol 2015; 212 (04) 539.e1-539.e24
  • 18 Beyerlein A, Schiessl B, Lack N, von Kries R. Optimal gestational weight gain ranges for the avoidance of adverse birth weight outcomes: a novel approach. Am J Clin Nutr 2009; 90 (06) 1552-1558
  • 19 Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines; Rasmussen KM, Yaktine AL. eds. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington (DC): National Academies Press; 2009
  • 20 American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. report of the american college of obstetricians and gynecologists' task force on hypertension in pregnancy. Obstet Gynecol 2013; 122 (05) 1122-1131
  • 21 Oken E, Kleinman KP, Rich-Edwards J, Gillman MW. A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatr 2003; 3: 6
  • 22 Siddiqui A, Azria E, Howell EA, Deneux-Tharaux C. EPIMOMS Study Group. Associations between maternal obesity and severe maternal morbidity: Findings from the French EPIMOMS population-based study. Paediatr Perinat Epidemiol 2019; 33 (01) 7-16
  • 23 Chu SY, Kim SY, Schmid CH. et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev 2007; 8 (05) 385-394
  • 24 Kim SY, Sharma AJ, Sappenfield W, Wilson HG, Salihu HM. Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births. Obstet Gynecol 2014; 123 (04) 737-744
  • 25 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 (05) 969-975
  • 26 Kominiarek MA, Saade G, Mele L. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Association between gestational weight gain and perinatal outcomes. Obstet Gynecol 2018; 132 (04) 875-881
  • 27 Goldstein RF, Abell SK, Ranasinha S. et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA 2017; 317 (21) 2207-2225
  • 28 Crane JM, White J, Murphy P, Burrage L, Hutchens D. The effect of gestational weight gain by body mass index on maternal and neonatal outcomes. J Obstet Gynaecol Can 2009; 31 (01) 28-35
  • 29 Siegel AM, Tita AT, Machemehl H, Biggio JR, Harper LM. Evaluation of institute of medicine guidelines for gestational weight gain in women with chronic hypertension. AJP Rep 2017; 7 (03) e145-e150
  • 30 Deputy NP, Sharma AJ, Kim SY, Hinkle SN. Prevalence and characteristics associated with gestational weight gain adequacy. Obstet Gynecol 2015; 125 (04) 773-781
  • 31 Krukowski RA, Bursac Z, McGehee MA, West D. Exploring potential health disparities in excessive gestational weight gain. J Womens Health (Larchmt) 2013; 22 (06) 494-500
  • 32 Cheney K, Berkemeier S, Sim KA, Gordon A, Black K. Prevalence and predictors of early gestational weight gain associated with obesity risk in a diverse Australian antenatal population: a cross-sectional study. BMC Pregnancy Childbirth 2017; 17 (01) 296
  • 33 Di Carlo C, Iannotti G, Sparice S. et al. The role of a personalized dietary intervention in managing gestational weight gain: a prospective, controlled study in a low-risk antenatal population. Arch Gynecol Obstet 2014; 289 (04) 765-770
  • 34 Barakat R, Pelaez M, Montejo R, Luaces M, Zakynthinaki M. Exercise during pregnancy improves maternal health perception: a randomized controlled trial. Am J Obstet Gynecol 2011; 204 (05) 402.e1-402.e7
  • 35 Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev 2015; (06) CD007145
  • 36 Deputy NP, Sharma AJ, Kim SY, Olson CK. Achieving appropriate gestational weight gain: the role of healthcare provider advice. J Womens Health (Larchmt) 2018; 27 (05) 552-560
  • 37 Kominiarek MA, Crockett A, Covington-Kolb S, Simon M, Grobman WA. Association of group prenatal care with gestational weight gain. Obstet Gynecol 2017; 129 (04) 663-670
  • 38 Ananth CV, Schisterman EF. Confounding, causality, and confusion: the role of intermediate variables in interpreting observational studies in obstetrics. Am J Obstet Gynecol 2017; 217 (02) 167-175