Download PDF
Am J Perinatol 2022; 39(03): 272-280
DOI: 10.1055/s-0040-1715529
Original Article

Factors Associated with Appropriate Gestational Weight Gain among Women with Obesity

Gabriella D. Cozzi
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Christina T. Blanchard
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Macie L. Champion 
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Allison Todd
3   Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, Alabama
,
Margaret Davis
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
3   Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, Alabama
,
Paula Chandler-Laney
3   Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, Alabama
,
Krista Casazza
3   Department of Nutritional Sciences, University of Alabama at Birmingham, Birmingham, Alabama
4   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
,
Brian M. Casey
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Alan T. Tita
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Jeff M. Szychowski
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
5   Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
,
Akila Subramaniam
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations Funding This research was funded, in part, by the Center for Medicare and Medicaid Services. It had no role in the study design, collection, analysis, or interpretation of data, writing of the report, or in the decision to submit the article for publication.
This publication was made possible by Grant 1D1CMS331145 from the Department of Health and Human Services, Centers for Medicare and Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the US Department of Health and Human Services or any of its agencies. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the findings of the independent evaluation contractor.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective This study aimed to compare attendance of nutritional counseling, dietary composition, exercise patterns, and socioeconomic factors among obese women with inappropriate gestational weight gain (iGWG) versus appropriate GWG (aGWG).

Study Design Medicaid-eligible women receiving prenatal care at a tertiary care center from January 2013 to December 2015 were offered individualized nutritional counseling by a registered dietitian encouraging well-balanced meals and 150 min/wk of exercise. We conducted a prospective case–control study of obese women (body mass index or BMI ≥30) with a singleton gestation with iGWG (<11 or >20 pounds) versus aGWG (11–20 pounds). Dietary intake, activity level, and socioeconomic factors were compared with Chi-square, Fisher's exact, Student's t-test, and Wilcoxon Rank Sum tests as indicated, and odds ratios with 95% confidence intervals were calculated. Multivariate regression analysis for significant variables was performed. A subgroup analysis of women with BMI ≥40 was planned.

Results A total of 401 women were analyzed: 78% (n = 313) with iGWG and 22% (n = 88) with aGWG. Demographics were similar between groups. Women with iGWG less frequently reported physician reinforcement of counseling and reported more physical inactivity and unemployment; there were no differences in caloric intake or macronutrient profile between groups. Multivariate regression identified physician reinforcement and employment as independent predictors of aGWG. Among women with BMI ≥40 (n = 133), those with iGWG (78%) were less likely to attend counseling, report physician reinforcement of counseling, and have adequate caloric and protein intake when compared with those with aGWG (22%). Activity level and socioeconomic factors were not different between groups.

Conclusion Physician reinforcement of nutritional counseling, greater activity level, and employment are associated with aGWG in women with BMI ≥30, while individualized professional nutritional counseling and dietary modifications were further associated with aGWG in women with BMI ≥40. Thus, greater focus should be placed on enhancing exposure to counseling and altering nutritional and exercise choices to optimize aGWG.

Key Points

  • Physician reinforcement of nutritional counseling by a dietitian is crucial for obese women.

  • Physical inactivity and unemployment are associated with inappropriate gestational weight gain.

  • Nutritional counseling is associated with appropriate gestational weight gain in women with BMI ≥40.

Keywords

gestational weight gain - nutritional counseling - obesity - social factors

Note

This study was presented as a poster (#748) at the 40th Annual Society for Maternal Fetal Medicine Meeting in Grapevine, TX, February 3 to 8, 2020.


Supplementary Material



Publication History

Received: 24 April 2020

Accepted: 07 July 2020

Article published online:
27 August 2020

© 2020. Thieme. All rights reserved.

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

 

  • References

  • 1 Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief 2017; (288) 1-8
    PubMedGoogle Scholar
  • 2 Avgerinos KI, Spyrou N, Mantzoros CS, Dalamaga M. Obesity and cancer risk: emerging biological mechanisms and perspectives. Metabolism 2019; 92: 121-135
    CrossrefPubMedGoogle Scholar
  • 3 Engin A. The definition and prevalence of obesity and metabolic syndrome. Adv Exp Med Biol 2017; 960: 1-17
    CrossrefPubMedGoogle Scholar
  • 4 Lavie CJ, De Schutter A, Parto P. et al. Obesity and prevalence of cardiovascular diseases and prognosis—the obesity paradox updated. Prog Cardiovasc Dis 2016; 58 (05) 537-547
    CrossrefPubMedGoogle Scholar
  • 5 Malik S, Wong ND, Franklin SS. et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 2004; 110 (10) 1245-1250
    CrossrefPubMedGoogle Scholar
  • 6 Edwards RK, Cantu J, Cliver S, Biggio Jr JR, Owen J, Tita AT. The association of maternal obesity with fetal pH and base deficit at cesarean delivery. Obstet Gynecol 2013; 122 (2 Pt 1): 262-267
    CrossrefPubMedGoogle Scholar
  • 7 Kim SS, Zhu Y, Grantz KL. et al. Obstetric and neonatal risks among obese women without chronic disease. Obstet Gynecol 2016; 128 (01) 104-112
    CrossrefPubMedGoogle Scholar
  • 8 Norman SM, Tuuli MG, Odibo AO, Caughey AB, Roehl KA, Cahill AG. The effects of obesity on the first stage of labor. Obstet Gynecol 2012; 120 (01) 130-135
    CrossrefPubMedGoogle Scholar
  • 9 Nuthalapaty FS, Rouse DJ, Owen J. The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction. Obstet Gynecol 2004; 103 (03) 452-456
    PubMedGoogle Scholar
  • 10 Pevzner L, Powers BL, Rayburn WF, Rumney P, Wing DA. Effects of maternal obesity on duration and outcomes of prostaglandin cervical ripening and labor induction. Obstet Gynecol 2009; 114 (06) 1315-1321
    CrossrefPubMedGoogle Scholar
  • 11 Yao R, Ananth CV, Park BY, Pereira L, Plante LA. Perinatal Research Consortium. Obesity and the risk of stillbirth: a population-based cohort study. Am J Obstet Gynecol 2014; 210 (05) 457.e1-457.e9
    CrossrefPubMedGoogle Scholar
  • 12 Rasmussen KM, Yaktine AL. eds. Weight Gain During Pregnancy: Reexamining the Guidelines. DC, Washington: National Research Council; 2009
    Google Scholar
  • 13 American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol 2013; 121 (01) 210-212
    CrossrefPubMedGoogle Scholar
  • 14 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
    CrossrefPubMedGoogle Scholar
  • 15 Hedderson MM, Weiss NS, Sacks DA. et al. Pregnancy weight gain and risk of neonatal complications: macrosomia, hypoglycemia, and hyperbilirubinemia. Obstet Gynecol 2006; 108 (05) 1153-1161
    CrossrefPubMedGoogle Scholar
  • 16 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
    CrossrefPubMedGoogle Scholar
  • 17 Siegel AM, Tucker A, Adkins LD, Mitchell C, Brown HL, Dotters-Katz S. Postpartum weight loss in women with class-III obesity: do they lose what they gain?. Am J Perinatol 2020; 37 (01) 53-58
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Stotland NE, Cheng YW, Hopkins LM, Caughey AB. Gestational weight gain and adverse neonatal outcome among term infants. Obstet Gynecol 2006; 108 (3 Pt 1): 635-643
    CrossrefPubMedGoogle Scholar
  • 19 Dude AM, Grobman W, Haas D. et al. Gestational weight gain and pregnancy outcomes among nulliparous women. Am J Perinatol 2019; (e-pub ahead of print) DOI: 10.1055/s-0039-1696640.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Thangaratinam S, Rogozinska E, Jolly K. et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ 2012; 344: e2088
    CrossrefPubMedGoogle Scholar
  • 21 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
    PubMedGoogle Scholar
  • 22 Institute of Medicine. Alabama Medicaid Agency Annual Report Fiscal Year 2013. Washington, DC: Alabama Medicaid Agency; 2014
    Google Scholar
  • 23 United States Department of Agriculture. DRI Nutrient Reports. Accessed November 27, 2019 at: https://www.nal.usda.gov/fnic/dri-nutrient-reports
    PubMedGoogle Scholar
  • 24 Agha M, Agha RA, Sandall J. Interventions to reduce and prevent obesity in pre-conceptual and pregnant women: a systematic review and meta-analysis. PLoS One 2014; 9 (05) e95132
    CrossrefPubMedGoogle Scholar
  • 25 Haakstad LA, Bø K. Effect of regular exercise on prevention of excessive weight gain in pregnancy: a randomised controlled trial. Eur J Contracept Reprod Health Care 2011; 16 (02) 116-125
    CrossrefPubMedGoogle Scholar
  • 26 Schellinger MM, Abernathy MP, Amerman B. et al. Improved outcomes for Hispanic women with gestational diabetes using the Centering Pregnancy© Group prenatal care model. Matern Child Health J 2017; 21 (02) 297-305
    CrossrefPubMedGoogle Scholar
  • 27 Kominiarek MA, Lewkowitz AK, Carter E, Fowler SA, Simon M. Gestational weight gain and group prenatal care: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19 (01) 18
    CrossrefPubMedGoogle Scholar