682 Everything in moderation: impact of extremes of BMI & gestational weight gain on perinatal outcomes

Abstract

Body mass index (BMI) and extremes of gestational weight gain (GWG) have been shown to negatively affect perinatal outcomes. IOM guidelines recommend GWG based on BMI, providing a basis for counseling on weight gain and potential pregnancy complications. The COVID-19 pandemic has created unique conditions predisposing women to extremes of GWG by limiting ability to exercise and access adequate nutrition, compounded by financial strain. The objective of the current study was to evaluate the effect of GWG based on BMI category on multiple perinatal outcomes. This is a retrospective analysis of a prospective population-based cohort from a single institution. We utilized a 2-hospital, single academic institution database from August 2011 through July 2019 to collect maternal characteristics and obstetric outcomes. Analyses limited to pregnancy with documented 1st trimester visit. Groups were evaluated based on BMI category according to IOM guidelines for GWG. Outcomes adjusted for tobacco use, ethnicity, delivery route, maternal education, and hypertension. Adjusted OR estimated by logistic regression, with adjusted mean by general linear models. 42,419 pregnancies were evaluated with 22,155 gravidae included for analysis. Significantly increased BW and Cesarean delivery rate was observed among gravidae too much GWG (Table 1). Conversely, too little GWG was associated with a significantly earlier GA at delivery and 5-minute Apgar scores <7 (Table 1). Importantly, multivariate analysis of factors associated with too little GWG demonstrated a higher occurrence among GDM, with an adjusted OR of 6.08 for stillbirth and significantly increased risk of poor predictors of neonatal outcomes (Table 2). Untoward perinatal outcomes are associated with extremes of BMI and GWG. Much emphasis has focused on excess weight gain and obesity, but women with inadequate weight gain are also at increased risk for poor obstetric outcomes. Increased provider attention to risks of extremes of GWG is particularly important during the COVID-19 pandemic.View Large Image Figure ViewerDownload Hi-res image Download (PPT)