765: Gestational weight gain and severe maternal morbidity and mortality during delivery hospitalization

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To examine whether women who exceeded the recommended gestational weight gain (GWG) guidelines by the Institute of Medicine (IOM) were at increased risk of severe maternal morbidity and mortality (SMM) compared to those who kept within the guidelines This retrospective cross-sectional study used 2008-2012 New York City birth certificates linked to hospital discharge data to identify delivery hospitalizations. Cases of SMM were identified using ICD-9 diagnosis and procedure codes based on the CDC criteria, consisting of 21 indicators for a possible life-threatening diagnosis or a life-saving procedure, and includes death. Data were limited to singleton live births with information on pre-pregnancy weight and GWG. Multivariable logistic regression was used to evaluate the association between GWG categories based on pre-pregnancy body mass index (BMI) (i.e., below, within, between 1-19 pounds above, and greater than 20 pounds above the IOM guidelines) and SMM adjusting for maternal demographics, socioeconomic status, and medical comorbidities. During 2008-2012 there were 565,664 singleton live births in New York City with pre-pregnancy weight and gestational weight gain information. In 26%, 35%, and 39% of these births, women gained below, within, and above the IOM guidelines respectively. After adjusting for maternal comorbidities and socioeconomic and demographic characteristics, women who had gestational weight gain greater than 20 pounds above the IOM recommendations had a slightly significantly higher risk of overall SMM compared to women who gained within the recommended weight gain guidelines (Table). This was primarily due to high rates of heart failure and blood transfusion; which were significantly associated with gestational weight gain below and above IOM recommendations. Those who gained >20 pounds over the IOM recommendations had an aOR of 1.84 (CI 1.23-2.74) and 1.24 (CI 1.15-1.34) for heart failure and blood transfusion, respectively. Women whose gestational weight gain is greater than 20 pounds in excess of the IOM guidelines are at a slight overall increased risk of SMM. Additionally, the risks of heart failure and blood transfusion are associated with any amount of gestational weight gain either above or below IOM guidelines.