829: The impact of early gestational weight gain on neonatal outcomes in morbidly obese women

Abstract

Early excessive gestational weight gain (GWG) is associated with large for gestation (LGA) neonates and adiposity. No data exists regarding the impact of early GWG in women with class III obesity. We evaluated the influence of early GWG on neonatal outcomes among this population Retrospective cohort of women with class III obesity at a single center from 7/2013-12/2017 who gained more than the Institute of Medicine (IOM) guidelines(>20lbs). Women gaining >75% of total gestational weight prior to 28 weeks(EWG) were compared to women gaining less than <75% of their total weight prior to 28 weeks(SWG). Pregnancies complicated by twins, late prenatal care, preterm birth, fetal anomalies, intrauterine demise, and missing BMI data were excluded. Primary outcome was a neonatal composite morbidity and mortality. Secondary outcomes included individual components of composite and LGA. Analysis was performed using simple statistics as appropriate. Regression models used to adjust for confounding factors. Of 144 women who gained greater than IOM guidelines, 42(29.2%) gained early(EWG) and 102(70.8%) were in the SWG group. The EWG group was more likely to be African American, multiparous, use illicit drugs, and have inadequate prenatal care. Gestational diabetes, mode of delivery, macrosomia, and IUGR were not different (Table 1). Though 11% of the total population had the composite neonatal morbidity, this did not differ between groups (p=0.4) (Table 2). LGA was nearly twice as common in the SWG group (41% vs 26%, p=0.13). In adjusted models, there was no difference between groups in the neonatal composite morbidity or NICU admission. However, EWG was associated with a decreased risk of LGA (AOR 0.25 95% CI 0.08-0.78) and lower median birth weight Though adverse neonatal outcomes were surprisingly common in this population, timing of gestational weight gain did not correlate with them. However, increased rates of LGA and higher median birth weight in the SWG group suggests that excessive GWG continuing in the third trimester of pregnancy may be of increased importance for neonatal growth in this groupView Large Image Figure ViewerDownload Hi-res image Download (PPT)