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Abstract
This study was performed to investigate whether the Japanese guidelines for gestational weight gain (GWG) can be used to determine the risks of multiple pregnancy outcomes and estimate optimal GWG in 101,336 women with singleton pregnancies in 2013. Multivariable logistic regression analyses indicated that the risks associated with low birth weight, small for gestational age, and preterm birth increased significantly with weight gain below the Japanese guidelines, and the risks of macrosomia and large for gestational age increased with weight gain above the guidelines regardless of Asian-specific pre-pregnancy body mass index (BMI). The GWG cutoff points estimated from the adjusted area under the receiver operating characteristics curve >0.6 corresponded to 10–13.8 kg in underweight women with pre-pregnancy BMI < 18.5 kg/m2; 10–13.7 kg in normal weight women with pre-pregnancy BMI 18.5–22.9 kg/m2; 8.5–11.4 kg in overweight women with pre-pregnancy BMI 23–24.9 kg/m2, 5–13.3 kg in obese women with pre-pregnancy BMI 25–29.9 kg/m2; and 4.7 kg in obese women with pre-pregnancy BMI ≥ 30 kg/m2. The optimal GWG ranges proposed by the present study are slightly higher than those recommended by the current Japanese guidelines.
Highlights
In Japan, one quarter of women of reproductive age are underweight, as defined by body mass index (BMI) < 18.5 kg/m2, and underweight women are at risk of delivering low-birth-weight (LBW) infants[1,2]
We previously investigated whether the Institute of Medicine (IOM) and Japanese guidelines could identify the risks of small for gestational age (SGA) and large for gestational age (LGA) births associated with gestational weight gain (GWG) below and above the recommended level and estimated the optimal GWG in a population of 8,152 Japanese women recruited at a single hospital[21]
The present study was performed to investigate whether the current Japanese GWG recommendations can significantly determine the risks of multiple pregnancy outcomes using the World Health Organization (WHO) Asian-specific pre-pregnancy BMI classification[22], and to estimate the optimal weight gain range using a GWG cutoff point associated with the risk of multiple pregnancy outcomes by multivariate adjusted receiver operating characteristic (ROC) curve analysis[23]
Summary
In Japan, one quarter of women of reproductive age are underweight, as defined by body mass index (BMI) < 18.5 kg/m2, and underweight women are at risk of delivering low-birth-weight (LBW) infants[1,2]. In 2018, the incidence of LBW infants was higher in Japan (9.4%) than the average among Organization for Economic Cooperation and Development (OECD) countries (6.5%)[5] This high incidence of small babies has been observed for over two decades in Japan[6], and pre-pregnancy underweight mothers and poor weight gain during pregnancy are major related factors[7]. The present study was performed to investigate whether the current Japanese GWG recommendations can significantly determine the risks of multiple pregnancy outcomes using the World Health Organization (WHO) Asian-specific pre-pregnancy BMI classification[22], and to estimate the optimal weight gain range using a GWG cutoff point associated with the risk of multiple pregnancy outcomes by multivariate adjusted receiver operating characteristic (ROC) curve analysis[23]. We focused on the Japanese guidelines, as the incidence of LBW infants in Japan has been high among OECD countries for over two decades, and scientific evidence is urgently required to determine whether the current guidelines should be changed
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