Abstract

ObjectiveTo investigate the association between weekly weight gain, during the second and third trimesters, classified according to the 2009 Institute of Medicine (IOM/NRC) recommendations, and maternal and fetal outcomes.MethodsGestational weight gain was evaluated in 2,244 pregnant women of the Brazilian Study of Gestational Diabetes (Estudo Brasileiro do Diabetes Gestacional – EBDG). Outcomes were cesarean delivery, preterm birth and small or large for gestational age birth (SGA, LGA). Associations between inadequate weight gain and outcomes were estimated using robust Poisson regression adjusting for pre-pregnancy body mass index, trimester-specific weight gain, age, height, skin color, parity, education, smoking, alcohol consumption, gestational diabetes and hypertensive disorders in pregnancy.ResultsIn fully adjusted models, in the second trimester, insufficient weight gain was associated with SGA (relative risk [RR] 1.72, 95% confidence interval [CI] 1.26–2.33), and excessive weight gain with LGA (RR 1.64, 95% CI 1.16–2.31); in third trimester, excessive weight gain with preterm birth (RR 1.70, 95% CI 1.08–2.70) and cesarean delivery (RR 1.21, 95% CI 1.03–1.44). Women with less than recommended gestational weight gain in the 2nd trimester had a lesser risk of cesarean deliveries (RR 0.82, 95% CI 0.71–0.96) than women with adequate gestational weight gain in this trimester.ConclusionThough insufficient weight gain in the 3rd trimester was not associated with adverse outcomes, other deviations from recommended weight gain during second and third trimester were associated with adverse pregnancy outcomes. These findings support, in part, the 2009 IOM/NRC recommendations for nutritional monitoring during pregnancy.

Highlights

  • Nutritional interventions during prenatal care aimed at achieving adequate maternal weight gain have been shown to be effective [1,2,3,4]

  • The pattern of gestational weight gain (GWG) is related to maternal pre-pregnancy body mass index (BMI), mean weekly weight gain is generally higher in the second trimester

  • Gestational diabetes was diagnosed in 164 (7.7%; 95% confidence interval (CI) 6.5– 8.8)

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Summary

Introduction

Nutritional interventions during prenatal care aimed at achieving adequate maternal weight gain have been shown to be effective [1,2,3,4]. Debate remains concerning ideal gestational weight gain (GWG), and how to monitor it over the trimesters to reduce maternal and fetal complications. This debate has extended over at least seven decades. Studies have demonstrated a positive association between maternal second or third trimester weight gain and obstetric outcomes, for example, birth weight and gestational length [11], [12]. The pattern of GWG is related to maternal pre-pregnancy body mass index (BMI), mean weekly weight gain is generally higher in the second trimester. Few studies have evaluated weight gain per trimester [13], [14]

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