Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: a prospective observational cohort study.

Margaretha Haugen,Per Magnus,Helle Margrete Meltzer,Lauren Lissner,Anne Lise Brantsæter,Anna Winkvist,Jan Alexander,Bente Oftedal

doi:10.1186/1471-2393-14-201

Margaretha Haugen, Per Magnus + Show 6 more

Open Access

https://doi.org/10.1186/1471-2393-14-201

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Abstract

BackgroundExcessive gestational weight gain (GWG) is associated with pregnancy complications, and Norwegian Health Authorities have adopted the GWG recommendations of the US Institute of Medicine and National Research Council (IOM). The aim of this study was to evaluate if a GWG outside the IOM recommendation in a Norwegian population is associated with increased risk of pregnancy complications like hypertension, low and high birth weight, preeclampsia, emergency caesarean delivery, and maternal post-partum weight retention (PPWR) at 6 and 18 months.MethodsThis study was performed in 56 101 pregnant women included in the prospective national Norwegian Mother and Child Cohort Study (MoBa) in the years 1999 to 2008. Women who delivered a singleton live born child during gestational week 37 to 42 were included. Maternal prepregnant and postpartum weight was collected from questionnaires at 17th week of gestation and 6 and 18 months postpartum.ResultsA weight gain less than the IOM recommendations (GWG < IOM rec.) increased the risk for giving birth to a low weight baby among normal weight nulliparous women. A weight gain higher than the IOM recommendations (GWG > IOM rec.) significantly increased the risk of pregnancy hypertension, a high birth weight baby, preeclampsia and emergency cesarean delivery in both nulliparous and parous normal weight women. Similar results were found for overweight women except for no increased risk for gestational hypertension in parous women with GWG > IOM rec. Seventy-four percent of the overweight nulliparous women and 66% of the obese women had a GWG > IOM rec. A GWG > IOM rec. resulted in increased risk of PPWR > 2 kg in all weight classes, but most women attained their prepregnant weight class by 18 months post-partum.ConclusionsFor prepregnant normal weight and overweight women a GWG > IOM rec. increased the risk for unfavorable birth outcomes in both nulliparous and parous women. A GWG > IOM rec. increased the risk of a PPWR > 2 kg at 18 months in all weight classes. This large study supports the Norwegian Health authorities’ recommendations for normal weight and overweight women to comply with the IOM rec.

Highlights

Excessive gestational weight gain (GWG) is associated with pregnancy complications, and Norwegian Health Authorities have adopted the GWG recommendations of the US Institute of Medicine and National Research Council (IOM)
We evaluated the IOM recommendations in these weight classes where a predicted value should have been 20% since small for gestational age (SGA) is defined as the 10th percentile of the birthweight and large for gestational age (LGA) as the 90th percentile of the birth weights with regard to gender and gestational length
In this study we found that a GWG < IOM rec. increased the risk of low birth weight babies in normal weight nulliparous women, while GWG > IOM rec. significantly increased the risk of high birth weight babies, LGA, development of hypertension, preeclampsia and emergency cesarean deliveries in both nulliparous and parous normal weight and overweight women

Summary

Introduction

Excessive gestational weight gain (GWG) is associated with pregnancy complications, and Norwegian Health Authorities have adopted the GWG recommendations of the US Institute of Medicine and National Research Council (IOM). The Norwegian Directorate of Health has adopted these recommendations, which take into account prepregnancy BMI; and while normal weight women are recommended to gain 11.5 -16 kg, obese women are recommended to gain no more than 5–9 kg during pregnancy (Table 1). The purpose of these guidelines is to reduce perinatal morbidity and mortality and to reduce health problems later in life for both mother and child [6,7]. Gestational weight loss has been suggested for heavily obese women (class II and III), while others did not find weight loss advisable in obese women in class I and II, due to increased risk for prematurity and for small for gestational age (SGA) babies [11,12]

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