Optimal gestational weight gain for Chinese women - analysis from a longitudinal cohort with childhood follow-up

Yuanying He,Claudia Ha-Ting Tam,Lai Yuk Yuen,Patrick M Catalano,Ronald Ching-Wan Ma,Wing Hung Tam

doi:10.1016/j.lanwpc.2021.100190

Abstract

BackgroundMaternal gestational weight gain (GWG) influences not only on pregnancy outcome but also impacts on mothers’ and children's long-term health. However, there is no consensus on recommendations of optimal GWG in Asians or the Chinese population. MethodsWe performed a secondary analysis of the birth outcome of Chinese women who had joined the “Hyperglycemia and Adverse Pregnancy Outcome” study in Hong Kong and their children's cardiometabolic risk at 7-year of age. Optimal ranges of GWG were derived from models based on the probabilities of small for gestational age and large for gestational age (model 1), lean and fat infants (model 2) and the integration of model 1 and 2 (model 3), and were compared with that recommended by the Institute of Medicine (IOM) on children's cardiometabolic risk. FindingsGWG range derived from model 2 is associated with 8 cardiometabolic risk factors, while that from models 1 and 3 are associated with 1 and 7 of them respectively. Mothers whose GWG lie within the recommended range increases from 40.8% according to the IOM recommendation to 50.2% according to that derived from model 2. InterpretationOptimal GWG derived from model 2 (i.e. 14.0-18.5 kg, 9.0-16.5 kg and 5.0-11.0 kg for underweight, normal weight and overweight Chinese women, respectively) appeared to be associated with the lowest cardiometabolic risk in the offspring. FundingGeneral Research Fund of the Research Grants Council of the Hong Kong SAR, China (grants CUHK 473408 and, in part, CUHK 471713).

Highlights

Maternal gestational weight gain (GWG) influences pregnancy outcomes, as well as mother’s and offspring’s long-term health
We applied the optimal ranges of GWG obtained from model 1 to model 3 to assess children’s cardiometabolic risk factors at seven years of age, which include adiposity traits (i.e. body mass indeces (BMI), waist circumference, sum of skinfold thickness at four sites, namely, biceps, triceps, subscapular and suprailiac), blood pressure [i.e. systolic and diastolic blood pressures (SBP and DBP)], glucose and insulin levels [i.e. fasting plasma glucose and insulin (FPG and FPI), 2 h glucose and insulin, as well as beta cell function and insulin sensitivity [i.e. HOMA-β, insulinogenic index, HOMA-IR, Matsuda insulin sensitivity index (ISI) and oral disposition index (ODI)] and compared them with the GWG recommended by the Institute of Medicine (IOM) using the analyses we described previously elsewhere
We observed a slightly greater proportion of infants being classified as small for gestational age (SGA) than being classified as lean (10.1% vs. 8.5%, p=0.04), but a lower rate of infants classified as large for gestational age (LGA) than being fat (6.9% vs 10.5%, p=0.004) in the entire cohort

Summary

Introduction

Maternal gestational weight gain (GWG) influences pregnancy outcomes, as well as mother’s and offspring’s long-term health. [2] On the other hand, inadequate GWG, especially among those underweight mothers, increases the risks of preterm birth, small for gestational age (SGA) and low birth weight (LBW). Studies from the Asian continent suggested that Chinese and Japanese mothers should have GWG less than that proposed by the IOM. [6,7] The categorisation of underweight, normal weight, overweight and obesity based on BMI are different between Caucasian and Asian women. There were several studies in Japanese, Korean and Vietnamese recommending different ethnicity-specific guidelines on GWG. Maternal gestational weight gain (GWG) influences on pregnancy outcome and impacts on mothers’ and children’s long-term health. There is no consensus on recommendations of optimal GWG in Asians or the Chinese population

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