Pregnancy Outcomes in Patients With Inadequate Gestational Weight Gain [31N

Abstract

INTRODUCTION: The objective of this study is to compare the risks for small for gestational age (SGA) neonates and composite adverse neonatal outcomes (CANO) in patients with inadequate gestational weight gain (IWG) versus adequate gestational weight gain (AWG). METHODS: This is a secondary analysis of a prospective study of women undergoing fetal growth assessment. Participants were sorted into AWG and IWG cohorts based on IOM guidelines. Primary outcomes were SGA and CANO (neonatal ICU admission, death, seizures, IVH, respiratory distress syndrome, necrotizing enterocolitis, and pH <7.10). Secondary outcomes included: hypertensive disorders of pregnancy, preterm delivery (PTD), gestational diabetes (GDM), and large for gestational age (LGA) newborns. We performed chi square, t-test, and adjusted multivariable logistical regression. A stratified analysis was performed by pre-pregnancy BMI category. RESULTS: 214 patients experienced IWG and 282 patients experienced AWG. The risk of SGA was increased in patients with IWG, 47 patients (22.0%) compared to 34 patients (12.2%) with AWG (aOR 1.99, CI 1.19–3.33). CANO were similar between groups (14.5% versus 11.8%, P=.384). IWG was associated with decreased risk of LGA (aOR 0.29, CI 0.12–0.71) but did not have an effect on GDM, PTD, gestational hypertension, or preeclampsia. In obese patients, IWG was protective against GDM (RR 0.44, CI 0.21–0.93) and LGA neonates (RR 0.10, CI 0.03–0.44) without increased risk of SGA neonates. CONCLUSION: IWG increases risk of SGA but did not increase neonatal morbidity. IWG was protective against GDM and LGA without increasing other risks in obese patients, suggesting lower weight gain in this population may be beneficial.