Socioeconomic Status and Excessive Gestational Weight Gain Among Full-Term, Normal-BMI Parturients [A256

Abstract

INTRODUCTION: The Institute of Medicine (IOM) recommends a weight gain of 25–35-pounds for pregnant patients with a body mass index (BMI) of 18.5–24.9. The purpose of this study is to assess socioeconomic and clinical factors that affect excessive gestational weight gain (eGWG) in women with normal prepregnancy BMI (pBMI). METHODS: Retrospective cohort study of term patients with normal BMI from seven hospitals within a large integrated health system between January 2018 and February 2020. eGWG was defined as >35 pounds for those with normal BMIs. Twin pregnancies and overweight and obese patients were excluded. Data collected included demographics, medical comorbidities, and ZIP codes, which were linked to neighborhood data from the U.S. Census Bureau’s American Community Survey. Patients with eGWG were compared to those without eGWG. RESULTS: A total of 23,691 patients were included: 13,940 (59%) met IOM guidelines and 9,751 (41%) had eGWG. When comparing patients with and without eGWG, significant differences were observed in race, preferred language, marital status, parity, pBMI, mood disorders, and neighborhood socioeconomic characteristics (educational attainment, households receiving supplemental income, single parent households, and owner-occupied housing). Patients who met IOM guidelines were less likely to have gestational diabetes (6% versus 3%). Maternal age, ethnicity, gestational age, medical comorbidities (chronic hypertension and diabetes mellitus), type of health insurance, and neighborhood characteristics (median annual household income, unemployment rate, mean persons per household) were not associated with eGWG. CONCLUSION: Neighborhood socioeconomic conditions contribute to eGWG and subsequent maternal and fetal complications.