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Abstract
BackgroundControversy exists about how much, if any, weight obese pregnant women should gain. While the revised Institute of Medicine guidelines on gestational weight gain (GWG) in 2009 recommended a weight gain of 5–9 kg for obese pregnant women, many studies suggested even gestational weight loss (GWL) for obese women.ObjectivesA systematic review was conducted to summarize pregnancy outcomes in obese women with GWL compared to GWG within the 2009 Institute of Medicine guidelines (5–9 kg).DesignFive databases were searched from 1 January 2009 to 31 July 2014. The Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA Statement were followed. A modified version of the Newcastle-Ottawa scale was used to assess individual study quality. Small for gestational age (SGA), large for gestational age (LGA) and preterm birth were our primary outcomes.ResultsSix cohort studies were included, none of which assessed preterm birth. Compared to GWG within the guidelines, women with GWL had higher odds of SGA <10th percentile (adjusted odds ratio [AOR] 1.76; 95% confidence interval [CI] 1.45–2.14) and SGA <3rd percentile (AOR 1.62; 95% CI 1.19–2.20) but lower odds of LGA >90th percentile (AOR 0.57; 95% CI 0.52–0.62). There was a trend towards a graded relationship between SGA <10th percentile and each of three obesity classes (I: AOR 1.73; 95% CI 1.53–1.97; II: AOR 1.63; 95% CI 1.44–1.85 and III: AOR 1.39; 95% CI 1.17–1.66, respectively).ConclusionDespite decreased odds of LGA, increased odds of SGA and a lack of information on preterm birth indicate that GWL should not be advocated in general for obese women.
Highlights
Obesity is a global epidemic affecting an estimated 500 million people [1]
A systematic review was conducted to summarize pregnancy outcomes in obese women with gestational weight loss (GWL) compared to gestational weight gain (GWG) within the 2009 Institute of Medicine guidelines (5–9 kg)
Despite decreased odds of large for gestational age (LGA), increased odds of small for gestational age (SGA) and a lack of information on preterm birth indicate that GWL should not be advocated in general for obese women
Summary
Obesity is a global epidemic affecting an estimated 500 million people [1]. Among women of childbearing age, up to three in ten are obese [2,3], defined as having a body mass index (BMI) greater than or equal to 30 kg/m2, 10% of whom meet the criteria for obesity class II (BMI: 35–39.9 kg/m2) or III (BMI: 40 kg/m2) [3]. The gestational weight gain (GWG) guidelines were recently revised by the Institute of Medicine (IOM) in 2009, and recommended a weight gain of 5–9 kg for all classes of obesity [18]. Since adverse pregnancy complications are often more frequently associated with more severe obesity such as class II and/or III [5,6,8,19], the question has arisen whether the same weight gain requirements should apply to all classes of obese women. Controversy exists about how much, if any, weight obese pregnant women should gain. While the revised Institute of Medicine guidelines on gestational weight gain (GWG) in 2009 recommended a weight gain of 5–9 kg for obese pregnant women, many studies suggested even gestational weight loss (GWL) for obese women
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