Adequacy Of Gestational Weight Gain Research Articles

The association of food insecurity with the relative reinforcing value of food, BMI, and gestational weight gain among pregnant women

ObjectiveFood insecurity is associated with obesity among adults. During pregnancy, food insecurity increases obesity risk among mothers and infants. This study investigated the association of food security with pre-pregnancy body mass index (BMI), gestational weight gain (GWG) adequacy to date, and the relative reinforcing value (RRV) of food during pregnancy. MethodsThis secondary data analysis examined 258 pregnant women (mean gestational age = 21.21 ± 10.21 weeks) surveyed on pre-pregnancy weight, height, pregnancy due date and GWG to date, current diagnoses related to eating and pregnancy, and demographics. The survey also assessed current food security and RRV of meals, snacks, cognitive activities, and active activities. BMI was calculated from pre-pregnancy height and weight (kg/m2). Gestational weight gain adequacy to date was derived from the Institute of Medicine guidelines. Multivariable linear regression models were used to examine the relation of food security with pre-pregnancy BMI and RRVs of foods/activities. The relation between food security and GWG adequacy to date was examined using multinomial regression models. ResultsLower food security was related to both greater pre-pregnancy BMI (β = 0.60, p < .001) and greater RRV of snack foods (β = 3.46, p < .05), after controlling for covariates. Lower food security was also related to GWG to date below recommended levels (OR = 1.25, p < .05). ConclusionsFood insecurity is related to higher relative food reinforcement during pregnancy, and greater pre-pregnancy weight status. Future research should replicate and extend these findings by assessing them longitudinally to better evaluate the directions of these relationships.

Effect of Behavioural Interventions for Obesity Prevention in Pregnancy on the Adequacy of Gestational Weight Gain and Retention: Metabolic Health of Indian Women

Abstract The aim of this study was to measure the adequacy of gestational weight gain (GWG) in Indian women using various behavioural interventions during pregnancy, which primarily aim to observe the effects on obesity markers and weight retention. In this experimental study, one hundred and forty pregnant women underwent interventions in 5 groups, control (C), diet (D), home exercise (HE), supervised exercise (SE) and supervised exercise with diet (SED), from pregnancy through delivery with 2 months follow-up post-delivery. The outcome measures were GWG and baby birth weight. A one-way ANOVA indicated no differences in the mean GWG between groups (12.39±4.71 kg, p=0.947). The control group had the most (50%) and both the supervised exercise groups had the fewest (32%) women who gained above the recommended GWG, followed by the diet group (33.3%). The D and HE groups had the most women who gained within the GWG range, while both the SE and SED groups had the most women who gained below the GWG range. However, these results did not affect the birth weight between the groups (mean 2.96 kg±0.40, p=0.203). In women with normal BMIs, (18.5-22.9 kg/m2), the diet group had the most effective maintenance of adequate GWG, with 15%, 55%, and 30% of the women gaining above, within, and below the recommended GWG, respectively. The SE and SED groups had the least postpartum weight retention (PPWR) at 2 months, followed by the HM, D and C groups; i.e., the results showed a trend in the desired direction clinically, although they were not statistically significant (p=0.12). Supervised exercise can be effectively used as a pregnancy intervention to prevent excess GWG in Indian women. Diet counselling was found to be the next best intervention in combination with exercise, as well as for women with normal BMI.

Poor maternal nutritional status before and during pregnancy is associated with suspected child developmental delay in 2-year old Brazilian children

Inadequate pre-pregnancy BMI and gestational weight gain (GWG) have been associated with sub-optimal child development. We used data from the 2015 Pelotas (Brazil) Birth Cohort Study. Maternal anthropometry was extracted from antenatal/hospital records. BMI (kg/m2) and GWG (kg) adequacy were classified according to WHO and IOM, respectively. Development was evaluated using the INTER-NDA assessment tool for 3,776 children aged 24 months. Suspected developmental delay (SDD) was defined as <10th percentile. Associations between maternal exposures and child development were tested using linear and logistic regressions. Mediation for the association between BMI and child development through GWG was tested using G-formula. Sex differences were observed for all child development domains, except motor. Maternal pre-pregnancy underweight increased the odds of SDD in language (OR: 2.75; 95%CI: 1.30–5.80), motor (OR: 2.28; 95%CI: 1.20–4.33), and global (OR: 2.14; 95% CI: 1.05–4.33) domains for girls; among boys, excessive GWG was associated with SDD in language (OR: 1.59; 95%CI: 1.13–2.24) and cognition (OR: 1.59; 95%CI: 1.15–2.22). Total GWG suppressed the association of pre-pregnancy BMI with percentiles of global development in the entire sample. Maternal underweight and excessive GWG were negatively associated with development of girls and boys, respectively. The association of pre-pregnancy BMI with global child development was not mediated by GWG, irrespective of child’s sex.

Association between time interval from bariatric surgery to pregnancy and maternal weight outcomes

Background The majority of patients having bariatric surgery are reproductive-age women who are advised to delay pregnancy for at least 12 months after surgery. Many women become pregnant sooner and the association between gestational weight gain (GWG) and maternal long-term weight is unknown. Objectives The primary objective of this study was to compare weight outcomes in pregnancies occurring < 12 months versus ≥ 12 months after bariatric surgery. The secondary objectives were to determine the association between time interval from bariatric surgery to pregnancy and maternal nutritional status and maternal and neonatal outcomes. Study design This is a retrospective cohort study of women with singleton livebirths after bariatric surgery who received care at a single tertiary care center between 2009 and 2017. GWG was the difference in weight between the first prenatal visit and delivery. GWG adequacy was determined by the IOM 2009 guidelines according to prepregnancy BMI (inadequate, adequate, excessive). Postpartum weight retention was calculated as the difference between weight at first prenatal visit and measured postpartum weight. Weight outcomes along with maternal nutritional status and maternal and neonatal outcomes were compared between < 12 months versus ≥ 12 months after bariatric surgery with t-tests, Mann-Whitney U and chi-square tests, as appropriate. Results Of the 76 pregnancies that met inclusion criteria, 36.8% occurred < 12 months (median 7.2 months) and 63.2% occurred ≥ 12 months after surgery (median 26.9 months). Of those with pregnancies < 12 months from surgery, 34% had a restrictive procedure (adjustable gastric band or sleeve gastrectomy) while 66% had a combined restrictive-malabsorptive procedure (Roux-en-Y gastric bypass). In the ≥ 12 months group, 42.3% had a restrictive procedure while 57.7% had a combined restrictive-malabsorptive procedure. There were no significant differences in maternal age, ethnicity or nulliparity between groups, but there were more women with obesity in the < 12 months group (75 vs. 52%, p = .03). The mean prepregnancy BMI in the < 12 months group was 34.3 vs. 31.2 kg/m2 in the ≥ 12 months group. The < 12 months group had lower mean GWG (4.9 vs. 10.9 kg, p = .01) and higher frequency of weight loss during pregnancy (28.6 vs. 4.2%, p < .01) compared to the ≥ 12 months group. The < 12 months group had significantly less postpartum weight retention at 6 months compared to the ≥ 12 months group (−1.3 vs. 8.3 kg, p = .02). The < 12 months group had a higher prevalence of vitamin B12 deficiency (23.1 versus 4.9%, p = .05). There were no differences in hyperemesis, hypertensive disorders, gestational diabetes or delivery mode between groups (p > .05). There were no differences in gestational age at delivery, birth weight and small for gestational age infants between groups (p > .05). Conclusion Pregnancy < 12 months after bariatric surgery is associated with significantly lower mean GWG and a higher frequency of weight loss during pregnancy as well as less postpartum weight retention at 6 months. Although there were no differences birthweight, weight loss during pregnancy and its accompanying metabolic changes are concerning for a developing fetus. Further study is needed to determine the optimal timing of pregnancy after bariatric surgery with respect to both maternal and infant short and long-term outcomes.

One size does not fit all: Examining ethnicity in gestational weight gain guidelines

Pregnancy-related metrics vary by race/ethnicity, yet most gestational weight gain (GWG) guidelines are ethnicity-blind. We estimated small-for-gestational age (SGA) risk in a Japanese population, examining GWG adequacy categorized by Institute of Medicine (IOM) and Japanese guidelines in male (N = 192) and female (N = 191) full-term singleton infants. For predicting SGA, IOM guidelines had high sensitivity ( ≥ 0.75), but low specificity ( ≤ 0.25); Japanese guidelines had high specificity ( ≥ 0.80) but low sensitivity ( ≤ 0.50). GWG guidelines’ implicit notions of Caucasian–Americans as optimal may lead to ‘One Size Fits All’ recommendations that can obscure important biocultural factors contributing to maternal child health outcomes.

Factors associated with gestational weight gain: a cross-sectional survey

BackgroundThe aim of this study was to describe the dietary patterns in pregnant women and determine the association between diet factors, pre-pregnancy body mass index, socio-demographic characteristics and gestational weight gain.MethodsThe analysis was conducted on a group of 458 women. Cut-off values of gestational weight gain adequacy were based on recommendations published by the US Institute of Medicine and were body mass index-specific. Logistic regression analysis was used to assess the risk of the occurrence of inadequate or excessive gestational weight gain. Dietary patterns were identified by factor analysis.ResultsThree dietary patterns characteristic of pregnant women in Poland were identified: ‘unhealthy’, ‘varied’ and ‘prudent’. The factor associated with increased risk of inadequate gestational weight gain was being underweight pre-pregnancy (OR = 2.61; p = 0.018). The factor associated with increased risk of excessive weight gain were being overweight or obese pre-pregnancy (OR = 7.00; p = 0.031) and quitting smoking (OR = 7.32; p = 0.019). The risk of excessive weight gain was decreased by being underweight pre-pregnancy (OR = 0.20; p = 0.041), being in the third or subsequent pregnancy compared to being in the first (OR = 0.37; p = 0.018), and having a high adherence to a prudent dietary pattern (OR = 0.47; p = 0.033).ConclusionsWomen who were overweight or obese pre-pregnancy and those who quit smoking at the beginning of pregnancy should be provided with dietary guidance to prevent excessive gestational weight gain.

Association between Gestational Weight Gain Adequacy and Adverse Maternal and Neonatal Outcomes.

To estimate the prevalence of gestational weight gain (GWG) adequacy according to the 2009 guidelines, and to examine the association between GWG adequacy and the adverse outcomes, stratified by prepregnancy body mass index (BMI). A retrospective cohort study, using the 2011 to 2013 U.S. linked birth/infant death datasets, restricted to nonanomalous singleton live births at 37 to 41 weeks. The adverse outcomes included composite maternal morbidity (CMM), composite neonatal morbidity (CNM), and neonatal and infant mortalities. We used multivariable Poisson's regression models with robust error variance to examine the association between GWG adequacy and adverse outcomes. Of 8,656,791 singleton live births, 20, 32, and 48% had inadequate, adequate, and excessive GWG, respectively. After multivariable regression adjustment, compared with adequate GWG, excessive GWG had 1.10 (1.08-1.13) and 1.12 (1.10-1.14) times higher risk of CMM and CNM, respectively; similar findings were observed in BMI subgroups. Compared with adequate GWG, inadequate GWG had 1.14 (1.03-1.26) and 1.12 (1.07-1.18) times higher risk of neonatal and infant mortalities, respectively. Similar results were noted among women with normal weight. Excessive GWG was associated with an increased risk of CMM and CNM, while inadequate GWG was associated with a higher risk of neonatal and infant mortalities.

The influence of maternal dietary patterns on gestational weight gain: A large prospective cohort study in China.

The relationship between dietary patterns and gestational weight gain (GWG) in different pregnancy stages has rarely been reported among the Asian population. The aim of this study was to examine the relationship between dietary patterns and GWG in Chinese pregnant women. Participants were women from the Born in Guangzhou Cohort Study who completed a validated food frequency questionnaire at 24 to 27 wk gestation (N = 5733). Dietary patterns were generated by cluster analysis. Maternal prepregnancy weight was self-reported; weights during pregnancy were extracted from medical records. Regression analyses were performed to test the associations between dietary patterns and total GWG and GWG rates (linear regression), and the adequacy of GWG (logistic regression). According to food consumption frequency, six dietary patterns were generated: "richer in cereals," "richer in vegetables," "richer in meats," "richer in fruits," "richer in fish, beans, nuts, and yogurt," and "richer in milk and milk powder." Compared with women following the richer in cereals pattern, those who followed the richer in fruits pattern had a significantly higher GWG (β = 0.592; 95% confidence interval [CI], 0.166-1.018) and total rate of GWG; those who followed the richer in fish, beans, nuts, and yogurt" pattern had a greater GWG rate in the second trimester, and also had a decreased risk for inadequate GWG (odds ratio, 0.797; 95% CI, 0.638-0.997). Consuming a variety of foods and frequent consumption of fruits during pregnancy contributes to a more rapid increase in GWG among pregnant women in China. Findings may be useful in pregnancy weight monitoring.

Impact of Pre-Pregnancy Body Mass Index and Gestational Weight Gain on Preterm Birth [6A

INTRODUCTION: This study was undertaken to evaluate the differential impact of pre-pregnancy body mass index (PPBMI) and gestational weight gain (GWG) on preterm birth (PTB). METHODS: Vital statistics (birth) data collected by the National Center for Health Statistics (NCHS) was utilized. Using the 2015 data for singleton gestations, GWG was calculated and PPBMI was categorized as per WHO guidelines. Each PPBMI category was further stratified based on the adequacy of GWG - into inadequate, adequate and excess GWG subgroups using the 2009 IOM guidelines. Multivariate logistic regression analyses were used to predict the risk for preterm birth (&lt;37 weeks) in each PPBMI and GWG group while adjusting for age, race, education, marital status, insurance and smoking status. RESULTS: The rate of preterm birth was noted to be 7.65% (276,820/3,619,295 deliveries). In comparison to women with adequate GWG, those with inadequate GWG [OR = 1.637 (95% CI 1.621 – 1.653)] had an overall increased risk for PTB across all PPBMI categories. Specifically, inadequate GWG was noted to increase the risk for PTB in normal weight [OR = 1.976 (95% CI 1.948 – 2.004)], underweight [OR = 2.384 (95% CI 2.286 – 2.486)], overweight [OR = 1.435 (95% CI 1.404 – 1.468)] and obese women [OR = 1.161 (95% CI 1.138 – 1.185)] as compared to women in the matched PPBMI categories with adequate GWG in the adjusted regression analyses. CONCLUSION: In this cohort, weight gain outside of the IOM recommendations was noted to significantly impact the risk for PTB across all PPBMI categories.

Epidemiological and Nutritional Characteristics of Twin Gestations in A Sample of Brazilian Maternity Hospital

Objective: The aim was to describe socio demo graphic, clinical, obstetric and nutritional profile of twin pregnants receiving prenatal care at a public maternity hospital in Rio de Janeiro. Methods: An analytical and cross-sectional study was conducted from consulting patient records during prenatal care and delivery for adults and teenagers twin pregnancy. Exploratory data analysis included sample description through averages and standard deviation (SD) for continuous variables and proportions for categorical variables. The chi-square test and the Fisher exact test were used to detect association between maternal age (adult or teenager) and independent variables Results: 109 pregnant women were evaluated, 101 were adults and eight were teenagers. Adults and teenagers were similar for the variables pre-pregnancy body mass index (p=0,709), complications during delivery (p=0,638) and postpartum (p=0,674), adequacy of gestational weight gain (p=0,631), gestational age at birth (p=0,791) and type of delivery (p=0,423). The most frequent pregnancy complications were anemia 49(44.9) and hypertensive disorders during pregnancy31(28.4). Prematurity occurred in 52.3% and 92.7% of deliveries were cesarean. Percentage of normal pre-pregnancy body mass index was 53.3%, insufficient weight gain was62.6% and 75.2%were referred a nutritional care during pregnancy. Conclusion: The high prevalence of obstetric complications, caesarean delivery and prematurity are important issues for twin pregnancy. The inadequate total weight gain shows the need for nutritional care during twin pregnancy. Keywords: Twin pregnancy; Nutritional Epidemiology; Prenatal care; Prenatal nutrition

Characterizing gestational weight gain in a cohort of Indigenous Australian women

Objectiveto determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index. Designanalysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy. Settingwomen recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program. Participants110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child. Measurements and findingsmeasurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on prepregnancy body mass index, the rate of adequate gestational weight gain in this cohort was very low (15%). 32% of women had inadequate weight gain and 54% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (74%), with rates of 48% and 50% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.5, p<0.01) and hypertension (coefficient 4.8, p = 0.04) were found to be significantly associated with gestational weight gain in mixed model linear regression. Conclusionsfew women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring. Implications for practicea systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian.

805: Pregnancy after bariatric surgery: What is the association between time from surgery and maternal weight outcomes?

The majority of patients having bariatric surgery are reproductive-age women who are advised to delay pregnancy for at least 12 months after surgery. However many women become pregnant sooner and influence on gestational weight gain (GWG) or long-term weight is unknown. The objective of this study was to compare weight outcomes in pregnancies <12 vs. ≥12 months after bariatric surgery. This is a retrospective cohort study of women with singleton livebirths after bariatric surgery who received care at a single tertiary care center from 2009-2017. GWG was difference in weight at 1st prenatal visit and delivery. GWG adequacy was determined by IOM 2009 guidelines according to prepregnancy BMI (inadequate, adequate, excessive). Postpartum weight retention was calculated as difference between weight at 1st prenatal visit and measured postpartum weight. Weight, maternal and neonatal outcomes were compared between <12 vs. ≥12 months after bariatric surgery with t-tests, Mann-Whitney U and chi-square tests as appropriate. Of 76 pregnancies that met inclusion criteria, 36.8% occurred <12 months (median 7.2) and 63.2% occurred ≥12 months after surgery (median 26.9). There were no significant differences in maternal age, ethnicity or nulliparity between groups, but there were more women with obesity in the <12 group (75% vs. 52%, p=0.03). The <12 group had lower mean GWG (p=0.01) and higher weight loss during pregnancy (p=0.004) compared to the ≥12 group (table). The <12 group had significantly less postpartum weight retention at 6 months compared to the ≥12 group (p=0.02). There were no differences in hyperemesis, hypertensive disorders, gestational diabetes or delivery mode between groups (p>0.05). There were no differences in gestational age at delivery, birth weight and small for gestational age infants between groups (p>0.05). Pregnancy <12 months after bariatric surgery is associated with significantly lower mean GWG and weight loss during pregnancy, but less postpartum weight retention at 6 months. Although there were no differences birthweight, weight loss during pregnancy and its accompanying metabolic changes are concerning for a developing fetus. Further study is needed to determine optimal timing of pregnancy after bariatric surgery with respect to both maternal and infant short and long-term outcomes.

Intimate Partner Violence and Gestational Weight Gain in a Population-Based Sample of Perinatal Women

ObjectiveTo examine the effects of intimate partner violence (IPV) at varied time points in the perinatal period on inadequate and excessive gestational weight gain. DesignRetrospective cohort using population-based secondary data. SettingPregnancy Risk Assessment Monitoring System and birth certificate data from New York City and 35 states. ParticipantsData were obtained for 251,342 U.S. mothers who gave birth from 2004 through 2011 and completed the Pregnancy Risk Assessment Monitoring System survey 2 to 9 months after birth. MethodsThe exposure was perinatal IPV, defined as experiencing physical abuse by a current or ex-partner in the year before or during pregnancy. Adequacy of gestational weight gain (GWG) was categorized using 2009 Institute of Medicine guidelines. Weighted descriptive statistics and multivariate logistic regression models were used. ResultsApproximately 6% of participants reported perinatal IPV, 2.7% reported IPV in the year before pregnancy, 1.1% reported IPV during pregnancy only, and the remaining 2.5% reported IPV before and during pregnancy. Inadequate GWG was more prevalent among participants who experienced IPV during pregnancy and those who experienced IPV before and during pregnancy (23.3% and 23.5%, respectively) than in participants who reported no IPV (20.2%; p < .001). Participants who experienced IPV before pregnancy only were significantly more likely to have excessive GWG (p < .001). Results were attenuated in the multivariate modeling; only participants who experienced IPV before pregnancy had weakly significant odds of excessive GWG (adjusted odds ratio = 1.14, 95% CI [1.02, 1.26]). ConclusionThe association between perinatal IPV and inadequate GWG was explained by confounding variables; however, women who reported perinatal IPV had greater rates of GWG outside the optimal range. Future studies are needed to determine how relevant confounding variables may affect a woman's GWG.

Social inequality in pre-pregnancy BMI and gestational weight gain in the first and second pregnancy among women in Sweden

BackgroundHigh pre-pregnancy body mass index (BMI) and inappropriate gestational weight gain (GWG) are associated with adverse short and long-term maternal and neonatal outcomes and may act as modifiable risk factors...

Prevalence and characteristics associated with gestational weight gain adequacy.

To estimate the prevalence of gestational weight gain adequacy according to the 2009 Institute of Medicine recommendations and examine demographic, behavioral, psychosocial, and medical characteristics associated with inadequate and excessive gain stratified by prepregnancy body mass index (BMI) category. We used cross-sectional, population-based data on women delivering full-term (37 weeks of gestation or greater), singleton neonates in 28 states who participated in the 2010 or 2011 Pregnancy Risk Assessment Monitoring System. We estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for inadequate and excessive compared with adequate gain, stratified by prepregnancy BMI. Overall, 20.9%, 32.0%, and 47.2% of women gained inadequate, adequate, and excessive gestational weight, respectively. Prepregnancy BMI was strongly associated with weight gain outside recommendations. Compared with normal-weight women (prevalence 51.8%), underweight women (4.2%) had decreased odds of excessive gain (adjusted OR 0.50, CI 0.40-0.61), whereas overweight and obese class I, II, and III (23.6%, 11.7%, 5.4%, and 3.5%, respectively) women had increased odds of excessive gain (adjusted OR range 2.07, CI 1.63-2.62 to adjusted OR 2.99, CI 2.63-3.40). Underweight and obese class II and III women had increased odds of inadequate gain (adjusted OR 1.25, CI 1.01-1.55 to 1.86, CI 1.45-2.36). Most characteristics associated with weight gain adequacy were demographic such as racial or ethnic minority status and education and varied by prepregnancy BMI. Notably, one behavioral characteristic-smoking cessation-was associated with excessive gain among normal-weight and obese women. Most women gained weight outside recommendations. Understanding characteristics associated with inadequate or excessive weight gain may identify potentially at-risk women and inform much-needed interventions.

Racial/Ethnic Disparities in Inadequate Gestational Weight Gain Differ by Pre-pregnancy Weight.

Pre-pregnancy body mass index (BMI) varies by race/ethnicity and modifies the association between gestational weight gain (GWG) and adverse pregnancy outcomes, which disproportionately affect racial/ethnic minorities. Yet studies investigating whether racial/ethnic disparities in GWG vary by pre-pregnancy BMI are inconsistent, and none studied nationally representative populations. Using categorical measures of GWG adequacy based on Institute of Medicine recommendations, we investigated whether associations between race/ethnicity and GWG adequacy were modified by pre-pregnancy BMI [underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), or obese (≥30.0 kg/m(2))] among all births to Black, Hispanic, and White mothers in the 1979 USA National Longitudinal Survey of Youth cohort (n = 6,849 pregnancies; range 1-10). We used generalized estimating equations, adjusted for marital status, parity, smoking during pregnancy, gestational age, and multiple measures of socioeconomic position. Effect measure modification between race/ethnicity and pre-pregnancy BMI was significant for inadequate GWG (Wald test p value = 0.08). Normal weight Black [risk ratio (RR) 1.34, 95 % confidence interval (CI) 1.18, 1.52] and Hispanic women (RR 1.33, 95 % CI 1.15, 1.54) and underweight Black women (RR 1.38, 95 % CI 1.07, 1.79) experienced an increased risk of inadequate GWG compared to Whites. Differences in risk of inadequate GWG between minority women, compared to White women, were not significant among overweight and obese women. Effect measure modification between race/ethnicity and pre-pregnancy BMI was not significant for excessive GWG. The magnitude of racial/ethnic disparities in inadequate GWG appears to vary by pre-pregnancy weight class, which should be considered when designing interventions to close racial/ethnic gaps in healthy GWG.

Comparison of gestational weight gain z-scores and traditional weight gain measures in relation to perinatal outcomes.

Conventional measures of gestational weight gain (GWG) are correlated with pregnancy duration, and may induce bias to studies of GWG and perinatal outcomes. A maternal weight-gain-for-gestational-age z-score chart is a new tool that allows total GWG to be classified as a standardised z-score that is independent of gestational duration. Our objective was to compare associations with perinatal outcomes when GWG was assessed using gestational age-standardised z-scores and conventional GWG measures. We studied normal-weight (n=522 120) and overweight (n=237 923) women who delivered liveborn, singleton infants in Pennsylvania, 2003-11. GWG was expressed using gestational age-standardised z-scores and three traditional measures: total GWG (kg), rate of GWG (kg per week of gestation), and the GWG adequacy ratio (observed GWG/GWG recommended by the Institute of Medicine). Log-binomial regression models were used to assess associations between GWG and preterm birth, and small- and large-for-gestational-age births, while adjusting for race/ethnicity, education, smoking, and other confounders. The association between GWG z-score and preterm birth was approximately U-shaped. The risk of preterm birth associated with weight gain <10th percentile of each measure was substantially overestimated when GWG was classified using total kilogram and was moderately overestimated using rate of GWG or GWG adequacy ratio. All GWG measures had similar associations with small- or large-for-gestational-age birth. Our findings suggest that studies of gestational age-dependent outcomes misspecify associations if total GWG, rate of GWG, or GWG adequacy ratio are used. The potential for gestational age-related bias can be eliminated by using z-score charts to classify total GWG.

Prepregnancy body mass index is an independent risk factor for gestational hypertension, gestational diabetes, preterm labor, and small- and large-for-gestational-age infants

Objective: We examined if prepregnancy body mass index (BMI) is a risk factor for gestational hypertension, gestational diabetes, preterm labor, and small-for-gestational-age (SGA) and large-for-gestational-age (LGA) infants with consideration of gestational weight gain, to document the importance of preconception versus prenatal stage.Methods: We used the data of 219 868 women from 2004 to 2011 Pregnancy Risk Assessment Monitoring System (PRAMS). Multivariate logistic regression analyses were performed to examine the effect of prepregnancy BMI for gestational hypertension, gestational diabetes, preterm labor, and SGA and LGA infants with consideration of gestational weight gain.Results: Regardless of gestational weight gain, women with obese prepregnancy BMI (≥30 kg/m2) had increased odds of gestational hypertension (adjusted odds ratios (AOR) = 2.91; 95% CI = 2.76–3.07), gestational diabetes (2.78; 2.60–2.96), and LGA (1.87; 1.76–1.99) compared to women with normal prepregnancy BMI (18.5–24.9 kg/m2). Women with underweight prepregnancy BMI (<18.5 kg/m2) had increased odds of preterm labor (1.25; 1.16–1.36) and SGA infants (1.36; 1.25–1.49), but decreased odds of LGA infants (0.72; 0.61–0.85) in reference to women with normal prepregnancy BMI (18.5–24.9 kg/m2).Conclusions: Regardless of adequacy of gestational weight gain, the risk of gestational hypertension, gestational diabetes, and LGA infants increases with obese prepregnancy BMI, whereas that of preterm labor and SGA infants increases with underweight prepregnancy BMI. Preconception care of reproductive aged women is as important as prenatal care to lower the risk of gestational hypertension, gestational diabetes, preterm labor, and SGA and LGA infants.

The performance of various anthropometric assessment methods for predicting low birth weight in adolescent pregnant women.

To evaluate the performance of various anthropometric evaluation methods for adolescent pregnant women in the prediction of birth weight. It is a cross-sectional study including 826 adolescent pregnant women. In the pre-pregnancy body mass index (BMI) classification, the recommendations of the World Health Organization were compared with that of the Brazilian Ministry of Health and the Institute of Medicine (IOM) of 1992 and 2006. The gestational weight gain adequacy was evaluated according to the classification of IOM of 1992, of 2006 and of the Brazilian Ministry of Health. The newborns were classified as low birth weight (LBW) or macrosomic. Multinomial logistic regression was used for statistical analysis and sensibility, specificity, accuracy, positive and negative predictive values were calculated. The evaluation, according to the Brazilian Ministry of Health, showed the best prediction for LBW among pregnant women with low weight gain (specificity = 69.5%). The evaluation according to the IOM of 1992 showed the best prediction for macrosomia among pregnant women with high weight gain (specificity = 50.0%). The adequacy of weight gain according to the IOM of 1992 classification showed the best prediction for LBW (OR = 3.84; 95%CI 2.19 - 6.74), followed by the method of the Brazilian Ministry of Health (OR = 2.88, 95%CI 1.73 - 4.79), among pregnant women with low weight gain. It is recommended the adoption of the Brazilian Ministry of Health proposal, associated with BMI cut-offs specific for adolescents as an anthropometric assessment method for adolescent pregnant women.

Developmental trajectories of postpartum weight 3 years after birth: Norwegian Mother And Child Cohort study.

This study explored the developmental trajectories of postpartum weight from 0.5 to 3years after childbirth, and aimed to determine the associations between postpartum weight trajectories and prepregnancy body mass index and adequacy of gestational weight gain (GWG). Data from the Norwegian Mother and Child Cohort study were used, following 49,528 mothers 0.5, 1.5, and 3years after childbirth. Analyses were performed using latent growth mixture modeling. Three groups of developmental trajectories of postpartum weight were found, with most women (85.9%) having a low level of weight retention initially and slight gain over 3years, whereas 5.6% of women started at a high postpartum weight retention (on average 7.56kg) at 0.5years but followed by a marked weight loss over time (2.63kg per year on average), and the third trajectory represented women (8.5%) who had high weight retention high initially (on average 4.67kg at 0.5years) and increasing weight over time (1.43kg per year on average). Prepregnancy overweight and obesity and excessive GWG significantly predicted a high postpartum weight trend. Women had substantial variability in postpartum weight development-both initially after birth and in their weight trajectories over time. Early preventive interventions may be designed to assist women with prepregnancy overweight and obesity and excessive GWG, which helps to reduce the increasing trend for postpartum weight.