Associations Of Gestational Weight Gain Research Articles

Critical Threshold of Average Weekly Weight Gain in Overweight Pregnant Women During the Second and Third Trimesters: A Strategy to Prevent Macrosomia.

The study aimed to obtain more evidence on the association of gestational weight gain and pre-pregnancy body mass index (BMI) with macrosomia. The data on 5409 live births delivered at Peking Union Medical College Hospital from July 2020 to June 2022 were collected. Group analyses were performed according to the presence or absence of macrosomia. Multivariable binary logistic regression and incidence heatmaps was used to analyze the related factors of macrosomia. The following variables were significantly associated with macrosomia: overweight (odds ratio [OR]: 2.24, 95% confidence interval [CI]: 1.62-3.10), obesity (OR: 4.56, 95% CI: 2.93-6.98), excessive gestational weight gain (OR: 2.39, 95% CI: 1.67-3.43), gestational age at delivery at 39-41weeks (OR: 3.83, 95% CI: 2.56-5.95), gestational age at delivery over 41weeks (OR: 7.88, 95% CI: 4.37-14.19), education level of junior college or below (OR: 1.95, 95% CI: 1.19-3.09), and multipara (OR: 1.62, 95% CI: 1.09-2.42). "v" represents the mean weekly weight gain during the second and third trimesters. A higher v value increased the risk of macrosomia by 2.6-fold (95% CI: 1.37-4.89, P = 0.003). Compared to normal weight women, after adjustment for different pre-pregnancy BMI subgroups, overweight pregnant women had higher weekly weight gain in the second and third trimesters (OR: 4.57, 95% CI: 2.27-9.10, P < 0.001). Obese pregnant women had higher average weekly weight gain during the second and third trimesters, and the OR value for macrosomia was 11.33 (95% CI: 4.95-25.18, P < 0.001). To reduce the incidence of macrosomia in overweight pregnant women, v = 0.32 could be considered the critical threshold of average weekly weight gain in these women in the second and third trimesters of pregnancy. Pre-pregnancy BMI and weight gain during pregnancy are closely related to macrosomia. The introduction of average weekly weight gain values in the second and third trimesters of pregnancy probably help pregnant women minimizing adverse pregnancy-related outcomes.

Effect modification of pre-pregnancy body mass index on association of gestational weight gain with birth weight

BackgroundMaternal weight status, before or during pregnancy, is a significant determinant of fetus development, birth weight, and the short-term and long-term health outcomes of the offspring. ObjectiveThis study aimed to evaluate the effect modification of pre-pregnancy body mass index (BMI) on the associations of gestational weight gain (GWG) and birth weight, as per the latest guidelines from the Chinese Nutrition Society. MethodsThis is a retrospective cohort study performed in a tertiary hospital with the largest deliveries in Shanghai, China. This study included all women who had singleton live births from 2021 to 2022 (n = 50,391). Data on pre-pregnancy weight, GWG, and birth weight were extracted from the medical register system. Logistic regression models were used to estimate the associations of pre-pregnancy BMI and GWG with the risks of being small for gestational age (SGA) and large for gestational age (LGA). The potential for effect modification by BMI on the associations of GWG and birth weight was assessed using both additive and multiplicative scales. ResultsPre-pregnancy BMI and GWG were consistently associated with birth weight. We observed a positive effect modification by underweight on the relationships between insufficient GWG and SGA both in multiplicative (adjusted odds ratio (OR), 2.49, 95 % confidence interval (CI): 2.06–2.99), and additive (relative excess risk due to interaction (RERI), 3.04, 95 % CI: 1.70–4.37) scales. Similarly, obesity was found to modify the effect of excessive GWG on the risk of LGA (adjusted OR, 3.82, 95 % CI, 3.14–4.63; RERI, 14.67, 95 % CI: 7.92–21.41). ConclusionOur findings indicate that increased GWG is associated with a higher risk of abnormal birth weight in singleton pregnancies. Additionally, there is evidence of an additive interaction between pre-pregnancy BMI and GWG on the risk of small for gestational age or large for gestational age.

The Long-Term Associations of Perinatal Obesogenic Environment with Offspring Biological Aging.

Biological age (BA), reflecting aging-related health decline beyond chronological age, varies among individuals. While previous research explored associations of maternal pregnancy-related body size with offspring health outcomes, its implications for BA in young adults remain unclear. Utilizing longitudinal data of 1,148 mother-offspring pairs from the Jerusalem Perinatal Study, we analyzed associations of maternal pre-pregnancy BMI and gestational weight gain (GWG) with offspring Klemera-Doubal method (KDM)-based BA at age 32, and potential familial life-course underlying mechanisms. Maternal pregnancy-related body size, adjusted for sociodemographic/lifestyle factors was associated with offspring BA (βmaternal pre-pregnancy BMI=0.183,95%CI:0.098,0.267;βGWG=0.093,95%CI:0.021,0.165). Association of GWG with BA was largely direct (90%,95%CI,44%,100%), while association with maternal pre-pregnancy BMI was partially mediated through adolescent BMI (36%,95%CI=18%,75%), with both associations eliminated after adjustment for offspring adult BMI. Associations persisted after adjusting for offspring polygenic risk score for BMI (βmaternal pre-pregnancy BMI=0.128;95%CI=0.023,0.234; βGWG=0.102;95%CI=0.006,0.198), and somewhat altered after adjustment for maternal cardiometabolic conditions (βmaternal pre-pregnancy BMI=0.144,95%CI=0.059, 0.230). Impact on GWG associations was negligible. Thus, perinatal obesogenic environment contributes to offspring BA beyond sociodemographic factors and maternal cardiometabolic history, yet intergenerational transmission of obesity seems to underlie these associations. Nonetheless, the period between adolescence and young adulthood could be targeted for weight-reducing interventions, ultimately promoting healthy aging.

Associations of gestational weight gain with the long-term postpartum weight gain, body mass index, waist circumference and abdominal obesity: A 27-year prospective cohort study

BackgroundThis prospective cohort study aimed to investigate the associations between gestational weight gain (GWG) and long-term postpartum maternal weight gain, body mass index (BMI), waist circumference (WC), and the risk of general and abdominal obesity, beyond motherhood (some 27 y after childbirth). MethodsParticipants were 1953 women enrolled in the Mater-University of Queensland Study of Pregnancy cohort study that started in the early 1980 s, with the most recent follow-up at 27 y postpartum. We examined the prospective associations of GWG in pregnancy with weight, BMI, and WC and the risk of adiposity 27 y after the index pregnancy. We used linear and multinomial logistic regressions to examine the independent effect of GWG on each outcome, adjusting for potential confounders and mediators. ResultsThe average GWG during pregnancy was 14.88 kg (SD 5.24). One in four women (25.50%) gained below the Institute of Medicine (IOM) recommendations and one in three (34.00%) gained excess weight during pregnancy. Every 100 g/week increment of GWG was associated with 2.0 (95% CI: 1.5, 2.6) kg, 0.7 (0.5, 0.9) kg/m2, 1.3 (0.8, 1.8) cm greater body weight, BMI, and WC, respectively 27 y postpartum. Women who gained inadequate weight in pregnancy had significantly lower odds of general obesity (OR; 0.70, 95% CI:0.53,0.94) or abdominal obesity (0.73; 0.56,0.96), whereas those who gained excess gestational weight had much higher odds of general obesity (4.49; 3.36,6.00) and abdominal obesity (3.09; 2.29,4.16). These associations were independent of potential confounders. ConclusionMaternal GWG in pregnancy independently and strongly predicted beyond motherhood weight gain trajectory. GWG within IOM recommendation may prevent long-term development of both general and central obesity.

Gestational weight gain and its association with maternal and neonatal outcomes among pregnant women with normal pre-pregnancy body mass index from a Middle Eastern country

BackgroundInappropriate gestational weight gain (GWG) is one of the leading health problems during pregnancy. Little is known about the association of GWG with the pregnancy outcomes among Middle Eastern pregnant women. PurposeTo examine the relationship between GWG and maternal and neonatal outcomes among pregnant women with normal pre-pregnancy BMI. MethodsThis retrospective cohort study was conducted in Oman among 763 healthy women with normal pre-pregnancy BMI between August 1, 2021, and June 30, 2022. Maternal and neonatal outcomes were retrieved from participants’ medical records using a standardized form. The analytical tools included descriptive statistics and the chi-square test. ResultsDescriptive statistics showed 22.6 % and 21.4 % of the study participants gained weight above or below the guidelines, respectively. The findings from the chi-square test showed a significant association between total GWG and the incidence of emergency caesarean section (p < .01), gestational diabetes mellitus (p < .01), and gestational hypertension (p < .01), macrosomia (p < .01), small for gestational age (p < .01), large for gestational age (p < .01), low birth weight (p < .01), intrauterine growth retardation (p < .01), and preterm birth (p < .01). Conclusion and implications for practiceOur study found that inappropriate gestational weight gain (GWG) contributes to several adverse maternal and neonatal outcomes. We recommend that Ministries of Health in Middle East and North Africa area includes GWG as a risk factor for pregnancy-related adverse outcomes. Midwives should closely monitor and manage GWG to ensure optimal pregnancy outcomes. In addition, midwives should encourage mothers to maintain GWG within the recommended range using various strategies such as continuous counselling and motivational health promotion interventions.

Associations of gestational weight gain with birth weight outcomes in early pregnancy weight loss women: Findings from the Beijing Birth Cohort Study.

To explore the relationship between gestational weight gain (GWG) and birth weight outcomes and establish suggested GWG patterns in early pregnancy weight loss women. This retrospective study was conducted based on the Beijing Birth Cohort Study from 2014 to 2021 and included 20 688 women. Weight change in early pregnancy was calculated using weight measurements within 16 weeks of gestation. Multivariable logistic regression was used to analyze the relationships of different GWG categories, based on the Chinese standard, and birth weight outcomes. The statistical-based approach was used to determine the optimal GWG ranges and weekly weight gain. Compared to 3313 women who gained appropriate weight in early pregnancy, 2614 women who lost weight in the same period increased the risk of small for gestational age (SGA) (OR = 1.43, 95% CI: 1.14-1.80, P = 0.002). However, the relationship disappeared after adjusting for total GWG. Among the early pregnancy weight loss women, both excessive GWG and inadequate GWG were associated with adverse birth weight outcomes after adjusting for confounders. The suggested GWG range and rate were 11.0 ~ 16.0 kg and 0.46 to 0.67 kg/week from 16 weeks to delivery for women with normal body mass index (BMI) and weight loss in early pregnancy. Weight loss in early pregnancy was not the independent risk factor of birth weight outcomes. GWG may offset the expected effects. To achieve optimal outcomes, women with normal BMI and weight loss in early pregnancy need to have a higher weight gain rate in mid-late pregnancy but similar total GWG ranges with the Chinese standard for general women.

The associations of gestational weight gain and midpregnancy lipid levels with placental size and placental-to-birth weight ratio: findings from a chinese birth cohort study

BackgroundThe placenta serves as the sole maternal organ responsible for transmitting nutrients to the fetus, playing a crucial role in supporting standard fetal growth and development. To date, only a small number of studies have investigated the impact of maternal gestational weight gain and lipid concentrations on placental development. This study aimed to explore the influence of weight gain during pregnancy and lipid levels in the second trimester on placental weight, volume, and the placental weight ratio.MethodsThis birth cohort study encompassed 1,358 mother-child pairs. Placental data for each participant was gathered immediately post-delivery, and the study incorporated data on gestational weight gain throughout pregnancy and lipid profiles from the mid-trimester. A linear regression model was employed to assess the correlations between gestational weight gain, mid-trimester lipid levels, and metrics such as placental weight, placental volume, and the placental-to-birth weight ratio (PFR).ResultsIn the study groups of pre-pregnancy underweight, normal weight, and overweight, the placental weight increased by 4.93 g (95% CI: 1.04–8.81), 2.52 g (95% CI: 1.04–3.99), and 3.30 g (95% CI: 0.38–6.22) per 1 kg of gestational weight gain, respectively. Within the pre-pregnancy underweight and normal weight groups, the placental volume increased by 6.79 cm^3 (95% CI: 3.43–10.15) and 2.85 cm^3 (95% CI: 1.31–4.39) per 1 kg of gestational weight gain, respectively. Additionally, placental weight exhibited a positive correlation with triglyceride (TG) levels (β = 9.81, 95% CI: 3.28–16.34) and a negative correlation with high-density lipoprotein (HDL-C) levels (β = − 46.30, 95% CI: − 69.49 to − 23.11). Placental volume also showed a positive association with TG levels (β = 14.54, 95% CI: 7.69–21.39). Conversely, PFR demonstrated a negative correlation with increasing HDL-C levels (β = − 0.89, 95% CI: − 1.50 to − 0.27).ConclusionsGestational weight gain was significantly correlated with both placental weight and volume. This association was especially pronounced in women who, prior to pregnancy, were underweight or of normal weight. Additionally, TG and HDL-C levels during the mid-trimester were linked to placental development.

Gestational weight gain in women with pre-pregnancy overweight or obesity and anthropometry of infants at birth.

To examine the association of gestational weight gain (GWG) among women with pre-pregnancy overweight or obesity with infant weight and BMI z-score at birth. This study is a secondary analysis of a randomized controlled trial including data from 208 infants at birth born by mothers with pre-pregnancy BMI between 28 and 45 kg/m2 who completed the APPROACH study (randomized to a high-protein low-glycemic index diet or a moderate-protein moderate-glycemic index diet). This analysis pooled the two diet treatment groups together and data were analyzed using a linear mixed model. Limiting GWG by 1 kg was associated with lower birthweight (-16 g, P = 0.003), BMI z-score (-0.03SD, P = 0.019), weight z-score (-0.03SD, P = 0.004), and infant abdominal circumference (-0.06 cm, P = 0.039). Infants born by mothers whose GWG was ≤9 kg weighed less (122 g, 95% CI: 6-249, P = 0.040), had similar BMI z-score (0.2SD, 95% CI: -0.06 to 0.55, P = 0.120), and lower incidence of emergency cesarean deliveries (11.5% vs. 23.1%, P = 0.044) compared to infants born by mothers whose GWG was >9 kg. When women were classified into GWG quartiles, women in Q1 (GWG range: -7.0 to 3.2 kg) gave birth to smaller infants (3,420 g, P = 0.015) with lower BMI z-score (-0.5SD, P = 0.041) than women in Q2 (3.3-7.1 kg), Q3 (7.2-10.9 kg) and Q4 (11.1-30.2 kg). Limiting GWG among women with pre-pregnancy overweight or obesity was associated with lower infant weight, BMI z-score, weight z-score, and abdominal circumference at birth. Moreover, GWG below the Institute of Medicine guideline of a maximum of 9 kg was associated with lower birthweight and fewer emergency cesarean deliveries.

Associations of Gestational Weight Gain at Different Trimesters with Adverse Pregnancy Outcomes. A Prospective Study of 1273 Subjects

Background: The incidence of excessive weight gain during pregnancy continues to increase. Our aim was to compare pregnancy outcomes at different trimesters and different classification criteria of gestational weight gain (GWG) and to examine whether GWG was correlated with adverse outcomes in the population of Southwest China. Methods: In the randomized controlled trial of Complex Lipids in Mothers and Babies (CLIMB) conducted in Chongqing, China, data from 1273 women was analyzed. We used two criteria to define GWG as insufficient, appropriate or excessive. The first was based on Chinese, Asian, European Body Mass Index (BMI) and US Institute of Medicine (IOM) guidelines. The second was based on the quantiles of GWG of the subjects studied. Results: After adjusting for confounding factors, excessive GWG during gestational periods 12–33 weeks and 12 weeks to delivery was linked to the occurrence of large for gestational age (LGA) infants. The 12 weeks to delivery group was linked to the occurrence of macrosomia, and all periods studied (12–33 weeks, 12 weeks to delivery, and 33 weeks to delivery) were associated with an increased incidence of C-section. Insufficient GWG during 12–33 weeks was associated with the occurrence of small gestational age (SGA) infants. Conclusions: Our results support that inappropriate GWG during specific gestational periods was associated with an increased risk of adverse pregnancy outcomes among women in southwestern China. Clinical Trial Registration: Clinical Trial Registration number ChiCTR-IOR-16007700.

Low Gestational Weight Gain in Women With Gestational Diabetes Is Safe With Better Metabolic Profile Postpartum.

More data are needed on the potential benefits and risks of gestational weight gain (GWG) less than recommended and excessive GWG in women with gestational diabetes (GDM) compared to women with normal glucose tolerance (NGT) during pregnancy. This work aimed to evaluate association of gestational weight gain (GWG) as low, within, or above (excessive) according to Institute of Medicine (IOM) guidelines, with pregnancy outcomes in women with gestational diabetes (GDM) and normal glucose tolerance (NGT). This prospective cohort study included 7 Belgian hospitals and 1843 women receiving universal GDM screening with a 75-g oral glucose tolerance test. Pregnancy outcomes and postpartum characteristics were the main outcome measures. Women with GDM and low GWG (n = 97, 52.4%) had similar rates of small-for-gestational age infants and preterm delivery, were less often overweight or obese postpartum (35.7% [30] vs 56.5% [26]; P < .022) and less often had postpartum weight retention (PPWR) (48.8% [41] vs 87.9% [40]; P < .001) compared to GWG within range (n = 58, 31.3%). GDM with excessive GWG (n = 30, 16.2%) more often had neonatal hypoglycemia (30.8% (8) vs 5.9% [3], aOR 7.15; 95% CI, 1.52-33.63; P = .013) compared to GWG within range. NGT with excessive GWG (28.3% [383]) more often had instrumental delivery (15.9% [61] vs 11.9% [64], aOR 1.53; 95% CI, 1.03-2.27; P = .035) and more large-for-gestational age infants (19.3% [74] vs 10.4% [56], aOR 1.67; 95% CI, 1.13-2.47; P = .012) compared to GWG within range. GWG below IOM guidelines occurred frequently in GDM women, without increased risk for adverse pregnancy outcomes and with better metabolic profile postpartum. Excessive GWG was associated with increased risk for neonatal hypoglycemia and worse metabolic profile postpartum in women with GDM, and with higher rates of LGA and instrumental delivery in NGT women.

Metabolome-Wide Associations of Gestational Weight Gain in Pregnant Women with Overweight and Obesity.

Excessive gestational weight gain (GWG) is associated with adverse pregnancy outcomes. This metabolome-wide association study aimed to identify metabolomic markers for GWG. This longitudinal study included 39 Black and White pregnant women with a prepregnancy body mass index (BMI) of ≥ 25 kg/m2. Untargeted metabolomic profiling was performed using fasting plasma samples collected at baseline (mean: 12.1 weeks) and 32 weeks of gestation. The associations of metabolites at each time point and changes between the two time points with GWG were examined by linear and least absolute shrinkage and selection operator (LASSO) regression analyses. Pearson correlations between the identified metabolites and cardiometabolic biomarkers were examined. Of the 769 annotated metabolites, 88 metabolites at 32 weeks were individually associated with GWG, with four (phosphatidylcholine (PC) 34:4, triacylglycerol (TAG) 52:6, arachidonic acid, isoleucine) jointly associated with GWG (area under the receiver operating characteristic curve (AUC) for excessive GWG: 0.80, 95% CI: 0.67, 0.93). No correlations were observed between the 88 metabolites and insulin, C-peptide, and high-sensitivity C-reactive protein at 32 weeks. Twelve metabolites at baseline (AUC for excessive GWG: 0.80, 95% CI: 0.62, 0.99) and three metabolite changes (AUC for excessive GWG: 0.73, 95% CI: 0.44, 1.00) were jointly associated with GWG. We identified novel metabolites in the first and third trimesters associated with GWG, which may shed light on the pathophysiology of GWG.

Parental body mass index and maternal gestational weight gain associations with offspring body composition in young women from the Nutritionists' Health Study.

Intrauterine environment can induce fetal metabolic programming that predisposes to adiposity-related chronic diseases in its lifespan. We examined the associations of parental nutritional status and gestational weight gain with offspring body composition in early adulthood. This is cross-sectional analysis of female participants of the NutriHS who were submitted to questionnaires, clinical examinations and body composition assessed by DXA. Association of preconception parental BMI and maternal gestational weight gain (exposures) with body composition measurements (outcomes) were analyzed using multiple linear models adjusted for Directed Acyclic Graphs-based covariables (maternal and paternal educational level, maternal age, and tobacco, alcohol and/or drugs use). The sample included 124 women (median 28 (24-31) years) with a mean BMI of 25.4 ± 4.7 kg/m2. No association between previous paternal BMI and offspring's body composition was detected. In the fully adjusted linear regression model, maternal BMI was associated with offspring's total lean mass (β = 0.66, p = 0.001), appendicular skeletal muscle mass index (ASMI) (β = 0.11, p = 0.003) and fat mass index (FMI) (β = 0.03, p = 0.039). Gestational weight gain was associated with increased offspring's BMI (OR 1.12 [95% CI 1.02-1.20], p = 0.01). The linear regression model adjusted for maternal age and maternal and paternal education levels showed associations of gestational weight gain with offspring's ASMI (β = 0.42, p = 0.046), FMI (β = 0.22, p = 0.005) and android-to-gynoid fat ratio (β = 0.09, p = 0.035). Our findings suggest that preconception maternal BMI could influence lean mass and general adiposity of young adult female offspring and that gestational weight gain could be useful for predicting centrally distributed adiposity.

Gestational weight gain and adverse maternal and perinatal outcomes among women with gestational diabetes mellitus according to International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria: A cross sectional study.

To evaluate the association of gestational weight gain and adverse maternal and perinatal outcomes among Brazilian women with gestational diabetes mellitus (GDM). Cross-sectional study conducted in women with GDM, and their newborns, who attended a public maternity hospital. The Institute of Medicine criteria were adopted to assess adequacy of gestational weight gain (GWG). Cesarean delivery, maternal hypertensive disorders of pregnancy (HDP), premature birth, macrosomia, and birth weight adequacy for gestational age were analyzed as outcomes. Simple and multiple logistic regression models were tested to assess the effect of adequacy of GWG on maternal and newborn outcomes. Among the 545 women studied, 64.2% (n=344) had inadequate weight gain: 27.2% (n=146) insufficient and 37% (n=198) excessive. Women with insufficient GWG were more likely to have a preterm birth (OR 2.57; 95% CI: 1.06-6.19), while those with excessive GWG had a greater chance of HDP (OR 2.62; 95% CI: 1.54-4.45) and large for gestational age newborn (OR 1.88; 95% CI: 1.08-3.29), compared with those with adequate weight gain. Inadequate gestational weight gain was frequent in women with GDM, especially in pregnant women with overweight and obesity, and is associated with unfavorable outcomes.

Associations of Gestational Weight Gain with Perinatal Outcomes in Western Brazilian Amazon

To investigate the association between gestational weight gain (GWG) and perinatal outcomes in pregnant Amazonian women. Data from 1305 mother-child pairs from the MINA-Brazil population-based birth cohort study were used. GWG was classified according to two methods, the Institute of Medicine (IOM) guidelines and INTERGROWTH-21st standards. Poisson and linear regression analyses were conducted to evaluate associations with perinatal outcomes. Following IOM guidelines (n = 1305), the rates of insufficient and excessive GWG were found to be similar (32%). Excessive GWG was associated with higher new-born birthweight (BW) z-scores; increased risks of macrosomia, large for gestational age (LGA), and caesarean delivery; and lower risks of low birthweight (LBW) and being small for gestational age (SGA). Insufficient GWG was associated with lower new-born BW z-scores. Among women with normal pre-pregnancy body mass indices (BMIs, n = 658), inappropriate GWG was high following both methods (IOM: 41.2% insufficient, 24.8% excessive; INTERGROWTH-21st: 25.2% below -1 z-score, 16.9% above 1 z-score). Both methods also indicated that new-borns of women with excessive GWG had higher BW z-scores and increased risk of macrosomia and LGA. Women with GWG below the INTERGROWTH-21st standards were more likely to deliver an infant SGA and with lower BW z-scores. Inappropriate GWG remains a health concern irrespective of the method used to classify weight gain. GWG above the recommendations of both methods and below the INTERGROWTH-21st standard was associated with adverse perinatal outcomes. Therefore, INTERGROWTH-21st standards seem to be a better fit for healthy women in this population.

Gestational weight gain during the second and third trimesters and adverse pregnancy outcomes, results from a prospective pregnancy cohort in urban Tanzania

BackgroundAppropriate gestational weight gain (GWG) is important for optimal pregnancy outcomes. This study prospectively evaluated the associations between GWG during the second and third trimesters of pregnancy and adverse pregnancy outcomes in an urban Tanzanian pregnancy cohort.MethodsWe used data from a randomized clinical trial conducted among pregnant women recruited by 27 weeks of gestation in Dar es Salaam, Tanzania (N = 1230). Women’s gestational weight was measured at baseline and at monthly antenatal visits. Weekly GWG rate during the second and third trimesters was calculated and characterized as inadequate, adequate, or excessive, in conjunction with measured or imputed early-pregnancy BMI status according to the 2009 Institute of Medicine (IOM) GWG guidelines. We used multivariable Poisson regression with a sandwich variance estimator to calculate risk ratios (RR) for associations of GWG with low birth weight, preterm birth, small for gestational age (SGA), and large for gestational age (LGA). Degree of appropriate GWG defined using additional metrics (i.e., percentage of adequacy, z-score) and potential effect modification by maternal BMI were additionally evaluated.ResultsAccording to the IOM guidelines, 517 (42.0%), 270 (22.0%), and 443 (36.0%) women were characterized as having inadequate, adequate, and excessive GWG, respectively. Overall, compared to women with adequate GWG, women with inadequate GWG had a lower risk of LGA births (RR = 0.54, 95% CI: 0.36–0.80) and a higher risk of SGA births (RR = 1.32, 95% CI: 0.95–1.81). Women with inadequate GWG as defined by percentage of GWG adequacy had a higher risk of LBW (OR = 1.93, 95% CI: 1.03–3.63). In stratified analyses by early-pregnancy BMI, excessive GWG among women with normal BMI was associated with a higher risk of preterm birth (RR = 1.59, 95% CI: 1.03–2.44).ConclusionsA comparatively high percentage of excessive GWG was observed among healthy pregnant women in Tanzania. Both inadequate and excessive GWGs were associated with elevated risks of poor pregnancy outcomes. Future studies among diverse SSA populations are warranted to confirm our findings, and clinical recommendations on optimal GWG should be developed to promote healthy GWG in SSA settings.Trial registration: This trial was registered as “Prenatal Iron Supplements: Safety and Efficacy in Tanzania” (NCT01119612; http://clinicaltrials.gov/show/NCT01119612).

1036-P: The Association between Maternal Gestational Weight Gain and Autonomic Nervous System Is Disturbed in GDM: Results from Two-Year-Old Children

Objective: The intrauterine environment is known to affect the offspring's long-term risk for obesity and diabetes. Previous data show that maternal metabolism and gestational weight gain (GWG) are associated with autonomic nervous system (ANS) function in fetuses in utero, which can be assessed with heart rate variability (HRV) . We have now examined whether this association is also present in 2-year-old children and addressed the impact of gestational diabetes (GDM) . Research Design and Methods: We examined children of participants of the ongoing PREG study (NCT04270578) who had a 5-point 75g oral glucose tolerance test during pregnancy. To assess HRV, a 10-minute ECG was recorded in the offspring. We analyzed time domain (beats per minute (BPM) , Root Mean Square of successive differences (RMSSD)) , Standard Deviation of RR-Intervals (SDNN) and frequency domain parameters (low frequency (LF) , high frequency (HF) and LF/HF) of HRV. Results: We examined 67 children (33 girls, 34 boys, age 25.3±1.6 months) . During pregnancy, 30 of their mothers had GDM, which was treated according to national guidelines. There were no differences between groups in birth weight, weight at age 2, and body fat. We observed statistically significant associations of GWG with heart rate, RMSSD, SDNN, HF power, and HF/LF, indicating a lower parasympathetic tone in children of mothers with low GWG. This association was attenuated in GDM-exposed children. ANS function correlated with body weight and body fat only in children from normoglycemic pregnancies (NGT) . Conclusion: We found an impact of maternal GWG on offspring ANS function, which was missing in the presence of treated GDM. The balance of the ANS was related to offspring body composition only in children from NGT pregnancies. Our results point towards a critical impact of maternal weight gain during pregnancy on the developing ANS with longstanding consequences for body composition. Disclosure L.Fritsche: None. H.Preissl: None. M.Heni: Advisory Panel; Boehringer Ingelheim International GmbH, Research Support; Boehringer Ingelheim International GmbH, Sanofi, Speaker's Bureau; Amryt Pharma Plc, Boehringer Ingelheim International GmbH, Novo Nordisk. J.Hartkopf: None. J.Hummel: None. D.Löffler: None. H.Häring: None. A.Peter: None. A.L.Birkenfeld: None. R.Wagner: Advisory Panel; Akcea Therapeutics, Daiichi Sankyo, Sanofi-Aventis Deutschland GmbH, Speaker's Bureau; Lilly, Novo Nordisk, Sanofi-Aventis Deutschland GmbH. A.Fritsche: Advisory Panel; Boehringer Ingelheim International GmbH, Novo Nordisk, Sanofi-Aventis Deutschland GmbH. Funding The PREG study is supported in part by a grant from the Federal Ministry of Education and Research (BMBF) (01GI0925) to the German Center for Diabetes Research (DZD) and by grant from the Deutsche Diabetes Stiftung (380/02/16) to LF

Gestational Diabetes Mellitus as an Effect Modifier of the Association of Gestational Weight Gain with Perinatal Outcomes: A Prospective Cohort Study in China.

The association of gestational weight gain (GWG) with perinatal outcomes seems to differ between women with and without gestational diabetes mellitus (GDM). Whether GDM is an effect-modifier of the association has not been verified. This study aimed to assess the modifying effect of GDM on the association of GWG with perinatal outcomes. Data on 12,128 pregnant women (3013 with GDM and 9115 without GDM) were extracted from a prospective, multicenter, cohort study in China. The associations of total and trimester-specific GWG rates (GWGR) with perinatal outcomes, including small size for gestational age, large size for gestational age (LGA), preterm birth, cesarean delivery, and gestational hypertension disorders, were assessed. The modifying effect of GDM on the association was assessed on both multiplicative and additive scales, as estimated by mixed-effects logistic regression. As a result, total GWGR was associated with all of the perinatal outcomes. GDM modified the association of total GWGR with LGA and cesarean delivery on both scales (all p < 0.05) but did not modify the association with other outcomes. The modifying effect was observed in the third trimester but not in the first or the second trimester. Therefore, maternal GWG is associated with perinatal outcomes, and GDM modifies the association with LGA and cesarean delivery in the third trimester.

Associations between prepregnancy body mass index, gestational weight gain, and pregnancy outcomes in women with twin pregnancies: A five-year prospective study.

The purpose of this project was to investigate the relationship between prepregnancy body mass index (ppBMI), gestational weight gain (GWG), and pregnancy outcomes in women with twin pregnancies. A prospective cohort of 369 women with dichorionic diamniotic twin pregnancies was recruited from 2016 to 2020. According to ppBMI using Chinese BMI classifications, they were categorized into the underweight (BMI < 18.5kg/m2 ), normal (BMI 18.5-23.9kg/m2 ), and overweight and obese (BMI ≥ 24 kg/m2 ) groups. In each ppBMI group, they were divided into two subgroups based on the presence or absence of the complications such as gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and small for gestational age (SGA). The outcomes including GDM, HDP, and SGA were compared among three ppBMI groups, and the associations of GWG with these outcomes within each ppBMI category were analyzed. Twin-pregnant women with overweight and obesity were at increased risks of HDP (aOR=4.417 [95% CI=1.826-9.415]) and SGA (2.288 [1.102-4.751]), whereas underweight women were prone to deliver SGA newborns (2.466 [1.157-5.254]). Women with GDM gained less weight during pregnancy than those without GDM within each ppBMI category. For overweight and obese women, greater GWG increased the incidence of HDP (1.235 [1.016-1.500]) and decreased the risk of SGA (0.818 [0.702-0.953]). Both ppBMI and GWG in twin-pregnant women were strongly associated with HDP and SGA, but not GDM.

Maternal Diet Influences Association of Gestational Weight Gain and Birth Weight Among Undernourished Mothers

Objective: Maternal nutrition intervention improves birth outcomes in undernourished but not in well-nourished populations. Therefore, objective was to examine its role in association of weight gain and pregnancy outcome in undernourished mothers. Design: Prospective study Setting:&nbsp; Obstetrics and Gynaecology out patients department of Rural Hospital Talegaon, Participants: Mothers (n=370) registering within 20 weeks of gestation were studied for socioeconomic variables, diet, anthropometric measurements and were followed up till delivery. Results: Mothers were undernourished with mean weight 45.9±7.3 kg, height150.8±6.1 cm and BMI 20.2±3.1kg/m2.&nbsp; In fact proportion of mothers below LBW risk cur off for weight (38Kg), height (&lt;145 cm) and BMI(18.5 kg/m2 ) was respectively 9.8 %, 8.6 % and 32.8%.&nbsp; Mothers in lower tertile of weight (&lt;42.5 Kg), BMI (&lt;18.5Kg/m2) body fat (&lt;21.8%) had babies with significantly lower birth weights with highest prevalence of LBW. &nbsp;Maternal BMI associated inversely with weight gain but positively with birth weight indicating that foetal growth was not benefitted fully by gained weight in undernourished mothers.&nbsp; Consumption of milk/milk products, fruits, non-vegetarian foods, dal and roti was associated with birth weight but not with weight gain. Comparison of mothers of LBW and normal weight babies within low (18.5 kg/m2) and high (≥21.1kg/m2) BMI groups showed that consumption of milk was discriminatory, indicating importance of proteins and micronutrients in facilitating foetal growth. Conclusion: Consumption of milk facilitated sparing of gained weight for foetal growth among undernourished mothers and promoting it could be a simple public health approach for prevention of LBW in rural India.

A STUDY OF ASSOCIATION OF GESTATIONAL WEIGHT GAIN WITH PERINATAL OUTCOME OF PREGNANCY IN PRIMIGRAVIDA WOMEN DELIVERING SINGLE LIVE BABY

BACKGROUND: Gestational weight gain and the body mass index (BMI) of the woman are two important factors for a good perinatal outcome. Maternal nutrition during pregnancy may also have a lifelong consequence on the baby. AIM:1) To study gestational weight gain in primigravida women delivering a single live baby.2) To study the association of gestational weight gain with morbidity during pregnancy and perinatal outcome in primigravida women delivering a single live baby. MATERIALAND METHODS: 500 patients were included in the study. All primigravida in between 37 to 42 weeks of gestational age were included GWG, BMI and associations with the risks. RESULTS:Women with &lt;18.5, 25- 29.9, &gt;30 BMI had 65.3% of inadequate weight gain, 57.5% of excessive weight gain, 94.9% of excessive weight gain respectively.9.3 %, 3.7% of women with excessive weight gain showed preeclampsia, GDM respectively. 15.9%,17.4% of women with inadequate weight gain had oligohydramnios and BNNW admission respectively. 51% of women with excessive weight gain ended up in caesarean section. CONCLUSION: After analysing all the computed data in the present study, we can conclude that from the beginning of pregnancy, by keeping pre-pregnancy body weight under control and monitoring increase in gestational body weight within prescribed limits, few adverse outcomes of pregnancy can be prevented. CLINICAL SIGNIFICANCE: GWG is usually neglected. But increase or decrease in GWG can convert a normal pregnancy to high-risk pregnancy.