Effect Of Gestational Weight Gain Research Articles

Gestational Weight Gain, Early Pregnancy Maternal Adiposity Distribution, and Maternal Hyperglycemia

To estimate the effects of gestational weight gain (GWG), central adiposity and subcutaneous fat on maternal post-load glucose concentration, pregnant women [n = 413, 62% black, 57% with pregravid body mass index (BMI) ≥25] enrolled in a cohort study at ≤13 weeks gestation. GWG was abstracted from medical records. In a sub-sample of women (n = 214), waist circumference (WC), and biceps and triceps skinfold thicknesses were measured at enrollment. At 24-28 weeks gestation, post-load glucose concentration was measured using a 50-g 1-h oral glucose tolerance test. After adjustment for pre-pregnancy BMI, age, parity, race/ethnicity, smoking, marital status, annual family income, education, family history of diabetes, and gestational age of GDM screening, each 0.3-kg/week increase in weight in the first trimester was associated with a 2.2 (95% CI 0.1, 4.3)-mg/dl increase in glucose concentration. Each 8.6-mm increase in biceps skinfold thickness and each 11.7-mm increase in triceps skinfold thickness was associated with 4.3 (95% CI 0.2, 8.5)-mg/dl increase in maternal glucose, independent of BMI and other confounders. Neither GWG in the second trimester nor WC at ≤13 weeks was significantly associated with glucose concentration after confounder adjustment. Independent of pre-pregnancy BMI, high early pregnancy GWG and maternal subcutaneous body fat may be positively associated with maternal glucose concentrations at 24-28 weeks.

Effects of gestational weight gain on the outcome of labor at the Yaounde central hospital maternity, Cameroon

Obesity rates are increasing in Cameroon. Obstetric literature has recently focused on the rising incidence of complications with increases in weight gain in pregnancy. Some of these complications include gestational diabetes, hypertensive disorders, operative deliveries, genital tract lacerations and fetal birth trauma. Examining the effects of excess weight gain during the course of pregnancy could help identify weight gain limits. The Institute of Medicine (IOM) was recommended by the World Health Organization (WHO) to develop guidelines for weight gain during pregnancy and we designed this study in order to determine delivery outcomes when weight is gained above these guidelines. We also sought to know if these guidelines are applicable in our environment. In this cross-sectional analytic design, pre-pregnancy and intra-partum BMIs were calculated for all the parturients who consented. They were classified into normal weight gain and excessive weight gain based on IOM recommendations. Those in the normal weight gain group were women with BMIs that ranged between 18.5 kg/m2 and 30 kg/m2 and who gained 9 - 16 kgs. Those who gained weight above these range were considered as having gained excessive weight during pregnancy. They were all follow-up in labor using the partogram. We compared prepartum, intra-partum and post-partum outcomes in the two groups by calculating odds ratios (ORs), 95% confidence intervals and p values. One hundred and ten (110) overweight women were matched against the same number of women who had normal weight gain. There was no significant difference between social status, marital status as well as level of educational and weight gain in the two groups. Underweight (BMI p = 0.048). Women who gained weight above the recommended range suffered from preeclampsia 18.2% vs. 6.4% (OR 3.2, 95% CI 1.3 - 8.0, p = 0.014), higher cesarean section rates 27.3% vs. 10% (OR 3.3, 95% CI 1.5 - 7.1, p = 0.002), higher rates of induced labor 19.1% vs. 9.0% (OR 2.4, 95% CI 1.0 - 5.2, p = 0.05), prolonged labor 43.6% vs. 16.4% (OR 4.0, 95% CI 2.1 - 7.4, p = 0.000), postpartum hemorrhage 10% vs. 1.8% (OR 6.2, 95% CI 1.3 - 9.2, p = 0.002). There were also higher rates of fetal mal-presentation, 11.8% vs. 3.6% (OR 4.0, 95% CI 1.31 - 11.9, p = 0.004), macrosomia 30.9% vs. 6.4% (OR 7.0, 95% CI 2.7 - 15.6, p p = 0.0045) and birth trauma 10% vs. 1.8%. (OR 6.2, 95% CI 1.3 - 9.2, p = 0.023). Women who gained weight during pregnancy above the recommended range had increased risk of adverse obstetric and neonatal outcomes.

Gestational Weight Gain as a Predictor of Longitudinal Body Mass Index Transitions Among Socioeconomically Disadvantaged Women

Socioeconomically disadvantaged women are at greater risk for gestational weight gain and postpartum weight retention compared to socioeconomically advantaged women. This study examines the effect of gestational weight gain on body mass index (BMI) transitions 5 years after pregnancy in socioeconomically disadvantaged women. Gestational weight gain was assessed in 2136 postpartum women participating in the Fragile Families and Child Well-being study who experienced full-term, singleton gestations. Longitudinal BMI transitions were defined as a change or stability in BMI category between two time points: BMI before the index pregnancy and BMI 5 years after the index pregnancy. Logistic regression models estimated the association between gestational weight gain and longitudinal BMI transitions, controlling for health before the index pregnancy, pregnancy history, and sociodemographic characteristics. Excessive gestational weight gain was related to transitioning to a higher BMI category 5 years after the index pregnancy. Compared to white women, black and Hispanic women were more likely to transition or maintain a higher BMI category. Pregnancy history (i.e., parity at index pregnancy, interim pregnancy) and public assistance participation were associated with transitioning to a higher BMI category. Among socioeconomically disadvantaged women, excessive gestational weight gain is related to transitioning to, but not maintaining, a higher weight category 5 years after the index pregnancy. Black and Hispanic women who are also socioeconomically disadvantaged and overweight or obese before conception may benefit from preconception or postpartum counseling about the long-term effect of gaining excessive weight during pregnancy and in the years immediately after childbirth.

Gestational Weight Gain and Body Mass Index in Children: Results from Three German Cohort Studies

IntroductionPrevious studies suggested potential priming effects of gestational weight gain (GWG) on offspring’s body composition in later life. However, consistency of these effects in normal weight, overweight and obese mothers is less clear.MethodsWe combined the individual data of three German cohorts and assessed associations of total and excessive GWG (as defined by criteria of the Institute of Medicine) with offspring’s mean body mass index (BMI) standard deviation scores (SDS) and overweight at the age of 5–6 years (total: n = 6,254). Quantile regression was used to examine potentially different effects on different parts of the BMI SDS distribution. All models were adjusted for birth weight, maternal age and maternal smoking during pregnancy and stratified by maternal pre-pregnancy weight status.ResultsIn adjusted models, positive associations of total and excessive GWG with mean BMI SDS and overweight were observed only in children of non- overweight mothers. For example, excessive GWG was associated with a mean increase of 0.08 (95% CI: 0.01, 0.15) units of BMI SDS (0.13 (0.02, 0.24) kg/m2 of ‘real’ BMI) in children of normal-weight mothers. The effects of total and excessive GWG on BMI SDS increased for higher- BMI children of normal-weight mothers.DiscussionIncreased GWG is likely to be associated with overweight in offspring of non-overweight mothers.

144: Second-trimester maternal serum free β-hCG is associated with discordant growth in twin gestations

associated with discordant growth in twin gestations Neeraj Desai, Amanda Roman, Burton Rochelson, Nidhi Vohra, David Krantz, Meir Greenberg Hofstra North Shore-LIJ School of Medicine, Division of Maternal-Fetal Medicine, Manhasset, NY, NTD Labs/PerkinElmer, Genetic Screening, Melville, NY OBJECTIVE: To determine whether second-trimester aneuploidy serum analytes are associated with adverse perinatal outcomes in twin gestations. STUDY DESIGN: Retrospective case control study of patients with twin gestations who underwent second trimester aneuploidy screening, and delivered at our institution between 2004-2010. Pregnancies with known aneuploidy, structural anomalies, pregnancy reductions, and terminations were excluded. Maternal serum alpha-feto protein(AFP), free -hCG, unconjugated estriol, and inhibin were expressed as corrected MoM. Means and extreme values (95%ile) for each analyte were generated from this twin population and the relationship between maternal and fetal outcomes were analyzed, using Fisher’sexact test and Mann-Whitney. RESULTS: There were 200 pregnancies available for review. The mean maternal age was 34 years, and 10.5% were monochorionic twins. Free -hCG 95%ile ( 2.87 MoM) was significantly associated with birth weight discordance 20% (OR 7.36; 95% CI 1.97-27.5) and discordance 20% with at least one SGA newborn (OR 11.6; 95% CI 3.044.6), p 0.01. The mean free -hCG MoM was also significantly higher in patients who developed hypertension (1.6 vs. 1.2; p 0.05). However, the extreme values were not significantly associated with this outcome(table 1). AFP, inhibin, and estriol MoM levels were not associated with any adverse obstetrical outcome in this cohort. CONCLUSION: Free -hCG 95%ile in the second trimester when measured as part of the aneuploidy screen for twins is associated with discordant growth with or without an SGA infant. Free -hCG may provide an early basis to initiate more frequent surveillance of fetal growth in twin gestations. 145 Pre-pregnant body mass index, gestational weight gain and the risk of operative delivery Nils-Halvdan Morken, Per Magnus, Rolv Skjaerven Haukeland University Hospital, Dept Obstet Gynecol, Bergen, Norway, Norwegian Institute of Public Health, Division of Epidemiology, Oslo, Norway, University of Bergen, Dept Community Medicine and Primary Health Care, Bergen, Norway OBJECTIVE: To assess the risk of operative vaginal delivery and Caesarean section in low risk pregnancies according to maternal pre-pregnant body mass index (BMI); underweight ( 18.5), overweight (2529.9), obese I, II and III relative the normal weight (BMI: 18.5-24.9) and to assess de independent effect of gestational weight gain. STUDY DESIGN: Data from the Norwegian Mother and Child cohort during 1999 to 2008 was used and record linkage with the Medical Birth Registry of Norway was performed. Preeclampsia, chronic hypertension, diabetes prior to pregnancy, gestational diabetes and placenta previa were excluded. Singleton pregnancies with cephalic presentation and gestational age 37 weeks were included. Relative risk (RR) was estimated using generalised linear models with extensions to the binary family and adjusting for maternal age, parity and maternal smoking. RESULTS: After exclusions, 58 193 pregnancies with complete data were included in the analyses. Overweight and obese women had an increased risk of Caesarean section with the strongest association among obese women category III (BMI 40) (RR: 4.0, 95%CI: 3.34.9). There was a tendency of an even stronger association when the acute caesareans were analysed alone. The risk of vacuum assisted delivery was also increased for overweight (RR: 1.1, 95%CI: 1.01-1.2), obese II (RR: 1.3, 95%CI: 1.03-1.6) and obese III (RR: 1.5, 95%CI: 1.1-2.2). There was no significant associations for forceps assisted delivery. Women with a gestational weight gain of 16 kg had a significantly increased risk of forceps delivery (RR: 1.2, 95%CI: 1.1-1.4), vacuum delivery (RR: 1.1, 95%CI: 1.08-1.2) and caesarean section (RR: 1.3, 95%CI: 1.26-1.4) independent of maternal pre-pregnant BMI category. CONCLUSION: Obese and overweight women from a low-risk Norwegian cohort have a considerably increased risk of operative delivery with vacuum and caesarean section. All women, independent of maternal pre-pregnant BMI, should be advised not to increase their gestational weight gain above 16 kg to reduce the risk of operative intervention during delivery. Poster Session I Clinical Obstetrics, Medical-Surgical-Disease, Neonatology, Physiology-Endocrinology www.AJOG.org

Associations of Gestational Weight Gain With Maternal Body Mass Index, Waist Circumference, and Blood Pressure Measured 16 Years After Pregnancy: The Avon Longitudinal Study of Parents and Children

ABSTRACTThe long-term effects of gestational weight gain (GWG) on postpartum maternal health outcomes are unclear. Although there is some evidence for an association between GWG and postpartum weight retention, studies have not investigated the possible association between GWG and cardiovascular dis

Effect of gestational weight gain on perinatal outcomes in women with type 2 diabetes mellitus using the 2009 Institute of Medicine guidelines

We sought to examine associations between gestational weight gain according to the 2009 Institute of Medicine (IOM) guidelines and perinatal outcomes in overweight/obese women with type 2 diabetes mellitus (T2DM). This is a retrospective cohort study of 2310 women with T2DM enrolled in the California Diabetes and Pregnancy Program. Gestational weight gain was categorized by 2009 IOM guidelines. Perinatal outcomes were assessed using the χ(2) test and multivariable logistic regression analysis. With excessive gestational weight gain, the odds of having large-for-gestational age (adjusted odds ratio [aOR], 2.00; 95% confidence interval [CI], 1.33-3.00) or macrosomic (aOR, 2.59; 95% CI, 1.56-4.30) neonates and cesarean delivery (aOR, 1.47; 95% CI, 1.03-2.10) was higher. Women with excessive gestational weight gain per week had increased odds of preterm delivery (aOR, 1.57; 95% CI, 1.11-2.20). In overweight or obese women with T2DM, gestational weight gain greater than the revised IOM guidelines was associated with higher odds of perinatal morbidity, suggesting these guidelines are applicable to a diabetic population.

598: Eating for two: the effect of gestational weight gain, maternal BMI, and race on birthweight

598: Eating for two: the effect of gestational weight gain, maternal BMI, and race on birthweight

266: Effect of gestational weight gain on perinatal outcomes in women with type 2 diabetes mellitus using the 2009 Institute of Medicine guidelines

266: Effect of gestational weight gain on perinatal outcomes in women with type 2 diabetes mellitus using the 2009 Institute of Medicine guidelines

Efecto de la ganancia de peso gestacional en la madre y el neonato

To evaluate the effects of gestational weight gain (GWG) on maternal and neonatal outcomes. During 2009, women in the immediate puerperium were assessed at the Gynecology and Obstetrics Hospital in Tijuana, Baja California, Mexico. GWG was considered optimal when < or =18 kg, < or =16 kg, < or =11.5 kg and < or =9 kg for women who, before pregnancy, were underweight, normal weight, overweight and obese, respectively. A total of 38% of women gained more than the recommended weight during pregnancy Women with normal weight previous to pregnancy who exceeded gestational weight-gain recommendations had a risk of oligo/polyhydramnios (OR 2.1, CI 95% 1.04-4.2) and cesarean delivery; overweight women previous to pregnancy had an increased risk of preeclampsia (OR 2.2 CI 95% I.I-4.6) and newborn macrosomia (OR 2.5, CI 95% 1.1-5.6); and obese women had a risk of newborn macrosomía (OR 6.6 IC 95% I.8-23). Pre-pregnancy weight was more greatly associated with gestational diabetes than gestational weight gain. Women whose weight gain during pregnancy is outside of the recommended ranges had an increased risk of adverse obstetric and neonatal outcomes.

Association of Nutrient Intake and Pregnancy Outcome with Gestational Weight Gain

Gestational age and infant birth weight are influenced by gestational weight gain. This study was aimed to examine the effects of gestational weight gain on pregnancy outcomes. Pregnant women were recruited at two hospitals in Seoul area. Characteristics and dietary intakes of pregnant women were ob...

Pregnancy outcome according to gestational weight gain in twin pregnancies on the basis of the 2009 Institute of Medicine (IOM) recommendations

Objective: The aim of this study was to investigate the effect of gestational weight gain on pregnancy outcome in twin pregnancies according to prepregnancy body mass index (BMI), on the basis of 2009 Institute of Medicine (IOM) recommendations. Methods: One hundred ninety-eight twin pregnancy women and their 396 neonates who delivered in Yonsei University Health System from January 1st, 2005 to April 30th, 2010. Maternal height, maternal weight in prepregnancy and gestational weight gain were retrospectively reviewed. Women were grouped into four categories of BMI: underweight (), normal weight (18.5~24.9 kg/), overweight (25~29.9 kg/) and obese (30 kg/). Gestational weight gain was categorized as Less if it was below the IOM's recommended range for the woman's prepregnancy BMI, Within if it was within the range, and More if it was above the range. Results: Underweight with Less or Within maternal weight gain groups were associated with significantly increased odds for small for gestational age (Less, odds ratio [OR] 6.5, confidence interval [CI] 1.75~24.14; Within, OR 3.55, CI 1.37~9.14) and More weight gain with overweight or obesity groups were associated with significantly increased odds for large for gestational age (overweight, OR 6.25, CI 1.14~34.32; obesity, OR 8.33, CI 1.14~47.93). Overweight or obese women and excessive gestational weight gain were associated with significantly increased odds of pregnancy induced hypertension (overweight: OR 7.04, CI 1.04~47.78, obesity: OR 10.56, CI 1.32~84.14) and gestational diabetes mellitus (overweight: OR 13.2, CI 1.78~97.74, obesity: OR 19.8, CI 2.29~171.02). Conclusion: Overweight or obese women with excessive gestational weight gain were associated with significantly increased risk of adverse pregnancy outcome in twin pregnancies. Therefore, physician should pay attention not only to prepregnancy BMI but also to maternal weight gain. A large prospective study is necessary to confirm the relationships between gestational weight gain and pregnancy outcome in twin pregnancies.

The Effect of Gestational Weight Gain by Body Mass Index on Maternal and Neonatal Outcomes

Maureen Heaman is Professor and Canadian Institutes of Health Research Chair in Gender and Health, Faculty of Nursing, Helen Glass Centre for Nursing, University of Manitoba, Winnipeg, Manitoba, Canada, and an editorial board member of MCN. She can be reached via e-mail at [email protected]

The impact of past pregnancy experience on subsequent perinatal outcomes

In perinatal epidemiology, the basic unit of analysis has traditionally been the individual pregnancy. In this study, we sought to explore the idea of a 'reproductive life'-based approach to modelling the effects of reproductive exposures and outcomes, where the basic unit of analysis is a woman's entire reproductive experience. Our objective was to explore whether a first pregnancy risk factor, excess gestational weight gain, has a direct effect on the birthweight outcomes of a subsequent pregnancy, independent of the weight gain and other risk factors of the second pregnancy. A study population was created by linking the obstetric records of 1220 women who delivered their first and second offspring at a McGill University teaching hospital in Montreal, Canada. Multivariable linear and logistic regression analyses were used to model the effects of gestational weight gain above recommendation on the birthweight Z-score and risk of large-for-gestational age (LGA) subsequent offspring. After adjusting for the risk factors of the second pregnancy, an independent effect from the first pregnancy was seen on the birthweight Z-score, (effect size OR 0.17 [95% CI 0.05, 0.28] but not risk of LGA of the second pregnancy 1.30 [95% CI 0.89, 1.89]). We concluded that a pregnancy-centred approach to research that conceptualizes pregnancies as self-contained and interchangeable events may not always be appropriate, and propose that analytical methods for some perinatal research questions may need to consider a given pregnancy in the context of a woman's past reproductive experiences.

276: The effects of gestational weight gain by body mass index on obstetric and neonatal outcomes

AND NEONATAL OUTCOMES JOAN CRANE, JOANNE WHITE, DONNA HUTCHENS, LORRAINE BURRAGE, PHILLIP MURPHY, Memorial University, Eastern Health, St. John’s, Newfoundland, Canada, Eastern Health, Provincial Perinatal Program, St. John’s, Newfoundland, Canada OBJECTIVE: To evaluate the effects of gestational weight gain, in different body mass index(BMI) classes, on obstetric and neonatal outcomes. STUDY DESIGN: A population-based cohort study using the Newfoundland and Labrador Perinatal Database April 2001-April 2007 (5377 women) compared obstetric and neonatal outcomes, based on gestational weight gain (Health Canada guidelines), in underweight, normal weight, overweight, obese and morbidly obese (BMI 40.00) women. Univariate and multivariate logistic regression analyses controlling for maternal age, parity, smoking, partnered status and gestational age were performed, and ORs and 95% CIs were calculated. RESULTS: Only 30.6% women gained the recommended amount of weight, with 52.3% gaining more than recommended(excess weight gain) and 17.1% less than recommended(poor weight gain). In women with normal BMI, excess weight gain was associated with increased risks of gestational hypertension(1.27,95%CI1.08-1.49), augmentation of labour(1.09,95%CI1.011.18), length of stay 5days(2.49,95%CI1.19-5.23), neonatal metabolic problems(1.32,95%CI0.99-1.76) and birthweight(BW) 4.0kg(1.21,95%CI 1.101.34). In overweight women, excess weight gain was associated with increased rates of gestational hypertension(1.31,95%CI1.10-1.55), induction(1.11,95%CI1.001.23) and BW 4.0kg(1.86, 95%CI1.02-3.40). In obese and morbidly obese women combined, excess weight gain was associated with increased rates of Cesarean delivery(1.00,95%CI1.00-1.20), BW 4kg(1.20,95%CI1.07-1.34) and neonatal metabolic problems(1.31,95%CI1.00-1.70). In morbidly obese women, poor weight gain was associated with lower rates of induction(0.44,95%CI0.19-1.01) and epidural use(0.34,95%CI 0.12-0.95). In overweight, obese and morbidly obese women combined, as well as in normal and overweight women, poor weight gain was associated with BW 2.5kg. CONCLUSION: The effects of gestational weight gain depend on the woman’s BMI. A weight gain of 15-25lb appears appropriate for obese and morbidly obese women, in order to minimize the risk of Cesarean delivery and optimize neonatal outcomes.

Effects of Gestational Weight Gain and Physical Activity on Postpregnancy Weight Gain and Body Composition

Retaining weight gained during pregnancy is a risk factor for a woman becoming overweight, obese, and/or increasing body fatness later in life. Pregnancy weight gain has been found to be directly related to weight retention several years following delivery. However, less is known about whether physical activity may affect postpartum weight retention or maternal body composition. PURPOSE: The purpose of this study was to examine the relationship of pregnancy weight gain, postpartum and current physical activity, to maternal body weight change over the past six years, and current body fatness. METHODS: Daily leisure time physical activity was quantified in 56 women (31 were available for this follow-up study) at 20 and 32 weeks gestation and 12 weeks postpartum. Weight gain during pregnancy was calculated by subtracting women's self-reported prepregnancy weight from body weight measured in our laboratory at approximately 32 weeks gestation. Bioelectrical Impedance Analysis was used to assess current fat free mass. Percent body fat was calculated using fat free mass and measured weight. A Modifiable Activity Questionnaire was used to assess 12 week postpartum and current physical activity levels in kcal/day/kg. Stepwise regression was used to predict weight change and current % body fat using pregnancy weight gain, physical activity at 12 weeks postpartum, and current physical activity levels as predictor variables. RESULTS: On average, the women's body weights increased 2.8 (±5.1) kg in the six years following pregnancy, with current fatness levels averaging 32±9 %. Change in body weight in the past six years was related most strongly to weight gain during pregnancy (r2=0.20), with current physical activity adding to the prediction model (final r2=0.27). In contrast, current % body fat was most strongly predicted by postpartum physical activity (r2=0.20), although pregnancy weight gain accounted for 14% additional variance (final r2=0.34) in fatness. CONCLUSIONS: Although weight gained during pregnancy was found to be more influential on long term body weight change compared to exercise performed after delivery, initiating a program of regular physical activity during the postpartum period appears to have a greater effect on body composition.

Treatment With Selective Serotonin Reuptake Inhibitors During Pregnancy: Deceleration of Weight Gain Because of Depression or Drug?

Treatment With Selective Serotonin Reuptake Inhibitors During Pregnancy: Deceleration of Weight Gain Because of Depression or Drug?

Effects of gestational weight gain and body mass index on obstetric outcome in Sweden

Objective The objective of this study was to estimate the effects of low and high gestational weight gain, in different maternal Body Mass Index (BMI) classes, on obstetric and neonatal outcomes. Method A prospective population-based cohort study of 245,526 singleton term pregnancies. Women were grouped in five categories of BMI and in three gestational weight gain categories; < 8 kg (low weight gain), 8–16 kg and > 16 kg (high weight gain). Obstetric and neonatal outcomes were evaluated after adjustments for maternal age, parity, smoking, year of birth. Result Obese women with low gestational weight gain had a decreased risk for the following outcomes (adjusted odds ratio; 95% confidence interval): preeclampsia (0.52; 0.42–0.62), cesarean section (0.81; 0.73–0.90), instrumental delivery (0.75; 0.63–0.88), and LGA births (0.66; 0.59–0.75). There was a 2-fold increased risk for preeclampsia and LGA infants among average and overweight women with excessive weight gain. High gestational weight gain increased the risk for cesarean delivery in all maternal BMI classes. Conclusion The effects of high or low gestational weight gain differ depending on maternal BMI and the outcome variable studied. Obese women may benefit from a low weight gain during pregnancy.

Gestational weight gain and pregnancy outcomes in obese and morbidly obese women: How much is enough?

The effect of gestational weight gain on pregnancy outcomes in obese women is not well studied. Given the tendency for postpartum weight retention and the implication of pregnancy in the development of obesity later in life, further study is required to determine appropriate gestational weight gain ranges for obese women. The purpose of this study was to examine the effects of reduced weight gain on pregnancy outcomes in obese and morbidly obese women.

Gestational Weight Gain and Pregnancy Outcomes in 481 Obese Glucose-Tolerant Women

To investigate the effect of gestational weight gain in obese glucose-tolerant women. We performed a historical cohort study of 481 women with prepregnancy BMI > or = 30 kg/m2 and a normal 2-h 75-g oral glucose tolerance test (OGTT) during the third trimester (according to World Health Organization criteria). Data on OGTT results and clinical outcomes were collected from medical records. Four groups were defined according to weight gain: group 1, <5.0 kg (n = 93); group 2, 5.0-9.9 kg (n = 134); group 3, 10.0-14.9 kg (n = 132); and group 4, > or = 15.0 kg (n = 122). Birth weight increased significantly with increasing weight gain (mean grams +/- SD): group 1, 3,456 +/- 620; group 2, 3,624 +/- 675; group 3, 3,757 +/- 582; and group 4, 3,784 +/- 597 (P < 0.001). The birth weight in group 1 was similar to that of the background population of primarily normal-weight women (3,478 g). In multivariate analyses, increasing weight gain was associated with significantly higher rates of hypertension (OR 4.8 [95% CI for group 4 vs. group 1: 1.7-13.1]), cesarean section (3.5 [1.6-7.8]), induction of labor (3.7 [1.7-8.0]), and large-for-gestational-age infants (4.7 [2.0-11.0]). There was no difference in rates of small-for-gestational-age infants. Significant predictors for birth weight (determined by multiple linear regression) were gestational weight gain, 2-h OGTT result, pre-gestational BMI, maternal age, gestational age, and smoking. Increasing weight gain in obese women is associated with increasing pregnancy complications. Our data suggest that minimal gestational weight gain might normalize birth weight. Prospective studies should be performed to clarify the safety of recommending limited gestational weight gain.