Optimal Gestational Weight Gain Research Articles

Optimal gestational weight gain: prepregnancy BMI specific influences on adverse pregnancy and infant health outcomes.

BACKGROUNDThe Institute of Medicine (IOM) 2009 gestational weight gain (GWG) guidelines are based on prepregnancy body mass index (BMI) categories. We intended to refine optimal GWG for each prepregnancy BMI unit in relation to the risk of small- and large-for-gestational-age (SGA and LGA) births, cesarean section (C-section), and infant death.METHODSWe used data from 836,841 Ohio birth records from 2006 to 2012, and applied generalized additive models to calculate optimal GWG by prepregnancy BMI unit.RESULTSThe suggested optimal GWG was generally similar to IOM 2009 GWG guidelines for prepregnancy BMIs <25 kg/m2, but higher for prepregnancy BMIs 25–32 kg/m2 and lower for BMIs 38–50 kg/m2. The suggested optimal GWG was 14–18.5, 13–17, 11.5–16, 8.5–12.5, 4–10, 3–7, 1.5–6, and 1.5–4.5 kg for prepregnancy BMIs 15, 20, 25, 30, 35, 40, 45, and 50 kg/m2, respectively.CONCLUSIONThis research suggests that GWG recommendations may be refined at individual prepregnancy BMI levels.

Gestational Weight Gain in Japanese Women With Favorable Perinatal Outcomes.

BackgroundWe examined the optimal gestational weight gain (GWG) in the healthy Japanese women with favorable perinatal outcomes of singleton pregnancy.MethodsWe calculated the average GWG in the women whose height was 150 - 164 cm with favorable perinatal outcomes set for this study. The women were categorized to underweight, normal, overweight and obese based on the pre-pregnancy body mass index categories according to the Institute of Medicine guideline.ResultsThe average GWG in the normal-weight women with the favorable perinatal outcomes was 11.4 ± 3.7 kg. It was not significantly different from that in the underweight and overweight women (12.0 ± 3.4 and 10.0 ± 4.8 kg) by Student’s t-test. The average GWG in the obese women was significantly lower than that in the other three groups (3.2 ± 2.2 kg, P < 0.01).ConclusionBased on the current results, the optimal GWG for the Japanese women without obesity was found to be 10 - 12 kg.

Calculation of optimal gestation weight gain in pre-pregnancy underweight women due to body mass index change in relation to mother's height.

Optimal gestational weight gain has not yet been clearly defined and remains one of the most controversial issues in modern perinatology. The role of optimal weight gain during pregnancy is critical, as it has a strong effect on perinatal outcomes. In this study, gestational body mass index (BMI) change, accounting for maternal height, was investigated as a new criterion for gestational weight gain determination, in the context of fetal growth assessment. We had focused on underweight women only, and aimed to assess whether the Institute of Medicine (IOM) guidelines could be considered acceptable or additional corrections are required in this subgroup of women. The study included 1205 pre-pregnancy underweight mothers and their neonates. Only mothers with singleton term pregnancies (37th-42nd week of gestation) with pre-gestational BMI<18.5kg/m2 were enrolled. The share of small for gestational age (SGA) infants in the study population was 16.2%. Our results showed the minimal recommended gestational weight gain of 12-14kg and BMI change of 4-5kg/m2 to be associated with a lower prevalence of SGA newborns. Based on our results, the recommended upper limit of gestational mass change could definitely be substantially higher. Optimal weight gain in underweight women could be estimated in the very beginning of pregnancy as recommended BMI change, but recalculated in kilograms according to body height, which modulates the numerical calculation of BMI. Our proposal presents a further step forward towards individualized approach for each pregnant woman.

Excess Gestational Weight Gain in Pregnancy and the Role of Lifestyle Intervention.

With increasingly adverse lifestyles, young women in many countries have rapid weight gain and rising obesity. In keeping with this, most pregnant women exceed recommended gestational weight gain (GWG) and then retain weight postpartum. The consequences of excess GWG include maternal risks during pregnancy, neonatal risks and maternal obesity and chronic disease longer term, presenting a significant public health and economic burden worldwide. This article discusses the adverse maternal and infant risks with excess GWG apparent from observational studies, summarizes the existing guidelines for optimal GWG and highlights the need for further research to identify optimal GWG recommendations across the different ethnicities and weight ranges.We also review the evidence for lifestyle interventions in pregnancy to prevent excess GWG and highlighting the work underway to integrate large scale meta-analyses of individual patient data from lifestyle intervention studies to inform clinical practice beyond current observational data. Finally, we address the need to implement lifestyle interventions into routine pregnancy care to improve short and long term maternal health outcomes.

Gestational Weight Gain and Perinatal Outcomes in Adolescent Mothers: A Retrospective Cohort Study.

Optimal gestational weight gain (GWG) may differ for adolescents since they themselves may continue to grow throughout pregnancy. We examined the associations between GWG and perinatal outcomes among adolescents aged < 20 years and determined whether they differed from the associations among adult women aged 20 to 35 years. We conducted a retrospective cohort study of live born, singleton deliveries to 3725 adolescents and 50 400 adult women in Nova Scotia between 2003 and 2014. GWG was categorized as below, within, or above the 2009 Institute of Medicine recommendations. Primary outcomes were preterm birth (< 37 weeks), small for gestational age (SGA; < 10(th) percentile), large for gestational age (LGA; > 90th percentile), and delivery by Caesarean section. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were estimated from logistic regression models. Adolescent mothers with GWG above the recommendations (relative to mothers who gained within the recommendations) had higher odds of having an LGA neonate (OR 2.20; 95% CI 1.62 to 2.99) and having a Caesarean section (OR 1.33; 95% CI 1.07 to 1.64), but lower odds of having an SGA neonate (OR 0.65; 95% CI 0.51 to 0.84). Adolescent mothers with low GWG had decreased odds of having an LGA neonate (OR 0.58; 95% CI 0.34 to 0.98) andincreased odds of having an SGA neonate (OR 1.72; 95% CI 1.30 to 2.27). Among adolescents, GWG was significantly associated with several perinatal outcomes. More research considering other outcomes is needed to determine the optimal GWG for adolescent women.

Gestational weight gain standards based on women enrolled in the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: a prospective longitudinal cohort study

Objective To describe patterns in maternal gestational weight gain (GWG) in healthy pregnancies with good maternal and perinatal outcomes.Design Prospective longitudinal observational study.Setting Eight geographically diverse urban regions in Brazil,...

Certified Nurse-Midwives’ Experiences with Gestational Weight Management

Excessive gestational weight gain is associated with fetal metabolic reprogramming and subsequent childhood obesity, as well as maternal recalcitrant obesity and its successive morbidities. We conducted a review of the literature and an explorative, descriptive study of the techniques and strategies used by a subset of certified nurse-midwives to help women achieve optimal gestational weight gain. We also identified barriers to this outcome. With more effective management approaches to gestational weight gain, adverse maternal and neonatal health outcomes could potentially be prevented. http://dx.doi.org/10.1016/j.nwh.2015.12.007

Towards Defining Optimal Gestational Weight Gain

In 2009, the Institute of Medicine (IOM) Committee to Reexamine Pregnancy Weight Gain Guidelines published updated recommendations on the rate and amount of weight that women should gain during pregnancy. These recommendations were based on a large body of primarily observational literature reporting ranges of total pregnancy weight gain associated with lowest risks of a number of adverse maternal and newborn health outcomes. However, the IOM committee identified many gaps in the evidence to support guidelines for optimal amount and pattern of gain. In this article, the authors outline how recent insights on the role of early pregnancy weight gain, patterns of weight gain, emerging evidence from randomized trials of weight gain interventions, and accounting for the relative importance that women and care-providers place on different maternal and child health outcomes may advance our understanding of optimal pregnancy weight gain and inform the creation of improved pregnancy weight gain guidelines.

Australian Pregnant Women's Awareness of Gestational Weight Gain and Dietary Guidelines: Opportunity for Action.

Background. Excessive gestational weight gain (GWG) can negatively impact on maternal and foetal health. Guidelines based on Institute of Medicine (IOM) encourage managing GWG by following healthy eating recommendations and increasing physical activity. This study investigated pregnant women's knowledge of their optimal GWG and recommended dietary approaches for GWG management. Method. English-speaking pregnant women were recruited from five hospitals in New South Wales (Australia) and an online link. Prepregnancy Body Mass Index (BMI) was calculated from self-reported height and prepregnancy weight. Participants identified their recommended GWG. A survey assessed practical dietary knowledge and asked about broad dietary recommendations to prevent excessive GWG. Chi square and logistic regression analyses were used. Results. N = 326 pregnant women completed the surveys; 49% entered pregnancy overweight (25.2%) or obese (23.6%); and knowledge of recommended GWG was lacking. Prepregnancy BMI was a significant predictor of GWG recommendation knowledge (P < 0.000). Pregnant women were highly knowledgeable about broad dietary recommendations but had poor knowledge of detailed recommendations. Conclusions. Limited knowledge of IOM's GWG guidelines and of specific dietary recommendations for pregnancy should be addressed by health care providers and education initiatives to assist the high number of women who enter pregnancy overweight or obese.

Influence of Gestational Weight Gain and Body Mass Index on Cesarean Delivery Risk in Adolescent Pregnancies [6

OBJECTIVE: Obesity and excessive gestational weight gain increase cesarean delivery risk; their influence in teen pregnancies is less clear. We describe the influence of gestational weight gain and body mass index (BMI, calculated as weight (kg)/[height (m)]2) on cesarean delivery risk in adolescent compared with adult pregnancies. METHODS: This was a population-based cohort study of Ohio births (2006–2012) (N=1,034,552). Analyses were limited to 309,935 singleton live births in term (37–42 weeks of gestation) primiparous women. Multivariate logistic regression estimated an association among BMI, gestational weight gain, and cesarean delivery risk in teens compared with adults (20–34 years), adjusting for breech presentation and labor induction. RESULTS: Primary cesarean delivery rate for primiparous women was 27%. It was lower for adolescents (18% younger than 15 years, 18% 15–17 years, 21% 18–19 years) compared with adults (29%, P<.001). Cesarean delivery increased with excessive (31%) compared with Institute of Medicine–recommended gestational weight gain (22%) and overweight (31%), obesity (41%) compared with normal BMI (22%, P<.001). Lowest primary cesarean delivery rate (12.9%) observed in normal-weight teens younger than 18 years was with appropriate gestational weight gain (adjusted odds ratio [OR] 0.58, 95% confidence interval [CI] 0.52–0.64). Compared with adults, teens have 47% lower primary cesarean delivery risk (adjusted OR 0.53, 95% CI 0.48–0.58). Excessive gestational weight gain increased risk in adults by 50% (adjusted OR 1.49, 95% CI 1.45–1.52). Excessive gestational weight gain increased primary cesarean delivery in the highest risk groups, obese adults (adjusted OR 1.2, 1.2–1.3) and teens younger than 18 years old (adjusted OR 1.74, 95% CI 1.58–1.93). CONCLUSION: Excessive gestational weight gain increases cesarean delivery risk. Young maternal age was protective of this effect. However, excessive gestational weight gain increased cesarean delivery risk in both teen and adult mothers. Efforts should target education on optimal gestational weight gain in attempt to reduce the primary cesarean delivery rate, especially those at highest risk, obese women of all ages.

Effect of a Behavioral Intervention with Cereal Fiber or Resistant Starch on Gestational Weight Gain: A Randomized Clinical Trial

Optimal gestational weight gain is a critical determinant of both fetal health and pregnancy outcomes. A randomized behavioral intervention with recommendations to consume a high fiber diet was con...

Association Between Obstetric Provider's Advice and Gestational Weight Gain in a Diverse Sample of Women

BackgroundOptimal gestational weight gain (GWG) reduces the risk of adverse pregnancy outcomes. Thus, the Institute of Medicine provides recommendations for GWG. However, the frequency in which obstetric providers deliver GWG advice to their patients is unclear. Moreover, little is known about the degree to which women follow such advice.ObjectiveTo examine the frequency of subjects' self‐reported GWG advice received from providers and self‐reported adherence to such advice.Methods: Healthy pregnant women (N=94) enrolled in care &lt;17 weeks gestation completed assessments that included survey (demographics, questions on receipt of, agreement with and adherence to provider GWG advice) and anthropometric measures. GWG data were abstracted from medical records. Analyses included chi‐square and t‐tests, and binary and multivariate logistic regressions.Results: The cohort age was 28 (+5.1) years; 67% White, 28% Hispanic, 51% overweight pre‐pregnancy, and 64% with above‐guideline GWG. 71% reported receiving GWG advice from their obstetric providers. Controlling for gestational age and pre‐pregnancy BMI, receiving GWG advice was associated with increased risk of excessive weight gain (OR=3.216, CI: 1.098, 9.419). However, those that reported following the advice, gained on average 13.4 pounds less than those that did not and had lower odds of excessive weight gain (OR=0.144, CI: 0.033, 0.624).ConclusionRecollection of provider GWG advice is less than optimal. Advice was associated with greater GWG. Findings show favorable outcomes among women who reported following their providers' advice. Strategies that promote obstetric providers' delivery of GWG advice and pregnant women's adherence to the GWG advice received are needed.

The association between gestational weight gain and substantial weight retention 1-year postpartum.

Postpartum weight retention contributes to obesity development of women in their reproductive age. The studies about the association between gestational weight gain (GWG) and substantial weight retention are lacking. This study examined the association between GWG and substantial postpartum weight retention (SPPWR). The participants (n=1,122) in the study were healthy, mature and fed their infants whose ages were 3, 6, 9, 12months (2010-2012), respectively. They self-reported their socio-demographic, clinical prenatal and behaviors characteristics via questionnaires. We collected their weight data including pre-pregnancy and prior to delivery, as well as weight at 3, 6, 9, and 12months postpartum. The major outcomes included weight retention and substantial weight gain 1year postpartum. Of the 1,122 women, the median weight retention was 3.0 (IQR=5.5) kg 12months postpartum. 35.7% of them reported substantial weight retention (≥4.55kg). GWG categories were established as follows: inadequate weight gain (n=366, 33%), adequate weight gain (n=596, 53%), and excessive weight gain (n=160, 14%). Adjusted odds ratios of SPPWR were 0.59 (95% CI 0.43, 0.81) for inadequate weight gain and 4.05 (95% CI 2.75, 5.95) for excessive weight gain versus adequate weight gain (P<0.001). Excessive GWG would increase the risk of substantial weight retention 1-year postpartum. The interventions to prevent postpartum obesity should consider the strategies how to attain optimal maternal GWG.

Development of a New Nordic Diet score and its association with gestational weight gain and fetal growth - a study performed in the Norwegian Mother and Child Cohort Study (MoBa).

To construct a diet score for assessing degree of adherence to a healthy and environmentally friendly New Nordic Diet (NND) and to investigate its association with adequacy of gestational weight gain and fetal growth in a large prospective birth cohort. Main exposure was NND adherence, categorized as low, medium or high adherence. Main outcomes were adequacy of gestational weight gain, described as inadequate, optimal or excessive according to the 2009 Institute of Medicine guidelines, and fetal growth, categorized as being small, appropriate or large for gestational age. Associations of NND adherence with gestational weight gain and fetal growth were estimated with multinomial logistic regression in crude and adjusted models. Norway. Women (n 66 597) from the Norwegian Mother and Child Cohort Study (MoBa). Higher NND adherence implied higher energy and nutrient intakes, higher nutrient density and a healthier macronutrient distribution. Normal-weight women with high as compared with low NND adherence had lower adjusted odds of excessive gestational weight gain (OR=0·93; 95 % CI 0·87, 0·99; P=0·024). High as compared with low NND adherence was associated with reduced odds of the infant being born small for gestational age (OR=0·92; 95 % CI 0·86, 0·99; P=0·025) and with higher odds of the baby being born large for gestational age (OR=1·07; 95 % CI 1·00, 1·15; P=0·048). The NND score captures diet quality. Adherence to a regional diet including a large representation of fruits and vegetables, whole grains, potatoes, fish, game, milk and drinking water during pregnancy may facilitate optimal gestational weight gain in normal-weight women and improve fetal growth in general.

Determining optimal gestational weight gain in a multiethnic Asian population

To define the optimal gestational weight gain (GWG) for the multiethnic Singaporean population. Data from 1529 live singleton deliveries was analyzed. A multinomial logistic regression analysis, with GWG as the predictor, was conducted to determine the lowest aggregated risk of a composite perinatal outcome, stratified by Asia-specific body mass index (BMI) categories. The composite perinatal outcome, based on a combination of delivery type (cesarean section [CS], vaginal delivery [VD]) and size for gestational age (small [SGA], appropriate [AGA], large [LGA]), had six categories: (i) VD with LGA; (ii) VD with SGA; (iii) CS with AGA; (iv) CS with SGA; (v) CS with LGA; (vi) and VD with AGA. The last was considered as the 'normal' reference category. In each BMI category, the GWG value corresponding to the lowest aggregated risk was defined as the optimal GWG, and the GWG values at which the aggregated risk did not exceed a 5% increase from the lowest aggregated risk were defined as the margins of the optimal GWG range. The optimal GWG by pre-pregnancy BMI category, was 19.5 kg (range, 12.9 to 23.9) for underweight, 13.7 kg (7.7 to 18.8) for normal weight, 7.9 kg (2.6 to 14.0) for overweight and 1.8 kg (-5.0 to 7.0) for obese. The results of this study, the first to determine optimal GWG in the multiethnic Singaporean population, concur with the Institute of Medicine (IOM) guidelines in that GWG among Asian women who are heavier prior to pregnancy, especially those who are obese, should be lower. However, the optimal GWG for underweight and obese women was outside the IOM recommended range.

Gestational Weight Gain and Postpartum Weight Retention in a Cohort of Nova Scotian Women

Excess gestational weight gain (GWG) may predispose mothers to becoming overweight or obese. The aim of this study was to investigate the association between GWG, according to the American Institute of Medicine (IOM) guidelines, and postpartum weight retention (PPWR). A cohort of 12,875 women from Nova Scotia, Canada with at least two consecutively recorded pregnancies was identified through a population-based perinatal database between 1993 and 2010. GWG was calculated as the difference between delivery and prepregnancy weights. PPWR, analyzed as a continuous variable in linear regression models, was calculated via interpregnancy weight change. Fifty eight percent of the total study population gained in excess of the IOM guidelines. Mean PPWR, adjusted for age and prepregnancy body mass index (BMI) among women with excess GWG was 5.0 kg (95 % CI 4.9-5.2), greater than women with adequate (2.1 kg, 95 % CI 1.8-2.3) or inadequate GWG (0.3 kg, 95 % CI 0-0.7). Effect modification by prepregnancy BMI was observed; the relationship between excess GWG and increased PPWR was observed in all prepregnancy BMI categories, yet was greatest among underweight women (7.5 kg, 95 % CI 6.6-8.3). Effect modification by parity was also observed; in contrast to multiparous women, primiparous women who gained in excess of GWG guidelines retained more postpartum weight (5.3 kg, 95 % CI 5.1-5.5 vs. 4.3 kg, 95 % CI 4.0-4.7). This study demonstrates that excess GWG is associated with an increase in the amount of weight retained after pregnancy. Interventions targeted to promote optimal GWG are warranted.

Relation between gestational weight gain and pregnancy outcomes

The aim of this study was to evaluate the effects of gestational weight gain on pregnancy outcomes in pregnant Thai women with different pre-pregnancy body mass indexes (BMI). A retrospective study was carried out by reviewing 5200 medical records of pregnant women who delivered at the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital during 1 September 2011-1 August 2012. Inclusion criteria were singleton pregnancy with available pre-pregnant weight and maternal height. Pre-pregnancy BMI were categorized according to World Health Organization criteria. Pregnancy outcomes of interest were appropriate-for-gestational-age infants. The optimal gestational weight gain for each BMI group was proposed to achieve a high proportion of appropriate-for-gestational age infants. Patients were divided into four groups according to their pre-pregnancy BMI: underweight (21.3%), normal weight (64.1%), overweight (11.5%), and obese (3.1%). Optimal gestational weight gain ranges for each group were 10-18, 8-16, 6-14 and 4-8 kg, respectively. Our proposed criteria seem to be realistic, with 60% of pregnant Thai women able to adhere to the recommendation, compared to 40.5% adherence to the 2009 Institute of Medicine recommendation. There were no significant complications when following either of the recommendations. Adverse pregnancy outcomes, including large for gestational age, cesarean section, and severe pre-eclampsia, were significantly decreased in women who complied with our recommendation. To achieve a high proportion of appropriate-for-gestational-age infants, Thai pregnant women could follow our gestational weight gain recommendation.

Associations of maternal pre‐pregnancy underweight with small‐for‐gestational‐age and spontaneous preterm birth, and optimal gestational weight gain in Japanese women

To determine associations of maternal pre-pregnancy underweight with poor outcomes and evaluate how gestational weight gain affects risks for such outcomes in pre-pregnancy underweight Japanese women. By analyzing the January 2001-December 2012 hospital database, we retrospectively identified 6954 women with pre-pregnancy normal weights (body mass index, 18.5-24.9 kg/m²) and 1057 pre-pregnancy underweight women (body mass index, <18.5 kg/m²) who delivered at the Perinatal Maternity and Neonatal Center of Yokohama City University. These women were stratified by weekly weight gain during the second/third trimesters to investigate associations of gestational weight gain with spontaneous preterm birth and small for gestational age (SGA). Spontaneous preterm birth and SGA incidences were compared with those of women meeting Institute of Medicine (IO M) guidelines to determine optimal weight gain in Japanese women. Preterm birth and SGA incidences were significantly higher in pre-pregnancy underweight than in pre-pregnancy normal weight women (4.6% vs 2.4% [P=0.005] and 13.9% vs 9.7% [P = 0.003], respectively). For pre-pregnancy normal weight women, preterm birth incidence was significantly higher in those with weight gain of less than 0.2 kg/week than in those IOM guidelines. For pre-pregnancy underweight women, preterm birth and SGA incidences were significantly higher in those with weight gain of less than 0.3 kg/week than in those meeting IOM guidelines. Preterm birth and SGA incidences did not differ significantly between pre-pregnancy normal weight women with weight gain of 0.2 kg/week or more and pre-pregnancy underweight women with weight gain of 0.3 kg/week or more, as compared to women meeting IOM guidelines. These results suggest that IOM guidelines for gestational weight gain may lack external validity in Japanese women.

Relationship between gestational weight gain and birthweight among clients enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Hawaii, 2003-2005.

To investigate the relationship between gestational weight gain (GWG) and birthweight outcomes among a low-income population in Hawaii using GWG recommendations from the 2009 Institute of Medicine (IOM) guidelines. Data were analyzed for 19,130 mother-infant pairs who participated in Hawaii's Special Supplemental Nutrition Program for Women, Infants, and Children from 2003 through 2005. GWG was categorized as inadequate, adequate, or excessive on the basis of GWG charts in the guidelines. Generalized logit models assessed the relationship between mothers' GWG and their child's birthweight category (low birthweight [LBW: < 2,500 g], normal birthweight [2,500 g ≤ BW < 4,000 g], or high birthweight [HBW: ≥ 4,000 g]). Final models were stratified by prepregnancy body mass index (underweight, normal weight, overweight, or obese) and adjusted for maternal age, education, race/ethnicity, smoking status, parity, and marital status. Overall, 62% of the sample had excessive weight gain and 15% had inadequate weight gain. Women with excessive weight gain were more likely to deliver a HBW infant; this relationship was observed for women in all prepregnancy weight categories. Among women with underweight or normal weight prior to pregnancy, those with inadequate weight gain during pregnancy were more likely to deliver a LBW infant. Among the low-income population of Hawaii, women with GWG within the range recommended in the 2009 IOM guidelines had better birthweight outcomes than those with GWG outside the recommended range. Further study is needed to identify optimal GWG goals for women with an obese BMI prior to pregnancy.

Associations of Maternal Weight Gain in Pregnancy With Offspring Cognition in Childhood and Adolescence

Nutrition in utero and during early infancy is critical for normal development and cognition. It is still unclear whether less drastic undernutrition that affects gestational weight gain (GWG), but does not necessarily cause weight loss, is related to offspring long-term cognition. This study was designed to examine the association of GWG with a child’s School Entry Assessment (SEA) scores at age 4 years, IQ at age 8 years, and school final examination results at age 16 years. The Avon Longitudinal Study of Parents and Children is a prospective, population-based birth cohort study that recruited 14,541 pregnant women with expected delivery dates between April 1991 and December 1992. Analyses included only women with complete GWG data (n = 12,484) and with term deliveries (n = 12,449). Maternal GWG was determined as a measure of “less than recommended,” “as recommended,” and “more than recommended,” based on the 2009 Institute of Medicine recommendations, in which the recommended weight gain varies depending on prepregnancy body mass index. Pregnancy weight measurements were used to develop a linear spline multilevel model relating weight to gestational age. This model was then used to predict each woman’s weight at 0 weeks’ gestation (prepregnancy weight) and GWG/wk from 0 to 18, 18 to 28, and 28 weeks to delivery. Outcomes included SEA scores at age 4 years, cognitive function at age 8 years using the Wechsler Intelligence Scale for Children from which IQs are derived, and results of General Certificate of Secondary Education examinations at age 16 years. Multivariable logistic and linear regression models were created, with model 1 adjusted for gestational age, maternal age, age at outcome assessment, and sex. Model 2, the main model, was adjusted for the confounders in model 1 and prepregnancy body mass index, maternal smoking during pregnancy, parity, mode of delivery, and maternal education. Interactions between being overweight/obese before pregnancy and GWG and their association with outcomes were also assessed. Compared with women who gained as recommended (reference group), those who gained less than recommended were slightly older (28.7 ± 4.7 vs 29.0 ± 4.9 years) and more likely to smoke, be from a manual social class, be multiparous, and have babies with a lower mean birth weight (3511.4 ± 445.2 vs 3333.4 ± 445.4 g). Compared with the reference group, those who gained more than recommended were slightly younger (28.7 ± 4.7 vs 27.9 ± 4.6 years), were less likely to smoke, were less educated, and were more likely to be nulliparous, have a cesarean delivery, and have heavier offspring (3511.4 ± 445.2 vs 3639.6 ± 481.1 g). Compared with the reference group, offspring of women who gained less than recommended had lower mean SEA scores, even after adjusting for confounders, with mean differences of SEA scores in model 1 and model 2 of −0.100 and −0.075, respectively (95% confidence intervals [CIs], −0.155 to −0.046 and −0.127 to −0.013, respectively). No association was found between less than recommended GWG and offspring IQ, nor was there strong evidence found for associations of more than recommended GWG with SEA scores or IQs. More than recommended GWG was associated with decreased odds of obtaining adequate final examination results in model 1 (OR, 0.89; 95% CI, 0.79–1.00), but this was attenuated after adjusting for confounders in model 2 (OR, 1.00; 95% CI, 0.88–1.14). Both less and more than recommended GWGs were associated with greater odds of low General Certificate of Secondary Education achievement. Gestational weight gain in all 3 periods of pregnancy was positively associated with IQs in models 1 and 2. The magnitudes of these associations were modest and unlikely to have major importance for individuals. At a population level, modest shifts in the distribution of educational attainment could be important. The results indicate the importance of defining optimal GWG, which is a complex process involving many competing risks.