Relationships Of Gestational Weight Gain Research Articles

Effect of Gestational Weight Gain on Length of Induction of Labor [ID: 1377561

INTRODUCTION: Review of institutional data found an association between maternal obesity and increased cesarean delivery (CD) among nulliparous, term, single, vertex (NTSV) pregnancies. To identify modifiable risk factors for CD, we evaluated the relationship of gestational weight gain (GWG) to length of induction of labor. METHODS: From January 2020 to May 2021, NTSV inductions were identified via retrospective chart review (IRB#4954). Gestational weight gain according to prepregnancy body mass index (BMI) was categorized using ACOG standards as appropriate, insufficient, or excessive. Time of initial induction agent to delivery time equated to total induction time. Chi square, t test, and regression analyses were performed where appropriate. RESULTS: Of 1,031 inductions, 244 (24%) patients had appropriate, 160 (15%) had insufficient, and 627 (61%) had excessive GWG. 366 (36%) had prepregnancy BMI greater than 30. Average total induction times for appropriate, insufficient, and excessive GWG were 1,179, 1,072, and 1,286 minutes, respectively. Excessive GWG was a positive predictor of length of induction (P<.001). Additionally, those with excessive GWG labored significantly longer with ruptured membranes (84 minutes) than those with appropriate GWG (P=.006). CONCLUSION: Excessive GWG correlated with 107 additional minutes in the induction process and more time with ruptured membranes. These data emphasize the importance of appropriate GWG particularly in patients beginning pregnancy with obesity. Patients with obesity otherwise have worse pregnancy outcomes; therefore, nutrition and exercise counseling during prenatal care could be advantageous. These data also help inform counseling and preparation on labor units, particularly as inductions become more prevalent.

Effects of Weight Gain During Pregnancy in Normal-Weight Women on Changes in the Gut Microbiota of Pregnant Women in the Third Trimester.

With the improvement of living standards and the lack of nutrition awareness during pregnancy, the phenomenon of excessive weight gain (EWG) of pregnancy is increasing. EWG during pregnancy has profound effects on the health of mother and offspring. The role of intestinal flora in regulating metabolic diseases has gradually attracted attention in recent years. The study explored the effect of EWG during pregnancy on gut microbiota, and analyzed the diversity and composition of gut microbiota in pregnant women in third trimester. Fecal samples were collected and divided into: insufficient weight gain (IWG)during pregnancy (group A1, N = 4), and appropriate weight gain (AWG) during pregnancy (group A2, N = 9), and EWG during pregnancy (N = 9 in A3 group). MiSeq high-throughput sequencing technology and bioinformatics analysis were introduced to investigate relationship of gestational weight gain and maternal gut microbiota. General data analysis showed that gestational weight gain and delivery mode have significant differences among the three groups. The overall level and diversity of intestinal microbiota in A1 and A3 group were increased. Composition of gut microbiota has no difference among three groups at the phylum level, but species of gut microbiota were different. Alpha diversity index analysis showed that the richness of A3 group was increased versus A2 group. EWG during pregnancy affects the abundance and proportion of gut microbiota in the third trimester. Therefore, maintaining moderate weight gain during pregnancy helps to maintain intestinal homeostasis.

Polymorphisms in gene MTHFR modify the association between gestational weight gain and adverse birth outcomes.

Evidence suggests a potential relationship between gestational weight gain (GWG) and adverse birth outcomes. However, the role of maternal genetic polymorphisms remains unclear. This study was conducted to investigate whether the relationship of GWG with risk of adverse birth outcomes was modified by methylenetetrahydrofolate reductase (MTHFR) polymorphisms. A total of 2,967 Chinese pregnant women were included and divided into insufficient, sufficient, and excessive groups based on the Institute of Medicine (IOM) criteria. Polymorphisms of C677T and A1298C in gene MTHFR were genotyped. Multivariable logistic regression models were introduced after controlling major confounders. Excessive GWG was found to increase the odds ratio (OR) for macrosomia [OR = 3.47, 95% confidence interval (CI): 1.86–6.48] and large-for-gestational age (LGA, OR = 3.25, 95% CI: 2.23–4.74), and decreased the OR for small-for-gestational age (SGA, OR = 0.60, 95% CI: 0.45–0.79). Pregnant women with insufficient GWG had a higher frequency of SGA (OR = 1.68, 95% CI: 1.32–2.13) and a lower rate of LGA (OR = 0.51, 95% CI: 0.27–0.96). Interestingly, significant associations of GWG categories in relation to low birth weight (LBW), macrosomia, and SGA were only suggested among pregnant women with MTHFR A1298C AA genotype. Among pregnant women with insufficient GWG group, an increased risk of 3.96 (95% CI: 1.57–10.01) for LBW was observed among subjects with the A1298C AA genotype, compared to the AC+CC genotype group. GWG categories are closely related to LBW, macrosomia, SGA and LGA, and the associations were modified by the polymorphism of MTHFR A1298C.

Changes in Visceral and Ectopic Adipose Tissue Stores Across Pregnancy and Their Relationship to Gestational Weight Gain

BackgroundExcessive gestational weight gain has been associated with increased total body fat (TBF), metabolic syndrome, and abdominal obesity. However, little is known about the relationship of gestational weight gain with changes in metabolically active visceral or ectopic (hepatic and skeletal muscle) lipid stores. ObjectivesIn a prospective study of 50 healthy, pregnant women, we assessed whether changes in weight were associated with changes in total, visceral, and ectopic lipid stores. MethodsParticipants (ages 19–39) were primarily White (84%). The mean preconception BMI was 25.8 kg/m2 (SD, 4.5 kg/m2; min-max, 17.1–35.9 kg/m2). Measurements were completed at visits 1 and 2 at means of 16 and 34 weeks gestation, respectively, and included TBF using BOD POD; abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) using MRI; and intrahepatic lipids (IHL), intramyocellular lipids (IMCL), and extramyocellular lipids (EMCL) using magnetic resonance spectroscopy. We used paired t-tests to examine changes in adipose tissue and Pearson's correlation to examine associations of adipose tissue changes and weight changes. We also examined whether changes in adipose tissue stores differed by preconception BMI (normal, overweight, and obese), using 1-way ANOVA. ResultsThe TBF (mean change, +3.5 kg; 95% CI: 2.4–4.6 kg), SAT (mean change, +701 cm3; 95% CI: 421–981 cm3), VAT (mean change, +275 cm3; 95% CI: 170–379 cm3), and IHL (percentage water peak; median, +0.15; IQR = −0.01 to 0.32) values increased significantly; the IMCL and EMCL values did not change. Changes varied by BMI strata, with the least increase (or, for SAT, net loss) among women with obesity. Weight change was positively correlated with changes in TBF (r = 0.83; P < 0.001), SAT (r = 0.74; P < 0.001), and VAT (r = 0.63; P < 0.001) but not significantly correlated with changes in ectopic lipids (IHL, IMCL, and EMCL; −0.14 < r < 0.26). ConclusionsPreferential deposition of adipose tissue to the viscera in pregnancy, as seen in our sample, could serve an important metabolic function; however, excessive deposition in this region could negatively affect maternal health.

Gestational weight gain and adverse pregnancy outcomes by pre-pregnancy BMI category in women with chronic hypertension: A cohort study.

It is important to understand relationships of gestational weight gain with adverse pregnancy outcomes in women with chronic hypertension, given their high baseline risk of adverse outcomes. We assessed associations of gestational weight gain with adverse pregnancy outcomes in women with chronic hypertension by pre-pregnancy body mass index categories. We identified 14,369 women with chronic hypertension using electronic health records from 3 integrated health care delivery systems (2005-2014). Gestational weight gain-for-gestational age charts were used to calculate gestational weight gain z-scores, which account for gestational age. Modified Poisson regression models using generalized estimating equations were used to calculate relative risks and 95% confidence intervals, adjusted for sociodemographic and medical characteristics. Preeclampsia, preterm delivery, cesarean delivery, neonatal intensive care unit admission, birthweight (extracted from the electronic health record). In women with normal weight or overweight, low gestational weight gain (z-score<-1) was associated with 27-28% greater risk of preterm delivery and 48-82% greater risk of small-for-gestational age birthweight, while high gestational weight gain (z-score>1) was associated with 40-90% greater risk of preeclampsia and 59-113% greater risk of large-for-gestational age birthweight. In women with obesity, low gestational weight gain was associated with 27-54% lower risk of several adverse pregnancy outcomes, including preeclampsia and cesarean delivery. In women with chronic hypertension and normal weight or overweight, moderate gestational weight gain may confer the lowest risk of adverse outcomes. In women with chronic hypertension and obesity, low gestational weight gain may be necessary for the lowest risk of adverse pregnancy outcomes.

Risk of Excess and Inadequate Gestational Weight Gain among Hispanic Women: Effects of Immigration Generational Status.

There is a dearth of information on the risk of inadequate and excess gestational weight gain (GWG) among different generations of Hispanic women in the United States. Therefore, the objective of this study was to understand the relationship of GWG and immigration across three generations of Hispanic women. The study was conducted using data from National Longitudinal Survey of Youth 1979 (NLSY79). The study sample included 580 (unweighted count) women (148 first-generation, 117 second-generation, and 315 third-/higher-generation). Sociodemographic and immigration data were extracted from the main NLSY79 survey, and pregnancy data were extracted from the child/young adult survey following the biological children born to women in NLSY79. Covariate adjusted weighted logistic regression models were conducted to assess the risk of inadequate and excess GWG among the groups. Average total GWG was 14.98 kg, 23% had inadequate GWG, and 50% had excess GWG. After controlling for the covariates, there was no difference in the risk of inadequate GWG between the three generations. First-generation women (OR = 0.47, p = 0.039) and third-/higher-generation women (OR = 0.39, p = 0.004) had significantly lower risk of excess GWG compared to second-generation women. It is important to recognize the generational status of Hispanic women as a risk factor for excess GWG.

1379-P: Insufficient and Excessive Gestational Weight Gain across Midpregnancy to Delivery Are Associated with Multiple Adverse Maternal–Infant Outcomes: From the Camden Study

Retrospective studies on the relationship of gestational weight gain (GWG) with pregnancy outcomes such as preterm delivery and preeclampsia are inconsistent. We examined the association of longitudinally assessed GWG above (excessive) and below (insufficient) the IOM guidelines with maternal-infant outcomes from the Camden study - a large prospective cohort in young pregnant women (n=2,444, African-American 38%, Hispanic 45%, Caucasian 17%, age 22 ± 5.2 yr., BMI 26 ± 6 kg/m2). All of the analyses were multivariable adjusted. Excessive GWG was 48%, 53%, 56% and 58% in all pregnancies and insufficient GWG was 25%, 27%, 23%, 21% assessed at gestational week of 24, 28, 32 and at delivery, respectively. At delivery, insufficient GWG was associated with increased risk of preterm delivery (&amp;lt;37 weeks’ gestation) (AOR 2.14, 95% CI 1.55-2.95) and small for gestational age (SGA, AOR 1.64, 95% CI 1.27-2.11). Excessive GWG was associated with higher risk of preeclampsia (AOR 1.56, 95% CI 1.08-2.27), large for gestational age (LGA, AOR 2.49, 95% CI 1.58-3.94) and a decreased risk of SGA (AOR 0.49, 95% CI 0.33-0.73). There was no significant difference in GDM. Similar results between insufficient or excessive GWG and risk of LGA, preeclampsia and SGA were observed in GWG assessed at week 24, 28, and 32, but no significant difference for preterm delivery. Significant linear trends among insufficient, adequate and excessive GWG at delivery with infant birth weight, birth length, chest and head circumferences were observed (p&amp;lt;0.001 to p&amp;lt;0.0001 for each). The relationship persisted and found as early as gestational week 24. Insufficient or excessive GWG across mid pregnancy to delivery are significantly associated with increased risk of several adverse maternal-infant outcomes. Maintaining adequate GWG from early pregnancy are important to improve the prognosis of maternal infant outcomes. Disclosure X. Chen: None. T.O. Scholl: None. Funding National Institutes of Health (R01MD007828)

The relationship of gestational weight gain and development of gestational diabetes mellitus

Objective: To assess the effect of gestational weight gain in women developing gestational diabetes mellitus (GDM). Methods: In this retrospective case control study, singleton mothers with GDM (n=51) were compared with a control group (n=153) matched for age (±2 years), parity, booking visit BMI (±2 kg/m2). They were reviewed at delivery to identify sociodemographic risk factors and treatment modality if they were found to have GDM. Maternal weight at booking visit, at the end of 1st trimester and at the time of glucose tolerance testing was extracted from maternity records. Total gestational weight gain, and rate of weight gain per week during 1st and 2nd trimesters were the primary outcome data. Results: Having a 1st degree relative with diabetes had a significant association for development of GDM. No significant difference was observed in total weight gain or 2nd trimester weight gain between case and controls. However, weight gain during 1st trimester was significantly higher among mothers diagnosed with GDM when compared with controls. This difference was most significant among normal and overweight BMI categories. Out of the GDM group, although the mean rate of weight gain was higher in the pharmacotherapy sub group, there was no statistical significance compared with the group who was only on Medical Nutrition Therapy. Conclusions and recommendations: Gestational weight gain during first trimester was significantly higher among patients with GDM who were in the normal and overweight BMI categories compared to normal glucose tolerant individuals. Mothers with excessive 1st trimester weight gain should be carefully followed up for development of GDM.

Relationship of Gestational Weight Gain with Cesarean Delivery Risk, Perinatal Birth Weight, and Gestational Age in Overweight and Obese Women

Background: Gestational weight gain (GWG) is an important issue for all pregnant women due to its effect on pregnancy outcomes. Regarding this, the aim of the present study was to assess the relationship of GWG with cesarean section, birth weight, and gestational age at birth in the women with a pre-pregnancy body mass index (BMI) of ≥ 25 kg/m2. Methods: This cross-sectional study was conducted on 2,147 obese or overweight pregnant females who had singleton births as a secondary analysis. The data were collected by filling out a checklist in 103 hospitals, which were equipped with department of obstetrics and gynecology, in Tehran province, Iran, in 2015. Data analysis was performed using binomial logistic regression model in Stata software version 14. Results: According to the results, the prevalence of cesarean section was 74.35%. Furthermore, the mean GWG was 11.7 kg. The odds of cesarean delivery in the women with low and high GWG were 0.62 times smaller and 1.20 times larger than that for normal GWG, respectively (95% CI: 0.42-0.92, P=0.019 and 95% CI:0.90-1.59, P=0.197, respectively). After adjusting for confounding variables, GWG had no significant association with birth weight and gestational age at birth in the overweight and obese women. Conclusion: The findings of this study revealed a significant relationship between GWG and cesarean section. Furthermore, the odds of cesarean section in the women with low GWG was less than that in the women with normal GWG. Regarding this, GWG should be considered as one of the determinants of cesarean delivery. Therefore, it is suggested to conduct further prospective cohort studies to clarify the impact of GWG on pregnancy complications.

Maternal obesity and gestational weight gain are risk factors for infant death.

Assessment of the joint and independent relationships of gestational weight gain and prepregnancy body mass index (BMI) on risk of infant mortality was performed. This study used Pennsylvania linked birth-infant death records (2003-2011) from infants without anomalies born to mothers with prepregnancy BMI categorized as underweight (n = 58,973), normal weight (n = 610,118), overweight (n = 296,630), grade 1 obesity (n = 147,608), grade 2 obesity (n = 71,740), and grade 3 obesity (n = 47,277). Multivariable logistic regression models stratified by BMI category were used to estimate dose-response associations between z scores of gestational weight gain and infant death after confounder adjustment. Infant mortality risk was lowest among normal-weight women and increased with rising BMI category. For all BMI groups except for grade 3 obesity, there were U-shaped associations between gestational weight gain and risk of infant death. Weight loss and very low weight gain among women with grades 1 and 2 obesity were associated with high risks of infant mortality. However, even when gestational weight gain in women with obesity was optimized, the predicted risk of infant death remained higher than that of normal-weight women. Interventions aimed at substantially reducing preconception weight among women with obesity and avoiding very low or very high gestational weight gain may reduce risk of infant death.

Achieving a Healthy Weight Gain During Pregnancy

This review uses the 1990 U.S. Institute of Medicine (IOM) gestational weight gain recommendations to examine the question, what is a healthy pregnancy weight gain? The relationship of gestational weight gain to infant size at birth; pregnancy, labor, and delivery complications; neonatal, infant, and child outcomes; and maternal weight and health outcomes in U.S. and European populations are discussed. Pregnancy weight gains within the IOM recommendations are associated with better outcomes. The possible exception is very obese women, who may benefit from weight gains less than the 7 kg (15 pounds) recommended. Only about 33% to 40% of U.S. women gain within IOM recommendations. Excessive gestational weight gain is more prevalent than inadequate gain. Women's gestational weight gains tend to follow the recommendations of health care providers. Current interventions demonstrate efficacy in influencing gestational weight gain in low-income women with normal and overweight body mass index in the United States and obese women in Scandinavia.