Total Pregnancy Weight Gain Research Articles

Effect of pre-pregnancy body mass index and gestational weight gain on fetal outcome

Fetaldevelopment and growth in uterus is most critical. Most commonly used indicator is birth weight for determining well-being of infant. Body mass index (BMI) of mother before pregnancy, pregnancy weight gain, and other factors related to behavior, socio-cultural as well as genetics influence the birth weight. To study effect of pre-pregnancy BMI and gestational weight gain on fetal outcomeHospital-based follow-up study was carried out among 189 antenatal women. Gestational age, weight, height, BMI and fetal growth were recorded. Regular sonography was carried out to rule out fetal congenital abnormalities and fetal well-being. Daily fetal movement count, fetal heart rate monitoring was carried out daily. Estimation of the “total pregnancy weight gain” was done by subtracting last measured weight before delivery from weight recorded at first visit in first trimester. Birth weight of the neonate was recorded within 24 hours of delivery. BMI before pregnanacy was normal in Majority (75.1%). Underweight women earlier to conception had either normal Gestational weight gain (GWG) or less than normal GWG. Their babies also had significantly low average birth weight compared to either normal weight females or overweight and obese before conception. Overweight and obese females before conception had higher incidence of gestational diabetes (GDM) and cesarean section. Normal weight females before conception had higher incidence of Pregnancy induced hypertension.Being underweight before conception is a risk factor for low birth weight babies whereas being overweight and obese before pregnancy is a risk factor for GDM.

PS-C29-10: WEIGHT GAIN IS ASSOCIATED WITH INCREASED ARTERIAL STIFFNESS IN HIGH-RISK PREGNANT WOMEN

Objective: There have been increasing efforts to establish effective screening tools for preeclampsia in early pregnancy. Arterial stiffness is a composite indicator of vascular health, reflects endothelial dysfunction, and has been shown to be predictive of cardiovascular events in the general population, while it has been noted to be increased at the time for preeclampsia. Pregnancy is characterized by acute weight gain. However, whether pregnancy weight gain can affect arterial stiffness is not known. Therefore, we aimed to investigate the impact of pregnancy weight gain on arterial stiffness in high-risk pregnant women. Design and method: In this prospective longitudinal cohort study, pregnant women (n = 177) in their first trimester (10–13 weeks gestation) who met established clinical criteria for high-risk of preeclampsia were recruited from obstetrics clinics. Arterial stiffness measurements and weight were recorded every 4 weeks throughout pregnancy. Arterial stiffness was measured non-invasively using the validated tonometry-based SphygmoCor System. Results: Continuous variables were analyzed using linear. Analysis adjusted for maternal age showed that an increase in total pregnancy weight gain was significantly associated with increased arterial stiffness during pregnancy (0.213 [95%CI: 0.007, 0.068], p < 0.02). More specifically, an increase in late pregnancy weight gain, from second to third trimester, was significantly associated with an increase in arterial stiffness during pregnancy (adjusted beta: 0.052 [CI: 0.002, 0.102], p < 0.05). Conclusion: An increase in total pregnancy weight gain and more specifically late pregnancy weight gain is associated with an increase in arterial stiffness. This is important as arterial stiffness could be a predictive tool for preeclampsia in clinical practice.

Weight Gain during and after Pregnancy in Women with Gestational Diabetes Mellitus-A Preliminary Study.

Appropriate gestational weight gain (GWG) favors fewer complications related to pregnancy, delivery, puerperium, and the condition of the fetus and newborn baby. The aim of this study was to evaluate weight gain in women during and after pregnancy, including both women with and without gestational diabetes mellitus (GDM). Materials and methods: The study involved 42 singleton pregnant women diagnosed with GDM between the 24th and 28th week of pregnancy. The control group consisted of 28 nondiabetic women with a singleton pregnancy. The pre-pregnancy BMI, intra-pregnancy weight gain, and postpartum body weight were assessed in the participants. Results: There were no statistically significant differences in the values of intra-pregnancy weight gain. Only diabetic women who were also overweight or obese had a significantly higher percentage of weight gain during pregnancy. The analysis of the percentage of weight gain during the entire pregnancy showed differences only in the group of women with pre-pregnancy BMI over 30. Conclusions: There were no significant differences in total pregnancy or mid-pregnancy weight gain between women with and without GDM. Most of the women had too high or too low total-pregnancy and mid-pregnancy weight gain. Therefore it is necessary to control GWG and educate pregnant women about it.

Gestational weight gain in triplet pregnancies in the United States

The Institute of Medicine has published national recommendations for optimal pregnancy weight gain ranges for singletons and twins but not for higher-order multiples. A common clinical resource suggests weight gain targets for triplet pregnancies, but they are based on a single, small study conducted over 20 years ago. We sought to describe contemporary maternal weight gain patterns in triplet gestations in the United States, the weight gain patterns associated with good neonatal outcomes, and how these patterns compare with those of healthy twin pregnancies. We used data from 7705 triplet pregnancies drawn from the United States live birth and fetal death files (2012‒2018). We calculated total pregnancy weight gain as weight at delivery minus the prepregnancy weight. A good neonatal outcome was defined as delivery at ≥32 weeks' gestation of 3 liveborn infants weighing ≥1500 g with 5-minute Apgar scores of ≥3. We described the weight gain patterns of triplet pregnancies with good neonatal outcomes by calculating week-specific percentiles of the total weight gain distribution for deliveries at 32 to 37 weeks' gestation. For comparative purposes, we plotted these values against the percentiles of a previously published weight gain chart for monitoring and evaluating twin pregnancies from a referent cohort. Most participants were over weight (26%) or obese (30%), and 42% were normal weight or underweight. The 50th percentile (25th-75th) of total weight gain in triplet pregnancies was 17 (11-23) kg. As the body mass index category increased, the total weight gain declined: underweight or normal weight, median 19 (14-25) kg; overweight, 17 (12-23) kg; obese, 14 (7.7-20) kg. Approximately 46% of triplet pregnancies had a good neonatal outcome (n=3562). For underweight or normal weight triplet pregnancies with good neonatal outcomes, the 50th percentiles of weight gain at 32 weeks' and 36 weeks' gestation were 12.3 kg and 22.7 kg, respectively. The 10th and 90th percentiles were 12.3 kg and 32.7 kg, respectively, at 32 weeks, and 15.0 kg and 34.1 kg, respectively, at 36 weeks. Triplet pregnancies with prepregnancy overweight or obesity and a good neonatal outcome had lower weight gains. Compared with the reference values for pregnancy weight gain from a twin-specific weight gain chart, the median total weight gain in triplet pregnancies with good neonatal outcomes was approximately 3 to 5 kg more than twins, regardless of body mass index. Our study fills an important gap in understanding how much weight gain can be expected among triplet pregnancies by body mass index category. These descriptive data are a necessary first step to inform science-based triplet gestational weight gain guidelines. Additional research is needed to determine whether monitoring triplet pregnancy weight gain is useful for promoting healthy outcomes for pregnant individuals and children and what targets should be used to optimize maternal and neonatal health.

Grocery Delivery to Support Healthy Weight Gain Among Pregnant Young Women With Low Income: Protocol for a Randomized Controlled Trial.

BackgroundExcessive weight gain during pregnancy is associated with complications for both the mother and her infant including gestational diabetes, hypertensive disorders, operative delivery, and long-term obesity. A healthy diet during pregnancy promotes healthy gestational weight gain and determines fetal epigenetic programming in infants that impacts risk for future chronic disease.ObjectiveThis project will examine the impact of grocery delivery during pregnancy on the weight, diet, and health outcomes of young pregnant women and their infants.MethodsA three-arm randomized controlled trial design will be performed. A total of 855 young pregnant women, aged 14-24 years, from across the state of Michigan will be enrolled and randomized equally into the three study arms. Participants in arm one (control) will receive usual care from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); arm two will receive WIC plus biweekly grocery delivery; and arm three will receive WIC plus biweekly grocery and unsweetened beverage delivery. Weight will be assessed weekly during pregnancy, and total pregnancy weight gain will be categorized as above, below, or within guidelines. Additionally, dietary intake will be assessed at three time points (baseline, second trimester, and third trimester), and pregnancy outcomes will be extracted from medical records. The appropriateness of pregnancy weight gain, diet quality, and occurrence of poor outcomes will be compared between groups using standard practices for multinomial regression and confounder adjustment.ResultsThis study was funded in April 2021, data collection started in December 2021, and data collection is expected to be concluded in 2026.ConclusionsThis study will test whether grocery delivery of healthy foods improves weight, diet, and pregnancy outcomes of young moms with low income. The findings will inform policies and practices that promote a healthy diet during pregnancy, which has multigenerational impacts on health.Trial RegistrationClinicalTrials.gov NCT05000645; https://clinicaltrials.gov/ct2/show/NCT05000645International Registered Report Identifier (IRRID)DERR1-10.2196/40568

Gestational Weight Gain and Adverse Maternal and Neonatal Outcomes for Pregnancies Complicated by Pregestational and Gestational Diabetes.

This study aimed to investigate the association between excess and less than recommended gestational weight gain (GWG) and adverse maternal and neonatal outcomes in women with pregestational and gestational diabetes. We conducted a secondary analysis of the National Institute of Child Health and Human Development (NICHD) Consortium on Safe Labor (CSL) study. We included deliveries >23 weeks of nonanomalous singletons with either pregestational or gestational diabetes. The exposure was GWG greater than or less than compared with the U.S. Institute of Medicine recommendations for total pregnancy weight gain per prepregnancy body mass index. Consistent with the 2020 Delphi outcome for diabetes in pregnancy, maternal outcomes included cesarean delivery and preeclampsia and neonatal outcomes included small for gestational age (SGA), large for gestational age (LGA), macrosomia >4,000 g, preterm birth <37 weeks, stillbirth, and neonatal death. We modeled both absolute GWG and GWG z-scores, standardized for gestational duration. Multivariable logistic regression with generalized estimating equations was used, adjusting for age, race/ethnicity, parity, prior cesarean delivery, chronic hypertension, tobacco use, U.S. region, and delivery year. Of 8,322 deliveries (n = 8,087 women) complicated by pregestational or gestational diabetes, 47% were in excess, 27% were within, and 26% were less than GWG recommendations. Deliveries with excess absolute GWG were at higher adjusted odds of cesarean delivery, preeclampsia, LGA, and macrosomia, compared with those within recommendations. Similar results were observed when using standardized GWG z-scores, in addition to higher likelihood of preterm birth and neonatal death. Less than recommended GWG was associated with a lower likelihood of these adverse outcomes but higher SGA. Additionally, less GWG by z-score was associated with a lower likelihood of stillbirth. Excess GWG increases the risk of adverse maternal and neonatal outcomes for women with pregestational and gestational diabetes. Less GWG than recommended may decrease this risk. · Understanding the impact of GWG modeled using both absolute and standardized measures is needed.. · Among pregnant women with diabetes, excess GWG was common and increased the risk of adverse outcomes and less than recommended GWG may decrease the risk of adverse outcomes, including stillbirth.. · Current recommendations may require revision for women with diabetes in pregnancy..

242 Gestational weight gain recommendations and perinatal outcomes for patients with gestational and pregestational diabetes

Our objective was to assess the impact of gestational weight gain (GWG) outside the Institute of Medicine (IOM) recommendations on perinatal outcomes among women with pregestational and gestational diabetes (GDM). We conducted a secondary analysis of the NICHD Consortium on Safe Labor study inclusive of deliveries >23 gestational weeks of non-anomalous singletons with either pregestational diabetes or GDM. The exposure was GWG within (reference), less than, or greater than IOM recommendations for total pregnancy weight gain per pre-pregnancy BMI. Consistent with the 2020 Delphi core outcome set for diabetes in pregnancy, maternal outcomes were cesarean delivery (CD) and preeclampsia, and neonatal outcomes were small for gestational age (SGA, 90th percentile), macrosomia (>4000 g), preterm birth (PTB) <37 weeks, stillbirth, and neonatal death. We used generalized estimating equations, adjusted for age, race, parity, prior CD, chronic hypertension, tobacco use, U.S. region, and delivery year. Of 8,366 deliveries to 8,128 women with pregestational diabetes or GDM, 47% were in excess, 27% within, and 26% less than IOM GWG recommendations. Women with excess GWG were at higher odds of CD (49% vs. 40%; adjusted odds ratios, aOR: 1.58) and preeclampsia (16% vs. 9%; aOR: 1.69), as well as LGA (31% vs. 19%; aOR: 1.97) and macrosomia (18% vs. 9%; aOR: 2.22), but not SGA (5% vs. 8%; aOR: 0.55), compared to those within IOM GWG recommendations. However, women with less GWG were at lower odds of CD (35% vs. 49%; aOR: 0.80), but at higher odds of SGA (10% vs. 8%; aOR: 1.44). GWG was not associated with PTB <37 weeks, stillbirth, and neonatal death. The above associations between GWG and perinatal outcomes persisted when pregestational diabetes and GDM were modeled separately. Women with pregestational and gestational diabetes should be counseled about the increased risk of adverse perinatal outcomes with excess weight gain, in particular CD, preeclampsia, and LGA at birth.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Early maternal weight gain as a risk factor for SGA in pregnancies with hyperemesis gravidarum: a 15-year hospital cohort study

BackgroundInadequate maternal weight gain increases the risk of small-for-gestational age (SGA) infants. Women with hyperemesis gravidarum (HG) are at risk of significant early pregnancy weight loss and insufficient total pregnancy weight gain. Recent studies have implied that weight gain during the first half of pregnancy is more crucial to pregnancy outcome than total weight gain.The aim of this study was to investigate whether not regaining prepregnancy weight by 13–18 weeks of gestation contributed to not reaching minimum body mass index (BMI)-specific total pregnancy weight gain and influenced the risk of SGA outcome in HG pregnancies.MethodsIn this retrospective 15-year cohort (2002–2016) of women hospitalized due to hyperemesis gravidarum, we reviewed individual patient hospital files and corresponding outpatient maternity records to collect prepregnancy BMI and weight, pregnancy weight gain (spanning 3-week intervals), delivery weight and foetal outcomes. BMI and total pregnancy weight gain goals were categorized according to the Institute of Medicine (IOM) 2009 guidelines: BMI < 18,5 kg/m2: 12.5–18 kg, 18.5–24.9 kg/m2: 11.5–16 kg, 25–29.9 kg/m2: 7–11.5 kg and ≥ 30 kg/m2: 5–9 kg. Birth weight was categorized as SGA if less than the 10th percentile of sex- and gestational length-specific Norwegian neonatal weight charts. Nonparametric tests were used to compare weight categories, and logistic regression was used to predict the odds ratio (OR) of inadequate total pregnancy weight gain or SGA delivery.ResultsOut of 892 women hospitalized for HG during 2002–2016, 784 had a pregnancy lasting ≥ 24 weeks, of which 746 were singleton pregnancies with follow-up until delivery. Among these women, 42 were classified as underweight, 514 as normal weight, 230 as overweight and 102 as obese before pregnancy. Not regaining prepregnancy weight by week 13–18 was an independent predictor of inadequate total gestational weight gain with an OR of 7.05 (95% CI 4.24–11.71) and an independent predictor for SGA outcome with an OR of 2.66 (95% CI 1.11–6.34), even when adjusted for total pregnancy weight gain, prepregnancy BMI, parity, age and smoking status.ConclusionInadequate total maternal weight gain and not regaining prepregnancy weight by week 13–18 may be considered independent risk factors for delivering a baby that is small for gestational age in pregnancies with hyperemesis gravidarum. Achieving adequate weight gain during the first trimester in HG pregnancies is important for the foetal outcome, underscoring the importance of nutritional treatment during this period.

Prediction of Neonatal Birth Weight in Obese Women by Presence of Diabetes [29D

INTRODUCTION: To design a model that will predict neonatal birth weight within obese mothers by diabetic status. METHODS: A secondary data analysis of an RCT (NCT 02909582) was utilized to create a neonatal birth weight prediction model. Women (n=325) with a BMI &gt;35 kg/m2 from a tertiary academic institution, 2016–2019, were included to estimate the risk of large for gestational age (LGA) infants and neonatal birth weight based on maternal pre-pregnancy BMI and diabetic status. LGA was defined as an infant birth weight &gt;90th percentile. Analysis included Chi-square, t-test, multivariate logistic and linear regression. RESULTS: Mean birthweight did not differ in obese mothers based on diabetic status (P&gt;.05). The frequency of large for gestational age infants was significantly greater for diabetic mothers (17% vs 7% without diabetes, P=.024). Total pregnancy weight gain (continuous, lbs) (OR 1.03; 95% CI 1.01, 1.05; P=.016) and pre-pregnancy BMI (continuous, OR 1.08; 95% CI 1.01, 1.15; P=.018) were associated with the risk of LGA infants when accounting for demographics (model R2=0.074). The presence of diabetes (RR 146; 95% CI 24, 268; P=.019), total weight gain (lbs) (RR 4; 95% CI 1, 7; P=.015), and gestational age (RR 197; 95% CI 175, 220; P&lt;.001) were associated with neonatal birth weight when accounting for demographics (model R2=0.550). CONCLUSION: These models incorporate the joint effects of maternal obesity and diabetic status in predicting neonatal birthweight, thereby enabling clinicians to counsel their high-risk patients on risk for large for gestational age infants.

Pregnancy Outcomes Among Class 3 Obese Women With Normal Early Glucola [31D

INTRODUCTION: ACOG recommends early screening for glucose intolerance in obese women, who are at increased risk of insulin resistance. We aimed to assess the risk of developing GDM based on the value of a normal early 50g oral glucose challenge test (GCT). METHODS: Retrospective cohort of non-anomalous singleton pregnancies with maternal BMI ≥40 at one institution, 2013–2017. Pregnancies with multiple gestation, late entry to care, type 1 or 2 diabetes, and missing diabetes-screening information are excluded. Primary outcome was development of GDM. Secondary outcomes include fetal growth restriction, fetal macrosomia, gestational age at delivery, large for gestational age, delivery BMI, total pregnancy weight gain, labor induction, shoulder dystocia, and cesarean delivery. Bivariate statistics compare demographics, pregnancy complications and delivery characteristics of women with early GCT &gt;100 and women who with early GCT 101–134. Regression models used to estimate odds of primary outcome. RESULTS: Of 169 women, 66 (39%) had an early GCT &lt;100, and 103 (61%) had an early GCT of 101–134. Women with low normal eGCT were more likely to use recreational drugs (P=.03). Other baseline demographics did not differ. The rate of GDM was low in this population (5.3%), with no difference in the rate of GDM between women with a low normal eGCT and high normal eGCT (P=.9). The median neonatal birthweight was higher in the normal GCT group as compared to the low GCT (P=.03). CONCLUSION: Among women with class 3 obesity, the specific value of an early normal GCT was not predictive of developing GDM by the third trimester.

Gestational Weight Gain and Adverse Birth Outcomes in Twin Pregnancies.

To evaluate the association between gestational weight gain in twin pregnancies and small-for-gestational-age (SGA) and large-for-gestational-age (LGA) birth, preterm birth before 32 weeks of gestation, cesarean delivery, and infant death within each prepregnancy body mass index (BMI) category. Data in this population-based study came from Pennsylvania-linked infant birth and death records (2003-2013). We studied 54,836 twins born alive before 39 weeks of gestation. Total pregnancy weight gain (kg) was converted to gestational age-standardized z scores. Multivariable modified Poisson regression models stratified by prepregnancy BMI were used to estimate associations between z scores and outcomes. A probabilistic bias analysis, informed by an internal validation study, evaluated the effect of BMI and weight gain misclassification. Gestational weight gain z score was negatively associated with SGA and positively associated with LGA and cesarean delivery in all BMI groups. The relation between weight gain and preterm birth was U-shaped in nonobese women. An increased risk of infant death was observed for very low weight gain among normal-weight women and for high weight gain among women without obesity. Most excess risks of these outcomes were observed at weight gains at 37 weeks of gestation that are equivalent to less than 14 kg or more than 27 kg in underweight or normal-weight women, less than 11 kg or more than 28 kg in overweight women, and less than 6.4 kg or more than 26 kg in women with obesity. The bias analysis supported the validity of the conventional analysis. Very low or very high weight gains were associated with the adverse outcomes we studied. If the associations we observed are even partially reflective of causality, targeted modification of pregnancy weight gain in women carrying twins might improve pregnancy outcomes.

Pregnancy weight gain by gestational age and stillbirth: a population‐based cohort study

ObjectiveTo study the association between total and early pregnancy (<22 completed weeks) weight gain and risk of stillbirth, stratified by early‐pregnancy body mass index (BMI).DesignPopulation‐based cohort study.SettingStockholm‐Gotland Region, Sweden.PopulationPregnant women with singleton births (n = 160 560).MethodsPregnancy weight gain was standardised into gestational age‐specific z‐scores. For analyses of total pregnancy weight gain, a matched design with an incidence density sampling approach was used. Findings were also contrasted with current Institute of Medicine (IOM) weight gain recommendations.Main outcome measuresStillbirth defined as fetal death at ≥22 completed weeks of gestation.ResultsFor all BMI categories, there was no statistical association between total or early pregnancy weight gain and stillbirth within the range of a weight gain z‐score of −2.0 SD to +2.0 SD. Among normal‐weight women, the adjusted odds ratio of stillbirth for lower (−2.0 to −1.0 SD) and higher (+1.0 to +1.9 SD) total weight gain was 0.85 (95% CI; 0.48–1.49) and 1.03 (0.60–1.77), respectively, as compared with the reference category. Further, there were no associations between total or early pregnancy weight gain and stillbirth within the range of weight gain currently recommended by the IOM. For the majority of the BMI categories, the point estimates at the extremes of weight gain values (<−2.0SD and ≥2.0 SD) suggested protective effects of low weight gain and increased risks of high weight gain, but estimates were imprecise and not statistically significant.ConclusionWe found no associations between total or early pregnancy weight gain and stillbirth across the range of weight gain experienced by most women.Tweetable abstractThere was no association between weight gain during pregnancy and stillbirth among most women.

Weighing as a stand-alone intervention does not reduce excessive gestational weight gain compared to routine antenatal care: a systematic review and meta-analysis of randomised controlled trials

BackgroundExcessive gestational weight gain is associated with short and long-term adverse maternal and infant health outcomes, independent of pre-pregnancy body mass index. Weighing pregnant women as a stand-alone intervention during antenatal visits is suggested to reduce pregnancy weight gain. In the absence of effective interventions to reduce excessive gestational gain within the real world setting, this study aims to test if routine weighing as a stand-alone intervention can reduce total pregnancy weight gain and, in particular, excessive gestational weight gain.MethodsA systematic review and meta–analysis of randomised controlled trials (RCTs) was conducted between November 2014 and January 2016, and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Seven databases were searched. A priori eligibility criteria were applied to published literature by at least two independent reviewers. Studies considered methodologically rigorous, as per the Academy of Nutrition and Dietetics Quality Criteria Checklist for Primary Research, were included. Meta-analysis was conducted using fixed-effects models.ResultsA total of 5223 (non-duplicated) records were screened, resulting in two RCTs that were pooled for meta-analysis (n = 1068 randomised participants; n = 538 intervention, n = 534 control). No difference in total weight gain per week was observed between intervention and control groups (weighted mean difference (WMD) -0.00 kg/week, 95% confidence interval (CI) -0.03 to 0.02). There was also no reduction in excessive gestational weight gain between intervention and control, according to pre-pregnancy body mass index (BMI). However, total weight gain was lower in underweight women (n = 23, BMI <18.5 kg/m2) in the intervention compared to control group (−0.12 kg/week, 95% CI −0.23 to −0.01). No significant differences were observed for other pregnancy, birth and infant outcomes.ConclusionWeighing as a stand-alone intervention is not worse nor better at reducing excessive gestational weight gain than routine antenatal care.

Low Gestational Weight Gain and Risk of Adverse Perinatal Outcomes in Obese and Severely Obese Women.

Our objective was to estimate associations between gestational weight gain z scores and preterm birth, neonatal intensive care unit admission, large- and small-for-gestational age birth, and cesarean delivery among grades 1, 2, and 3 obese women. We included singleton infants born in Pennsylvania (2003-2011) to grade 1 (body mass index 30-34.9 kg/m, n = 148,335), grade 2 (35-39.9 kg/m, n = 72,032), or grade 3 (≥40 kg/m, n = 47,494) obese mothers. Total pregnancy weight gain (kg) was converted to gestational age-standardized z scores. Multivariable Poisson regression models stratified by obesity grade were used to estimate associations between z scores and outcomes. A probabilistic bias analysis, informed by an internal validation study, evaluated the impact of body mass index and weight gain misclassification. Risks of adverse outcomes did not substantially vary within the range of z scores equivalent to 40-week weight gains of -4.3 to 9 kg for grade 1 obese, -8.2 to 5.6 kg for grade 2 obese, and -12 to -2.3 kg for grade 3 obese women. As gestational weight gain increased beyond these z score ranges, there were slight declines in risk of small-for-gestational age birth but rapid rises in cesarean delivery and large-for-gestational age birth. Risks of preterm birth and neonatal intensive care unit admission were weakly associated with weight gain. The bias analysis supported the validity of the conventional analysis. Gestational weight gain below national recommendations for obese mothers (5-9 kg) may not be adversely associated with fetal growth, gestational age at delivery, or mode of delivery.

Gestational weight gain and its related social and demographic factors in health care settings of rural and urban areas in northwest Iran

ABSTRACTThe current study was aimed to evaluate gestational weight gain and its socio-demographic determinants among pregnant women in north-west of Iran. In the current cross-sectional study, four hundred eighty one pregnant women aged 26.12 ± 7.45 years were enrolled. Data on pre-pregnancy weight, height, age, educational attainment, parity, household size, hemoglobin status and total pregnancy weight gain were extracted from routine health center records. The pregnant women were categorized based on their pre-pregnancy body mass index (BMI) as underweight, normal weight and overweight or obese according to the 2009 Institute of Medicine (IOM) recommendations. Participants were also classified according to their educational level into three ‘some school’, ‘high school’ and ‘college’ groups. Gestational weight gain in 27.6% of pregnant women was in normal IOM recommended range; while, weight gain in 49% and 23.2% of pregnant women was below and above recommended range respectively. Women with high educational attainment (≥12 years) have significantly higher weight gain compared with low-educated women (<12 years) (P < 0.001). Age was in negative relationship with gestational weigh gain even after adjusting for confounder effects of residency, educational attainment and household size (r = 0.2, P < 0.001). Our data showed a high prevalence of abnormal gestational weight gain in pregnant women attending to public health centers in northwest of Iran. Moreover educational level, parity and age were significant determinants of gestational weight gain in pregnancy. Special attention should be focused on prenatal nutritional status and health care programs in current health care services in Iran.

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.

Weight gain in gestational diabetes: the effect of treatment modality

Objective: To evaluate treatment effectiveness (diet alone, insulin or glyburide) on maternal weight gain in gestational diabetes (GDM).Methods: GDM patients were treated with diet alone, insulin or glyburide. Weight gain was stratified into: prior to GDM diagnosis, from diagnosis to delivery and total pregnancy weight gain. Good glycemic control was defined as mean blood glucose ≤105 mg/dl and obesity as Body Mass Index (BMI) ≥ 30 kg/m2, overweight BMI 25–29 kg/m2 and normal < 25 kg/m2.Results: Total weight gain was similar in all the treatment groups. Two-thirds of weight gain occurred prior to diagnosis (diet 85%, insulin 67% and glyburide 78%). Post-diagnosis, patients on diet alone gained less weight than those on insulin or glyburide (p < 0.001); insulin-treated patients showed greater weight gain than glyburide-treated patients (p < 0.001). Patients on diet with good glycemic control showed less weight gain after diagnosis than patients on insulin or glyburide (2.8 ± 13, 6.6 ± 10, 5.2 ± 7.9 lbs, respectively, p < 0.02). Poorly-controlled patients, regardless of treatment, had similar patterns of weight gain throughout pregnancy.Conclusion: Patterns of maternal weight gain in GDM pregnancies are associated with treatment modality and level of glycemic control.

The Maternal Health Clinic: A New Window of Opportunity for Early Heart Disease Risk Screening and Intervention for Women with Pregnancy Complications

W cardiovascular health is a key national priority that should be addressed through improving cardiovascular awareness and prevention and reducing care inequities for women in general and younger women in particular.1–5 Given the costs of treating cardiovascular disease and screening for it, novel and innovative ways to identify women who should undergo cardiovascular risk screening, including biochemical testing, is critical to achieving this goal.

Maternal weight gain might predict child’s weight at the 12th and 24th months of age in Damavand city, North-East Tehran

The purpose of this study was to investigate the possible association between pregnancy weight gain and child weight at the 12 th and 24 th months of age in Damavand city, North-East Tehran, Iran. Materials and Methods: In a cross-sectional study, using existing data collected by the urban health centers, records of 266 women who attended urban health centers for prenatal care and delivered between March 2004 and March 2008 with singleton term pregnancy were analyzed. Data on pre-pregnancy weight and height, total pregnancy weight gain, mother’s age, parity, neonatal birth weight, birth order, mother’s education, working status, breastfeeding practice and child weight at the 12 th and 24 th months of age were extracted. Pregnant Women were categorized based on their pre-pregnancy body mass index (BMI) as underweight, normal, and overweight and obese. Chi-square and ANOVA tests were employed to analyze data using SPSS software. Mean (±SD) of gestational weight gain was 11.4±3.9 kg. On average, 34% of mothers had inadequate weight gain, while 44 and 22% gained appropriate and excessive weight, respectively, based on the US Institute of Medicine (IoM-1990) guidelines. About 11, 56, 20 and 13% of mothers were defined as underweight, normal, overweight, and obese based on their BMI values. Initial BMI and educational level was associated with pregnancy weight gain. There was a significant difference between mean child weight at the 12 th and 24 th months of ages in all three categories of pregnancy weight gain, i.e. inadequate ( 11.3 Kg) (p< 0.01). Gestational weight gain seemed associated with child weight. Educating and assisting pregnant women to meet the weight gain within recommendations range might therefore be an important strategy to prevent child malnutrition, both under- and overweight, in early life.

Gestational Outcome in Rats That Consumed Aqueous Extract of Hibiscus sabdariffa During Pregnancy

The present study was designed to investigate the effect of consumption of aqueous extract of Hibiscus sabdariffa (HS) during pregnancy on fluid and food intake, weight gain during pregnancy, length of gestation, litter size and birth weight. Eighteen in-bred virgin female Sprague-Dawley rats aged between 1012 weeks and weighing 125 ± 5.5g (mean ± SEM) with two consecutive regular 4-day estrus cycle were used for this study. These rats were randomly assigned to one of three groups on gestational day one. Group A (control) were given tap water to drink throughout pregnancy, while groups B and C were given 0.6gextract/100ml and 1.8g-extract/100ml respectively to drink throughout pregnancy. All groups had normal rat chow and their respective drinking solution ad libitum. Mean fluid and food intake and total pregnancy weight gain were significantly reduced in the HS group. There was no significant difference in length of gestation among the various groups but there was a significant reduction in litter size and a significant increase in litter birth weight in HS groups (B and C) compared with control group (A). There were no apparent malformations at birth.