Trimester-specific Weight Gain Research Articles

Effect of Pregestational Body Mass Index, Trimester-specific Weight Gain, and Total Gestational Weight Gain on Pregnancy Outcomes: A Retrospective Observational Study

Effect of Pregestational Body Mass Index, Trimester-specific Weight Gain, and Total Gestational Weight Gain on Pregnancy Outcomes: A Retrospective Observational Study

A prospective analysis of optimal total weight gain ranges and trimester-specific weight gain rates for Chinese pregnant women

BackgroundGestational weight gain (GWG) criteria recommended by the Institute of Medicine may not be appropriate for Asians. Our aims are to investigate the association between GWG and adverse pregnancy outcomes, and to propose optimal total GWG and rates of GWG for Chinese women.MethodsProspective data of 51,125 mother-child pairs from 27 hospitals and community health care centers from Guizhou, Yunnan and Sichuan provinces in China between 2014 and 2018 were analyzed. Generalized Additive Models were performed to determine the associations of GWG with the risk of aggregated adverse outcomes (gestational diabetes mellitus, preeclampsia, cesarean delivery, stillbirth, preterm birth, macrosomia, large for gestational age, and small for gestational age). The range that did not exceed a 2.5% increase from the lowest risk of aggregated adverse outcomes was defined as the optimal GWG range.ResultsAmong all participants, U-shaped prospective association was found between GWG and the risk of aggregated adverse pregnancy outcomes. The optimal GWG range of 8.2–13.0 kg was proposed for underweight, 7.3–12.5 kg for normal weight, and 2.0–9.4 kg for overweight/obese women. Meanwhile, a higher GWG rate in the first two trimesters than that in the last trimester was suggested, except for overweight/obese women. After stratified by maternal age, mothers ≥35 years were suggested to gain less weight compared to younger mothers.ConclusionsTo keep a balance between maternal health and neonatal growth, optimal GWG ranges based on Asia-specific BMI categories was suggested for Chinese women with different pre-gravid BMIs and maternal ages.

Examining the effects of second-and third-trimester gestational weight gain rates on the perinatal outcomes among Chinese twin pregnancies: a retrospective cohort study

BackgroundThis paper investigated how second- and third-trimester gestational weight gain relates to perinatal outcomes among normal weight women with twin pregnancies in Fujian, China.MethodsA retrospective study examining the medical records of 931 normal weight twin-pregnant women was conducted in Fujian Maternity and Child Health Hospital from 2014 to 2018.The 2nd and 3rdtrimester weekly weight gain rates were calculated, and women were categorized as gaining below, within, or above the 2009 Institute of Medicine (IOM) recommended rates. The association between the trimester-specific weight gain rate and perinatal outcome was determined by traditional regression analysis among groups.ResultsA total of 25.9%, 19.8% and 54.3% of women had rates of weight gain across the 2nd and 3rd trimesters less than, greater than or within the recommended rates respectively. Multivariate logistic regression analysis showed that weight gain greater than the recommended rate in the 2nd trimester was associated with a decreased risk of preeclampsia (aOR:0.489,95%CI:0.289 ~ 0.974). Weight gain less than the recommended rate of weight gain in the 3rd trimester was associated with increased risks of premature delivery(aOR:2.079, 95%CI:1.467 ~ 2.968), gestational diabetes mellitus (aOR: 2.048, 95%CI:1.411 ~ 2.971), intrahepatic cholestasis syndrome (aOR:3.015,95%CI: 1.058 ~ 8.587), pre-labour rupture of membrane (aOR: 1.708,95%CI: 1.169 ~ 2.493), average twin birth weight < 2500 g(aOR:1.532,95%CI: 1.125 ~ 2.084) and neonatal respiratory distress syndrome (aOR:4.934,95%CI:1.626 ~ 15.083) and was associated with decreased risks of caesarean section (aOR:0.589,95%CI:0.386 ~ 0.898) and preeclampsia (aOR:0.471, 95%CI:0.274 ~ 0.808). In addition, weight gain greater than the recommended rate of weight gain in the 3rd trimester was associated with increased risks of premature delivery (aOR:1.589,95%CI:1.428 ~ 2.951) and gestational hypertension (aOR:2.137,95% CI:1.034 ~ 4.415) as well as preeclampsia (aOR:2.246, 95%CI:1.462 ~ 3.452). The stratified analysis of weight gain in the 3rd trimester showed that there was no significant difference in the incidence of adverse pregnancy outcomes compared to the 2nd trimester weight gain groups.ConclusionsWhile this study showed that a gestational weight gain rate above or below the recommendation in the 3rd trimester was associated with some adverse maternal and neonatal outcomes, further prospective and multicentre studies are required to explore alternate ranges of gestational weight gain rates in twin pregnancies.

Pregestational body mass index, trimester-specific weight gain and total gestational weight gain: how do they influence perinatal outcomes?

Objective To investigate the association between pre-gestational body mass index (BMI), total gestational weight gain (GWG), and/or trimester-specific weight gain (GWGT) with adverse maternal or perinatal outcomes (AMPOs). Materials and methods Maternal clinical characteristics and pregnancy and perinatal outcomes were used to predict AMPOs. The predictive ability of BMI, GWG, or GWGT for AMPOs was analyzed using the area under the curve (AUC). Logistic regression models in a univariate and multivariate analysis were performed to estimate the odds ratios (OR) and 95% confidence intervals (CI) to predict maternal outcomes (pregnancy-induced hypertension, preeclampsia or gestational diabetes mellitus) and perinatal outcomes (small for gestational age, large for gestational age, 5-min Apgar score, admission to neonatal intensive care unit or umbilical cord pH <7.15). Results Women with AMPOs (n = 293) were younger with higher rate of nulliparity (p < .001) and with lower height (p = .018) as compared to controls (n = 134). In the univariate study, GWGT in third trimester was associated with double risk of pregnancy-induced hypertension (OR 2.00; 95% CI, 1.01–3.97). Nonetheless, third-trimester GWG and total GWG have a negative relationship with gestational diabetes mellitus OR 0.32 (95% CI, 0.18–0.58) and OR 0.35 (95% CI, 0.21–0.59), respectively. Women with greater overall and in second trimester, GWG have a lower risk of having SGA neonates, OR 0.62 (95% CI, 0.39–0.98) and OR 0.60 (95% CI, 0.37–0.98), respectively. In the multivariate study, pre-gestational BMI is strongly related to the development of preeclampsia and the area under the curve (AUC) of the combination of pre-gestational BMI and total weight gain was 0.832 (95% CI, 0.63–0.81) for preeclampsia and 0.719 (95% CI, 0.71–0.94) for gestational diabetes mellitus. Conclusion Our results suggest than timing of gestational weight gain influence in maternal and perinatal outcomes. Pre-gestational BMI is a determinant of preeclampsia, maternal weight gain in the third trimester is a determinant of pregnancy-induced hypertension and the increase in total GWG reduces the risk of gestational diabetes mellitus and small for gestational age.

The Association Between Trimester-Specific Weight Gain and Severe Preeclampsia/Adverse Perinatal Outcome in Gestational Diabetes Mellitus Complicated by Preeclampsia: A Retrospective Case Study.

IntroductionGestational diabetes mellitus (GDM) and preeclampsia share many risk factors, e.g., gestational weight gain (GWG). Previous studies on the co-occurrence of these two diseases cannot powerfully clear up the effects of GWG on perinatal outcome.MethodsA total of 329 pregnant women with GDM complicated by preeclampsia were enrolled. Clinical data of mothers and newborns were retrospectively analyzed, including baseline characteristics of pregnant women and pregnancy outcomes. We focused on the association between trimester-specific weight gain and severe preeclampsia (s-PE)/adverse perinatal outcomes in GDM complicated by preeclampsia, including cesarean section (C-sect), preterm birth, and large for gestational age birth (LGA). Regression analysis was used to adjust the impact of confounding factors, including height, age, parity, scarred uterus, and so on.ResultBy unconditional regression analysis, middle trimester excessive GWG is a risk factor for LGA [OR 6.586, 95% CI (2.254–19.242), AOR 6.481, 95% CI (2.213–18.981)]; late excessive GWG is a risk factor for s-PE and C-sect [OR 1.683, 95% CI (1.084–2.614), AOR 1.888, 95% CI (1.193–2.990); and OR 1.754, 95% CI (1.121–2.744), AOR 1.841, 95% CI (1.153–2.937)], excessive total GWG is a risk factor for LGA, and is a protective factor for the preterm [OR 5.920, 95% CI (2.479–14.139), AOR 5.602, 95% CI (2.337–13.431); and OR 0.448, 95% CI (0.248–0.841), AOR 0.429, 95% CI (0.235–0.783)].ConclusionsThe trimester-specific weight gain has a significant impact on the perinatal outcomes among pregnant women with both GDM and preeclampsia. This study is helpful for carry out risk monitoring in time, identifying early warning signs, and improving maternal and infant health.

Trimester-Specific Weight Gain and Midpregnancy Diastolic Blood Pressure Rebound During Normotensive Pregnancy.

The longitudinal exposure-response relationship between trimester-specific gestational weight gain (GWG) and blood pressure (BP) during pregnancy is not well understood. We retrospectively assessed 1112 uncomplicated, normotensive pregnant women whose body weight and BP were measured from 12+0 to 40+0 weeks of gestation from a hospital-based cohort. By using growth curve modeling, a J-shaped pattern dominated diastolic BP (DBP) changing dynamics, with a midpregnancy drop at 20+0 to 22+0 weeks followed by a rebound. Using group-based trajectory modeling, 3 distinctive trajectories of DBP were identified: high-J shaped (18.5%), moderate-J shaped (48.3%), and low-J shaped (33.1%), as well as 3 distinctive GWG trajectories: high increasing (14.7%), moderate increasing (48.6%) and low increasing (36.8%). A temporal coincidence between the maximal rate of GWG and DBP transition from its nadir to rebound was observed during 20+0 to 22+0 weeks. Moreover, women in the high-increasing GWG group had the highest probability of being in the high-J DBP group. The GWG rate during the late midsecond trimester (22+0 to 26+0 weeks) was consistently associated with an elevated DBP level: for every 200 g/wk increase, the multivariable-adjusted odds ratio was 1.27 (95% confidence interval, 1.13-1.43) for the trajectory shift to the high-J group and 1.20 (95% confidence interval, 1.07-1.35) for the occurrence of diastolic prehypertension after 37+0 weeks. Furthermore, adding a trimester-specific GWG rate (22+0 to 26+0 weeks) contributed to the incremental yield for the prediction of diastolic prehypertension after 37+0 weeks. Our results thus provide the timing and extent of gestational weight control relevant to the optimized BP level during pregnancy.

Association of Second and Third Trimester Weight Gain in Pregnancy with Maternal and Fetal Outcomes

ObjectiveTo investigate the association between weekly weight gain, during the second and third trimesters, classified according to the 2009 Institute of Medicine (IOM/NRC) recommendations, and maternal and fetal outcomes.MethodsGestational weight gain was evaluated in 2,244 pregnant women of the Brazilian Study of Gestational Diabetes (Estudo Brasileiro do Diabetes Gestacional – EBDG). Outcomes were cesarean delivery, preterm birth and small or large for gestational age birth (SGA, LGA). Associations between inadequate weight gain and outcomes were estimated using robust Poisson regression adjusting for pre-pregnancy body mass index, trimester-specific weight gain, age, height, skin color, parity, education, smoking, alcohol consumption, gestational diabetes and hypertensive disorders in pregnancy.ResultsIn fully adjusted models, in the second trimester, insufficient weight gain was associated with SGA (relative risk [RR] 1.72, 95% confidence interval [CI] 1.26–2.33), and excessive weight gain with LGA (RR 1.64, 95% CI 1.16–2.31); in third trimester, excessive weight gain with preterm birth (RR 1.70, 95% CI 1.08–2.70) and cesarean delivery (RR 1.21, 95% CI 1.03–1.44). Women with less than recommended gestational weight gain in the 2nd trimester had a lesser risk of cesarean deliveries (RR 0.82, 95% CI 0.71–0.96) than women with adequate gestational weight gain in this trimester.ConclusionThough insufficient weight gain in the 3rd trimester was not associated with adverse outcomes, other deviations from recommended weight gain during second and third trimester were associated with adverse pregnancy outcomes. These findings support, in part, the 2009 IOM/NRC recommendations for nutritional monitoring during pregnancy.

OS021. Risk factors and outcomes of maternal obesity and excessive weight gain during pregnancy

The prevalence of overweight and obesity among women of reproductive age is increasing. Maternal obesity seems to be associated with short-term and long-term adverse outcomes. Excessive gestational weight gain might also influence the risk of adverse pregnancy outcomes. Not much is known about risk factors of maternal obesity and excessive gestational weight gain. Also, little is known about critical periods of gestational weight gain in relation to adverse pregnancy outcomes. We aimed to determine risk factors and maternal, fetal and childhood consequences of maternal obesity and excessive gestational weight gain. Furthermore, we examined the associations of trimester-specific weight gain with the risk of adverse pregnancy outcomes. The study was embedded in a population-based prospective cohort study among 6959 mothers and their children. Maternal anthropometrics were measured in each trimester of pregnancy. Information about maternal weight just before pregnancy, maximum weight during pregnancy and potential socio-demographic and lifestyle related determinants was obtained from questionnaire. Information about gestational hypertensive disorders and birth outcomes was obtained from medical records. Multivariate linear and logistic regression analyses were used. Maternal lower educational level, lower household income, multiparity, and FTO risk allel were associated with an increased risk of maternal obesity, whereas maternal European ethnicity, nulliparity, higher total energy intake, and smoking during pregnancy were associated with an increased risk of excessive gestational weight gain (all p-values <0.05). As compared to normal weight, maternal obesity was associated with increased risks of gestational hypertension (OR 6.31 (95% CI 4.30,9.26)), preeclampsia (OR (3.61 (95% CI 2.04,6.39)), gestational diabetes (OR 6.28 (95%CI 3.01,13.06)), caesarean delivery (OR 1.91 (95% CI 1.46,2.50)), delivering large size for gestational age infants (OR 2.97 (95% CI 2.16,4.08)), and childhood obesity (OR 5.02 (95% CI:2.97,8.45)). Weaker associations of excessive gestational weight gain with these outcomes were observed, with the strongest effects for first trimester weight gain. Weight gain in first and third trimester was associated with the risk of gestational hypertension (OR 1.24 (95% CI 1.12,1.39) and OR 1.27 (95% CI 1.06,1.51) per standard deviation of change in gestational weight gain per week, respectively), whereas weight gain in third trimester was associated with the risk of preeclampsia (OR 1.35 (95% CI 1.08,1.69), per standard deviation of change in gestational weight gain per week). Our study shows that maternal obesity and excessive weight gain during pregnancy are associated with socio-demographic, lifestyle, and genetic factors and with increased risks of adverse maternal, fetal and childhood health outcomes. As compared to prepregnancy overweight and obesity, excessive gestational weight gain has a limited influence on adverse pregnancy outcomes.