Association Between Gestational Weight Gain and Perinatal Outcomes
Open accessAbstract
OBJECTIVE: To evaluate the association between gestational weight gain and maternal and neonatal outcomes in a large, geographically diverse cohort. METHODS: Trained chart abstractors at 25 hospitals obtained maternal and neonatal data for all deliveries on randomly selected days over 3 years (2008–2011). Gestational weight gain was derived using weight at delivery minus prepregnancy or first-trimester weight and categorized as below, within, or above the Institute of Medicine (IOM) guidelines in this retrospective cohort study. Maternal (primary or repeat cesarean delivery, third- or fourth-degree lacerations, severe postpartum hemorrhage, hypertensive disease of pregnancy) and neonatal (preterm birth, shoulder dystocia, macrosomia, hypoglycemia) outcomes were compared among women in the gestational weight gain categories in unadjusted and adjusted analyses with odds ratios (ORs) and 95% CI reported. Covariates included age, race-ethnicity, tobacco use, insurance type, parity, prior cesarean delivery, pregestational diabetes, hypertension, and hospital type. RESULTS: Of the 29,861 women included, 51% and 21% had gestational weight gain above and below the guidelines, respectively. There was an association between gestational weight gain above the IOM guidelines and cesarean delivery in both nulliparous women (adjusted OR 1.44, 95% CI 1.31–1.59) and multiparous women (adjusted OR 1.26, 95% CI 1.13–1.41) and hypertensive diseases of pregnancy in nulliparous and multiparous women combined (adjusted OR 1.84, 95% CI 1.66–2.04). For the neonatal outcomes, gestational weight gain above the IOM guidelines was associated with shoulder dystocia (adjusted OR 1.74, 95% CI 1.41–2.14), macrosomia (adjusted OR 2.66, 95% CI 2.03–3.48), and neonatal hypoglycemia (adjusted OR 1.60, 95% CI 1.16–2.22). Gestational weight gain below the guidelines was associated with spontaneous (adjusted OR 1.50, 95% CI 1.31–1.73) and indicated (adjusted OR 1.34, 95% CI 1.12–1.60) preterm birth. CONCLUSION: In a large, diverse cohort with prospectively collected data, gestational weight gain below or above guidelines is associated with a variety of adverse pregnancy outcomes.
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Inadequate and excessive GWG are related to poor pregnancy outcomes for non-diabetic women in Western or high-income countries.
“most of the current evidences displayed that inadequate and excessive GWG were related to poor pregnancy outcomes for non-diabetic women in Western or high-income countries [9, 19, 20]”
From Associations of maternal pre-pregnancy BMI and gestational weight gain with the risks of adverse pregnancy outcomes in Chinese women with gestational diabetes mellitus (2023) · cites this paper as [20]
The Discussion (page not provided) reports associations between weight gain outside the guidelines and adverse maternal and neonatal outcomes, and the Methods describe a study at 25 U.S. hospitals. The study did not restrict its cohort to non-diabetic women: the Methods report gestational diabetes and adjust for pregestational diabetes. It therefore supports the U.S. pregnancy-outcomes finding, but not the claim as specifically phrased for non-diabetic women. (LLM, conf=0.88)
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- Authors
- Kominiarek, M. A., Saade, G., Mele, L., Bailit, J., Reddy, U. M., Wapner, R. J., Varner, M. W., Thorp, J. M., Caritis, S. N., Prasad, M., Tita, A. T. N., Sorokin, Y., Rouse, D. J., Blackwell, S. C., Tolosa, J. E., & for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
- Affiliations
- University of North Carolina at Chapel Hill (US)
- ORCID
- Venue
- Obstetrics & Gynecology
- Published
- 2018-10
- Volume
- 132
- Issue
- 4
- Pages
- 875-881
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC6153045
- OpenAlex
- W2894848896
- Semantic Scholar
- 89b01ab09ab3a19ccbf205664c66bcfa4d07dfa9
- Cited by
- 148
- References
- 17
- Citations by year
- 2026: 4 · 2025: 15 · 2024: 17 · 2023: 31 · 2022: 34 · 2021: 20 · 2020: 18 · 2019: 9
- FWCI
- 13.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR002548)
- National Center for Research Resources (UL1RR024989, UL1RR025764)
- National Center for Advancing Translational Sciences
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U01HD036801, U10HD040544, U10HD034208, U10HD040512, UG1HD034116, UG1HD053097, U10HD027915, U10HD040545, U10HD040560, U10HD027917, U10HD036801, U10HD021410, U10HD053097, U10HD034116, U10HD040500, U10HD040485, P2CHD050924, U10HD053118, U10HD027869, UG1HD034208, U24HD036801, UG1HD040500, UG1HD040512, UG1HD027869, UG1HD040544, UG1HD040485, UG1HD027915, UG1HD040560, UG1HD040545, K23HD076010)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- gestational weight gain, IOM weight gain guidelines, cesarean section, hypertensive disorders of pregnancy, shoulder dystocia, macrosomia, neonatal hypoglycemia, preterm birth, third- and fourth-degree lacerations, postpartum hemorrhage, maternal obesity, maternal underweight, maternal outcomes, neonatal outcomes, nulliparous women
- MeSH terms
- Gestational Weight Gain, Adult, Female, Humans, Infant, Newborn, Pregnancy, Pregnancy Outcome, United States, Cohort Studies, Young Adult
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