The association between gestational weight gain z-score and stillbirth: a case-control study
Open accessAbstract
BACKGROUND: There is limited information on potentially modifiable risk factors for stillbirth, such as gestational weight gain (GWG). Our purpose was to explore the association between GWG and stillbirth using the GWG z-score. METHODS: We analyzed 479 stillbirths and 1601 live births from the Stillbirth Collaborative Research Network case-control study. Women with triplets or monochorionic twins were excluded from analysis. We evaluated the association between GWG z-score (modeled as a restricted cubic spline with knots at the 5th, 50th, and 95th percentiles) and stillbirth using multivariable logistic regression with generalized estimating equations, adjusting for pre - pregnancy body mass index (BMI) and other confounders. In addition, we conducted analyses stratified by pre - pregnancy BMI category (normal weight, overweight, obese). RESULTS: Mean GWG was 18.95 (SD 17.6) lb. among mothers of stillbirths and 30.89 (SD 13.3) lb. among mothers of live births; mean GWG z-score was - 0.39 (SD 1.5) among mothers of cases and - 0.17 (SD 0.9) among control mothers. In adjusted analyses, the odds of stillbirth were elevated for women with very low GWG z-scores (e.g., adjusted odds ratio (aOR) and 95% Confidence Interval (CI) for z-score - 1.5 SD versus 0 SD: 1.52 (1.30, 1.78); aOR (95% CI) for z-score - 2.5 SD versus 0 SD: 2.36 (1.74, 3.20)). Results differed slightly by pre - pregnancy BMI. The odds of stillbirth were slightly elevated among women with overweight BMI and GWG z-scores ≥1 SD (e.g., aOR (95% CI) for z-score of 1.5 SD versus 0 SD: 1.84 (0.97, 3.50)). CONCLUSIONS: GWG z-scores below - 1.5 SD are associated with increased odds of stillbirth.
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Stillbirth is more likely in pregnancies complicated by overweight or obesity.
“Other studies suggest that stillbirth is more likely in pregnancies complicated by overweight 44 or obesity. 39 , 42 , 45”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [44]
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- Authors
- Pickens, C. M., Hogue, C. J., Howards, P. P., Kramer, M. R., Badell, M. L., Dudley, D. J., Silver, R. M., Goldenberg, R. L., Pinar, H., Saade, G. R., Varner, M. W., & Stoll, B. J.
- Affiliations
- Emory University (US)
- University of Virginia (US)
- University of Utah (US)
- Columbia University Irving Medical Center (US)
- The University of Texas Medical Branch at Galveston (US)
- The University of Texas Health Science Center at Houston (US)
- Corresponding author
- Pickens, Cassandra M.
- ORCID
- Venue
- BMC Pregnancy and Childbirth
- Published
- 2019-11-29
- Volume
- 19
- Issue
- 1
- Pages
- 451-451
- ISSN
- 1471-2393 (ISSN-L)
- PMC
- PMC6883690
- OpenAlex
- W2991613244
- Cited by
- 11
- References
- 43
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 3
- FWCI
- 1.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Pregnancy and Childbirth (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Columbia Academic Commons (Columbia University)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (5T32HD052460-10 (Emory University), U10-HD045953 (Brown University), U10-HD045925 (Emory University), U10-HD045952 (University of Texas Medical Branch at Galveston), U10-HD045955 (University of Texas Health Sciences Center at San Antonio), UK10-HD045944 (University of Utah Health Sciences Center), U10-HD045954 (RTI International))
- Maternal and Child Health Bureau (T03MC07651)
- Laney Graduate School
- 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 › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- gestational weight gain, stillbirth, pre-pregnancy body mass index, maternal obesity, overweight, low weight gain, stillbirth risk factors, restricted cubic splines
- MeSH terms
- Pregnancy in Obesity, Obesity, Maternal, Adult, Female, Gestational Age, Humans, Pregnancy, Risk Factors, Body Mass Index, Logistic Models, Odds Ratio, Case-Control Studies, Stillbirth, Young Adult
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