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Cited by 133Gestational Diabetes Research and ManagementMaternal and Neonatal HealthcareBirth, Development, and Health

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Gestational weight gain charts for different body mass index groups for women in Europe, North America, and Oceania

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Santos, Susana, Eekhout, Iris, Voerman, Ellis, Gaillard, Romy, Barros, Henrique, Charles, Marie-Aline, Chatzi, Leda, Chevrier, Cécile, Chrousos, George P., Corpeleijn, Eva, Costet, Nathalie, Crozier, Sarah, Doyon, Myriam, Eggesbø, Merete, Fantini, Maria Pia, Farchi, Sara, Forastiere, Francesco, Gagliardi, Luigi, Georgiu, Vagelis, Godfrey, Keith M., Gori, Davide, Grote, Veit, Hanke, Wojciech, Hertz-Picciotto, Irva, Heude, Barbara, Hivert, Marie-France, Hryhorczuk, Daniel, Huang, Rae-Chi, Inskip, Hazel, Jusko, Todd A., Karvonen, Anne M., Koletzko, Berthold, Küpers, Leanne K., Lagström, Hanna, Lawlor, Debbie A., Lehmann, Irina, Lopez-Espinosa, Maria-Jose, Magnus, Per, Majewska, Renata, Mäkelä, Johanna, Manios, Yannis, McDonald, Sheila W., Mommers, Monique, Morgen, Camilla S., Moschonis, George, Murínová, Ľubica, Newnham, John, Nohr, Ellen A., Andersen, Anne-Marie Nybo, Oken, Emily, Oostvogels, Adriëtte J. J. M., Pac, Agnieszka, Papadopoulou, Eleni, Pekkanen, Juha, Pizzi, Costanza, Polanska, Kinga, Porta, Daniela, Richiardi, Lorenzo, Rifas-Shiman, Sheryl L., Roeleveld, Nel, Santa-Marina, Loreto, Santos, Ana C., Smit, Henriette A., Sørensen, Thorkild I. A., Standl, Marie, Stanislawski, Maggie, Stoltenberg, Camilla, Thiering, Elisabeth, Thijs, Carel, Torrent, Maties, Tough, Suzanne C., Trnovec, Tomas, van Gelder, Marleen M. H. J., van Rossem, Lenie, von Berg, Andrea, Vrijheid, Martine, Vrijkotte, Tanja G. M., Zvinchuk, Oleksandr, van Buuren, Stef, Jaddoe, Vincent W. V.·2018·BMC Medicine
DOI 10.1186/s12916-018-1189-1PMC PMC6217770
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Abstract

BACKGROUND: Gestational weight gain differs according to pre-pregnancy body mass index and is related to the risks of adverse maternal and child health outcomes. Gestational weight gain charts for women in different pre-pregnancy body mass index groups enable identification of women and offspring at risk for adverse health outcomes. We aimed to construct gestational weight gain reference charts for underweight, normal weight, overweight, and grades 1, 2 and 3 obese women and to compare these charts with those obtained in women with uncomplicated term pregnancies. METHODS: We used individual participant data from 218,216 pregnant women participating in 33 cohorts from Europe, North America, and Oceania. Of these women, 9065 (4.2%), 148,697 (68.1%), 42,678 (19.6%), 13,084 (6.0%), 3597 (1.6%), and 1095 (0.5%) were underweight, normal weight, overweight, and grades 1, 2, and 3 obese women, respectively. A total of 138, 517 women from 26 cohorts had pregnancies with no hypertensive or diabetic disorders and with term deliveries of appropriate for gestational age at birth infants. Gestational weight gain charts for underweight, normal weight, overweight, and grade 1, 2, and 3 obese women were derived by the Box-Cox t method using the generalized additive model for location, scale, and shape. RESULTS: We observed that gestational weight gain strongly differed per maternal pre-pregnancy body mass index group. The median (interquartile range) gestational weight gain at 40 weeks was 14.2 kg (11.4-17.4) for underweight women, 14.5 kg (11.5-17.7) for normal weight women, 13.9 kg (10.1-17.9) for overweight women, and 11.2 kg (7.0-15.7), 8.7 kg (4.3-13.4) and 6.3 kg (1.9-11.1) for grades 1, 2, and 3 obese women, respectively. The rate of weight gain was lower in the first half than in the second half of pregnancy. No differences in the patterns of weight gain were observed between cohorts or countries. Similar weight gain patterns were observed in mothers without pregnancy complications. CONCLUSIONS: Gestational weight gain patterns are strongly related to pre-pregnancy body mass index. The derived charts can be used to assess gestational weight gain in etiological research and as a monitoring tool for weight gain during pregnancy in clinical practice.

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Fig. 1 Selected percentiles of weight gain for gestational age for maternal pre-pregnancy underweight (a), normal weight (b), overweight (c), obesity grade 1 (d), obesity grade 2 (e) and obesity grade 3 (f)
Fig. 1 Selected percentiles of weight gain for gestational age for maternal pre-pregnancy underweight (a), normal weight (b), overweight (c), obesity grade 1 (d), obesity grade 2 (e) and obesity grade 3 (f)CC BY · PubMed Central
Fig. 2 Equation for the calculation of pre-pregnancy body mass index-specific gestational weight gain z scores based on a Box-Cox t modela. awhere Y is weight gain at a certain gestational age, L is lambda, M is mu, and S is sigma. The random variable Z is assumed to follow a t distribution with degrees of freedom, Tau > 0, treated as a continuous parameter. The parameters of our Box-Cox t model for each pre-pregnancy body mass index group are provided for the rounded gestational ages. This equation can be applied on data using the y2z function of the AGD package in R. The function will allow the calculation of z scores for the exact gestational age by extrapolating the parameters. For applying the equation or function, weight gain must be > 0, because the model cannot deal with negative values. In order to fit the Box-Cox t model, parameters were calculated based on weight gain + 20 kg, and thus 20 kg must be added to weight gain to be able to use our parameters. The constant of 20 kg was chosen since − 20 kg is an extremely low value for weight change during pregnancy. After adding the 20 kg, weight gain must be > 0; otherwise, the equation or function using our Box-Cox t model parameters cannot be applied for the remaining ≤ 0 values
Fig. 2 Equation for the calculation of pre-pregnancy body mass index-specific gestational weight gain z scores based on a Box-Cox t modela. awhere Y is weight gain at a certain gestational age, L is lambda, M is mu, and S is sigma. The random variable Z is assumed to follow a t distribution with degrees of freedom, Tau > 0, treated as a continuous parameter. The parameters of our Box-Cox t model for each pre-pregnancy body mass index group are provided for the rounded gestational ages. This equation can be applied on data using the y2z function of the AGD package in R. The function will allow the calculation of z scores for the exact gestational age by extrapolating the parameters. For applying the equation or function, weight gain must be > 0, because the model cannot deal with negative values. In order to fit the Box-Cox t model, parameters were calculated based on weight gain + 20 kg, and thus 20 kg must be added to weight gain to be able to use our parameters. The constant of 20 kg was chosen since − 20 kg is an extremely low value for weight change during pregnancy. After adding the 20 kg, weight gain must be > 0; otherwise, the equation or function using our Box-Cox t model parameters cannot be applied for the remaining ≤ 0 valuesCC BY · PubMed Central
Fig. 3 Selected percentiles of weight gain for gestational age in women without any pregnancy complication for maternal pre-pregnancy underweight (a), normal weight (b), overweight (c), obesity grade 1 (d), obesity grade 2 (e) and obesity grade 3 (f)
Fig. 3 Selected percentiles of weight gain for gestational age in women without any pregnancy complication for maternal pre-pregnancy underweight (a), normal weight (b), overweight (c), obesity grade 1 (d), obesity grade 2 (e) and obesity grade 3 (f)CC BY · PubMed Central

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Authors
Santos, S., Eekhout, I., Voerman, E., Gaillard, R., Barros, H., Charles, M.-A., Chatzi, L., Chevrier, C., Chrousos, G. P., Corpeleijn, E., Costet, N., Crozier, S., Doyon, M., Eggesbø, M., Fantini, M. P., Farchi, S., Forastiere, F., Gagliardi, L., Georgiu, V., Godfrey, K. M., Gori, D., Grote, V., Hanke, W., Hertz-Picciotto, I., Heude, B., Hivert, M.-F., Hryhorczuk, D., Huang, R.-C., Inskip, H., Jusko, T. A., Karvonen, A. M., Koletzko, B., Küpers, L. K., Lagström, H., Lawlor, D. A., Lehmann, I., Lopez-Espinosa, M.-J., Magnus, P., Majewska, R., Mäkelä, J., Manios, Y., McDonald, S. W., Mommers, M., Morgen, C. S., Moschonis, G., Murínová, Ľ., Newnham, J., Nohr, E. A., Andersen, A.-M. N., Oken, E., Oostvogels, A. J. J. M., Pac, A., Papadopoulou, E., Pekkanen, J., Pizzi, C., Polanska, K., Porta, D., Richiardi, L., Rifas-Shiman, S. L., Roeleveld, N., Santa-Marina, L., Santos, A. C., Smit, H. A., Sørensen, T. I. A., Standl, M., Stanislawski, M., Stoltenberg, C., Thiering, E., Thijs, C., Torrent, M., Tough, S. C., Trnovec, T., van Gelder, M. M. H. J., van Rossem, L., von Berg, A., Vrijheid, M., Vrijkotte, T. G. M., Zvinchuk, O., van Buuren, S., & Jaddoe, V. W. V.
Affiliations
  • Erasmus MC (NL)
  • Netherlands Organisation for Applied Scientific Research (NL)
  • Universidade do Porto (PT)
  • Inserm (FR)
  • University of Southern California (US)
  • National and Kapodistrian University of Athens (GR)
  • University Medical Center Groningen (NL)
  • MRC Lifecourse Epidemiology Unit (GB)
  • Centre Hospitalier Universitaire de Sherbrooke (CA)
  • Norwegian Institute of Public Health (NO)
  • University of Bologna (IT)
  • Regione Lazio (IT)
  • Ospedale Versilia (IT)
  • University of Crete (GR)
  • University Hospital Southampton NHS Foundation Trust (GB)
  • Ludwig-Maximilians-Universität München (DE)
  • Nofer Institute of Occupational Medicine (PL)
  • Harvard University (US)
  • University of Illinois Chicago (US)
  • The Kids Research Institute Australia (AU)
  • University of Rochester Medicine (US)
  • Finnish Institute for Health and Welfare (FI)
  • University of Turku (FI)
  • University of Bristol (GB)
  • Helmholtz Centre for Environmental Research (DE)
  • Jagiellonian University (PL)
  • Åbo Akademi University (FI)
  • University of Calgary (CA)
  • Maastricht University (NL)
  • University of Copenhagen (DK)
  • La Trobe University (AU)
  • The University of Western Australia (AU)
  • University of Southern Denmark (DK)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • University of Helsinki (FI)
  • University of Turin (IT)
  • Radboud University Medical Center (NL)
  • Helmholtz Munich (DE)
  • Slovak Medical University (SK)
  • Utrecht University (NL)
  • Universitat Pompeu Fabra (ES)
Corresponding author
Jaddoe, Vincent W. V.
ORCID
Venue
BMC Medicine
Publisher
Springer Science and Business Media LLC
Published
2018-11-05
Volume
16
Issue
1
Pages
201-201
ISSN
1741-7015 (ISSN-L)
DOI
10.1186/s12916-018-1189-1
PMC
PMC6217770
OpenAlex
W2801299971
Cited by
133
References
35
Citations by year
2026: 7 · 2025: 13 · 2024: 19 · 2023: 19 · 2022: 21 · 2021: 18 · 2020: 21 · 2019: 15
FWCI
15.16
Type
journal article
Language
en
Open access
Licence
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  • PubMed Central (publishedVersion, cc-by)
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  • Pure Amsterdam UMC (acceptedVersion, cc-by)
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Funders
  • U.S. Environmental Protection Agency
  • U.S. Department of Veterans Affairs (TPR 15-230)
  • March of Dimes Foundation
  • Mead Johnson Nutrition
  • Compagnia di San Paolo
  • Max Bell Foundation
  • University of Notre Dame
  • Sundhed og Sygdom, Det Frie Forskningsråd
  • Diabète Québec
  • Yrjö Jahnssonin Säätiö
  • Wellcome Trust (102215/2/13/2))
  • University Hospital Southampton NHS Foundation Trust
  • National Institute for Health and Care Research (NF-SI-0611-10196, FP7/2007–2013, 308333, NF-SI-0515-10042, EU FP7 ENV.2007.1.2.2.2, 289346)
  • British Heart Foundation (RG/15/17/31749)
  • Dunhill Medical Trust
  • University of Southampton
  • European Commission (2011-2014, EU FP7-HEALTH-2009, 226285, QLK4‐CT‐2001‐00250, EU-FP7, 633595, 2007–2013, 733206, FP7 2007-2013, 603946, 211250, EU FP7 ENV.2007.1.2.2.2, FP7-HEALTH-2012, FP7/2007, 308333, FP7-HEALTH-2009, 289346)
  • Healthway
  • Raine Medical Research Foundation
  • National Research Foundation
  • Agence Nationale de la Recherche (ANR-2010-PRSP-007, ANR-10-PRSP-0007)
  • Institut National de la Santé et de la Recherche Médicale (ANR-2010-PRSP-007)
  • Rijksuniversiteit Groningen
  • Danmarks Grundforskningsfond
  • Curtin University of Technology
  • Edith Cowan University
  • Murdoch University
  • University of Notre Dame Australia
  • ZonMw (00812, 40–00812–98–11010)
  • Erasmus Universiteit Rotterdam
  • Generalitat de Catalunya (EU FP7 ENV.2007.1.2.2.2, 308333)
  • Fondation pour la Recherche Médicale
  • Eusko Jaurlaritza
  • Suomen Kulttuurirahasto
  • Ministero della Salute (502/92)
  • Nederlandse Organisatie voor Wetenschappelijk Onderzoek (FP7 2007-2013, 00812, EU-FP7)
  • Generalitat Valenciana (308333, EU FP7 ENV.2007.1.2.2.2)
  • Helse- og Omsorgsdepartementet (N01-ES-75558, UO1 NS 047537-01, UO1 NS 047537-06A1)
  • Lundbeckfonden
  • Juho Vainion Säätiö (139021, 287675)
  • Päivikki ja Sakari Sohlbergin Säätiö
  • Narodowym Centrum Nauki (/00998, DEC-2014/, 2014/15/B/NZ7/00998, DEC-2014/15/B/NZ7/00998, 603946)
  • Augustinus Fonden
  • Universitair Medisch Centrum Groningen
  • Norges Forskningsråd (289346)
  • Turun Yliopisto
  • Lastentautien Tutkimussäätiö
  • Universidade do Porto
  • Université Paris-Sud
  • Agence Nationale de Sécurité Sanitaire de l’Alimentation, de l’Environnement et du Travail
  • Mutuelle Générale de l'Education Nationale
  • Alberta Innovates
  • Regione Piemonte (502/92)
  • Egmont Fonden
  • Bundesministerium für Bildung, Wissenschaft, Forschung und Technologie
  • Turun Yliopistollinen Keskussairaala (121569, 123571)
  • H. Lundbeck A/S
  • Terveyden ja hyvinvoinnin laitos
  • Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana
  • National Institute for Health Research Southampton Biomedical Research Centre (289346, FP7/2007-2013)
  • National Institutes of Health (FP7/2007-2013, n01es75558-11-0-1, NIEHS R01, N01-ES-75558, UG3OD023286, HD034568, ES‐001247)
  • Centers for Disease Control and Prevention (UG3OD023286)
  • Canadian Institutes of Health Research (MOP – 115071)
  • Medical Research Council (FP7/20072013, MR/J000094/1, MC_UU_12011/4, EU FP7 ENV.2007.1.2.2.2, 308333, EU FP7)
  • National Health and Medical Research Council (139021)
  • Leibniz-Gemeinschaft
  • Fundação para a Ciência e a Tecnologia
  • Instituto de Salud Carlos III (EU FP7 ENV.2007.1.2.2.2, 308333, FP7/2007-2013)
  • Radboud Institute for Health Sciences
  • National Cancer Institute (R01CA096525)
  • Fogarty International Center (R03TW007152)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK103246)
  • National Institute of Neurological Disorders and Stroke (1-UO1-NS-047537, UO1-NS-047537, 2UO1 NS047537-06A1, 047537-01, UO1 NS 047537–01, NS 047537, U01NS047537, 047537-06A1, UO1 NS 047537-06A1, NS 047537-06A1, 1 UO1 NS 047537‐01, FP7/2007-2013)
  • National Institute of Environmental Health Sciences (ES-75558, N01-ES, UO1 NS 047537-01, N01ES75558, ES-001247, K12ES019852, N01 ES075558, 1 UO1 NS 047537-01, R01ES010165, R01ES015282, ES019852, 2 UO1 NS 047537-06A1, P30ES023513, P30ES001247)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD034568)
  • H2020 European Research Council (669545)
  • FP7 Health (289346, 226285, FP7/2007-2013, EU FP7)
  • CHIST-ERA (ANR-2010-PRSP-007)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Keywords
gestational weight gain, body mass index, maternal obesity, underweight pregnancy, overweight in pregnancy, reference charts, term pregnancy, maternal and child health outcomes, pregnancy cohort, individual patient data meta-analysis, birth weight
MeSH terms
Gestational Weight Gain, Adult, Europe, Female, Humans, North America, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Risk Factors, Body Mass Index, Oceania

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