Original Article

Effects of Gestational Weight Gain on Delivery Outcomes in an Obese, Low-Income Population

Authors: Allison Archer Sellner, MD, Abigail Hook Garbarino, MD, Di Miao, PhD, Lisa Marie Hollier, MD, MPH, Bani Maheshwari Ratan, MD

Abstract

Objective: To examine the effects of weight gain/loss on delivery outcomes stratified by class of obesity in an obese, low-income, predominantly minority population.

Methods: A retrospective review of a cohort of 1428 women receiving care at a large Medicaid clinic from 2013 to 2016 with pregravid body mass index ≥30 was conducted. Multinomial logistic regression analysis was used to compare differences in gestational weight change to the primary outcomes of birth-weight percentile and delivery type and secondary outcomes of preterm delivery, preterm labor, gestational diabetes mellitus, and gestational hypertension.

Results: Obesity class 1 patients who lost weight were more likely to have a small-for-gestational-age (SGA) infant compared with those who had recommended weight gain. Obesity classes 2 and 3 patients had no statistically significant increase in SGA infants with weight loss or weight gain below current recommendations. Obesity classes 1 and 2 patients with weight loss had a statistically significant increase in both preterm delivery and preterm labor; however, class 3 patients did not. Obesity class 3 patients who lost weight were significantly more likely to have gestational diabetes mellitus.

Conclusions: Obesity class 3 women may benefit from less weight gain than current recommendations without increasing their risk of SGA infants or preterm birth, especially if gestational diabetes mellitus is present.
Posted in: Obstetrics and Gynecology77 Pregnancy32

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Catalano PM. Management of obesity in pregnancy. Obstet Gynecol 2007; 109(2 Pt 1):419–433.
 
2. Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012; 307:491–497.
 
3. Fryar C, Carroll M, Ogden C. Prevalence of overweight, obesity, and extreme obesity among adults aged 20 and Over: United States, 1960–1962 through 2013–2014. https://www.cdc.gov/nchs/data/hestat/obesity_adult_15_16/obesity_adult_15_16.htm. Published 2018. Accessed February 19, 2019.
 
4. American College of Obstetrics and Gynecology. ACOG Practice Bulletin No 156: obesity in pregnancy. Obstet Gynecol 2015;126:e112–e126.
 
5. Rasmussen KM, Yaktine AL, Institute of Medicine, et al, eds. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington DC: The National Academies Press; 2009.
 
6. Rasmussen KM, Abrams B, Bodnar LM, et al. Recommendations for weight gain during pregnancy in the context of the obesity epidemic. Obstet Gynecol 2010;116:1191–1195.
 
7. Rooney BL, Schauberger CW. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol 2002;100:245–252.
 
8. Hruby A, Manson JE, Qi L, et al. Determinants and consequences of obesity. Am J Public Health 2016;106:1656–1662.
 
9. Catalano PM. Obesity and pregnancy–the propagation of a viscous cycle? J Clin Endocrinol Metab 2003;88:3505–3506.
 
10. Durst JK, Sutton AL, Cliver SP, et al. Impact of gestational weight gain on perinatal outcomes in obese women. Am J Perinatol 2016;33:849–855.
 
11. Dzakpasu S, Fahey J, Kirby RS, et al. (2014). Contribution of prepregnancy body mass index and gestational weight gain to caesarean birth in Canada. BMC Pregnancy Childbirth 2014;14:106.
 
12. Faucher MA, Barger MK. Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: a systematic review. Women Birth 2015;28:e70–e79.
 
13. Gavard JA, Artal R. The association of gestational weight gain with birth weight in obese pregnant women by obesity class and diabetic status: a population-based historical cohort study. Matern Child Health J 2014;18: 1038–1047.
 
14. Goldstein RF, Abell SK, Ranasinha S, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and metaanalysis. JAMA 2017;317:2207–2225.
 
15. Hinkle SN, Sharma AJ, Dietz PM. Gestational weight gain in obese mothers and associations with fetal growth. Am J Clin Nutr 2010;92:644–651.
 
16. Kominiarek MA, Seligman NS, Dolin C, et al. Gestational weight gain and obesity: is 20 pounds too much? Am J Obstet Gynecol 2013;209:214.e1–214.e11.
 
17. Kominiarek MA, Peaceman AM. Gestational weight gain. Am J Obstet Gynecol 2017;217:642–651.
 
18. Committee on Obstetric Practice, the American Institute of Ultrasound in Medicine, the Society for Maternal-Fetal Medicine. Committee opinion no. 700: methods for estimating the due date. Obstet Gynecol 2017;129:e150–e154.
 
19. Johnson J, Clifton RG, Roberts JM, et al. Pregnancy outcomes with weight gain above or below the 2009 Institute of Medicine guidelines. Obstet Gynecol 2013;121:969–975.
 
20. Antony KM, Ma J, Mitchell KB, et al. The preterm placental microbiome varies in association with excess maternal gestational weight gain. Am J Obstet Gynecol 2015;212:653.e1–653.16.
 
21. Chou JH, Roumiantsev S, Singh R. PediTools electronic growth chart calculators: applications in clinical care, research, and quality improvement. J Med Internet Res 2020;22:e16204.
 
22. Dencker A, Premberg Å, Olander EK, et al. Adopting a healthy lifestyle when pregnant and obese – an interview study three years after childbirth. BMC Pregnancy Childbirth 2016;16:201.
 
23. Lindqvist M, Lindkvist M, Eurenius E, et al. Change of lifestyle habits— motivation and ability reported by pregnant women in northern Sweden. Sex Reprod Healthc 2017;13:83–90.
 
24. Vesco KK, Dietz PM, Rizzo J, et al. Excessive gestational weight gain and postpartum weight retention among obese women. Obstet Gynecol 2009; 114:1069–1075.
 
25. Blomberg M. Maternal and neonatal outcomes among obese women with weight gain below the new Institute of Medicine recommendations. Obstet Gynecol 2011;117(5), 1065–1070.
 
26. Catalano PM, Mele L, Landon MB, et al. Inadequate weight gain in overweight and obese pregnant women: what is the effect on fetal growth? Am J Obstet Gynecol 2014;211:137.e1–137.e1377.
 
27. Kapadia MZ, Park CK, Beyene J, et al. Weight loss instead of weight gain within the guidelines in obese women during pregnancy: a systematic review and meta-analyses of maternal and infant outcomes. PLoS One 2015; 10:e0132650.
 
28. Kominiarek MA, Saade G, Mele L, et al. Association between gestational weight gain and perinatal outcomes. Obstet Gynecol 2018;132:875–881.
 
29. Beyerlein A, Schiessl B, Lack N, et al. Associations of gestational weight loss with birth-related outcome: a retrospective cohort study. BJOG 2011; 118:55–61.
 
30. Bodnar LM, Siega-Riz AM, Simhan HN, et al. Severe obesity, gestational weight gain, and adverse birth outcomes. Am J Clin Nutr 2010;91:1642–1648.