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 Gynecology69 Pregnancy29

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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.