Associations of Gestational Weight Gain With Short- and Longer-term Maternal and Child Health Outcomes

Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
American journal of epidemiology (Impact Factor: 5.23). 05/2009; 170(2):173-80. DOI: 10.1093/aje/kwp101
Source: PubMed


The authors investigated the rate of gestational weight gain associated with the lowest combined risk of 5 short- and longer-term maternal and child health outcomes for 2,012 mother-child pairs recruited in 1999-2002 into Project Viva, a prebirth cohort study in Massachusetts. Within each maternal prepregnancy body mass index (BMI, kg/m(2)) stratum, they performed a logistic regression analysis predicting all 5 outcomes, from which they determined the rate of gain at which average predicted prevalence of the adverse outcomes was the lowest. The mean rate of total gestational weight gain was 0.39 kg/week (standard deviation, 0.14). The prevalence of small for gestational age was 6%, large for gestational age was 14%, preterm delivery was 7%, substantial postpartum weight retention was 16%, and child obesity was 10%. The lowest predicted outcome prevalence occurred with a 0.28-kg/week gain for women whose BMI was 18.5-24.9, a 0.03-kg/week loss for a BMI of 25.0-29.9, and a 0.19-kg/week loss for a BMI of >or=30.0 kg/m(2)--the lowest observed weight changes in overweight and obese women. For normal-weight and overweight women, lowest-risk gains varied modestly with adjustment for maternal characteristics and with different outcome weightings. For obese women, the lowest-risk weight change was weight loss in all models. Recommendations for gestational weight gain for obese women should be revised.

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Available from: James K Hammitt, Jul 16, 2014
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    • "10,226 (1959–1965) 7 years Weight measured at delivery minus self-reported prepregnancy weight Total GWG (kg) IOM 1990 (i) Excessive (ii) Adequate (Ref) (iii) Inadequate BMI í µí± §-score based on measured height and weight OW: BMI ≥95th PCTL (CDC) Maternal age, prepregnancy BMI, parity, race, and smoking; child age at 7-year assessment, birth weight, gestational age, and sex Oken et al. 2009, USA (pros) [40] 2,012 (1999–2002) 3 years Medical record retrieved last prenatal weight minus self-reported prepregnancy weight Rate of GWG (kg/week) BM í µí± §-score based on measured height and weight OB: BMI >95th PCTL (CDC) "
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    ABSTRACT: Objectives: To systematically review the evidence from prospective and retrospective cohort studies on the association between gestational weight gain (GWG) and offspring's body weight. Methods: Electronic databases PubMed, Web of Science, CINAHL, and Academic Search Premiere were searched from inception through March 18, 2013. Included studies (n = 23) were English articles that examined the independent associations of GWG with body mass index (BMI) and/or overweight status in the offspring aged 2 to 18.9 years. Two authors independently extracted the data and assessed methodological quality of the included studies. Results: Evidence from cohort studies supports that total GWG and exceeding the Institute of Medicine maternal weight gain recommendation were associated with higher BMI z-score and elevated risk of overweight or obesity in offspring. The evidence of high rate of GWG during early- and mid-pregnancy is suggestive. Additionally, the evidence on inadequate GWG and net GWG in relation to body weight outcomes in offspring is insufficient to draw conclusions. Conclusions: These findings suggest that GWG is a potential risk factor for childhood obesity. However, findings should be interpreted with caution due to measurement issues of GWG and potential confounding effects of shared familial characteristics (i.e., genetics and maternal and child's lifestyle factors).
    Journal of obesity 10/2014; 2014. DOI:10.1155/2014/524939
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    • "Excess weight gain during pregnancy is of great concern given the associated health implications for both mother and child, including complications with the pregnancy, postpartum weight retention, and childhood overweight and obesity (Margerison Zilko et al. 2010; Oken et al. 2009). Two modifiable lifestyle factors contributing to excess weight gain during pregnancy include (i) an increase in energy intake from food and drink consumption above that required as pregnancy progresses (Olafsdottir et al. 2006) and (ii) a reduction in physical activity and exercise (Clapp and Little 1995; Stuebe et al. 2009). "
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    ABSTRACT: The effect of exercise on appetite and appetite-related hormones during pregnancy is not known. This study found that 30 min of moderate-intensity stationary cycling transiently attenuated hunger and increased fullness in late gestational women (n = 12). Exercise did not affect perceived appetite or appetite-related hormones in response to subsequent caloric consumption. These observations suggest that appetite responses do not intrinsically compensate for the additional energy expenditure induced by exercise, at least in the short term.
    Applied Physiology Nutrition and Metabolism 11/2013; 38(11):1162-5. DOI:10.1139/apnm-2013-0060 · 2.34 Impact Factor
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    • "In 45 studies of pre-pregnancy categories of the BMI, 10 studies were according to the recommendation of Abrams and Parker [40], [41], [43], [45], [49], [55], [58], [62], [64], [80], 24 studies were according to the classification set by the WHO [16], [42], [47], [48], [51]–[54], [56], [57], [65], [69]–[79], [81], [82], 8 studies were according to the IOM recommendations [44], [46], [50], [60], [61], [66]–[68], 2 studies were according to the classification proposed by the WGOC [13], [59] and 1 study was according to the APS [63]. According to the BW categories, SGA were investigated in 16 studies [13], [16], [41], [47], [48], [51], [53]–[57], [61], [66], [69]–[71], LGA in 21 studies [13], [16], [40], [42], [47]–[51], [53]–[57], [59]–[61], [66], [69]–[71], LBW in 10 studies [41], [43], [45], [46], [48], [61], [63], [65], [68], [71], HBW in 12 studies [41]–[43], [45], [46], [49], [58], [61], [63], [65], [67], [71] and macrosomia in 10 studies [44], [48]–[50], [52], [53], [57], [58], [62], [64]. According to the categories of overweight/obesity in offspring, 6 studies were according to CDC recommendations [54], [74]–[77], [82], 5 studies were according to IOTF recommendations [72], [73], [78], [80], [81] and 1 study was according to the classification set by the WHO (W/IW) [79]. "
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    ABSTRACT: Overweight/obesity in women of childbearing age is a serious public-health problem. In China, the incidence of maternal overweight/obesity has been increasing. However, there is not a meta-analysis to determine if pre-pregnancy body mass index (BMI) is related to infant birth weight (BW) and offspring overweight/obesity. Three electronic bibliographic databases (MEDLINE, EMBASE and CINAHL) were searched systematically from January 1970 to November 2012. The dichotomous data on pre-pregnancy overweight/obesity and BW or offspring overweight/obesity were extracted. Summary statistics (odds ratios, ORs) were used by Review Manager, version 5.1.7. After screening 665 citations from three electronic databases, we included 45 studies (most of high or medium quality). Compared with normal-weight mothers, pre-pregnancy underweight increased the risk of small for gestational age (SGA) (odds ratios [OR], 1.81; 95% confidence interval [CI], 1.76-1.87); low BW (OR, 1.47; 95% CI, 1.27-1.71). Pre-pregnancy overweight/obesity increased the risk of being large for gestational age (LGA) (OR, 1.53; 95% CI, 1.44-1.63; and OR, 2.08; 95% CI; 1.95-2.23), high BW (OR, 1.53; 95% CI, 1.44-1.63; and OR, 2.00; 95% CI; 1.84-2.18), macrosomia (OR, 1.67; 95% CI, 1.42-1.97; and OR, 3.23; 95% CI, 2.39-4.37), and subsequent offspring overweight/obesity (OR, 1.95; 95% CI, 1.77-2.13; and OR, 3.06; 95% CI, 2.68-3.49), respectively. Sensitivity analyses revealed that sample size, study method, quality grade of study, source of pre-pregnancy BMI or BW had a strong impact on the association between pre-pregnancy obesity and LGA. No significant evidence of publication bias was observed. Pre-pregnancy underweight increases the risk of SGA and LBW; pre-pregnancy overweight/obesity increases the risk of LGA, HBW, macrosomia, and subsequent offspring overweight/obesity. A potential effect modification by maternal age, ethnicity, gestational weight gain, as well as the role of gestational diseases should be addressed in future studies.
    PLoS ONE 04/2013; 8(4):e61627. DOI:10.1371/journal.pone.0061627 · 3.23 Impact Factor
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