Kiel DW, Dodson EA, Artal R, Boehmer TK, Leet TL. Gestational weight gain and pregnancy outcomes in obese women: how much is enough

Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University, Сент-Луис, Michigan, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 11/2007; 110(4):752-8. DOI: 10.1097/01.AOG.0000278819.17190.87
Source: PubMed


To examine the effect of gestational weight change on pregnancy outcomes in obese women.
A population-based cohort study of 120,251 pregnant, obese women delivering full-term, liveborn, singleton infants was examined to assess the risk of four pregnancy outcomes (preeclampsia, cesarean delivery, small for gestational age births, and large for gestational age births) by obesity class and total gestational weight gain.
Gestational weight gain incidence for overweight or obese pregnant women, less than the currently recommended 15 lb, was associated with a significantly lower risk of preeclampsia, cesarean delivery, and large for gestational age birth and higher risk of small for gestational age birth. These results were similar for each National Institutes of Health obesity class (30-34.9, 35-35.9, and 40.0 kg/m(2)), but at different amounts of gestational weight gain.
Limited or no weight gain in obese pregnant women has favorable pregnancy outcomes.

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    • "Terminations ≥ 20 weeks due to anomalies or other reasons Missing end of pregnancy weight (n = 1022) Missing gestation for end of pregnancy weight (n = 1854) n = 115) Underweight prepregnancy BMI category ( Auckland (n = 264) Adelaide (n = 475) Cork (n = 1211) Recruited to study at 14–16 weeks (n = 5026) Study population at 14–16 weeks' (n = 4970) (n = 12) Miscarriage or termination 15–19[6] "
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    ABSTRACT: Objective: Excessive gestational weight gain (GWG) is associated with adverse maternal and child outcomes and contributes to obesity in women. Our aim was to identify early pregnancy factors associated with excessive GWG, in a contemporary nulliparous cohort. Methods: Participants in the SCOPE study were classified into GWG categories ("not excessive" versus "excessive") based on pregravid body mass index (BMI) using 2009 Institute of Medicine (IOM) guidelines. Maternal characteristics and pregnancy risk factors at 14-16 weeks were compared between categories and multivariable analysis controlled for confounding factors. Results: Of 1950 women, 17% gained weight within the recommended range, 74% had excessive and 9% inadequate GWG. Women with excessive GWG were more likely to be overweight (adjOR 2.9 (95% CI 2.2-3.8)) or obese (adjOR 2.5 (95% CI 1.8-3.5)) before pregnancy compared to women with a normal BMI. Other factors independently associated with excessive GWG included recruitment in Ireland, younger maternal age, increasing maternal birthweight, cessation of smoking by 14-16 weeks, increased nightly sleep duration, high seafood diet, recent immigrant, limiting behaviour, and decreasing exercise by 14-16 weeks. Fertility treatment was protective. Conclusions: Identification of potentially modifiable risk factors for excessive GWG provides opportunities for intervention studies to improve pregnancy outcome and prevent maternal obesity.
    Journal of obesity 06/2014; 2014:148391. DOI:10.1155/2014/148391
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    • "However, these gestational weight gain cut off points were defined using limited data available at that time. Recent research advocates for less gestational weight gain, at least for severe obese women, since it is associated with less macrosomia or large for gestational age infants [77-79]. Insight into the diet and physical activity patterns that lead to less weight gain or even weight loss can be helpful to these recommendations and might explain some of the negative effects associated with excessive weight loss, such as small for gestational age babies. "
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    ABSTRACT: Gestational diabetes mellitus (GDM) is an increasing problem world-wide. Lifestyle interventions and/or vitamin D supplementation might help prevent GDM in some women.Methods/design: Pregnant women at risk of GDM (BMI>=29 (kg/m2)) from 9 European countries will be invited to participate and consent obtained before 19+6 weeks of gestation. After giving informed consent, GDM will be excluded (based on IADPSG criteria: fasting glucose<5.1mmol; 1 hour glucose <10.0 mmol; 2 hour glucose <8.5mmol) and women will be randomized to one of the 8 intervention arms using a 2x(2x2) factorial design: ( 1) healthy eating (HE), 2) physical activity (PA), 3) HE+PA, 4) control, 5) HE+PA+vitamin D, 6) HE+PA+placebo, 7) vitamin D alone, 8) placebo alone), pre-stratified for each site. In total, 880 women will be included with 110 women allocated to each arm. Between entry and 35 weeks of gestation, women allocated to a lifestyle intervention will receive 5 face-to-face, and 4 telephone coaching sessions, based on the principles of motivational interviewing. The lifestyle intervention includes a discussion about the risks of GDM, a weight gain target <5kg and either 7 healthy eating 'messages' and/or 5 physical activity 'messages' depending on randomization. Fidelity is monitored by the use of a personal digital assistance (PDA) system. Participants randomized to the vitamin D intervention receive either 1600 IU vitamin D or placebo for daily intake until delivery. Data is collected at baseline measurement, at 24--28 weeks, 35--37 weeks of gestation and after delivery. Primary outcome measures are gestational weight gain, fasting glucose and insulin sensitivity, with a range of obstetric secondary outcome measures including birth weight. DALI is a unique Europe-wide randomised controlled trial, which will gain insight into preventive measures against the development of GDM in overweight and obese women.Trial registration: ISRCTN70595832.
    BMC Pregnancy and Childbirth 07/2013; 13(1):142. DOI:10.1186/1471-2393-13-142 · 2.19 Impact Factor
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    • "Some researchers have agreed with the Institute of Medicine's initial recommendations for maternal weight gain during gestation [7-9]; however, recent studies suggest that lower gestational weight gain may be preferable [10,11]. In developing Asian countries, such as Iran, women generally have a lower BMI and/or a smaller gestational weight gain than in developed countries. "
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    ABSTRACT: Maternal obesity has been associated with adverse pregnancy outcomes, such as pre-eclampsia, eclampsia, pre- and post-term delivery, induction of labor, macrosomia, increased rate of caesarean section, and post-partum hemorrhage. The objective of this study was to determine the effect of maternal Body Mass Index (BMI) on pregnancy outcomes. 1000 pregnant women were enrolled in the study. In order to explore the relationship between maternal first trimester Body Mass Index and pregnancy outcomes, participants were categorized into five groups based on their first trimester Body Mass Index. The data were analyzed using Pearson Chi-square tests in SPSS 18. Differences were considered significant if p < 0.05. Women with an above-normal Body Mass Index had a higher incidence of pre-eclampsia, induction of labor, caesarean section, pre-term labor, and macrosomia than women with a normal Body Mass Index (controls). There was no significant difference in the incidence of post-term delivery between the control group and other groups. Increased BMI increases the incidence of induction of labor, caesarean section, pre-term labor and macrosomia. The BMI of women in the first trimester of pregnancy is associated with the risk of adverse pregnancy outcome.
    BMC Research Notes 01/2012; 5(1):34. DOI:10.1186/1756-0500-5-34
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