Associations of gestational weight loss with birth-related outcome: A retrospective cohort study

Institute of Social Paediatrics and Adolescent Medicine, Division of Epidemiology, Ludwig-Maximilians University of Munich, Munich, Germany.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 11/2010; 118(1):55-61. DOI: 10.1111/j.1471-0528.2010.02761.x
Source: PubMed


Although the prevention of gestational weight loss (GWL) has become a priority for clinicians in the past few decades, recent work has suggested that GWL may be beneficial for obese mothers. We aimed to identify the potential beneficial or adverse associations of GWL with pregnancy outcome stratified by maternal body mass index (BMI) category.
Retrospective cohort study.
Data on 709 575 singleton deliveries in Bavarian obstetric units from 2000-2007 were extracted from a standard dataset for which data are regularly collected for the national benchmarking of obstetric units.
We calculated the odds ratios (ORs) for adverse pregnancy outcome by GWL (explanatory variable) compared with nonexcessive weight gain with adjustment for confounders and stratification by BMI category (underweight, BMI < 18.5 kg/m²; normal weight, BMI = 18.5-24.9 kg/m²; overweight, BMI = 25-29.9 kg/m²; obese class I, BMI = 30-34.9 kg/m²; obese class II, BMI = 35-39.9 kg/m²; obese class III, BMI ≥ 40 kg/m²).
Pre-eclampsia, nonelective caesarean section, preterm delivery, small or large for gestational age (SGA/LGA) birth and perinatal mortality.
GWL was associated with a decreased risk of pregnancy complications, such as pre-eclampsia and nonelective caesarean section, in overweight and obese women [e.g. OR = 0.65 (95% confidence interval: 0.51, 0.83) for nonelective caesarean section in obese class I women]. The risks of preterm delivery and SGA births, by contrast, were significantly higher in overweight and obese class I/II mothers [e.g. OR = 1.68 (95% confidence interval: 1.37, 2.06) for SGA in obese class I women]. In obese class III women, no significantly increased risks of poor outcomes for infants were observed.
The association of GWL with a decreased risk of pregnancy complications appears to be outweighed by increased risks of prematurity and SGA in all but obese class III mothers.

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Available from: Andreas Beyerlein, Oct 13, 2014
    • "However, several authors reported no association between GWG below the IOM (0–4.9 kg) and SGA for obese women (Hinkle et al, 2010; Durie et al., 2011; Kominiarek et al., 2013; Haugen et al., 2014). The findings for gestational weight loss (GWL) vary, but increasing obesity severity appears to attenuate the association between GWL and adverse outcomes (Hinkle et al., 2010; Beyerlein et al., 2011; Blomberg, 2011; Durie et al., 2011; Kominiarek et al., 2013). Moreover, other studies report alternative optimal GWG ranges depending on the population and the different (combinations of) outcomes studied (Cedergren, 2007; Beyerlein et al., 2009; Oken et al., 2009; Bodnar et al., 2010). "
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    ABSTRACT: Objective: to examine the effect of gestational weight gain (GWG) on likelihood of referral from midwife-led to obstetrician-led care during pregnancy and childbirth for women in primary care at the outset of their pregnancy. Design: secondary analysis of data from a prospective cohort study. Setting: Dutch midwife-led practices. Participants: a cohort of 1288 women of Northern European descent, with uncomplicated, singleton pregnancy at antenatal booking who consequently were eligible for primary, midwife-led care. Measurements: because of the absence of an established GWG guideline in the Netherlands, we compared the effect of inadequate and excessive GWG according to two GWG guidelines: the criterion traditionally used, which is based on knowledge of the physiological components of GWG, advising 10-15kg as a normal GWG irrespective of a woman׳s BMI category, and the 2009 Institute of Medicine recommendations (IOMr) on GWG, which provide BMI related advice. Outcome measures were: number of women referred from midwife-led to obstetrician-led care during pregnancy and during childbirth; indications of referral and birth outcomes. Findings: GWG above traditional criteria (Tc; >15kg between 12 and 36 weeks) was associated with increased odds for referral during childbirth (adjusted odds ratio (aOR) 1.88; 95% confidence interval (CI) 1.22-2.90), but had no effect on referral during pregnancy (aOR .86; 95% CI .57-1.30). No associations were established between GWG below Tc (<10kg) and referral during pregnancy (aOR 1.08; 95% CI .78-1.50) or childbirth (aOR 1.08; 95% CI .74-1.56). No associations were found between GWG below and above the IOMr and referral during pregnancy (below IOMr: aOR 1.01; 95% CI .71-1.45; above IOMr: aOR .89; 95% CI .61-1.28) or childbirth (below IOMr: aOR .85; 95% CI .57-1.25; above IOMr: aOR 1.09; 95% CI .73-1.63). With regard to the effect of GWG according to both recommendations on indications for referral and birth outcomes, GWG above Tc was associated with higher rates of referral for hypertensive disorders (aOR 1.91; 95% CI 1.04-3.50) and for meconium stained liquor (aOR 2.22; CI 1.33-3.71) after adjusting for BMI and parity. Conclusions: GWG above Tc - irrespective of BMI category - was associated with doubled odds of referral to specialist care during childbirth. GWG below or above IOMR and GWG below TC were not associated with adverse obstetric outcomes in women who were eligible for primary care at the outset of their pregnancy. Implications for practice: weight gain <15kg between 12 and 36 weeks is advised for women in all BMI categories in this population. It is important to validate GWG guidelines in a target population before implementing them.
    No preview · Article · Dec 2015 · Midwifery
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    • "However, we found that the IOM guidelines seemed to be less protective for adverse birth outcomes in obese women examined in this study. The importance of obese women avoiding excessive GWG have also been documented in both earlier and more recent studies [1,9,28] and in grossly overweight women weight reduction has been recommended [12,28]. In obese women no increased risk for SGA among those who gained 0.1-4.9 "
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    ABSTRACT: Background Excessive gestational weight gain (GWG) is associated with pregnancy complications, and Norwegian Health Authorities have adopted the GWG recommendations of the US Institute of Medicine and National Research Council (IOM). The aim of this study was to evaluate if a GWG outside the IOM recommendation in a Norwegian population is associated with increased risk of pregnancy complications like hypertension, low and high birth weight, preeclampsia, emergency caesarean delivery, and maternal post-partum weight retention (PPWR) at 6 and 18 months. Methods This study was performed in 56 101 pregnant women included in the prospective national Norwegian Mother and Child Cohort Study (MoBa) in the years 1999 to 2008. Women who delivered a singleton live born child during gestational week 37 to 42 were included. Maternal prepregnant and postpartum weight was collected from questionnaires at 17th week of gestation and 6 and 18 months postpartum. Results A weight gain less than the IOM recommendations (GWG < IOM rec.) increased the risk for giving birth to a low weight baby among normal weight nulliparous women. A weight gain higher than the IOM recommendations (GWG > IOM rec.) significantly increased the risk of pregnancy hypertension, a high birth weight baby, preeclampsia and emergency cesarean delivery in both nulliparous and parous normal weight women. Similar results were found for overweight women except for no increased risk for gestational hypertension in parous women with GWG > IOM rec. Seventy-four percent of the overweight nulliparous women and 66% of the obese women had a GWG > IOM rec. A GWG > IOM rec. resulted in increased risk of PPWR > 2 kg in all weight classes, but most women attained their prepregnant weight class by 18 months post-partum. Conclusions For prepregnant normal weight and overweight women a GWG > IOM rec. increased the risk for unfavorable birth outcomes in both nulliparous and parous women. A GWG > IOM rec. increased the risk of a PPWR > 2 kg at 18 months in all weight classes. This large study supports the Norwegian Health authorities’ recommendations for normal weight and overweight women to comply with the IOM rec.
    Full-text · Article · Jun 2014 · BMC Pregnancy and Childbirth
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    • "While this was true for approximately 25% of our study population, a considerable number of initially overweight and obese women (18 and 20%, respectively) lost weight between pregnancies thus theoretically negating the risk of many of the maternal and perinatal complications associated with weight gain but increasing their risk of a SGA birth. In partial support a recent retrospective study involving more than 700,000 women has specifically shown that gestational weight loss protects against pre-eclampsia and emergency caesarean section but increases the risk of prematurity and SGA in all but the most severely obese women [29]. We have no information on the underlying causes of weight change in either direction in the present study but likely candidates not controlled for in the analysis presented here include inappropriate gestational weight change, diet, physical activity, breastfeeding and socio-economic status. "
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    ABSTRACT: The inter-pregnancy period is considered a teachable moment when women are receptive to weight- management guidance aimed at optimising pregnancy outcome in subsequent pregnancies. In population based studies inter-pregnancy weight change is associated with several adverse pregnancy outcomes but the impact on placental size is unknown. The association between inter-pregnancy weight change and the primary risk of adverse pregnancy outcomes in the second pregnancy was investigated in 12,740 women with first two consecutive deliveries at a single hospital using logistic regression. Compared with women who were weight stable, weight loss (>1BMI unit) between pregnancies was associated with an increased risk of spontaneous preterm delivery, low placental weight and small for gestational age (SGA) birth, while weight gain (>3BMI units) increased the risk of pre-eclampsia, gestational hypertension, emergency caesarean section, placental oversize and large for gestational age (LGA) birth at the second pregnancy. The relationship between weight gain and pre-eclampsia risk was evident in women who were overweight at first pregnancy only (BMI >=25 units), while that between weight loss and preterm delivery was confined to women with a healthy weight at first pregnancy (BMI <25 units). In contrast, the association between weight loss and SGA was independent of first pregnancy BMI. A higher percentage of women who were obese at first pregnancy were likely to experience a large weight gain (P < 0.01) or weight loss (P < 0.001) between consecutive pregnancies compared with the normal BMI reference group. Inter-pregnancy weight change in either direction increases the risk of a number of contrasting pregnancy complications, including extremes of placental weight. The placenta may lie on the causal pathway between BMI change and the risk of LGA or SGA birth.
    Full-text · Article · Jan 2014 · BMC Pregnancy and Childbirth
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