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Association of gestational weight gain with adverse maternal and infant outcomes

Association of gestational weight gain with adverse maternal and infant outcomes
Association of gestational weight gain with adverse maternal and infant outcomes

Importance: Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all prepregnancy weight ranges. Objectives: To examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories. Design, Setting, and Participants: Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample). Optimal gestational weight gain ranges were estimated for each prepregnancy body mass index (BMI) category by selecting the range of gestational weight gain that was associated with lower risk for any adverse outcome. Individual participant-level data from 3505 participants within 4 separate hospital-based cohorts were used as a validation sample. Data were collected between 1989 and 2015. The final date of follow-up was December 2015. Exposures: Gestational weight gain. Main Outcomes and Measures: The main outcome termed any adverse outcome was defined as the presence of 1 or more of the following outcomes: preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, and small or large size for gestational age at birth. Results: Of the 196 670 women (median age, 30.0 years [quartile 1 and 3, 27.0 and 33.0 years] and 40 937 were white) included in the main sample, 7809 (4.0%) were categorized at baseline as underweight (BMI <18.5); 133 788 (68.0%), normal weight (BMI, 18.5-24.9); 38 828 (19.7%), overweight (BMI, 25.0-29.9); 11 992 (6.1%), obesity grade 1 (BMI, 30.0-34.9); 3284 (1.7%), obesity grade 2 (BMI, 35.0-39.9); and 969 (0.5%), obesity grade 3 (BMI, ≥40.0). Overall, any adverse outcome occurred in 37.2% (n = 73 161) of women, ranging from 34.7% (2706 of 7809) among women categorized as underweight to 61.1% (592 of 969) among women categorized as obesity grade 3. Optimal gestational weight gain ranges were 14.0 kg to less than 16.0 kg for women categorized as underweight; 10.0 kg to less than 18.0 kg for normal weight; 2.0 kg to less than 16.0 kg for overweight; 2.0 kg to less than 6.0 kg for obesity grade 1; weight loss or gain of 0 kg to less than 4.0 kg for obesity grade 2; and weight gain of 0 kg to less than 6.0 kg for obesity grade 3. These gestational weight gain ranges were associated with low to moderate discrimination between those with and those without adverse outcomes (range for area under the receiver operating characteristic curve, 0.55-0.76). Results for discriminative performance in the validation sample were similar to the corresponding results in the main study sample (range for area under the receiver operating characteristic curve, 0.51-0.79). Conclusions and Relevance: In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights. The estimates of optimal gestational weight gain may inform prenatal counseling; however, the optimal gestational weight gain ranges had limited predictive value for the outcomes assessed.

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1702-1715
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LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group
Voerman, Ellis
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Lagström, Hanna
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Lehmann, Irina
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Majewska, Renata
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LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group (2019) Association of gestational weight gain with adverse maternal and infant outcomes. JAMA, 321 (17), 1702-1715. (doi:10.1001/jama.2019.3820).

Record type: Article

Abstract

Importance: Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all prepregnancy weight ranges. Objectives: To examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories. Design, Setting, and Participants: Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample). Optimal gestational weight gain ranges were estimated for each prepregnancy body mass index (BMI) category by selecting the range of gestational weight gain that was associated with lower risk for any adverse outcome. Individual participant-level data from 3505 participants within 4 separate hospital-based cohorts were used as a validation sample. Data were collected between 1989 and 2015. The final date of follow-up was December 2015. Exposures: Gestational weight gain. Main Outcomes and Measures: The main outcome termed any adverse outcome was defined as the presence of 1 or more of the following outcomes: preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, and small or large size for gestational age at birth. Results: Of the 196 670 women (median age, 30.0 years [quartile 1 and 3, 27.0 and 33.0 years] and 40 937 were white) included in the main sample, 7809 (4.0%) were categorized at baseline as underweight (BMI <18.5); 133 788 (68.0%), normal weight (BMI, 18.5-24.9); 38 828 (19.7%), overweight (BMI, 25.0-29.9); 11 992 (6.1%), obesity grade 1 (BMI, 30.0-34.9); 3284 (1.7%), obesity grade 2 (BMI, 35.0-39.9); and 969 (0.5%), obesity grade 3 (BMI, ≥40.0). Overall, any adverse outcome occurred in 37.2% (n = 73 161) of women, ranging from 34.7% (2706 of 7809) among women categorized as underweight to 61.1% (592 of 969) among women categorized as obesity grade 3. Optimal gestational weight gain ranges were 14.0 kg to less than 16.0 kg for women categorized as underweight; 10.0 kg to less than 18.0 kg for normal weight; 2.0 kg to less than 16.0 kg for overweight; 2.0 kg to less than 6.0 kg for obesity grade 1; weight loss or gain of 0 kg to less than 4.0 kg for obesity grade 2; and weight gain of 0 kg to less than 6.0 kg for obesity grade 3. These gestational weight gain ranges were associated with low to moderate discrimination between those with and those without adverse outcomes (range for area under the receiver operating characteristic curve, 0.55-0.76). Results for discriminative performance in the validation sample were similar to the corresponding results in the main study sample (range for area under the receiver operating characteristic curve, 0.51-0.79). Conclusions and Relevance: In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights. The estimates of optimal gestational weight gain may inform prenatal counseling; however, the optimal gestational weight gain ranges had limited predictive value for the outcomes assessed.

Full text not available from this repository.

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Accepted/In Press date: 29 March 2019
Published date: 7 May 2019

Identifiers

Local EPrints ID: 431363
URI: http://eprints.soton.ac.uk/id/eprint/431363
ISSN: 0098-7484
PURE UUID: ba072bd0-d544-49d2-bb98-4426f53884bd
ORCID for Hazel Inskip: ORCID iD orcid.org/0000-0001-8897-1749
ORCID for Sarah Crozier: ORCID iD orcid.org/0000-0002-9524-1127
ORCID for Keith Godfrey: ORCID iD orcid.org/0000-0002-4643-0618

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Date deposited: 30 May 2019 16:30
Last modified: 23 Feb 2021 02:36

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Contributors

Author: Ellis Voerman
Author: Susana Santos
Author: Hazel Inskip ORCID iD
Author: Pilar Amiano
Author: Henrique Barros
Author: Marie Aline Charles
Author: Leda Chatzi
Author: George P. Chrousos
Author: Eva Corpeleijn
Author: Sarah Crozier ORCID iD
Author: Myriam Doyon
Author: Merete Eggesbø
Author: Maria Pia Fantini
Author: Sara Farchi
Author: Francesco Forastiere
Author: Vagelis Georgiu
Author: Davide Gori
Author: Wojciech Hanke
Author: Irva Hertz-Picciotto
Author: Barbara Heude
Author: Marie France Hivert
Author: Daniel Hryhorczuk
Author: Carmen Iñiguez
Author: Anne M. Karvonen
Author: Leanne K. Küpers
Author: Hanna Lagström
Author: Debbie A. Lawlor
Author: Irina Lehmann
Author: Per Magnus
Author: Renata Majewska
Author: Johanna Mäkelä
Author: Yannis Manios
Author: Monique Mommers
Author: Camilla S. Morgen
Author: George Moschonis
Author: Ellen A. Nohr
Author: Anne Marie Nybo Andersen
Author: Emily Oken
Author: Agnieszka Pac
Author: Eleni Papadopoulou
Author: Juha Pekkanen
Author: Costanza Pizzi
Author: Kinga Polanska
Author: Daniela Porta
Author: Lorenzo Richiardi
Author: Sheryl L. Rifas-Shiman
Author: Nel Roeleveld
Author: Luca Ronfani
Author: Ana C. Santos
Author: Marie Standl
Author: Hein Stigum
Author: Camilla Stoltenberg
Author: Elisabeth Thiering
Author: Carel Thijs
Author: Maties Torrent
Author: Tomas Trnovec
Author: Marleen M. H. J. van Gelder
Author: Lenie van Rossem
Author: Andrea von Berg
Author: Martine Vrijheid
Author: Alet H. Wijga
Author: Oleksandr Zvinchuk
Author: Thorkild I. A. Sørensen
Author: Keith Godfrey ORCID iD
Author: Vincent W V Jaddoe
Author: Romy Gaillard
Corporate Author: LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group

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