Analysis and Comparison of Early Childhood Nutritional Outcomes Among Offspring of Chinese Women Under the Chinese 2021 and US 2009 Gestational Weight Gain Guidelines

Abstract

ImportanceIn 2009, the US National Academy of Medicine (NAM) released revised gestational weight gain (GWG) guidelines, which were established primarily for White North American women and may be unsuitable for Asian women. In 2021, the Chinese Nutrition Society (CNS) released its GWG guidelines, but their applicability requires re-examination.ObjectiveTo compare the differences between the CNS and NAM recommendations for GWG in association with health outcomes in the offspring of Chinese women.Design, Setting, and ParticipantsIn this bidirectional cohort study, children in China were recruited at age 3 years from 2017 to 2018, with 2 follow-up visits over the next 2 years (between September 2017 and September 2020). Information during pregnancy was retrieved from medical records. Data analysis was performed from October 2021 to January 2022.Main Outcomes and MeasuresGWG was classified as insufficient, appropriate, or excessive according to the CNS and NAM guidelines separately. Children’s height, weight, fat mass, fat-free mass, and percentage of body fat were measured at each visit. Body mass index, fat mass index, fat-free mass index, weighted κ score, risk ratio values, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.ResultsA total of 3822 children (1996 boys and 1826 girls; mean [SD] age, 3.79 [0.30] years) were enrolled; after exclusions, 3170 term singleton children were recruited and were followed at 4 and 5 years of age. According to the CNS guidelines, the prevalence rates were 14.1% for insufficient GWG, 48.1% for appropriate GWG, and 37.9% for excessive GWG, whereas the rates according to NAM guidelines were 39.7% for insufficient GWG, 37.2% for appropriate GWG, and 23.1% for excessive GWG. The weighted κ value for the classification agreement between the 2 guidelines was 0.530 (95% CI, 0.510-0.550). For the appropriate GWG group, the rates for low nutritional levels did not differ between the 2 guidelines, but the rates for high nutritional levels were significantly lower under CNS guidelines than under NAM guidelines. When the sensitivity, specificity, PPV, and NPV with respect to the mothers who maintained appropriate GWG were used to estimate the nonhigh nutritional status of their offspring, generally higher values based on the CNS guidelines were found compared with those based on the NAM recommendations.Conclusions and RelevanceThese findings suggest that the GWG recommendations promulgated by the NAM are higher than the CNS guidelines, with the latter more suitable for Chinese women.

Optimal Gestational Weight Gain for Women with Gestational Diabetes Mellitus — China, 2011–2021

“…exploration of optimal range in China and abroad have supported stricter optimal GWG ranges than the NAM standards to improve pregnancy outcomes (10)(11). Considering the great impact of GWG during the second and third trimesters on adverse outcomes, proposing an optimal GWG after diagnosis of GDM rather than the total GWG allows clinicians to give targeted suggestions and counsel their patients on their weekly GWG regarding their weight control performance.…”

A prospective analysis of optimal total weight gain ranges and trimester-specific weight gain rates for Chinese pregnant women

“…Furthermore, except for optimal total GWG range, the trimester-specific GWG rate is also an important parameter to monitor weight at different stages of pregnancy, but it has not been considered in existing evidence conducted in Chinese women [11][12][13][14][15][16] or other Asian women [7][8][9]. It should be noted that in 2021, the Chinese Nutrition Society (CNS) released its GWG guideline [19] and the first report about its applicability among Chinese women has published recently [20]. In this study, we attempted to propose the optimal total and trimester-specific GWG with a cohort of relatively large sample size based on modelling technique GAMs, which may provide a methodological reference for future studies to determine optimal GWG range in their countries, as well as providing evidence for the supplementation of the 2021 CNS guideline in the future.…”

Comparison of Chinese vs US Gestational Weight Gain Guidelines for Chinese Women

“…The mean (SD) maternal prepregnancy BMI was 22.3 (3.4). 1 By the Chinese criteria, prevalence rates were 14.1% for insufficient GWG, 48.1% for appropriate GWG, and 37.9% for excessive GWG; according to the NAM guidelines, the rates were 39.7% for insufficient GWG, 37.2% for appropriate GWG, and 23.1% for excessive GWG. 1 A substantive difference in the proportions of Chinese women meeting recommended GWG was noted between criteria, with potential implications around antenatal healthy lifestyle recommendations during pregnancy.…”

“…1 By the Chinese criteria, prevalence rates were 14.1% for insufficient GWG, 48.1% for appropriate GWG, and 37.9% for excessive GWG; according to the NAM guidelines, the rates were 39.7% for insufficient GWG, 37.2% for appropriate GWG, and 23.1% for excessive GWG. 1 A substantive difference in the proportions of Chinese women meeting recommended GWG was noted between criteria, with potential implications around antenatal healthy lifestyle recommendations during pregnancy. Child outcomes were generally similar across both GWG criteria, except that there was less macrosomia at birth and fat mass and obesity at 4 and 5 years of age by the Chinese guidelines compared with NAM guidelines, without alteration in nutritional status.…”

“…Child outcomes were generally similar across both GWG criteria, except that there was less macrosomia at birth and fat mass and obesity at 4 and 5 years of age by the Chinese guidelines compared with NAM guidelines, without alteration in nutritional status. 1 Healthy GWG is a highly topical area of international public health significance. 4,5 Worldwide, adiposity is increasing, with both higher BMI at conception and escalating rates of excess GWG, both independently associated with adverse health implications for women and their offspring.…”