Association of Timing of Weight Gain in Pregnancy With Infant Birth Weight

Retnakaran, Ravi; Wen, Shi Wu; Tan, Hongzhuan; Zhou, Shujin; Ye, Chang; Shen, Min; Smith, Graeme N.; Walker, Mark

doi:10.1001/jamapediatrics.2017.4016

Cited by 49 publications

(70 citation statements)

References 34 publications

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“…[8][9][10][11][12] Retnakaran et al measured pregravid and 10 intervals of weight change in pregnancy among a cohort of >1,000 women: only weight gain before 18 weeks was associated with infant birth weight, after adjusting for maternal prepregnancy BMI and other factors. 8 Others have found that excessive early GWG (before 18-20 weeks) increases risk of large-for-gestational age babies, 9 is associated with higher cord blood insulin and C-peptide, 10 and increased offspring obesity, waist circumference, and adverse cardiovascular risk factors up to age 9. 11,12 Lifestyle interventions provide benefits to women with GDM and their babies, and are useful as the primary therapeutic strategy.…”

Section: Discussionmentioning

confidence: 99%

“…7 Moreover, recent data in general populations have identified excessive GWG early in pregnancy as the critical gestational period for risk of high birth weight and other adverse offspring metabolic outcomes. [8][9][10][11][12] Excessive GWG doubles the risk of macrosomia independent of hyperglycemia. 13 Thus, the potential to mitigate excess GWG with advancing GDM diagnosis (and thus treatment) by more than a trimester could have high public health impact.…”

Section: Introductionmentioning

confidence: 99%

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Timing of Gestational Diabetes Diagnosis by Maternal Obesity Status: Impact on Gestational Weight Gain in a Diverse Population

Hillier

Ogasawara

Pedula

et al. 2020

Journal of Women's Health

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Background: We hypothesized that earlier gestational diabetes mellitus (GDM) diagnosis and treatment of high-risk women would reduce gestational weight gain (GWG) in the first trimester and overall. Materials and Methods: We evaluated timing of GDM diagnosis among 5,391 pregnant women who delivered singleton births 2010-2013 in a large diverse health maintenance organization (HMO). All GDM screening was by the same oral glucose tolerance testing protocol; GDM treatment protocols were also consistent irrespective of timing of diagnosis. Women without risk factors were universally screened at 24-28 weeks gestation (Usual). Early screening was recommended in obese and other high-risk women at the first prenatal visit; those who screened negative Early were rescreened at 24-28 weeks (Early+Usual). Results: Average GWG for all women was 12.8 kg; 10.7% of women were diagnosed with GDM. Average GWG for all women diagnosed with GDM was 10.7 kg, adjusted for gestational age. Women with EarlyGDM averaged 2.4 kg less GWG than women diagnosed with UsualGDM (p < 0.0001). Among obese women, only women diagnosed with EarlyGDM averaged overall GWG within Institute of Medicine (IOM) weight guidelines (mean 8.1 kg) and were weight neutral in the first trimester (-0.2 kg). Overall, 43% of all pregnant women exceeded IOM GWG guidelines (gained more total weight than recommended); 60% of obese women exceeded guidelines. Obese women diagnosed with GDM were less likely to exceed IOM guidelines if diagnosed earlier in pregnancy (35% EarlyGDM vs. 59% UsualGDM exceeded guidelines, p < 0.0001). Conclusion: Our results suggest that EarlyGDM diagnosis (and thus treatment) in high-risk women is beneficial for optimizing GWG.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Timing of Gestational Diabetes Diagnosis by Maternal Obesity Status: Impact on Gestational Weight Gain in a Diverse Population

Hillier

Ogasawara

Pedula

et al. 2020

Journal of Women's Health

View full text Add to dashboard Cite

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“…7 Some studies suggest that GWG during early pregnancy may be more important than GWG at late pregnancy for developing certain pregnancy outcomes such as GDM and adverse cardiometabolic profile in the offspring. [8][9][10][11] Overall, studies examining associations of early GWG with perinatal outcomes have been relatively few, and these studies have often not accounted Strengths and limitations of this study ► Weight gain data collected before and during pregnancy enabled us to investigate the effect of timing of weight gain on the outcomes. ► The use of z-scores instead of original weight gain value to account for the gestational-age-dependent nature of gestational weight gain allowed us to differentiate the effect caused by weight gain from the effect caused by duration of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Gestational weight gain and adverse pregnancy outcomes: a prospective cohort study

Wan

et al. 2020

BMJ Open

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ObjectiveTo assess the associations of gestational weight gain (GWG) in early and late pregnancy with subsequent risks of adverse pregnancy outcomes in Chinese women.DesignProspective cohort study.SettingShanghai, China.ParticipantsWe studied 2630 nulliparous singleton pregnant women with complete data on weight gain in early (≤17 weeks of gestation) and late (>17 weeks) pregnancy in the Shanghai Birth Cohort.MethodsGWG was standardised into z-scores by gestational age and categorised as low (z-score <−1), normal (−1 to +1) and high (>1). The adjusted relative risks (aRRs) and 95%CIs were estimated through log-binomial regression models. Interaction effects between GWG and some other adjustment factors were tested, further stratified analyses were performed separately where interaction terms were significant.Outcome measuresAdverse maternal and neonatal outcomes.ResultsIndependent from GWG in late pregnancy, higher GWG in early pregnancy was associated with higher risks of gestational diabetes mellitus (aRR: 1.66; 95% CI: 1.11 to 2.48), caesarean section (aRR: 1.21; 95% CI: 1.05 to 1.39) and prolonged hospitalisation (aRR: 1.56; 95% CI: 1.03 to 2.38). Higher GWG in late pregnancy was independently associated with higher risks of caesarean section (aRR: 1.24; 95% CI: 1.09 to 1.41), large for gestational age (aRR: 2.01; 95% CI: 1.50 to 2.7) and macrosomia (aRR: 1.90; 95% CI: 1.30 to 2.78). In addition, the risk of gestational hypertension increased significantly with increased total GWG (aRR: 1.78; 95% CI: 1.14 to 2.76). The effects of GWG in late pregnancy on maternal and neonatal outcomes were significantly different between the women bearing a female and the women bearing male fetus.ConclusionThe GWG associations with adverse pregnancy outcomes differ at early and late pregnancy, and there may be effect modification by fetal sex in the association of GWG in late pregnancy with some pregnancy outcomes.

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“…Prior trimester-specific studies on gestational weight gain have demonstrated an association between adequate second-and third-trimester weight gain and increased birthweight and infant growth; however, the vast majority of these studies were focused on singleton gestations. [8][9][10] One study that examined maternal weight gain in twin gestations concluded that adequate weight gain in the early rather than late second trimester was associated with increased birthweight in twins; however, this investigation did not focus on other trimesters of pregnancy. 11 Maternal weight gain recommendations in twin pregnancies are defined by the Institute of Medicine (IOM) guidelines (now called the National Academy of Medicine), which account for differences in prepregnancy body mass index (BMI).…”

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confidence: 99%

The Association between Gestational Weight Gain in Each Trimester and Pregnancy Outcomes in Twin Pregnancies

2020

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Objective Adequate maternal weight gain in twin pregnancies is associated with improved outcomes such as increased fetal growth and decreased incidence of preterm birth. However, it remains unclear when gestational weight gain has the greatest influence on pregnancy outcomes. Our objective was to identify at which time in a twin pregnancy does inadequate maternal weight gain have the greatest association with adverse pregnancy outcomes. Study Design This is a retrospective cohort study of women with twin pregnancies and normal prepregnancy body mass index (BMI, 18.5–24.9 kg/m2) who delivered at ≥24 weeks' gestation by a single maternal–fetal medicine practice between 2005 and 2017. Baseline characteristics and pregnancy outcomes were compared between women with and without adequate average gestational weight gain (weight gain per week based on the 2009 Institute of Medicine recommendations). This analysis was performed for weight gain over the entire pregnancy, as well as from 0 to 16, 16 to 24, and 24 weeks to delivery. Multivariable regression analysis was performed to control for potential confounding variables. Results A total of 609 women with twin pregnancies and normal prepregnancy BMI were included, of whom 386 (63.4%) had adequate average gestational weight gain over the entire pregnancy and 223 (36.6%) did not. Inadequate average gestational weight gain between 0 and 16 weeks' gestation was associated with a higher incidence of birthweight less than the 10th percentile for gestational age (adjusted odds ratio [aOR]: 1.67; 95% confidence interval [CI]: 1.11–2.51) and less than the 5th percentile for gestational age (aOR: 2.10; 95% CI: 1.29–3.40). Inadequate gestational weight gain between 16 and 24 weeks was associated with lower birthweight of the larger twin (β: –0.09; p = 0.04). Inadequate weight gain from 24 weeks to delivery was associated with spontaneous preterm birth <37 weeks' gestation (aOR: 1.67; 95% CI: 1.13–2.47), <34 weeks' gestation (aOR: 4.32; 95% CI: 2.45–7.63), <32 weeks' gestation (aOR: 9.07; 95% CI: 3.66–22.48), and a lower incidence of preeclampsia (aOR: 0.31; 95% CI: 0.16–0.63). Conclusion In twin pregnancies, gestational weight gain between 0 and 16 weeks as well as between 16 and 24 weeks is most associated with fetal growth, whereas gestational weight gain after 24 weeks is most associated with preterm birth. This may help elucidate the mechanism of action of the impact of gestational weight gain in twin pregnancies.

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Association of Timing of Weight Gain in Pregnancy With Infant Birth Weight

Cited by 49 publications

References 34 publications

Timing of Gestational Diabetes Diagnosis by Maternal Obesity Status: Impact on Gestational Weight Gain in a Diverse Population

Timing of Gestational Diabetes Diagnosis by Maternal Obesity Status: Impact on Gestational Weight Gain in a Diverse Population

Gestational weight gain and adverse pregnancy outcomes: a prospective cohort study

The Association between Gestational Weight Gain in Each Trimester and Pregnancy Outcomes in Twin Pregnancies

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