Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: a prospective observational cohort study

Abstract

BackgroundExcessive 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.MethodsThis 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.ResultsA 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.ConclusionsFor 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.

Association of Pregestational BMI and Antenatal Weight Gain With Pregnancy Outcome: A Prospective Observational Cohort Study

“…But it is significantly related to BMI of the patient (82.4% caesarean section rate in obese patients and 55.2% in normal BMI patients). (12) in 2014 showed significantly increased risk of pregnancy induced hypertension, macrosomia, and emergency cesarean delivery in both nulliparous and parous normal weight women and overweight women except for no increased risk for gestational hypertension in parous women with antenatal weight gain more than the IOM recommendation. Liu et al (13) showed that compared with antenatal weight gain within the IOM recommendations, excessive weight gain increased the incidence of cesarean section, preterm delivery, preeclampsia and infant macrosomia, and reduced the incidence of GDM, while inadequate antenatal weight gain increased the incidence of GDM and SGA.…”

“…Low weight gain significantly (P < 0.004) increases the incidence of low birth weight. In 2010 Chang et al (8) in Taiwan and Haugen et al (12) in 2014 proved weight gain less than the IOM recommendations increased the risk of low birth weight baby among normal weight nulliparous women. Our study shows no significant correlation between antenatal weight gain and NICU admission (P = 0.585) of the baby.…”

Ganancia de peso gestacional y retención de peso posparto en una cohorte de mujeres en Aragón (España).

“…Sin embargo, tal y como se ha venido observando en estudios previos (14,(17)(18)(19), el cumplimiento de los criterios de ganancia de peso gestacional del IOM fue más dificultoso para las gestantes con sobrepeso y obesidad. Sin duda, la explicación a este dato reside en que dichos criterios son considerablemente más exigentes para las mujeres de estos grupos.…”

Ethnic differences in postpartum weight retention: a Norwegian cohort study

“…19 In a large cohort study, GWG exceeding IOM recommendations increased the risk of PPWR by more than 2 kg, even after 18 months postpartum. 10 A study investigated weight trajectories 3 years after the index pregnancy to identify subgroups with the highest risk of future obesity. 36 Among the 14% with PPWR >7.5 kg 6 months after birth, 40% had a large decline in weight, whereas 60% continued to gain weight.…”

“…8,9 A recent study from the large Norwegian Mother and Child Cohort identified substantial variability in PPWR, and found that among those with initially high PPWR, one group continued to gain weight, whereas another group had a large decline in weight from 6 months to 3 years after birth. 10 Several studies have found that GWG is the strongest predictor of PPWR, 6,[11][12][13][14] yet PPWR may also be influenced by environmental and other factors before, during and immediately after pregnancy, such as pre-pregnancy BMI, 6 parity and breastfeeding, 15,16 smoking, diet and physical activity habits. 9,[16][17][18] Low educational level 19 and depression during pregnancy 20 have also been associated with higher PPWR.…”