Effects of Gestational Weight Gain on Delivery Outcomes in an Obese, Low-Income Population

Abstract

Objective: To examine the effects of weight gain/loss on delivery outcomes stratified by class of obesity in an obese, low-income, predominantly minority population.Methods: A retrospective review of a cohort of 1428 women receiving care at a large Medicaid clinic from 2013 to 2016 with pregravid body mass index ≥30 was conducted. Multinomial logistic regression analysis was used to compare differences in gestational weight change to the primary outcomes of birth-weight percentile and delivery type and secondary outcomes of preterm delivery, preterm labor, gestational diabetes mellitus, and gestational hypertension.Results: Obesity class 1 patients who lost weight were more likely to have a small-for-gestational-age (SGA) infant compared with those who had recommended weight gain. Obesity classes 2 and 3 patients had no statistically significant increase in SGA infants with weight loss or weight gain below current recommendations. Obesity classes 1 and 2 patients with weight loss had a statistically significant increase in both preterm delivery and preterm labor; however, class 3 patients did not. Obesity class 3 patients who lost weight were significantly more likely to have gestational diabetes mellitus.Conclusions: Obesity class 3 women may benefit from less weight gain than current recommendations without increasing their risk of SGA infants or preterm birth, especially if gestational diabetes mellitus is present.

Gestational Weight Gain and Small for Gestational Age in Obese Women: A Systematic Review and Meta-Analysis

“…Following the removal of duplicates, 684 titles and abstracts were screened. Eighty-three studies were selected for full-text review, and 29 studies [ 8 , 16 , 17 , 20 – 45 ], involving 1242420 obese pregnancies, met our eligibility criteria and were included in the systematic review. The kappa coefficient of agreement for included studies between the reviewers (LJ and LBY) was 0.99.…”

“…We got 29 articles [ 8 , 16 , 17 , 20 – 45 ] including prospective [ 17 , 29 ] and retrospective cohort studies [ 8 , 16 , 20 – 28 , 30 – 45 ], built into our meta-analysis. The included studies reported on at least 1242420 obese pregnant women.…”

“…At least 175247(14.11%) obese women were weight loss (<0 kg) and inadequate weight (0–4.9 kg) during the pregnancy compared with the recommendations of IOM guidelines. Twenty studies were American [ 8 , 22 – 25 , 27 – 31 , 33 , 34 , 36 , 37 , 40 – 45 ], one was Japanese [ 32 ], one was from Lebanon [ 26 ], and seven were in Europe [ 16 , 17 , 20 , 21 , 35 , 38 , 39 ]. All but fifteen studies [ 8 , 20 , 21 , 23 , 24 , 27 , 28 , 31 , 33 , 37 – 40 , 45 ] investigated outcomes according to three groups of obese people.…”

“…Twenty studies were American [ 8 , 22 – 25 , 27 – 31 , 33 , 34 , 36 , 37 , 40 – 45 ], one was Japanese [ 32 ], one was from Lebanon [ 26 ], and seven were in Europe [ 16 , 17 , 20 , 21 , 35 , 38 , 39 ]. All but fifteen studies [ 8 , 20 , 21 , 23 , 24 , 27 , 28 , 31 , 33 , 37 – 40 , 45 ] investigated outcomes according to three groups of obese people. In addition, twenty-six studies [ 8 , 16 , 17 , 20 – 22 , 24 – 38 , 40 – 42 , 44 , 45 ] also investigated outcomes for overall obesity except for three studies [ 23 , 39 , 43 ].…”

“…Some groups and meta-analyses suggested inadequate weight (0-4.9 kg) or weight loss (<0 kg) in obese women was associated with increase of SGA and low birth weight [8][9][10][11][12]. SGA and low birth weight not only increased the neonatal morbidity and mortality, but also some other chronic diseases such as type 2 diabetes, cardiovascular disease, and mental problems in adulthood [13][14][15].…”