Factors That Affect Weight Gain in an Obese Pregnant Population [16C]

Abstract

INTRODUCTION: The 2009 Institute of Medicine guidelines recommend 11-20 pounds weight gain for pregnant women with BMI ≥30. This study examines factors that affect compliance with weight gain recommendations in an obese, low-income population. METHODS: A retrospective cohort of 1,440 women receiving care at a large Medicaid clinic from 2013-2016 with BMI ≥30 was reviewed. Eligible women were non-smokers with a singleton full-term delivery that initiated care before 20 weeks. Linear and multinomial logistic regression analysis was used to compare gestational weight gain to demographic characteristics, nutritional education, participation in group prenatal care, and medical conditions. RESULTS: Inclusion criteria was met by 803 women, with mean weight gain of 21.8 pounds. In total, 162 (20%) gained weight within guidelines, 211 (26%) below, and 430 (54%) above. Controlling for pre-pregnancy BMI, multiparous women gained significantly fewer pounds then nulliparous women (19 versus 28, P<.001), with a greater proportion of multiparous women within the recommended guidelines (29% versus 16%, P<.001). In univariate analysis, patients that were married, had prior spontaneous preterm birth, or had chronic hypertension were associated with less weight gain, but none were significant after adjusting for parity. Race, nutritional education, and group prenatal care did not significantly affect weight gain. CONCLUSION: Interventions such as group prenatal care and nutrition visits do not significantly affect gestational weight gain in an obese, low-income population. Parity may be an important modifying factor in gestational weight gain. These findings may be useful for targeting policies aimed at attaining healthy weight gain based on parity.