Gestational weight gain and pregnancy outcomes: Findings from North Indian pregnancy cohort

Abstract

Despite the high prevalence of inadequate gestational weight gain (GWG) and adverse pregnancy outcomes, very few studies have addressed the association between GWG and pregnancy outcomes in South Asia. Our objectives were to estimate the prevalence of GWG during the second and third trimesters within, below and above the Institute of Medicine (IOM) guidelines, and to estimate the effect of the rate and adequacy of GWG on gestational age at the time of delivery, weight, length, length‐for‐age z‐score (LAZ), weight‐for‐length z‐score (WLZ) and adverse pregnancy outcomes, namely prematurity, small‐for‐gestational age (SGA), low birth weight (LBW), stunting and wasting at birth. We analysed data from the intervention group of the Women and Infants Integrated Interventions for Growth Study (WINGS), which is an ongoing individually randomized factorial design study. Of the 1332 women analysed, 40.2% [95% confidence interval (CI) 37.5 to 42.8] had GWG below the IOM guidelines. For every 100‐g/week increase in GWG, birth weight increased by 61 g, birth length by 0.16 cm, LAZ score by 0.08 SD, WLZ score by 0.14 SD, and gestational age at birth by 0.48 days. Women with GWG below the IOM guidelines had a higher relative risk of adverse pregnancy outcomes (44% for LBW, 27% for SGA, 32% for stunting and 42% for wasting at birth) than women who had GWG within the IOM guidelines, except for prematurity. The association between GWG and LAZ scores at birth was modified by early pregnancy body mass index (BMI). GWG is a strong predictor of newborn anthropometric outcomes and duration of gestation but not prematurity.

The impact of gestational weight gain on fetal and neonatal outcomes: The Araraquara Cohort Study

“…Similar to our results, Goldstein et al (2017b) in a systematic review and meta-analysis that investigated the association between GWG and maternal and infant outcomes observed that inadequate GWG, whether below or above the IOM recommendations, is associated with adverse outcomes. Similar ndings were reported in other studies (Athukorala et al, 2010b;Chowdhury et al, 2022;Truong et al, 2015b). The issue of prematurity deserves special attention, as women with premature babies have less time to gain weight during pregnancy, which may indicate reverse causality in the association between GWG and prematurity.…”

“…These ndings corroborate previous studies that also found associations between GWG below and above the recommendations and adverse outcomes, indicating that inadequate GWG can have negative effects on the health of the fetus and newborn [14,[27][28][29][30][31][32][33][34][35][36][37][38].…”

Gestational weight gain in the REVAMP pregnancy cohort in Western India: Comparison with international and national references

“…Excessive GWG is associated with an increased risk of gestational diabetes, gestational hypertension, preeclampsia, preterm birth, cesarean delivery, macrosomia, infant mortality, postpartum weight retention, and childhood obesity ( 8 – 12 ). Recent reports indicate a high prevalence of inadequate gestational weight gain in South Asia, in particular in India ( 13 , 14 ). Appropriate GWG is usually evaluated in comparison to two international standards – those of the Institute of Medicine (IOM) and International Fetal and Newborn Growth-21st (Intergrowth-21st) ( 9 , 15 ).…”

“…This study selected healthy women who were at low risk of adverse maternal and perinatal outcomes and provided centiles of GWG for each week of gestation. In India, maternal malnutrition is highly prevalent ( 28 ) and there is a high burden of inadequate GWG ( 13 ). Despite these challenges, and the association between GWG and optimal fetal growth, there are only few studies in Asia that have explored weight gain in different trimesters of pregnancy and compared against global references (Intergrowth-21st) ( 2 , 29 ).…”