Maternal characteristics associated with gestational weight gain in France: a population-based, nationally representative study

Abstract

ObjectivesTo provide nationally representative estimates of gestational weight gain (GWG) and identify maternal characteristics associated with inadequate GWG in France.DesignA population-based study using data from the French National Perinatal Survey: 2010 and 2016.SettingAll maternity units in metropolitan, mainland France (n=535 in 2010; n=493 in 2016).ParticipantsSingleton live births with GWG data (N=24 850).Primary outcome measuresGWG was calculated as end of pregnancy minus pre-pregnancy weight (kg) and categorised as ‘insufficient’, ‘adequate’, or ‘excessive’ using 2009 Institute of Medicine thresholds. Classification accounted for pre-pregnancy body mass index (BMI) (kg/m2; underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), obese (≥30)) and gestational age at birth. We estimated average GWG and the percentage of women in each GWG category. Polytomous logistic regression identified characteristics associated with GWG adequacy.ResultsAverage GWG was 13.0 kg (SD 5.6), with 26.8% of women gaining insufficiently, 37.0% adequately and 36.1% excessively. Among other factors, insufficient GWG was associated with underweight (vs normal weight; adjusted OR (aOR) 1.4, 95% CI 1.2 to 1.5) and obese (aOR 1.5, 95% CI 1.4 to 1.7) BMI. Excessive GWG was associated with overweight (aOR 2.8, 95% CI 2.6 to 3.1) and obese BMI (aOR 3.3, 95% CI 2.9 to 3.6). Examining obesity classes separately, odds of insufficient GWG increased from obesity class I to III, while odds of excessive GWG decreased from obesity class I to III. Primiparity (insufficient: aOR 0.9, 95% CI 0.9 to 1.0; excessive: aOR 1.2, 95% CI 1.2 to 1.3), maternal characteristics indicative of lower socioeconomic status, and continuing or quitting smoking during pregnancy were also associated with inadequate GWG.ConclusionsIn France, insufficient and excessive GWG are common. For optimal outcomes, clinician education, with special attention to the needs of higher risk/vulnerable groups, is needed to ensure all women receive appropriate advice for recommended GWG.

Impact of Pre-Gestational BMI and Gestational Weight Gain on Fetal Development Outcomes in Adolescent Pregnant Women

“…In a study conducted in France, Amyx et al demonstrated that women with underweight pregestational BMI had a higher prevalence of inadequate GWG (OR 1.4 CI 1.2-1.5). Contrary to our results, the same authors found that patients with obese pregestational BMI tended to develop inadequate GWG (OR 1.5; CI 95% 1.4-1.7) [20]. They report that 15% of pregnant women are minors aged 25 or younger, but the proportion of adolescents is unknown.…”

Gestational weight gain adequacy among twin pregnancies in France

“…As noted previously, the French obstetric population has a healthier BMI profile than the USA obstetric population (Coulm et al, 2017;Deputy et al, 2018), which could reflect cultural differences which also promote lower GWG, though lower GWG was observed in our cohort regardless of BMI. The Notably, the application of IOM GWG guidelines for singletons in France did not produce such different results (26.8% insufficient GWG; 37.0% adequate GWG; 36.1% excessive GWG [Amyx et al, 2021]). However, the of the IOM singleton guidelines differed substantially in that it was based on GWG associated with adverse outcomes rather than percentiles of GWG and included research commissioned in multiple singleton cohorts…”

“…Notably, the application of IOM GWG guidelines for singletons in France did not produce such different results (26.8% insufficient GWG; 37.0% adequate GWG; 36.1% excessive GWG [Amyx et al, 2021 ]). However, the derivation of the IOM singleton guidelines differed substantially in that it was based on GWG associated with adverse outcomes rather than percentiles of GWG and included research commissioned in multiple singleton cohorts (2 USA, 1 Danish; dates ranging from 1988 to 2003) in addition to published research (Rasmussen & Yaktine, 2009 ).…”

Impact of excessive gestational weight gain on exclusive breastfeeding among women with Type 1 and Type 2 diabetes and obesity

“…The reported prevalence of excessive GWG ranged from 36 to 73% for women with obesity [ 15 – 16 , 42 – 45 ], from 36 to 54% for women with gestational diabetes [ 17 , 45 , 46 ] and from 41 to 64% for women with obesity and pregestational diabetes [ 46 , 47 ]. The higher prevalence of excessive GWG (76%) reported here for the three obesity grades may be the result of the combination of diabetes mellitus and obesity that characterized our study population.…”