Timing of Gestational Weight Gain and Adverse Perinatal Outcomes in Overweight and Obese Women

Abstract

has been reviewed by the Editorial Board and by special expert referees. Although it is judged not acceptable for publication in Obstetrics & Gynecology in its present form, we would be willing to give further consideration to a revised version. If you wish to consider revising your manuscript, you will first need to study carefully the enclosed reports submitted by the referees and editors. Each point raised requires a response, by either revising your manuscript or making a clear and convincing argument as to why no revision is needed. To facilitate our review, we prefer that the cover letter include the comments made by the reviewers and the editor followed by your response. The revised manuscript should indicate the position of all changes made. We suggest that you use the "track changes" feature in your word processing software to do so (rather than strikethrough or underline formatting). Your paper will be maintained in active status for 21 days from the date of this letter. If we have not heard from you by Jan 25, 2019, we will assume you wish to withdraw the manuscript from further consideration. REVIEWER COMMENTS: Reviewer #1: This manuscript has a purpose to "evaluate the impact of insufficient or excessive gestational weight gain in the first and second trimester on adverse perinatal outcomes, and whether weight gain in the third trimester modifies these risks." This was a retrospective, cohort study using an institutional database, which the authors validated by randomly selecting 300 subjects and manually confirming data in the database. 1. Could the authors please include a 'Precis' for their manuscript? 2. The authors describe BMI and suggested gestational weight gain for the different categories for overweight and obese. Could the authors construct a table with the WHO definition of all the various BMI categories (underweight, normal, overweight, obese) in one column and suggested weight gain for each category in an adjacent column and reference in text? 3. How was gestational age determined? How accurate was determination of gestational age? Was gestational age at birth determined by the Pediatricians with a Ballard score? 4. The authors note that they performed a validation survey by manually abstracting a randomly selected group of 300 charts. How was randomization performed? Why did they select a n=300 charts to validate their database? Reviewer #2: Slight revision-please change "fetal gender" to "fetal sex" in line 145 [gender is a social construct, sex is a biologic construct]. Reviewer #3: This is a retrospective cohort study of over 5000 obese women that examined their weight gain as of 24-28 weeks and relationship to adverse pregnancy outcomes. The manuscript is well written. Line 72: IOM is now the National Academy of Medicine Line 77: "weight gain 11 pounds" I think is missing 'less than' as in weight gain less than 11 pounds

Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004–2013

“…Two large meta-analyses focusing on less severe adverse birth outcomes showed elevated rates of LGA and macrosomia in women with excess weight gain in all pre-pregnancy BMI categories, and elevated rates of SGA in women with low weight gain [2,31], which is consistent with our results. Low weight gain is known to be associated with preterm birth [4,5] and with infant death during the first year after birth [13,32]. The new findings in our study include the association between low weight gain and adverse perinatal outcomes, including stillbirth and neonatal death.…”

“…The association between low and excess gestational weight gain and perinatal outcomes has been studied with respect to small for gestational age (SGA), large for gestational age (LGA), macrosomia, neonatal seizures, low Apgar score, neonatal intensive care unit admission, and infant death [4–9]. And while the suboptimal weight gain is associated with preterm delivery [5,10–13], the majority of studies on gestational weight gain have included only term pregnancies [8,9,14,15], which largely underestimates the overall association between suboptimal weight gain and adverse pregnancy outcomes.…”

Association of Maternal Dietary Patterns With Birth Weight and the Mediation of Gestational Weight Gain: A Prospective Birth Cohort

“…Previous studies have found a positive link between GWG of women and the birth weight of newborns, and GWG above the recommendations was associated with a higher risk of LGA (12,26,27). Lu et al and Wei et al also found that the effect of a specific dietary pattern on GWG of pregnant women and the birth weight of newborns coexisted in the Chinese Guangzhou population (11,28).…”

Patterns of Women’s Postpartum Weight Retention and Its Associations with Maternal Obesity-Related Factors and Parity

“…The GWG rate during 22–26 weeks was consistently associated with an elevated diastolic blood pressure level [23]. Thus, researchers should pay more attention to the implication of timing of weight gain in pregnancy with PPWR, which might help to reduce excessive postpartum weight during the pregnancy period [24]. Third, numerous studies demonstrated that a higher pre-pregnancy waist circumference (WC) can reflect more visceral fat and central adiposity, and is also considered a better predictor of obesity-related diseases than BMI [25,26].…”