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Pregnancy Outcomes With Weight Gain Above or Below the 2009 Institute of Medicine Guidelines

Johnson, Julie MD; Clifton, Rebecca G. PhD; Roberts, James M. MD; Myatt, Leslie PhD; Hauth, John C. MD; Spong, Catherine Y. MD; Varner, Michael W. MD; Wapner, Ronald J. MD; Thorp, John M. Jr MD; Mercer, Brian M. MD; Peaceman, Alan M. MD; Ramin, Susan M. MD; Samuels, Philip MD; Sciscione, Anthony DO; Harper, Margaret MD, MSc; Tolosa, Jorge E. MD, MSCE; Saade, George MD; Sorokin, Yoram MD

doi: 10.1097/AOG.0b013e31828aea03
Original Research

OBJECTIVE: To evaluate pregnancy outcomes according to 2009 Institute of Medicine (IOM) gestational weight gain guidelines.

METHODS: This study is a secondary analysis of a preeclampsia prevention trial among nulliparas carrying singletons. Odds ratios and 95% confidence intervals (adjusted for maternal age, race, smoking, and treatment group) were calculated based on total weight gain below or above the IOM guidelines stratified by prepregnancy body mass index (BMI). The referent group was weight gain within the guidelines.

RESULTS: Of 8,293 pregnancies, 9.5% had weight gain below, 17.5% within, and 73% above IOM guidelines. With excess weight gain, all BMI categories had an increased risk of hypertensive disorders; normal weight and overweight women also had increased risk of cesarean delivery and neonatal birth weight at or above the 90th centile but a decreased risk of weight below the 10th centile. There were no consistent associations with insufficient weight gain and adverse outcomes.

CONCLUSION: Excess weight gain was prevalent and associated with an increased risk of hypertensive disorders, cesarean delivery, and large-for-gestational-age neonates.

Supplemental Digital Content is Available in the Text.Gestational weight gain above the 2009 Institute of Medicine guidelines is associated with adverse outcomes.

Departments of Obstetrics and Gynecology, Brown University, Providence, Rhode Island, the University of Pittsburgh, Pittsburgh, Pennsylvania, the University of Cincinnati, Cincinnati, Ohio, the University of Alabama at Birmingham, Birmingham, Alabama, the University of Utah, Salt Lake City, Utah, Columbia University, New York, New York, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio, Northwestern University, Chicago, Illinois, the University of Texas Health Science Center at Houston, Houston, Texas, The Ohio State University, Columbus, Ohio, Drexel University, Philadelphia, Pennsylvania, Wake Forest University Health Sciences, Winston-Salem, North Carolina, Oregon Health & Science University, Portland, Oregon, University of Texas Medical Branch, Galveston, Texas, and Wayne State University, Detroit, Michigan; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.

Corresponding author: Julie Johnson, MD, Women & Infants Hospital, 101 Dudley Street, Providence RI 02905; e-mail: .

The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (HD34208, HD27869, HD40485, HD40560, HD40544, HD34116, HD40512, HD21410, HD40545, HD40500, HD27915, HD34136, HD27860, HD53118, HD53097, HD27917, and HD36801); the National Heart, Lung, and Blood Institute (NHLBI); and the National Center for Research Resources (NCRR) (M01 RR00080, UL1 RR024153, UL1 RR024989) and its contents do not necessarily represent the official view of NICHD, NHLBI, NCRR, or National Institutes of Health.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Sabine Bousleiman, RNC, MSN, MPH, and Margaret Cotroneo, RN, for protocol development and coordination between clinical research centers, Elizabeth Thom, PhD, for protocol and data management and statistical analysis, Gail D. Pearson, MD, ScD, for protocol development and oversight, and Dwight Rouse, MD, MSPH, for help with editing.

Dr. Spong and Dr. Rouse, Associate Editors of Obstetrics & Gynecology, were not involved in the review or decision to publish this article.

* For a list of other members of the NICHD MFMU, see the Appendix online at

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.