To estimate the prevalence of gestational weight gain adequacy according to the 2009 Institute of Medicine recommendations and examine demographic, behavioral, psychosocial, and medical characteristics associated with inadequate and excessive gain stratified by prepregnancy body mass index (BMI) category.
We used cross-sectional, population-based data on women delivering full-term (37 weeks of gestation or greater), singleton neonates in 28 states who participated in the 2010 or 2011 Pregnancy Risk Assessment Monitoring System. We estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for inadequate and excessive compared with adequate gain, stratified by prepregnancy BMI.
Overall, 20.9%, 32.0%, and 47.2% of women gained inadequate, adequate, and excessive gestational weight, respectively. Prepregnancy BMI was strongly associated with weight gain outside recommendations. Compared with normal-weight women (prevalence 51.8%), underweight women (4.2%) had decreased odds of excessive gain (adjusted OR 0.50, CI 0.40–0.61), whereas overweight and obese class I, II, and III (23.6%, 11.7%, 5.4%, and 3.5%, respectively) women had increased odds of excessive gain (adjusted OR range 2.07, CI 1.63–2.62 to adjusted OR 2.99, CI 2.63–3.40). Underweight and obese class II and III women had increased odds of inadequate gain (adjusted OR 1.25, CI 1.01–1.55 to 1.86, CI 1.45–2.36). Most characteristics associated with weight gain adequacy were demographic such as racial or ethnic minority status and education and varied by prepregnancy BMI. Notably, one behavioral characteristic—smoking cessation—was associated with excessive gain among normal-weight and obese women.
Most women gained weight outside recommendations. Understanding characteristics associated with inadequate or excessive weight gain may identify potentially at-risk women and inform much-needed interventions.
Most women gain outside of Institute of Medicine gestational weight gain guidelines; characteristics associated with inadequate or excessive gain vary by prepregnancy body mass index.
Nutrition and Health Sciences Program, Laney Graduate School, Emory University, the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and the U.S. Public Health Service Commissioned Corps, Atlanta, Georgia; and the Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Corresponding author: Andrea J. Sharma, PhD, MPH, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS-F74, Atlanta, GA 30341; e-mail: firstname.lastname@example.org.
Presented at the Society for Pediatric and Perinatal Epidemiology Research Annual Meeting, June 23–24, 2014, Seattle, Washington.
Mr. Deputy was supported in part by a National Institutes of Health training grant (T32-DK007734) and an appointment to the Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science Education through an interagency agreement between the U.S. Department of Energy and the Centers for Disease Control and Prevention. Stefanie N. Hinkle was supported by the intramural research program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.
The authors thank the Pregnancy Risk Assessment Monitoring System Working Group for coordinating data collection. A list of members is available at: http://www.cdc.gov/prams/pdf/workinggroup_7-2012.pdf.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Financial Disclosure The authors did not report any potential conflicts of interest.