Obstetrics & Gynecology:
Gestational Weight Gain and Pregnancy Outcomes in Obese Women: How Much Is Enough?
Kiel, Deborah W. MSN1,3; Dodson, Elizabeth A. MPH1; Artal, Raul MD2; Boehmer, Tegan K. PhD1; Leet, Terry L. PhD1
From the Department of 1Community Health and 2the Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University; and the College of Nursing, University of Missouri-St. Louis, St. Louis, Missouri.
See related editorial on page 743.
Corresponding author: Raul Artal, MD, Professor and Chair, Department of Obstetrics, Gynecology and Women's Health, Saint Louis University, 6420 Clayton Road, St. Louis, MO 63117; e-mail: email@example.com.
Financial Disclosure The authors have no potential conflicts of interest to disclose.
OBJECTIVE: To examine the effect of gestational weight change on pregnancy outcomes in obese women.
METHODS: A population-based cohort study of 120,251 pregnant, obese women delivering full-term, liveborn, singleton infants was examined to assess the risk of four pregnancy outcomes (preeclampsia, cesarean delivery, small for gestational age births, and large for gestational age births) by obesity class and total gestational weight gain.
RESULTS: Gestational weight gain incidence for overweight or obese pregnant women, less than the currently recommended 15 lb, was associated with a significantly lower risk of preeclampsia, cesarean delivery, and large for gestational age birth and higher risk of small for gestational age birth. These results were similar for each National Institutes of Health obesity class (30–34.9, 35–35.9, and 40.0 kg/m2), but at different amounts of gestational weight gain.
CONCLUSION: Limited or no weight gain in obese pregnant women has favorable pregnancy outcomes.
LEVEL OF EVIDENCE: II
Effects of gestational weight gain on pregnancy outcomes are well recognized, and over the past decades the guidelines for ideal weight gain have been periodically questioned and revised. Previous gestational weight gain guidelines were restrictive, reflecting concerns about preeclampsia, labor and delivery complications, and weight retention after pregnancy.1 Subsequent guidelines were revised upward to minimize mortality and morbidity risks for low birth weight (LBW) infants.2 The current guidelines provide gestational weight gain ranges based on prepregnancy body mass index (BMI) and were recommended by the Institute of Medicine (IOM) to again limit adverse pregnancy outcomes.1 However, the current IOM guidelines for obese women (prepregnancy BMI greater than or equal to 30.0 kg/m2) do not provide an upper limit on gestational weight gain, only advising women to gain at least 15 lb, and do not distinguish between the different levels of obesity as defined by the National Institutes of Health (NIH).3
Given the increasing prevalence of obesity among childbearing women,4 the tendency for postpartum weight retention,1 the high prevalence of perinatal complications in obese women,5–9 and the influence of pregnancy in the development of obesity later in life,10 reevaluation of the IOM gestational weight gain guidelines for obese women has important clinical and public health implications. Particularly, a distinction between the different levels of gestational weight change for women entering pregnancy as obese may lead to adequate gestational weight gain while maintaining optimal pregnancy and neonatal outcomes. The purpose of this study was to examine the relationship between gestational weight gain and pregnancy outcomes in obese women by using NIH obesity classifications.
MATERIALS AND METHODS
A population-based cohort study was conducted by using data from the Missouri linked birth-death certificate registry. The study population included all obese women residing in Missouri who delivered (at 37 or more weeks of gestation) liveborn, singleton infants during 1990–2001 (N=120,251). Prepregnancy BMI was calculated from self-reported prepregnancy weight and height recorded on the birth certificate. According to NIH guidelines, obesity was defined as class I (BMI 30.0–34.9 kg/m2), class II (BMI 35.0–39.9 kg/m2), and class III (BMI 40 kg/m2 or more).3
Gestational weight gain, which was abstracted from the mother's medical chart or provided by the physician, was divided into eight categories as follows: 10-lb or less loss, 2–9 lb loss, no weight change, 2–9 lb gain, 10–14 lb gain, 15–25 lb gain, 26–35 lb gain, and greater than 35 lb gain. The eight categories were selected to reflect levels at which weight gain or loss could become clinically relevant. Because the current guidelines encourage obese women to gain at least 15 lb, the 15–25 lb weight gain category was chosen as the referent group because this also represents the current recommendation for pregnant, overweight (BMI 25–29.9 kg/m2) women.
Pregnancy outcomes analyzed included preeclampsia, cesarean delivery, small for gestational age (SGA), and large for gestational age (LGA) infant. On Missouri birth certificates, preeclampsia is defined as pregnancy-associated hypertension after the 20th week of gestation that resulted in an increase in blood pressure of 30 mm Hg or more systolic or 15 mm Hg or more diastolic on two measurements taken 6 hours apart. Women who developed eclampsia were combined with preeclamptic women into a single group, hereafter referred to as preeclampsia. Cesarean delivery included all primary and repeat surgical procedures used to deliver the infant. Small for gestational age and LGA were defined as birth weight below the 10th percentile and above the 90th percentile, respectively, for gestational age and race or ethnicity.11
Potential confounders for this analysis included maternal age (younger than 26, 26–35, older than 35 years), race (non-Hispanic white, other), education (less than 12, 12, more than 12 years), and the dichotomous variables of poverty, tobacco use, parity (0, 1 or more prior live births), and chronic hypertension.10,12,13 Because income level was not captured on the birth certificate, enrollment in Medicaid, the Women, Infants, and Children public health program, or food stamp programs was used as a proxy measure for poverty.
The three classes of obese women were assessed for homogeneity with respect to demographic, lifestyle, and medical characteristics by using χ2 analysis. Within each obesity class, the absolute risk (or cumulative incidence) for each pregnancy outcome was computed as the percentage of all women with the specific outcome and was stratified by gestational weight gain category to assess the effect of gestational weight gain for each pregnancy outcome. Logistic regression was also used to examine the association between gestational weight gain and the four pregnancy outcomes. Odds ratios and 95% confidence intervals were estimated to determine the strength and precision of each association after adjusting for potential confounders. All analyses were performed with SPSS 12 (SPSS Inc, Chicago, IL) software.
This research was reviewed by the Saint Louis University institutional review board and classified as exempt from the U.S. Department of Health and Human Services regulations for the protection of human subjects. The exemption, 45 CFR 46.101(b)(4), permits epidemiologic research that uses existing publicly available data that are maintained in such a manner that subjects cannot be identified directly or through identifiers linked to the subjects.
A total of 120,170 women met the eligibility criteria, and 59% were class I obese, 25% were class II obese, and 16% were class III obese. Twenty-three percent of all obese women gained less than 15 lb during pregnancy, 31% gained 15–25 lb, and 46% gained more than 25 lb. All three obesity classes were similar with respect to maternal age, race, and education (Table 1). Class III obese women were more likely to live in poverty and to experience chronic hypertension, preeclampsia, cesarean delivery, and LGA births than class I or II obese women.
Figures 1–3 show the absolute risk of preeclampsia, cesarean delivery, LGA, and SGA by gestational weight gain category for each obesity class. All three figures show similar patterns of increasing risk of preeclampsia, cesarean delivery, and LGA birth and decreasing risk of SGA birth with increasing gestational weight gain. Collectively, the minimal risk for all four outcomes corresponds to the gestational weight gain categories where the risk of LGA and SGA births intersect. This equates to a gestational weight gain of 10–25 lb for class I obese women, a gain of 0–9 lb for class II obese women, and weight loss of 0–9 lb for class III obese women.
Figures 4–6 display the adjusted odds ratios and 95% confidence intervals for preeclampsia, cesarean delivery, SGA, and LGA by gestational weight gain category and obesity class. Compared with women who gained 15–25 lb during their pregnancies, those who gained less weight had significantly lower odds of preeclampsia, cesarean delivery, and LGA births, but higher odds for SGA births. Women who gained more than 25 lb had higher odds for the same three pregnancy outcomes and lower odds for SGA births. The magnitude of the association for each outcome differed by obesity classification, even after adjusting for known or suspected confounders.
Because gestational age is estimated by clinicians and these estimates can influence SGA and LGA status, the analysis was repeated using birth weight. Low birth weight (LBW) was defined as birth weight less than 2,500 g, and macrosomia was defined as birth weight greater than 4,000 g. As expected, the risk of LBW and macrosomia were lower than the risk estimates noted for SGA and LGA births, but the trends across gestational weight gain categories were very similar (data not shown).
The absolute effect of gestational weight gain expressed as the number needed to treat is displayed in Table 2. The number needed to treat represents the reciprocal of the absolute risk difference for women gaining less than the NIH-recommended 15 lb and those gaining 15 lb or more. With the exception of cesarean delivery, the number needed to treat for each outcome differed by obesity class and gestational weight gain category. To reduce the risk of preeclampsia for one patient, the clinician would need to counsel and monitor the gestational weight gain of 29 obesity class I women, 26 obesity class II women, and 20 obesity class III women. For SGA births, the number needed to treat ranges from 21 for class I women to 52 for class III women.
The results of this study are consistent with other studies showing the protective effect of reduced gestational weight gain on LGA births and cesarean delivery for obese women regardless of obesity class.1,2,5–7,9,10 Although previous studies have consistently identified prepregnancy BMI as a risk factor for the development of preeclampsia,2,5–7,9,12 less is known about the effect of gestational weight gain on preeclampsia occurrence. Our results suggest that reduced gestational weight gain is associated with decreased risk of developing preeclampsia. As expected, we observed reduced SGA risk with increasing gestational weight gain for all three obese classes. Our results suggest that SGA risk for class II and III obese women gaining less than 15 lb is minimal. These results are consistent with Bianco et al,7 who found that women with a prepregnancy BMI greater than 35 kg/m2 and poor gestational weight gain did not have a significant increase in SGA births.
Our results showed similar trends for the effect of gestational weight gain on all four pregnancy outcomes analyzed in all three obese classes. However, the amount of gestational weight gain associated with minimal risk for all four outcomes collectively is different for each obesity class. Our results suggest that this minimal risk may correspond to a weight gain of 10–25 lb for class I obese women, a weight gain of 0–9 lb for class II obese women, and a weigh loss of 0–9 lb for class III obese women. Treating each obesity class as a distinct obstetric population reflects the different magnitude of baseline and pregnancy-induced risks associated with each obesity class.
Like all observational studies, our study has its limitations. We used birth certificate data to identify a large cohort of pregnant, obese women. In Missouri, birth certificates are completed using data from patient medical records, although prepregnancy weights are often self-reported. We acknowledge that women may underestimate their prepregnancy weight, but believe that self-reported and clinically recorded weights are similar for nonpregnant and pregnant women as reported in other studies.14,15 For a 5 ft 5 in woman weighing 260 lb to be misclassified in our study, she would have to underestimate her prepregnancy weight by at least 20 lb and 50 lb to move from obesity class III to obesity class II and obesity class I, respectively. Furthermore, we were only able to use the pregnancy outcomes that were reliably reported on the birth certificate. An audit of Missouri birth certificate data (Schramm W. Data quality: new certificates. Proceedings of the AVRHS/VSCP Project Directors Meeting, San Francisco, 1991) reported that 85% of all preeclampsia cases were identified correctly on the birth certificate. We acknowledge that LGA and SGA status is dependent upon the accuracy of gestational ages that are routinely estimated by clinicians but noted similar risk patterns by gestational weight gain categories when we evaluated macrosomia and LBW as other measures of extreme fetal growth. We were unable to evaluate the effect of gestational weight gain on the risk of developing gestational diabetes because the Missouri birth certificate does not differentiate between type I, type II, and gestational diabetes. We chose to restrict our study population to full-term, singleton, live births among Missouri residents and acknowledge that our study results may not be generalized to other populations of pregnant, obese women. We used logistic regression analysis to adjust for known and suspected confounders, which did not affect the overall trends that were reported in our study. However, there may be other confounders that may explain the associations that we observed for all four pregnancy outcomes. We acknowledge that our study results show only statistical associations and do not imply causality. The latter can only be achieved by conducting a prospective randomized controlled trial of obese women to determine the effect of controlled gestational weight gain on specific pregnancy outcomes.
Our study suggests that appropriate gestational weight gain recommendations should be developed separately for each of the three NIH obesity classes, and an upper limit on gestational weight gain should be considered to prevent weight gain and comorbidities among obese women.
1. Schieve LA, Cogswell ME, Scanlon KS. An empiric evaluation of the Institute of Medicine's pregnancy weight gain guidelines by race. Obstet Gynecol 1998;91:878–84.
2. Ogunyemi D, Hullett S, Leeper J, Risk A. Prepregnancy body mass index, weight gain during pregnancy, and perinatal outcome in a rural black population. J Matern Fetal Med 1998;7:190–3.
3. National Institutes of Health, National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults [publication no. 98-4083]. Bethesda (MD): National Institutes of Health; 1998.
4. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002;288:1723–7.
5. Edwards LE, Hellerstedt WL, Alton IR, Story M, Himes JH. Pregnancy complications and birth outcomes in obese and normal-weight women: effects of gestational weight change. Obstet Gynecol 1996;87:389–94.
6. Kabiru W, Raynor BD. Obstetric outcomes associated with increase in BMI category during pregnancy. Am J Obstet Gynecol 2004;191:928–32.
7. Bianco AT, Smilen SW, Davis Y, Lopez S, Lapinski R, Lockwood CJ. Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol 1998;91:97–102.
8. Abrams BF, Laros RK Jr. Prepregnancy weight, weight gain, and birth weight. Am J Obstet Gynecol 1986;154:503–9.
9. Caulfield LE, Stoltzfus RJ, Witter FR. Implications of the Institute of Medicine weight gain recommendations for preventing adverse pregnancy outcomes in black and white women. Am J Public Health 1998;88:1168–74.
10. Morin KH. Perinatal outcomes of obese women: a review of the literature. J Obstet Gynecol Neonatal Nurs 1998;27:431–40.
11. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996;87:163–8.
12. O'Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 2003;14:368–74.
13. Ray JG, Vermeulen MJ, Shapiro JL, Kenshole AB. Maternal and neonatal outcomes in pregestational and gestational diabetes mellitus, and the influence of maternal obesity and weight gain: The DEPOSIT study. Diabetes Endocrine Pregnancy Outcome Study in Toronto. QJM 2001;94:347–56.
14. Lederman SA, Paxton A. Maternal reporting of prepregnancy weight and birth outcome: consistency and completeness compared with the clinical record. Matern Child Health J 1998;2:123–6.
15. Rowland ML. Reporting bias in height and weight data. Stat Bull Metro Insur Co 1989;70:2–11.
This article has been cited 73 time(s).
Stem Cell Reviews and ReportsEpigenetic Programming and Risk: The Birthplace of Cardiovascular Disease?Stem Cell Reviews and Reports
Acta Obstetricia Et Gynecologica ScandinavicaThe macrosomic fetus: a challenge in current obstetricsActa Obstetricia Et Gynecologica Scandinavica
Annual Review of NutritionAchieving a healthy weight gain during pregnancyAnnual Review of Nutrition
American Journal of Obstetrics and GynecologyGestational weight gain by body mass index among US women delivering live births, 2004-2005: fueling future obesityAmerican Journal of Obstetrics and Gynecology
Diabetes CareFirst-Trimester Fasting Hyperglycemia and Adverse Pregnancy OutcomesDiabetes Care
Journal of Womens HealthPre-Pregnancy Overweight Status between Successive Pregnancies and Pregnancy OutcomesJournal of Womens Health
American Journal of Obstetrics and GynecologyAssociation of maternal gestational weight gain with short- and long-term maternal and child health outcomesAmerican Journal of Obstetrics and Gynecology
Bjog-An International Journal of Obstetrics and GynaecologySuper-obesity and risk for early and late pre-eclampsiaBjog-An International Journal of Obstetrics and Gynaecology
Obstetrics and Gynecology Clinics of North AmericaNutrition during pregnancyObstetrics and Gynecology Clinics of North America
Journal of the American Dietetic Association
A Balancing Act: Eating to Optimize A Child's Future Well-Being
Journal of the American Dietetic Association, 109(6):
American Journal of Clinical NutritionOptimal gestational weight gain must not be determined from adverse birth weight outcomes defined only as the total percentage of infants born small- or large-for-gestational-age ReplyAmerican Journal of Clinical Nutrition
Australian & New Zealand Journal of Obstetrics & GynaecologyMaternal obesity and pregnancy complications: A reviewAustralian & New Zealand Journal of Obstetrics & Gynaecology
Primary CareObesity in PregnancyPrimary Care
Mount Sinai Journal of MedicineObesity and Pregnancy: Implications and Management Strategies for ProvidersMount Sinai Journal of Medicine
Maternal and Child Health JournalImpact of Pre-Conception Health Care: Evaluation of a Social Determinants Focused InterventionMaternal and Child Health Journal
NutritionDeterminant factors of insufficient and excessive gestational weight gain and maternal-child adverse outcomesNutrition
ObesityPregravid Weight Is Associated With Prior Dietary Restraint and Psychosocial Factors During PregnancyObesity
American Journal of Obstetrics and GynecologyGestational weight gain among US women who deliver twins, 2001-2006American Journal of Obstetrics and Gynecology
Journal of Family Practice
Preconception counseling: Make it part of the annual exam
Journal of Family Practice, 58(6):
American Journal of Clinical NutritionOptimal gestational weight gain ranges for the avoidance of adverse birth weight outcomes: a novel approachAmerican Journal of Clinical Nutrition
Obstetrics and Gynecology Clinics of North AmericaChildbearing and Obesity in Women: Weight Before, During, and After PregnancyObstetrics and Gynecology Clinics of North America
Maternal and Child Health JournalPrepregnancy Obesity Prevalence in the United States, 2004-2005Maternal and Child Health Journal
Incremental Charges, Costs, and Length of Stay Associated With Obesity as a Secondary Diagnosis Among Pregnant Women
Medical Care, 47():
American Journal of EpidemiologyAssociations of Gestational Weight Gain With Short- and Longer-term Maternal and Child Health OutcomesAmerican Journal of Epidemiology
American Journal of PerinatologyThe Effects of Obesity and Weight Gain in Young Women on Obstetric OutcomesAmerican Journal of Perinatology
EndocrinologyChanges in Melanocortin Expression and Inflammatory Pathways in Fetal Offspring of Nonhuman Primates Fed a High-Fat DietEndocrinology
American Journal of PerinatologyObstetric Outcomes in Normal Weight and Obese Women in Relation to Gestational Weight Gain: Comparison between Institute of Medicine Guidelines and Cedergren CriteriaAmerican Journal of Perinatology
American Journal of Clinical NutritionSevere obesity, gestational weight gain, and adverse birth outcomesAmerican Journal of Clinical Nutrition
American Journal of Clinical Nutrition
Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy
American Journal of Clinical Nutrition, 87(6):
American Journal of Obstetrics and GynecologyA systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retentionAmerican Journal of Obstetrics and Gynecology
Reproductive SciencesSignificant Correlation Between Maternal Body Mass Index at Delivery and in the Second Trimester, and Second Trimester Circulating Total Cell-free DNA LevelsReproductive Sciences
Research in Nursing & HealthAdherence to Walking or Stretching, and Risk of Preeclampsia in Sedentary Pregnant WomenResearch in Nursing & Health
Nutrition ReviewsRole of nutrition in the risk of preeclampsiaNutrition Reviews
Journal of Nursing ScholarshipPrenatal Stretching Exercise and Autonomic Responses: Preliminary Data and a Model for Reducing PreeclampsiaJournal of Nursing Scholarship
Scandinavian Journal of Medicine & Science in SportsCorrelates of regular exercise during pregnancy: the Norwegian Mother and Child Cohort StudyScandinavian Journal of Medicine & Science in Sports
American Journal of PerinatologyExcessive Weight Gain among Obese Women and Pregnancy OutcomesAmerican Journal of Perinatology
Social Science ResearchBirth weight, cognitive development, and life chances: A comparison of siblings from childhood into early adulthoodSocial Science Research
Journal of the American Dietetic AssociationWhat Is Pregorexia?Journal of the American Dietetic Association
American Journal of Clinical NutritionPregnancy outcomes related to gestational weight gain in women defined by their body mass index, parity, height, and smoking statusAmerican Journal of Clinical Nutrition
Deutsche Medizinische WochenschriftGestational diabetes mellitus: which nutritional treatment is efficacious?Deutsche Medizinische Wochenschrift
Journal of the American Dietetic AssociationDietary Restraint and Gestational Weight GainJournal of the American Dietetic Association
British Medical JournalObesity and pregnancyBritish Medical Journal
Journal of the National Medical Association
Perinatal Outcomes in Nutritionally Monitored Obese Pregnant Women: A Randomized Clinical Trial
Journal of the National Medical Association, 101(6):
Acta Obstetricia Et Gynecologica ScandinavicaWeight gain restriction during pregnancy is safe for both the mother and neonateActa Obstetricia Et Gynecologica Scandinavica
American Journal of PerinatologyThe Impact of Maternal Obesity on the Incidence of Adverse Pregnancy Outcomes in High-Risk Term PregnanciesAmerican Journal of Perinatology
Journal of Clinical Endocrinology & MetabolismFetal and Postnatal Growth and Body Composition at 6 Months of AgeJournal of Clinical Endocrinology & Metabolism
Maternal and Child Health JournalMaternal Pre-Pregnancy Weight and Gestational Weight Gain and Their Association with Birthweight with a Focus on Racial DifferencesMaternal and Child Health Journal
Birth-Issues in Perinatal CareShould Obese Women Gain Less Weight in Pregnancy Than Recommended?Birth-Issues in Perinatal Care
Cochrane Database of Systematic ReviewsAntenatal interventions for reducing weight in obese women for improving pregnancy outcomeCochrane Database of Systematic Reviews
Maternal and Child Health JournalReliability of Gestational Weight Gain Reported Postpartum: A Comparison to the Birth CertificateMaternal and Child Health Journal
Plos OneAssociation of Second and Third Trimester Weight Gain in Pregnancy with Maternal and Fetal OutcomesPlos One
Bmc Pregnancy and ChildbirthExcess gestational weight gain: an exploration of midwives' views and practiceBmc Pregnancy and Childbirth
ObesityThe Influence of Weight Gain Patterns in Pregnancy on Fetal Growth Using Cluster Analysis in an Obese and Nonobese PopulationObesity
Journal of Perinatal MedicineMaternal weight gain in women with gestational diabetes mellitusJournal of Perinatal Medicine
MidwiferyPatterns of gestational weight gain in healthy, low-risk pregnant women without co-morbiditiesMidwifery
European Journal of Obstetrics & Gynecology and Reproductive BiologyGestational weight gain and adverse pregnancy outcomes in a nulliparous cohortEuropean Journal of Obstetrics & Gynecology and Reproductive Biology
Preventive MedicineThe effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: A systematic review and meta-analysis of randomized controlled trialsPreventive Medicine
Women and BirthAddressing obesity in pregnancy: The design and feasibility of an innovative intervention in NSW, AustraliaWomen and Birth
Bmc Pregnancy and ChildbirthPre-pregnancy BMI and weight gain: where is the tipping point for preterm birth?Bmc Pregnancy and Childbirth
American Journal of Obstetrics and GynecologyGestational weight gain and obesity: is 20 pounds too much?American Journal of Obstetrics and Gynecology
Maternal and Child Health JournalWeight Loss After Diagnosis with Gestational Diabetes and Birth Weight Among Overweight and Obese WomenMaternal and Child Health Journal
Journal of Womens HealthExploring Potential Health Disparities in Excessive Gestational Weight GainJournal of Womens Health
Journal of Midwifery & Womens HealthPrevention of Obesity and Diabetes in Childbearing WomenJournal of Midwifery & Womens Health
Bmc Pregnancy and ChildbirthDALI: Vitamin D and lifestyle intervention for gestational diabetes mellitus (GDM) prevention: an European multicentre, randomised trial - study protocolBmc Pregnancy and Childbirth
Clinical Obstetrics and GynecologyNutrition and PregnancyClinical Obstetrics and Gynecology
Current Opinion in Obstetrics and GynecologyRisks and management of obesity in pregnancy: current controversiesCurrent Opinion in Obstetrics and Gynecology
Obstetrics & GynecologyWeight Gain Recommendations in Pregnancy and the Obesity EpidemicObstetrics & Gynecology
Obstetrics & GynecologyIncreasing Maternal Obesity and Weight Gain During Pregnancy: The Obstetric Problems of PlentitudeObstetrics & Gynecology
Obstetrics & GynecologyMaternal Gestational Weight Gain and Offspring Weight in AdolescenceObstetrics & Gynecology
The Journal of Perinatal & Neonatal NursingObesity as a Complication of Pregnancy and LaborThe Journal of Perinatal & Neonatal Nursing
© 2007 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
ACOG MEMBER SUBSCRIPTION ACCESS
If you are an ACOG Fellow and have not logged in or registered to Obstetrics & Gynecology, please follow these step-by-step instructions to access journal content with your member subscription.