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Association of Maternal Body Mass Index, Excessive Weight Gain, and Gestational Diabetes Mellitus With Large-for-Gestational-Age Births

Kim, Shin Y. MPH; Sharma, Andrea J. PhD, MPH; Sappenfield, William MD, MPH; Wilson, Hoyt G. PhD; Salihu, Hamisu M. MD, PhD

doi: 10.1097/AOG.0000000000000177
Contents: Original Research

OBJECTIVE: To estimate the percentage of large-for-gestational age (LGA) neonates associated with maternal overweight and obesity, excessive gestational weight gain, and gestational diabetes mellitus (GDM)—both individually and in combination—by race or ethnicity.

METHODS: We analyzed 2004–2008 linked birth certificate and maternal hospital discharge data of live, singleton deliveries in Florida. We used multivariable logistic regression to assess the independent contributions of mother's prepregnancy body mass index (BMI), gestational weight gain, and GDM status on LGA (birth weight-for-gestational age 90th percentile or greater) risk by race and ethnicity while controlling for maternal age, nativity, and parity. We then calculated the adjusted population-attributable fraction of LGA neonates to each of these exposures.

RESULTS: Large-for-gestational age prevalence was 5.7% among normal-weight women with adequate gestational weight gain and no GDM and 12.6%, 13.5% and 17.3% among women with BMIs of 25 or higher, excess gestational weight gain, and GDM, respectively. A reduction ranging between 46.8% in Asian and Pacific Islanders and 61.0% in non-Hispanic black women in LGA prevalence might result if women had none of the three exposures. For all race or ethnic groups, GDM contributed the least (2.0–8.0%), whereas excessive gestational weight gain contributed the most (33.3–37.7%) to LGA.

CONCLUSION: Overweight and obesity, excessive gestational weight gain, and GDM all are associated with LGA; however, preventing excessive gestational weight gain has the greatest potential to reduce LGA risk.


Excess gestational weight gain is associated with a greater proportion of large-for-gestational-age neonates than either maternal prepregnancy body mass index of 25 or greater or gestational diabetes mellitus.

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; the College of Public Health and the Department of Biostatistics and Epidemiology, University of South Florida, Tampa, Florida; and D.B. Consulting Group, Inc, Silver Spring, Maryland.

Corresponding author: Shin Y. Kim, MPH, 4770 Buford Highway, NE MS K-23, Atlanta, GA 30341; e-mail:

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.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.