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Association Between Gestational Weight Gain and Perinatal Outcomes

Kominiarek, Michelle A., MD, MS; Saade, George, MD; Mele, Lisa, ScM; Bailit, Jennifer, MD, MPH; Reddy, Uma M., MD, MPH; Wapner, Ronald J., MD; Varner, Michael W., MD; Thorp, John M. Jr, MD; Caritis, Steve N., MD; Prasad, Mona, DO, MPH; Tita, Alan T.N., MD, PhD; Sorokin, Yoram, MD; Rouse, Dwight J., MD; Blackwell, Sean C., MD; Tolosa, Jorge E., MD, MSCE for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network

doi: 10.1097/AOG.0000000000002854
Contents: Prenatal Care: Original Research

OBJECTIVE: To evaluate the association between gestational weight gain and maternal and neonatal outcomes in a large, geographically diverse cohort.

METHODS: Trained chart abstractors at 25 hospitals obtained maternal and neonatal data for all deliveries on randomly selected days over 3 years (2008–2011). Gestational weight gain was derived using weight at delivery minus prepregnancy or first-trimester weight and categorized as below, within, or above the Institute of Medicine (IOM) guidelines in this retrospective cohort study. Maternal (primary or repeat cesarean delivery, third- or fourth-degree lacerations, severe postpartum hemorrhage, hypertensive disease of pregnancy) and neonatal (preterm birth, shoulder dystocia, macrosomia, hypoglycemia) outcomes were compared among women in the gestational weight gain categories in unadjusted and adjusted analyses with odds ratios (ORs) and 95% CI reported. Covariates included age, race-ethnicity, tobacco use, insurance type, parity, prior cesarean delivery, pregestational diabetes, hypertension, and hospital type.

RESULTS: Of the 29,861 women included, 51% and 21% had gestational weight gain above and below the guidelines, respectively. There was an association between gestational weight gain above the IOM guidelines and cesarean delivery in both nulliparous women (adjusted OR 1.44, 95% CI 1.31–1.59) and multiparous women (adjusted OR 1.26, 95% CI 1.13–1.41) and hypertensive diseases of pregnancy in nulliparous and multiparous women combined (adjusted OR 1.84, 95% CI 1.66–2.04). For the neonatal outcomes, gestational weight gain above the IOM guidelines was associated with shoulder dystocia (adjusted OR 1.74, 95% CI 1.41–2.14), macrosomia (adjusted OR 2.66, 95% CI 2.03–3.48), and neonatal hypoglycemia (adjusted OR 1.60, 95% CI 1.16–2.22). Gestational weight gain below the guidelines was associated with spontaneous (adjusted OR 1.50, 95% CI 1.31–1.73) and indicated (adjusted OR 1.34, 95% CI 1.12–1.60) preterm birth.

CONCLUSION: In a large, diverse cohort with prospectively collected data, gestational weight gain below or above guidelines is associated with a variety of adverse pregnancy outcomes.

Gestational weight gain below or above the Institute of Medicine guidelines is associated with adverse pregnancy outcomes in a large, geographically diverse cohort.

Departments of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, University of Texas Medical Branch, Galveston, Texas, MetroHealth Medical Center–Case Western Reserve University, Cleveland, Ohio, Columbia University, New York, New York, University of Utah Health Sciences Center, Salt Lake City, Utah, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, University of Pittsburgh, Pittsburgh, Pennsylvania, The Ohio State University, Columbus, Ohio, University of Alabama at Birmingham, Birmingham, Alabama, Wayne State University, Detroit, Michigan, Brown University, Providence, Rhode Island, University of Texas Health Science Center at Houston–Children’s Memorial Hermann Hospital, Houston, Texas, and Oregon Health & Science University, Portland, Oregon; 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: Michelle A. Kominiarek, MD, MS, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University, 250 East Superior Street, Suite 05-2175, Chicago, IL 60611; email:

The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (HD21410, HD27869, HD27915, HD27917, HD34116, HD34208, HD36801, HD40500, HD40512, HD40544, HD40545, HD40560, HD40485, HD53097, HD53118) and the National Center for Research Resources (UL1 RR024989; 5UL1 RR025764). This study was also supported by NICHD K23HD076010 (Dr. Kominiarek). Comments and views of the authors do not necessarily represent views of the National Institutes of Health.

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

Presented as a poster at the Annual Meeting of the Society for Maternal-Fetal Medicine, February 2–7, 2015, San Diego, California.

* See Appendix 1, available online at, for a list of other members of the NICHD MFMU Network.

The authors thank Cynthia Milluzzi, RN, and Joan Moss, RNC, MSN, for protocol development and coordination between clinical research centers; and William A. Grobman, MD, MBA, Elizabeth Thom, PhD, Madeline M. Rice, PhD, Brian M. Mercer, MD, and Catherine Y. Spong, MD, for protocol development and oversight.

Each author has indicated that he or she has met the journal’s requirements for authorship.

Received May 02, 2018

Received in revised form June 21, 2018

Accepted June 28, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.