Obstet Gynecol Sci.  2014 Nov;57(6):442-447. 10.5468/ogs.2014.57.6.442.

Gestational weight gain is an important risk factor for excessive fetal growth

• Lee JM
• Kim MJ
• Kim MY
• Han JY
• Ahn HK
• Choi JS
• Chung JH
• Lee SW
• Han YJ
• Kwak DW
• Ryu HM
• Kim MH

• KMID: 2314009
• DOI: http://doi.org/10.5468/ogs.2014.57.6.442

Abstract

OBJECTIVE
To estimate the odds ratio of prepregnant body mass index (BMI), gestational weight gain (GWG), and gestational diabetes mellitus (GDM) for excessive fetal growth, which we define as large for gestational age (LGA).
METHODS
We included 16,297 women who delivered a live-born singleton baby at term. We fit logistic regressions to estimate the odds ratios of variables, including maternal age, parity, prepregnant BMI > or =23, GWG > or =15 kg, and GDM, for LGA. We classified GWG into four categories (<10, 10-14.9, 15-19.9, and > or =20 kg) and BMI into four categories (underweight, normal, overweight, and obese). After adjusting for age and parity, we analyzed the odds ratios of prepregnant BMI according to GWG between non-GDM and GDM women for LGA.
RESULTS
The odds ratios of GWG > or =15 kg and prepregnancy BMI > or =23 for LGA were 2.40 (95% confidence interval [CI], 2.16-2.67) and 2.24 (95% CI, 1.99-2.51), respectively. The odd ratio of GDM was 1.37 (95% CI, 1.09-1.71). The risk of GDM women with normal/-overweight BMI and GWG <15 kg for LGA was not significantly greater than those of the reference group. The odd ratios of GDM women with overweight/obese BMI and GWG 15 to 19.9 kg were 3.95 (95% CI, 1.26-12.38) and 9.70 (95% CI, 3.79-24.87), respectively.
CONCLUSION
GWG > or =15 kg might be a more important risk factor for LGA than either prepregnancy BMI > or =23 or GDM. Risk for LGA was highest in obese GDM women with GWG > or =15 kg.

Keyword

Birth weight; Body mass index; Diabetes; Gestational; Weight gain

MeSH Terms

Birth Weight
Body Mass Index
Diabetes, Gestational
Female
Fetal Development*
Gestational Age
Humans
Logistic Models
Maternal Age
Odds Ratio
Overweight
Parity
Pregnancy
Risk Factors*
Weight Gain*

Reference

1. Oken E, Kleinman KP, Belfort MB, Hammitt JK, Gillman MW. Associations of gestational weight gain with short- and longer-term maternal and child health outcomes. Am J Epidemiol. 2009; 170:173–180. PMID: 19439579.

2. Margerison Zilko CE, Rehkopf D, Abrams B. Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes. Am J Obstet Gynecol. 2010; 202:574.e1–574.e8. PMID: 20132923.

3. Hayes M, Abrams B, Davidson EC. Influence of pregnancy weight on maternal and child health. Washington, DC: National Academies Press;2007.

4. Oken E, Rifas-Shiman SL, Field AE, Frazier AL, Gillman MW. Maternal gestational weight gain and offspring weight in adolescence. Obstet Gynecol. 2008; 112:999–1006. PMID: 18978098.

5. Whitaker RC. Predicting preschooler obesity at birth: the role of maternal obesity in early pregnancy. Pediatrics. 2004; 114:e29–e36. PMID: 15231970.

6. Leddy MA, Power ML, Schulkin J. The impact of maternal obesity on maternal and fetal health. Rev Obstet Gynecol. 2008; 1:170–178. PMID: 19173021.

7. Brawarsky P, Stotland NE, Jackson RA, Fuentes-Afflick E, Escobar GJ, Rubashkin N, et al. Pre-pregnancy and pregnancy-related factors and the risk of excessive or inadequate gestational weight gain. Int J Gynaecol Obstet. 2005; 91:125–131. PMID: 16202415.

8. Rooney BL, Schauberger CW. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol. 2002; 100:245–252. PMID: 12151145.

9. Young TK, Woodmansee B. Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain. Am J Obstet Gynecol. 2002; 187:312–318. PMID: 12193918.

10. Rasmussen KM, Yaktine AL. Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: The National Academy Press;2009.

11. Ehrenberg HM, Mercer BM, Catalano PM. The influence of obesity and diabetes on the prevalence of macrosomia. Am J Obstet Gynecol. 2004; 191:964–968. PMID: 15467573.

12. Van Wootten W, Turner RE. Macrosomia in neonates of mothers with gestational diabetes is associated with body mass index and previous gestational diabetes. J Am Diet Assoc. 2002; 102:241–243. PMID: 11846118.

13. Bowers K, Laughon SK, Kiely M, Brite J, Chen Z, Zhang C. Gestational diabetes, pre-pregnancy obesity and pregnancy weight gain in relation to excess fetal growth: variations by race/ethnicity. Diabetologia. 2013; 56:1263–1271. PMID: 23571827.

14. Silva JK, Kaholokula JK, Ratner R, Mau M. Ethnic differences in perinatal outcome of gestational diabetes mellitus. Diabetes Care. 2006; 29:2058–2063. PMID: 16936153.

15. Health Insurance Review and Assessment Service. Cesarean section assessment [Internet]. Seoul: Health Insurance Review and Assessment Service;2010. cited 2014 Oct 31. Available from: http://hira.or.kr/cms/statistics.

16. Deierlein AL, Siega-Riz AM, Adair LS, Herring AH. Effects of pre-pregnancy body mass index and gestational weight gain on infant anthropometric outcomes. J Pediatr. 2011; 158:221–226. PMID: 20863516.

17. Dietz PM, Callaghan WM, Sharma AJ. High pregnancy weight gain and risk of excessive fetal growth. Am J Obstet Gynecol. 2009; 201:51.e1–51.e6. PMID: 19576373.

18. Ouzounian JG, Hernandez GD, Korst LM, Montoro MM, Battista LR, Walden CL, et al. Pre-pregnancy weight and excess weight gain are risk factors for macrosomia in women with gestational diabetes. J Perinatol. 2011; 31:717–721. PMID: 21372797.

19. Black MH, Sacks DA, Xiang AH, Lawrence JM. The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth. Diabetes Care. 2013; 36:56–62. PMID: 22891256.

20. Park JE, Park S, Daily JW, Kim SH. Low gestational weight gain improves infant and maternal pregnancy outcomes in overweight and obese Korean women with gestational diabetes mellitus. Gynecol Endocrinol. 2011; 27:775–781. PMID: 21190417.