Pregnancy outcomes in the super obese, stratified by weight gain above and below institute of medicine guidelines

Morgan L. Swank, Nicole Marshall, Aaron Caughey, Elliott K. Main, William M. Gilbert, Kathryn A. Melsop, Judith H. Chung

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

OBJECTIVE: To examine the association of antenatal weight gain above and below the 2009 Institute of Medicine (IOM) guidelines in the super-obese population (body mass index [BMI] of 50 or higher) on the maternal and neonatal morbidities of gestational hypertension or preeclampsia (pregnancy-induced hypertension), gestational diabetes mellitus, cesarean delivery, birth weight more than 4,000 g and more than 4,500 g, low birth weight, and preterm birth.

METHODS: The effect of gestational weight gain was assessed in this retrospective cohort study using California birth certificate and patient discharge diagnosis data. Unconditional logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) as a function of antenatal weight gain. Weight gain within 2009 IOM guidelines (11-20 pounds) served as the reference group.

RESULTS: The study population consisted of 1,034 women. Women gaining below, within, and above IOM guidelines accounted for 38.3, 23.5, and 38.2%, respectively. Weight gain below IOM guidelines was not associated with a statistically increased odds of preterm birth (OR 1.82, 95% CI 0.60-5.59) or low birth weight (OR 1.20, 95% CI 0.57-2.49); however, birth weight more than 4,000 g was significantly reduced (OR 0.50, 95% CI 0.32-0.77). Excessive weight gain statistically increased the odds of pregnancy-induced hypertension (OR 1.96, 95% CI 1.26- 3.03) and cesarean delivery (OR 1.40, 95% CI 1.00-1.97) while not appearing to protect against the delivery of low-birth-weight neonates (OR 0.84, 95% CI 0.40-1.78).

CONCLUSION: Weight gain below the current guidelines in the super-obese cohort is not associated with an increase in maternal or neonatal risk while decreasing the odds of delivering a macrosomic neonate. Women with BMIs of 50 or higher may warrant separate gestational weight gain recommendations.

Original languageEnglish (US)
Pages (from-to)1105-1110
Number of pages6
JournalObstetrics and Gynecology
Volume124
Issue number6
DOIs
StatePublished - Dec 11 2014

Fingerprint

National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division
Pregnancy Outcome
Weight Gain
Guidelines
Odds Ratio
Confidence Intervals
Pregnancy Induced Hypertension
Low Birth Weight Infant
Premature Birth
Birth Weight
Mothers
Newborn Infant
Birth Certificates
Gestational Diabetes
Patient Discharge
Pre-Eclampsia
Population
Body Mass Index
Cohort Studies
Retrospective Studies

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

Pregnancy outcomes in the super obese, stratified by weight gain above and below institute of medicine guidelines. / Swank, Morgan L.; Marshall, Nicole; Caughey, Aaron; Main, Elliott K.; Gilbert, William M.; Melsop, Kathryn A.; Chung, Judith H.

In: Obstetrics and Gynecology, Vol. 124, No. 6, 11.12.2014, p. 1105-1110.

Research output: Contribution to journalArticle

Swank, Morgan L. ; Marshall, Nicole ; Caughey, Aaron ; Main, Elliott K. ; Gilbert, William M. ; Melsop, Kathryn A. ; Chung, Judith H. / Pregnancy outcomes in the super obese, stratified by weight gain above and below institute of medicine guidelines. In: Obstetrics and Gynecology. 2014 ; Vol. 124, No. 6. pp. 1105-1110.
@article{4c68cdf346884c47870b4607d719c541,
title = "Pregnancy outcomes in the super obese, stratified by weight gain above and below institute of medicine guidelines",
abstract = "OBJECTIVE: To examine the association of antenatal weight gain above and below the 2009 Institute of Medicine (IOM) guidelines in the super-obese population (body mass index [BMI] of 50 or higher) on the maternal and neonatal morbidities of gestational hypertension or preeclampsia (pregnancy-induced hypertension), gestational diabetes mellitus, cesarean delivery, birth weight more than 4,000 g and more than 4,500 g, low birth weight, and preterm birth.METHODS: The effect of gestational weight gain was assessed in this retrospective cohort study using California birth certificate and patient discharge diagnosis data. Unconditional logistic regression was used to calculate adjusted odds ratios (ORs) and 95{\%} confidence intervals (CIs) as a function of antenatal weight gain. Weight gain within 2009 IOM guidelines (11-20 pounds) served as the reference group.RESULTS: The study population consisted of 1,034 women. Women gaining below, within, and above IOM guidelines accounted for 38.3, 23.5, and 38.2{\%}, respectively. Weight gain below IOM guidelines was not associated with a statistically increased odds of preterm birth (OR 1.82, 95{\%} CI 0.60-5.59) or low birth weight (OR 1.20, 95{\%} CI 0.57-2.49); however, birth weight more than 4,000 g was significantly reduced (OR 0.50, 95{\%} CI 0.32-0.77). Excessive weight gain statistically increased the odds of pregnancy-induced hypertension (OR 1.96, 95{\%} CI 1.26- 3.03) and cesarean delivery (OR 1.40, 95{\%} CI 1.00-1.97) while not appearing to protect against the delivery of low-birth-weight neonates (OR 0.84, 95{\%} CI 0.40-1.78).CONCLUSION: Weight gain below the current guidelines in the super-obese cohort is not associated with an increase in maternal or neonatal risk while decreasing the odds of delivering a macrosomic neonate. Women with BMIs of 50 or higher may warrant separate gestational weight gain recommendations.",
author = "Swank, {Morgan L.} and Nicole Marshall and Aaron Caughey and Main, {Elliott K.} and Gilbert, {William M.} and Melsop, {Kathryn A.} and Chung, {Judith H.}",
year = "2014",
month = "12",
day = "11",
doi = "10.1097/AOG.0000000000000553",
language = "English (US)",
volume = "124",
pages = "1105--1110",
journal = "Obstetrics and Gynecology",
issn = "0029-7844",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Pregnancy outcomes in the super obese, stratified by weight gain above and below institute of medicine guidelines

AU - Swank, Morgan L.

AU - Marshall, Nicole

AU - Caughey, Aaron

AU - Main, Elliott K.

AU - Gilbert, William M.

AU - Melsop, Kathryn A.

AU - Chung, Judith H.

PY - 2014/12/11

Y1 - 2014/12/11

N2 - OBJECTIVE: To examine the association of antenatal weight gain above and below the 2009 Institute of Medicine (IOM) guidelines in the super-obese population (body mass index [BMI] of 50 or higher) on the maternal and neonatal morbidities of gestational hypertension or preeclampsia (pregnancy-induced hypertension), gestational diabetes mellitus, cesarean delivery, birth weight more than 4,000 g and more than 4,500 g, low birth weight, and preterm birth.METHODS: The effect of gestational weight gain was assessed in this retrospective cohort study using California birth certificate and patient discharge diagnosis data. Unconditional logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) as a function of antenatal weight gain. Weight gain within 2009 IOM guidelines (11-20 pounds) served as the reference group.RESULTS: The study population consisted of 1,034 women. Women gaining below, within, and above IOM guidelines accounted for 38.3, 23.5, and 38.2%, respectively. Weight gain below IOM guidelines was not associated with a statistically increased odds of preterm birth (OR 1.82, 95% CI 0.60-5.59) or low birth weight (OR 1.20, 95% CI 0.57-2.49); however, birth weight more than 4,000 g was significantly reduced (OR 0.50, 95% CI 0.32-0.77). Excessive weight gain statistically increased the odds of pregnancy-induced hypertension (OR 1.96, 95% CI 1.26- 3.03) and cesarean delivery (OR 1.40, 95% CI 1.00-1.97) while not appearing to protect against the delivery of low-birth-weight neonates (OR 0.84, 95% CI 0.40-1.78).CONCLUSION: Weight gain below the current guidelines in the super-obese cohort is not associated with an increase in maternal or neonatal risk while decreasing the odds of delivering a macrosomic neonate. Women with BMIs of 50 or higher may warrant separate gestational weight gain recommendations.

AB - OBJECTIVE: To examine the association of antenatal weight gain above and below the 2009 Institute of Medicine (IOM) guidelines in the super-obese population (body mass index [BMI] of 50 or higher) on the maternal and neonatal morbidities of gestational hypertension or preeclampsia (pregnancy-induced hypertension), gestational diabetes mellitus, cesarean delivery, birth weight more than 4,000 g and more than 4,500 g, low birth weight, and preterm birth.METHODS: The effect of gestational weight gain was assessed in this retrospective cohort study using California birth certificate and patient discharge diagnosis data. Unconditional logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) as a function of antenatal weight gain. Weight gain within 2009 IOM guidelines (11-20 pounds) served as the reference group.RESULTS: The study population consisted of 1,034 women. Women gaining below, within, and above IOM guidelines accounted for 38.3, 23.5, and 38.2%, respectively. Weight gain below IOM guidelines was not associated with a statistically increased odds of preterm birth (OR 1.82, 95% CI 0.60-5.59) or low birth weight (OR 1.20, 95% CI 0.57-2.49); however, birth weight more than 4,000 g was significantly reduced (OR 0.50, 95% CI 0.32-0.77). Excessive weight gain statistically increased the odds of pregnancy-induced hypertension (OR 1.96, 95% CI 1.26- 3.03) and cesarean delivery (OR 1.40, 95% CI 1.00-1.97) while not appearing to protect against the delivery of low-birth-weight neonates (OR 0.84, 95% CI 0.40-1.78).CONCLUSION: Weight gain below the current guidelines in the super-obese cohort is not associated with an increase in maternal or neonatal risk while decreasing the odds of delivering a macrosomic neonate. Women with BMIs of 50 or higher may warrant separate gestational weight gain recommendations.

UR - http://www.scopus.com/inward/record.url?scp=84916911997&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84916911997&partnerID=8YFLogxK

U2 - 10.1097/AOG.0000000000000553

DO - 10.1097/AOG.0000000000000553

M3 - Article

C2 - 25415161

AN - SCOPUS:84916911997

VL - 124

SP - 1105

EP - 1110

JO - Obstetrics and Gynecology

JF - Obstetrics and Gynecology

SN - 0029-7844

IS - 6

ER -