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Association Between Gestational Weight Gain and Adverse Obstetric and Neonatal Outcomes Among Overweight Women

This study examines the association between gestational weight gain and adverse obstetric and neonatal outcomes among overweight women. The findings suggest that gaining within the recommended range of 15-25 lbs reduces the risk of preeclampsia, C-sections, and macrosomia. Further research and preconception planning are recommended for overweight women.

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Association Between Gestational Weight Gain and Adverse Obstetric and Neonatal Outcomes Among Overweight Women

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  1. Association Between Gestational Weight Gain and Adverse Obstetric and Neonatal Outcomes Among Overweight Women Aisha Langford Saint Louis University School of Public Health December 7, 2006

  2. Background • ~47% of U.S. women are overweight (25.0 – 29.99 kg/m2) • Overweight women have increased risk for: • Preeclampsia • Cesarean-section • Macrosomic babies • Fetal death National Center for Health Statistics 2006, Baeten et al 2001, Callaway et al2006

  3. IOM Guidelines • In 1990, gestational weight guidelines were established to reduce adverse pregnancy outcomes • Overweight women (26.0 – 29.0 kg/m2) recommended to gain 15 - 25 lbs during pregnancy

  4. Existing Research • IOM guidelines appropriate for normal weight women • Overweight women who gained within IOM recommendations reduced their risk for high birth weight (HBW) and pre-term birth • High gestational weight gain is associated with short and long-term weight retention • Only 30-40% of women met recommendations Cogswell et al 1995, Dietz et al 2006, Linne et al 2004, Abrams et al 2000

  5. Study Question • Is there an association between gestational weight gain and adverse obstetric and neonatal outcomes among overweight women? • What amount of gestational weight gain minimizes risk? • Hypothesis: Meeting IOM guidelines reduces risk of poor outcomes.

  6. Study Design • Population-based cohort study • MO birth certificate data from 1990 to 2004 (residents only) • Exposure Categories: • Did not meet recommendations (<15 lbs) • Met recommendations (15 - 25 lbs) • Exceeded recommendations (>25 lbs)

  7. 35,576 singleton, full-term (> 37 wks) deliveries to overweight nulliparous 18-35 34,143 women without missing demographic or exposure data <15 lbs 1787 5% 15-25 lbs 7205 21% > 25 lbs 25151 74% Eligibility Criteria • *BMI is self-reported

  8. Adverse Outcomes • Preeclampsia (hypertension after 20th week) • C-section (emergency and elective) • Macrosomia (> 4000 grams) • Low birth weight (<2500 grams) • Perinatal death (at > 37 weeks – 28 days of life)

  9. Analysis • Bivariate analysis with chi-square • Risk % • Measure of Association – Relative Risk • Stratified analysis to identify confounders • Mantel Haenszel pooled estimator of relative risk • 95% Confidence Interval (CI) for precision

  10. Demographic Characteristics *p<.05

  11. Demographic Characteristics *p<.05

  12. Demographic Characteristics *p<.05

  13. Adverse Outcomes * Adjusted for age ** Reference group

  14. Adverse Outcomes by 10lb Categories Risk %

  15. Adverse Outcomes by 10lb Categories C-Section Risk %

  16. Adverse Outcomes by 10lb Categories C-Section Risk % Macrosomia

  17. Adverse Outcomes by 10lb Categories C-Section Risk % Macrosomia Preeclampsia

  18. Adverse Outcomes by 10lb Categories C-Section Risk % Macrosomia Preeclampsia LBW

  19. Relative Risk by Weight Gain

  20. Relative Risk by Weight Gain

  21. Strengths First study to evaluate multiple outcomes Extended time period (1990-2004) Limitations Low power for perinatal death Misclassification bias of exposure Birth certificate data

  22. Conclusions • Current IOM recommendations (15-25 lbs) for overweight women are appropriate • Overweight women should not gain more than 25lbs • Gaining 6-14lbs may reduce risk of preeclampsia, c-section and macrosomia • Findings are consistent with previous work on HBW and LBW

  23. Public Health Implications • Pre-conception planning and monitoring through pregnancy for overweight women • Increased risk of developing obesity • Further research on gestational weight gain in overweight women

  24. Acknowledgements • Corinne Joshu, MA • Thomas Myles, MD • Jen Jen Chang, PhD • Terry Leet, PhD • Anjali Deshpande, PhD

  25. Questions

  26. Sensitivity Analysis • Of 35,576 eligible women, 1433 were excluded • Chi-square statistic used to compare missing data with complete data • Missing more likely to be 18-24, non-Hispanic white, <high school, enrolled in Medicaid and WIC

  27. Adverse Outcomes * Adjusted for age ** Reference group

  28. Adverse Outcomes *Adjusted for age

  29. Adverse Outcomes *Adjusted for age

  30. Demographic Characteristics *p<.05 † Majority 18-24, Non-Hispanic white with high school education

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