Weight gain during pregnancy: too much, too little, or just right

1. Weight gain during pregnancy: too much, too little, or just right Lyn Kieltyka, PhD, MPH Ashley Chin, PhD, MPH, MA Dionka Pierce, MPH

2. Background • Achieving appropriate weight gain during pregnancy is important to healthy outcomes • The Institute of Medicine published recommendations for pregnancy weight gain

3. Louisiana History • 33% of Louisiana women did not gain enough weight during pregnancy according to LA PRAMS data from 1998-99 • Women not gaining enough weight had a higher percent (11.5%) of LBW infants compared to women with adequate weight gain (6.6%) • White women were twice as likely to have inadequate weight gain during pregnancy than black women

4. Louisiana Weight Gain Campaign

5. Future Plans of the Past • Develop a patient education lesson plan on adequate prenatal weight gain for public health providers • Promote patient education on prenatal weight gain to hospitals for their prenatal classes • Distribute a poster with the prenatal weight gain message in strategic locations to maximize promotion to women • To support health professionals and encourage counseling on adequate prenatal weight gain by providing educational presentations and support materials

6. 2004 US Low Birth Weight (LBW) Source: March of Dimes Peristats

7. Louisiana Outcomes Mortality = 11.4 per 1,000 2004 LBW: 11.0% 2004 IMR: 10.4 per 1,000 United Health Foundation: 49th

8. Research Questions • What is the relationship between weight gain and birth weight outcomes? • What factors are associated with inappropriate weight gain?

9. Methods • 2001-2004 linked Louisiana PRAMS-birth records • Institute of Medicine BMI-specific recommendations categorized weight gained into under, appropriate, and over-gaining • Birth weight categorized as LBW (500-2,500g), NBW (2,500-3,999g), and HBW (4,000+g);analytic data limited to singleton births • Relationship with weight gain investigated using chi-square tests and multinomial regression in SAS-callable SUDAAN v9 • Additional factors/markers of interest: • Maternal race, age, education, Pre-pregnancy BMI, 3rd trimester smoking, Maternal hypertension, previous LBW birth, and gestational age

10. Weight Gain Appropriateness • Only 33% (95%CI=32%,35%) of Louisiana women achieved the appropriate weight gain for BMI • 23% (95%CI=22%,24%) under-gained • 44% (95%CI=42%,45%) over-gained

11. Maternal Characteristics

12. Weight Gain and Birth Outcome* Adjusted for maternal race, maternal age, pre-pregnancy BMI, 3rd trimester smoking, maternal hypertension, previous LBW birth, and gestational age Note: point estimates did not meaningfully change between unadjusted and adjusted models

13. Factors Associated with Weight Gain Adjusted for maternal age, education, and prior LBW

14. Prenatal Weight Gain Counseling • Data available for 2004 only • 82% percent (95%CI=80%,84%) of women reported being counseled on pregnancy weight gain by a provider… • There was NO association between provider counseling and appropriateness of weight gained

15. Conclusions • Two-thirds of Louisiana women failed to gain the recommended amount of weight during pregnancy despite over 80% receiving weight gain counseling. • Weight gain during pregnancy is significantly associated with birth weight • Three modifiable risk factors identified for inappropriate weight gain • Pre-pregnancy BMI • Hypertension • Smoking

16. Public Health Implications • Further investigation is required to understand why so few women gain appropriate weight during pregnancy • Fewer Louisiana women undergained than before • Interventions beyond media education and current provider education are required to address adequate weight gain in Louisiana • Preconception health interventions, especially targeting appropriate pre-pregnancy weight and smoking, may provide the best opportunity for improved outcomes.

17. Additional Information Lyn Kieltyka, PhD Louisiana Office of Public Health rlkielty@dhh.la.gov 504-219-4572