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Current Epidemiology Reports

, Volume 3, Issue 1, pp 12–18 | Cite as

Towards Defining Optimal Gestational Weight Gain

  • Jennifer A. Hutcheon
  • Emily OkenEmail author
Reproductive and Perinatal Epidemiology (EF Schisterman and E Yeung, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Reproductive and Perinatal Epidemiology

Abstract

In 2009, the Institute of Medicine (IOM) Committee to Reexamine Pregnancy Weight Gain Guidelines published updated recommendations on the rate and amount of weight that women should gain during pregnancy. These recommendations were based on a large body of primarily observational literature reporting ranges of total pregnancy weight gain associated with lowest risks of a number of adverse maternal and newborn health outcomes. However, the IOM committee identified many gaps in the evidence to support guidelines for optimal amount and pattern of gain. In this article, the authors outline how recent insights on the role of early pregnancy weight gain, patterns of weight gain, emerging evidence from randomized trials of weight gain interventions, and accounting for the relative importance that women and care-providers place on different maternal and child health outcomes may advance our understanding of optimal pregnancy weight gain and inform the creation of improved pregnancy weight gain guidelines.

Keywords

Nutrition in pregnancy Gestational weight gain Reference values Practice guidelines Pregnancy complications Postpartum weight retention Childhood obesity 

Notes

Compliance with Ethical Standards

Conflict of Interest

Jennifer A. Hutcheon and Emily Oken declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All studies by both authors involving animal and/or human subjects were performed after approval by the appropriate institutional review boards. When required, written informed consent was obtained from all participants.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Institute of Medicine and National Research Council of the National Academies. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: National Academies Press; 2009.Google Scholar
  2. 2.
    Viswanathan M, Siega-Riz AM, Moos M-K, et al. Outcomes of maternal weight gain, evidence report/technology assessment No. 168. Rockville, MD: Agency for Healthcare Research and Quality; 2008.Google Scholar
  3. 3.
    Gage SH, Lawlor DA, Tilling K, Fraser A. Associations of maternal weight gain in pregnancy with offspring cognition in childhood and adolescence: findings from the Avon Longitudinal Study of Parents and Children. Am J Epidemiol. 2013;177(5):402–10.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Pugh SJ, Richardson GA, Hutcheon JA, et al. Maternal obesity and excessive gestational weight gain are associated with components of child cognition. J Nutr. 2015;145(11):2562–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Leermakers ET, Sonnenschein-van der Voort AM, Gaillard R, et al. Maternal weight, gestational weight gain and preschool wheezing: the Generation R Study. Eur Respir J. 2013;42(5):1234–43.CrossRefPubMedGoogle Scholar
  6. 6.
    Forno E, Young OM, Kumar R, Simhan H, Celedon JC. Maternal obesity in pregnancy, gestational weight gain, and risk of childhood asthma. Pediatrics. 2014;134(2):e535–546.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Harpsoe MC, Basit S, Bager P, et al. Maternal obesity, gestational weight gain, and risk of asthma and atopic disease in offspring: a study within the Danish National Birth Cohort. J Allergy Clin Immunol. 2013;131(4):1033–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Gilmore LA, Klempel-Donchenko M, Redman LM. Pregnancy as a window to future health: excessive gestational weight gain and obesity. Semin Perinatol. 2015;39(4):296–303.CrossRefPubMedGoogle Scholar
  9. 9.•
    Walter JR, Perng W, Kleinman KP, Rifas-Shiman SL, Rich-Edwards JW, Oken E. Associations of trimester-specific gestational weight gain with maternal adiposity and systolic blood pressure at 3 and 7 years postpartum. Am J Obstet Gynecol. 2015;212(4):499. e491-412. This paper included 801 women enrolled during the first trimester of pregnancy in the Boston-area Project Viva cohort. Among normal-weight women, both total and first-trimester gestational weight gain was associated with greater weight change at 3 and 7 years postpartum, but there was not strong evidence of association for either second- or third-trimester gain. First-trimester gain also related to 3-year postpartum weight change in overweight and obese women. Greater total and first-trimester gestational weight gain were associated with larger waist circumference and higher systolic blood pressure but not insulin resistance. These findings suggest that interventions targeting GWG beginning very early in pregnancy may benefit long-term maternal health.Google Scholar
  10. 10.
    Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol. 2010;115(3):597–604.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Gibson KS, Waters TP, Catalano PM. Maternal weight gain in women who develop gestational diabetes mellitus. Obstet Gynecol. 2012;119(3):560–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Carreno CA, Clifton RG, Hauth JC, et al. Excessive early gestational weight gain and risk of gestational diabetes mellitus in nulliparous women. Obstet Gynecol. 2012;119(6):1227–33.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Macdonald-Wallis C, Tilling K, Fraser A, Nelson SM, Lawlor DA. Gestational weight gain as a risk factor for hypertensive disorders of pregnancy. Am J Obstet Gynecol. 2013;209(4):327. e321-317.PubMedPubMedCentralGoogle Scholar
  14. 14.••
    Brunner S, Stecher L, Ziebarth S, et al. Excessive gestational weight gain prior to glucose screening and the risk of gestational diabetes: a meta-analysis. Diabetologia. 2015;58(10):2229–37. This meta-analysis included eight studies involving 13,748 participants. The pooled analysis of unadjusted OR yielded a summary OR of 1.40 (95% CI 1.21, 1.61; p < 0.001) for the relationship of excessive weight gain prior to glycemic screening and risk for gestational diabetesmellitus. No evidence was found that the effect of GWG on GDM differs depending on maternal pre-pregnancy BMI category. The implication of this study was that avoiding excessive weight gain in pregnancy prior to the GDM screening test may be a potential strategy to reduce GDM risk.CrossRefPubMedGoogle Scholar
  15. 15.
    McGiveron A, Foster S, Pearce J, Taylor MA, McMullen S, Langley-Evans SC. Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention. J Hum Nutr Diet : Off J Br Diet Assoc. 2015;28 Suppl 1:29–37.CrossRefGoogle Scholar
  16. 16.
    Haby K, Glantz A, Hanas R, Premberg A. Mighty mums—an antenatal health care intervention can reduce gestational weight gain in women with obesity. Midwifery. 2015;31(7):685–92.CrossRefPubMedGoogle Scholar
  17. 17.
    Hui AL, Back L, Ludwig S, et al. Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy body mass index in a randomized control trial. BMC Pregnancy Childbirth. 2014;14:331.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.••
    Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev. 2015;6:CD007145. This was a meta-analysis of randomised controlled trials (RCTs) of diet or exercise, or both, interventions for preventing excessive weight gain in pregnancy. 49 RCTs involving 11,444 women contributed data to quantitative meta-analysis. Diet or exercise, or both, interventions reduced the risk of excessive GWG on average by 20% overall (average risk ratio (RR) 0.80, 95% confidence interval (CI) 0.73 to 0.87). Other benefits may include a lower risk of caesarean delivery, macrosomia, and neonatal respiratory morbidity, particularly for high-risk women receiving combined diet and exercise interventions. Maternal hypertension may also be reduced. Exercise appears to be an important part of controlling weight gain in pregnancy and more research is needed to establish safe guidelines. Most included studies were carried out in developed countries and it is not clear whether these results are widely applicable to lower income settings.PubMedGoogle Scholar
  19. 19.
    Ronnberg AK, Ostlund I, Fadl H, Gottvall T, Nilsson K. Intervention during pregnancy to reduce excessive gestational weight gain—a randomised controlled trial. BJOG. 2015;122(4):537–44.CrossRefPubMedGoogle Scholar
  20. 20.
    Di Carlo C, Iannotti G, Sparice S, et al. The role of a personalized dietary intervention in managing gestational weight gain: a prospective, controlled study in a low-risk antenatal population. Arch Gynecol Obstet. 2014;289(4):765–70.CrossRefPubMedGoogle Scholar
  21. 21.
    Luo XD, Dong X, Zhou J. Effects of nutritional management intervention on gestational weight gain and perinatal outcome. Saudi Med J. 2014;35(10):1267–70.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Gesell SB, Katula JA, Strickland C, Vitolins MZ. Feasibility and initial efficacy evaluation of a community-based cognitive-behavioral lifestyle intervention to prevent excessive weight gain during pregnancy in Latina women. Matern Child Health J. 2015;19(8):1842–52.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ricketts S, Tolliver R, Schwalberg R. Short-lived success: assessment of an intervention to improve pregnancy weight gain in Colorado. Matern Child Health J. 2014;18(4):772–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Davenport MH, Ruchat SM, Giroux I, Sopper MM, Mottola MF. Timing of excessive pregnancy-related weight gain and offspring adiposity at birth. Obstet Gynecol. 2013;122(2 Pt 1):255–61.CrossRefPubMedGoogle Scholar
  25. 25.
    Margerison-Zilko CE, Shrimali BP, Eskenazi B, Lahiff M, Lindquist AR, Abrams BF. Trimester of maternal gestational weight gain and offspring body weight at birth and age five. Matern Child Health J. 2012;16(6):1215–23.CrossRefPubMedGoogle Scholar
  26. 26.
    Andersen CS, Gamborg M, Sorensen TI, Nohr EA. Weight gain in different periods of pregnancy and offspring’s body mass index at 7 years of age. Int J Pediatr Obes. 2011;6(2-2):e179–186.CrossRefPubMedGoogle Scholar
  27. 27.
    Fraser A, Tilling K, Macdonald-Wallis C, et al. Association of maternal weight gain in pregnancy with offspring obesity and metabolic and vascular traits in childhood. Circulation. 2010;121(23):2557–64.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Karachaliou M, Georgiou V, Roumeliotaki T, et al. Association of trimester-specific gestational weight gain with fetal growth, offspring obesity, and cardiometabolic traits in early childhood. Am J Obstet Gynecol. 2015;212(4):502. e501-514.PubMedGoogle Scholar
  29. 29.
    Gaillard R, Steegers EA, Franco OH, Hofman A, Jaddoe VW. Maternal weight gain in different periods of pregnancy and childhood cardio-metabolic outcomes. The Generation R Study. Int J Obes (Lond). 2015;39(4):677–85.CrossRefGoogle Scholar
  30. 30.
    Giblin L, Darimont C, Leone P, et al. Offspring subcutaneous adipose markers are sensitive to the timing of maternal gestational weight gain. Reprod Biol Endocrinol : RB E. 2015;13:16.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Kleinman KP, Oken E, Radesky JS, Rich-Edwards JW, Peterson KE, Gillman MW. How should gestational weight gain be assessed? A comparison of existing methods and a novel method, area under the weight gain curve. Int J Epidemiol. 2007;36(6):1275–82.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Diaz P, Powell TL, Jansson T. The role of placental nutrient sensing in maternal-fetal resource allocation. Biol Reprod. 2014;91(4):82.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Galjaard S, Pexsters A, Devlieger R, et al. The influence of weight gain patterns in pregnancy on fetal growth using cluster analysis in an obese and nonobese population. Obesity. 2013;21(7):1416–22.CrossRefPubMedGoogle Scholar
  34. 34.
    Dunson DB, Herring AH, Siega-Riz AM. Inference on changes in response densities over predictor clusters. J Am Stat Assoc. 2008;103(484):1508–17.CrossRefGoogle Scholar
  35. 35.
    Hutcheon JA, Platt RW, Abrams B, Himes KP, Simhan HN, Bodnar LM. A weight-gain-for-gestational-age z score chart for the assessment of maternal weight gain in pregnancy. Am J Clin Nutr. 2013;97(5):1062–7.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Xu J, Luntamo M, Kulmala T, Ashorn P, Cheung YB. A longitudinal study of weight gain in pregnancy in Malawi: unconditional and conditional standards. Am J Clin Nutr. 2014;99(2):296–301.CrossRefPubMedGoogle Scholar
  37. 37.
    Johansson K, Hutcheon JA, Stephansson O, Cnattingius S. Pregnancy weight gain by gestational age and BMI in Sweden: a population-based cohort study. Am J Clin Nutr. 2015;in press.Google Scholar
  38. 38.
    Cheikh-Ismail L. Gestational weight gain standard based on healthy, well-nourished women in the INTERGROWTH-21st Project. Paper presented at: 9th World Congress Developmental Origins of Health and Disease. Cape Town, South Africa; 2015.Google Scholar
  39. 39.
    Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology. 1991;181(1):129–33.CrossRefPubMedGoogle Scholar
  40. 40.
    Lubchenco LO, Hansman C, Dressler M, Boyd E. Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation. Pediatrics. 1963;32:793–800.PubMedGoogle Scholar
  41. 41.
    Bodnar LM, Siminerio LL, Himes KP, et al. Maternal obesity and gestational weight gain are risk factors for infant death. Obesity. 2015. doi: 10.1002/oby.21335.PubMedCentralGoogle Scholar
  42. 42.
    Kolu P, Raitanen J, Rissanen P, Luoto R. Cost-effectiveness of lifestyle counselling as primary prevention of gestational diabetes mellitus: findings from a cluster-randomised trial. PLoS One. 2013;8(2):e56392.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Gillman MW, Oakey H, Baghurst PA, Volkmer RE, Robinson JS, Crowther CA. Effect of treatment of gestational diabetes mellitus on obesity in the next generation. Diabetes Care. 2010;33(5):964–8.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Hawkins SS, Oken E, Gillman MW. Early in the life course: time for obesity prevention. In: Halfon N, Forrest C, Lerner R, Faustman EM, editors. Handbook of life course health development science. : Springer; 2016.Google Scholar
  45. 45.
    Oostdam N, Bosmans J, Wouters MG, Eekhoff EM, van Mechelen W, van Poppel MN. Cost-effectiveness of an exercise program during pregnancy to prevent gestational diabetes: results of an economic evaluation alongside a randomised controlled trial. BMC Pregnancy Childbirth. 2012;12:64.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    John E, Cassidy DM, Playle R, et al. Healthy eating and lifestyle in pregnancy (HELP): a protocol for a cluster randomised trial to evaluate the effectiveness of a weight management intervention in pregnancy. BMC Public Health. 2014;14:439.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Ruifrok AE, Rogozinska E, van Poppel MN, et al. Study protocol: differential effects of diet and physical activity based interventions in pregnancy on maternal and fetal outcomes—individual patient data (IPD) meta-analysis and health economic evaluation. Syst Rev. 2014;3:131.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Anstrom KJ, Eisenstein EL. From batting average to wins above replacement to composite end points-refining clinical research using baseball statistical methods. Am Heart J. 2011;161(5):805–6.CrossRefPubMedGoogle Scholar
  49. 49.
    Montori VM, Permanyer-Miralda G, Ferreira-Gonzalez I, et al. Validity of composite end points in clinical trials. BMJ. 2005;330(7491):594–6.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    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(2):173–80.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Petrou S, Henderson J. Preference-based approaches to measuring the benefits of perinatal care. Birth. 2003;30(4):217–26.CrossRefPubMedGoogle Scholar
  52. 52.
    Griebsch I, Coast J, Brown J. Quality-adjusted life-years lack quality in pediatric care: a critical review of published cost-utility studies in child health. Pediatrics. 2005;115(5):e600–614.CrossRefPubMedGoogle Scholar
  53. 53.
    Petrou S. Methodological issues raised by preference-based approaches to measuring the health status of children. Health Econ. 2003;12(8):697–702.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2016

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynaecology, University of British ColumbiaBC Children’s and Women’s HospitalVancouverCanada
  2. 2.Obesity Prevention Program, Department of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonUSA

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