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Gestational Weight Gain: Update on Outcomes and Interventions

  • Diabetes and Pregnancy (M-F Hivert and CE Powe, Section Editors)
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Abstract

Purpose of Review

Gestational weight gain is a modifiable risk factor for adverse perinatal outcomes. After the Institute of Medicine (IOM) released updated recommendations for gestational weight gain in 2009, a multitude of studies were released examining the recommendations, particularly for women with obesity. As the obesity epidemic continues, many physicians are interested in minimizing gestational weight gain for all women. Our aim was to review the evidence for the association of gestational weight gain and perinatal outcomes, particularly for weight gain outside the IOM guidelines.

Recent Findings

Gestational weight gain is associated with several adverse perinatal outcomes including fetal growth, preterm delivery, cesarean delivery, gestational diabetes, hypertensive disorders of pregnancy, and infant mortality as well as with long-term offspring metabolic health outcomes. Multiple randomized controlled trials have been conducted evaluating the efficacy of lifestyle intervention on gestational weight gain, and while lifestyle interventions may alter gestational weight gain, they have not been associated with improvement in perinatal outcomes. Weight loss during pregnancy is associated with decreased risks of macrosomia and cesarean delivery; however, given an association with low birth weight, it is not currently recommended.

Summary

Excessive gestational weight gain is known to be associated with multiple adverse fetal and maternal outcomes. Lifestyle interventions during pregnancy may be helpful in decreasing excessive weight gain, but have not shown to be beneficial for most adverse pregnancy outcomes. More research is needed before making recommendations for weight loss in women with obesity during pregnancy.

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References

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

  1. (US) NAP. Institute of Medicine Commitee on Nutritional Status During Pregnancy and Laction. National Academy Press; 1990.

  2. FG C. Maternal Physiology. Williams Obstetrics. 24 edn. New York, New York: McGraw Hill Education; 2018. p. 51–4.

  3. Rasmussen K. Weight gain during pregnancy: reexamining the guidelines. Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. 2009.

  4. Gynecology ACoOa. ACOG Committee Opinion No. 548: weight gain in pregnancy. Obstet Gynecol. 2013;121(1):210–2.

    Article  Google Scholar 

  5. Group LP-MOaCOS. Association of Gestational Weight Gain with adverse maternal and neonatal outcomes. J Am Med Assoc. 2019;321(17):1702–15. https://doi.org/10.1001/jama.2019.3820.

    Article  Google Scholar 

  6. Kapadia M, Park C, Beyene J, Giglia L, Maxwell C, McDonald S. Weight loss instead of weight gain within the guidelines in obese women during pregnancy: a systematic review and meta-analyses of maternal and infant outcomes. PLoS One. 2015;10(7):e0132650. https://doi.org/10.1371/journal.pone.0132650.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Requirements WHOHe. Food and nutrition technical report series 1. Rome, Food and Agriculture Organization of the United Nations. 2004:53.

  8. Chen XK, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol. 2007;36(2):368–73. https://doi.org/10.1093/ije/dyl284.

    Article  PubMed  CAS  Google Scholar 

  9. FE Hytten GC. Clincical Physiology in Obstetrics. In: Blackwell, editor.: Oxford; 1991. p. 152.

  10. Cunningham F. Obesity. Williams obstetrics. 24th ed. New York: McGraw-Hill Education; 2018. p. 965–6.

  11. Butte NF, Wong WW, Treuth MS, Ellis KJ, O'Brian SE. Energy requirements during pregnancy based on total energy expenditure and energy deposition. Am J Clin Nutr. 2004;79(6):1078–87. https://doi.org/10.1093/ajcn/79.6.1078.

    Article  PubMed  CAS  Google Scholar 

  12. Phelps RL, Metzger BE, Freinkel N. Carbohydrate metabolism in pregnancy. Am J Obstet Gynecol. 1981;140(7):730–6. https://doi.org/10.1016/0002-9378(81)90731-6.

    Article  PubMed  CAS  Google Scholar 

  13. Butte NF. Carbohydrate and lipid metabolism in pregnancy: normal compared with gestational diabetes mellitus. Am J Clin Nutr. 2000;71(5 Suppl):1256S–61S. https://doi.org/10.1093/ajcn/71.5.1256s.

    Article  PubMed  CAS  Google Scholar 

  14. Barbour LA, McCurdy CE, Hernandez TL, Kirwan JP, Catalano PM, Friedman JE. Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes. Diabetes Care. 2007;30(Suppl 2):S112–9. https://doi.org/10.2337/dc07-s202.

    Article  PubMed  CAS  Google Scholar 

  15. Lain KY, Catalano PM. Metabolic changes in pregnancy. Clin Obstet Gynecol. 2007;50(4):938–48. https://doi.org/10.1097/GRF.0b013e31815a5494.

    Article  PubMed  Google Scholar 

  16. Egan AM, Dennedy MC, Al-Ramli W, Heerey A, Avalos G, Dunne F. ATLANTIC-DIP: excessive gestational weight gain and pregnancy outcomes in women with gestational or pregestational diabetes mellitus. J Clin Endocrinol Metab. 2014;99(1):212–9. https://doi.org/10.1210/jc.2013-2684.

    Article  PubMed  CAS  Google Scholar 

  17. Brunner S, Stecher L, Ziebarth S, Nehring I, Rifas-Shiman SL, Sommer C, 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. https://doi.org/10.1007/s00125-015-3686-5.

    Article  PubMed  Google Scholar 

  18. Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol. 2010;115(3):597–604. https://doi.org/10.1097/AOG.0b013e3181cfce4f.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Carreno CA, Clifton RG, Hauth JC, Myatt L, Roberts JM, Spong CY, et al. Excessive early gestational weight gain and risk of gestational diabetes mellitus in nulliparous women. Obstet Gynecol. 2012;119(6):1227–33. https://doi.org/10.1097/AOG.0b013e318256cf1a.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Gibson KS, Waters TP, Catalano PM. Maternal weight gain in women who develop gestational diabetes mellitus. Obstet Gynecol. 2012;119(3):560–5. https://doi.org/10.1097/AOG.0b013e31824758e0.

    Article  PubMed  Google Scholar 

  21. 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 e1–17. https://doi.org/10.1016/j.ajog.2013.05.042.

    Article  Google Scholar 

  22. Ren M, Li H, Cai W, Niu X, Ji W, Zhang Z, et al. Excessive gestational weight gain in accordance with the IOM criteria and the risk of hypertensive disorders of pregnancy: a meta-analysis. BMC Pregnancy Childbirth. 2018;18(1):281. https://doi.org/10.1186/s12884-018-1922-y.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Chandrasekaran S, Levine LD, Durnwald CP, Elovitz MA, Srinivas SK. Excessive weight gain and hypertensive disorders of pregnancy in the obese patient. J Matern Fetal Neonatal Med. 2015;28(8):964–8. https://doi.org/10.3109/14767058.2014.939624.

    Article  PubMed  CAS  Google Scholar 

  24. • Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017;317(21):2207–25. https://doi.org/10.1001/jama.2017.3635Systematic review reporting higher risk of adverse maternal and fetal outcomes with gestational weight gain greater than or less than guideline recommendations.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Magnus P, Trogstad L. Pre-eclampsia research in the Norwegian Mother and Child Cohort study. Norwegian Institute of Public Health. 2014;24(1–2):97–102.

    Google Scholar 

  26. Hillesund ER, Seland S, Bere E, Sagedal LR, Torstveit MK, Lohne-Seiler H, et al. Preeclampsia and gestational weight gain in the Norwegian Fit for Delivery trial. BMC Res Notes. 2018;11(1):282–6. https://doi.org/10.1186/s13104-018-3396-4.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Stotland NE, Hopkins LM, Caughey AB. Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas. Obstet Gynecol. 2004;104(4):671–7. https://doi.org/10.1097/01.AOG.0000139515.97799.f6.

    Article  PubMed  Google Scholar 

  28. Okun N, Verma A, Mitchell BF, Flowerdew G. Relative importance of maternal constitutional factors and glucose intolerance of pregnancy in the development of newborn macrosomia. J Matern Fetal Med. 1997;6(5):285–90.

    PubMed  CAS  Google Scholar 

  29. Modanlou HD, Dorchester WL, Thorosian A, Freeman RK. Macrosomia—maternal, fetal, and neonatal implications. Obstet Gynecol. 1980;55(4):420–4.

    PubMed  CAS  Google Scholar 

  30. Menticoglou SM, Manning FA, Morrison I, Harman CR. Must macrosomic fetuses be delivered by a caesarean section? A review of outcome for 786 babies greater than or equal to 4,500 g. Aust N Z J Obstet Gynaecol. 1992;32(2):100–3. https://doi.org/10.1111/j.1479-828x.1992.tb01917.x.

    Article  PubMed  CAS  Google Scholar 

  31. Stones RW, Paterson CM, StG Saunders NJ. Risk factors for major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol. 1993;48(1):15–8. https://doi.org/10.1016/0028-2243(93)90047-g.

    Article  PubMed  CAS  Google Scholar 

  32. Gynecology ACoOa. Practice Bulletin No. 173: Fetal Macrosomia. Obstet Gynecol. 2016;128(5):e195–209. https://doi.org/10.1097/AOG.0000000000001767.

    Article  Google Scholar 

  33. Boulet SL, Alexander GR, Salihu HM, Pass M. Macrosomic births in the United States: determinants, outcomes, and proposed grades of risk. Am J Obstet Gynecol. 2003;188(5):1372–8. https://doi.org/10.1067/mob.2003.302.

    Article  PubMed  Google Scholar 

  34. Linne Y, Neovius M. Identification of women at risk of adverse weight development following pregnancy. Int J Obes. 2006;30(8):1234–9. https://doi.org/10.1038/sj.ijo.0803258.

    Article  CAS  Google Scholar 

  35. Vesco KK, Dietz PM, Rizzo J, Stevens VJ, Perrin NA, Bachman DJ, et al. Excessive gestational weight gain and postpartum weight retention among obese women. Obstet Gynecol. 2009;114(5):1069–75. https://doi.org/10.1097/AOG.0b013e3181baeacf.

    Article  PubMed  Google Scholar 

  36. Ashley-Martin J, Woolcott C. Gestational weight gain and postpartum weight retention in a cohort of Nova Scotian women. Matern Child Health J. 2014;18(8):1927–35. https://doi.org/10.1007/s10995-014-1438-7.

    Article  PubMed  Google Scholar 

  37. Ha AVV, Zhao Y, Pham NM, Nguyen CL, Nguyen PTH, Chu TK, et al. Postpartum weight retention in relation to gestational weight gain and pre-pregnancy body mass index: a prospective cohort study in Vietnam. Obes Res Clin Pract. 2019;13(2):143–9. https://doi.org/10.1016/j.orcp.2019.02.001.

    Article  PubMed  Google Scholar 

  38. Nehring I, Schmoll S, Beyerlein A, Hauner H, von Kries R. Gestational weight gain and long-term postpartum weight retention: a meta-analysis. Am J Clin Nutr. 2011;94(5):1225–31. https://doi.org/10.3945/ajcn.111.015289.

    Article  PubMed  CAS  Google Scholar 

  39. Rooney B. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol. 2002;100(2):245–52. https://doi.org/10.1016/s0029-7844(02)02125-7.

    Article  PubMed  Google Scholar 

  40. Siega-Riz AM, Evenson KR, Dole N. Pregnancy-related weight gain-a link to obesity? Nutr Rev. 2004;62:S105–S11. https://doi.org/10.1111/j.1753-4887.2004.tb00079.x.

    Article  PubMed  Google Scholar 

  41. Olson CM, Strawderman MS, Hinton PS, Pearson TA. Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum. Int J Obes Relat Metab Disord. 2003;27(1):117–27. https://doi.org/10.1038/sj.ijo.0802156.

    Article  PubMed  CAS  Google Scholar 

  42. Amorim A, Rossner S, Neovius M, Lourenco P, Linne Y. Does excess pregnancy weight gain constitute a major risk for increasing long-term BMI? Obesity (Silver Spring). 2007;15(5):1278–86. https://doi.org/10.1038/oby.2007.149.

    Article  Google Scholar 

  43. Oken E, Gillman M. Fetal origins of obesity. Obes Res. 2003;11(4):496–506. https://doi.org/10.1038/oby.2003.69.

    Article  PubMed  Google Scholar 

  44. Oken E, Huh S, Taveras E, Rich-Edwards J, Gillman M. Associations of maternal prenatal smoking with child adiposity and blood pressure. Obes Res. 2005;13(11):2021–8. https://doi.org/10.1038/oby.2005.248.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Oken E, Taveras E, Kleinman K, Rich-Edwards J, Gillman M. Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol. 2007;196(4):322 e1–8. https://doi.org/10.1016/j.ajog.2006.11.027.

    Article  Google Scholar 

  46. Oken E, Rifas-Shiman S, Field A, Frazier A, Gillman M. Maternal gestational weight gain and offspring weight in adolescence. Obstet Gynecol. 2008;112(5):999–1006. https://doi.org/10.1097/AOG.0b013e31818a5d50.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Mamun A, O'Callaghan M, Callaway L, Williams G, Najman J, Lawlor D. Associations of gestational weight gain with offspring body mass index and blood pressure at 21 years of age: evidence from a birth cohort study. Circulation. 2009;119(13):1720–7. https://doi.org/10.1161/CIRCULATIONAHA.108.813436.

    Article  PubMed  Google Scholar 

  48. Hivert M, Rifas-Shiman S, Gillman M, Oken E. Greater early and mid-pregnancy gestational weight gains are associated with excess adiposity in mid-childhood. Obesity (Silver Spring). 2016;24(7):1546–53. https://doi.org/10.1002/oby.21511.

    Article  Google Scholar 

  49. Mutsaerts M, van Oers A, Groen H, Burggraaff J, Kuchenbecker W, Perquin D, et al. Randomized trial of a lifestyle program in obese infertile women. N Engl J Med. 2016;374(20):1942–53. https://doi.org/10.1056/NEJMoa1505297.

    Article  PubMed  CAS  Google Scholar 

  50. Muktabhant B, Lawrie T, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev. 2015;6:CD007145. https://doi.org/10.1002/14651858.CD007145.pub3.

    Article  Google Scholar 

  51. Walsh J, McGowan C, Mahony R, Foley M, McAuliffe F. Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial. BMJ. 2012;345:e5605. https://doi.org/10.1136/bmj.e5605.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Olson C, Groth S, Graham M, Reschke J, Strawderman M, Fernandez I. The effectiveness of an online intervention in preventing excessive gestational weight gain: the e-moms roc randomized controlled trial. BMC Pregnancy Childbirth. 2018;18(1):148. https://doi.org/10.1186/s12884-018-1767-4.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Kunath J, Gunther J, Rauh K, Hoffmann J, Stecher L, Rosenfeld E, et al. Effects of a lifestyle intervention during pregnancy to prevent excessive gestational weight gain in routine care - the cluster-randomised GeliS trial. BMC Med. 2019;17(1):5. https://doi.org/10.1186/s12916-018-1235-z.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Phelan S, Wing R, Brannen A, McHugh A, Hagobian T, Schaffner A, et al. Randomized controlled clinical trial of behavioral lifestyle intervention with partial meal replacement to reduce excessive gestational weight gain. Am J Clin Nutr. 2018;107(2):183–94. https://doi.org/10.1093/ajcn/nqx043.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Peaceman A, Clifton R, Phelan S, Gallagher D, Evans M, Redman L, et al. Lifestyle interventions limit gestational weight gain in women with overweight or obesity: LIFE-moms prospective meta-analysis. Obesity (Silver Spring). 2018;26(9):1396–404. https://doi.org/10.1002/oby.22250.

    Article  Google Scholar 

  56. Davis R, Hofferth S, Shenassa E. Gestational weight gain and risk of infant death in the United States. Am J Public Health. 2014;104(Suppl 1):S90–5. https://doi.org/10.2105/AJPH.2013.301425.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Davis R, Hofferth S. The association between inadequate gestational weight gain and infant mortality among U.S. infants born in 2002. Matern Child Health J. 2012;16(1):119–24. https://doi.org/10.1007/s10995-010-0713-5.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Lindqvist M, Lindkvist M, Eurenius E, Persson M, Mogren I. Change of lifestyle habits - motivation and ability reported by pregnant women in northern Sweden. Sex Reprod Healthc. 2017;13:83–90. https://doi.org/10.1016/j.srhc.2017.07.001.

    Article  PubMed  Google Scholar 

  59. Edvardsson K, Ivarsson A, Eurenius E, Garvare R, Nystrom M, Small R, et al. Giving offspring a healthy start: parents’ experiences of health promotion and lifestyle change during pregnancy and early parenthood. BMC Public Health. 2011;11:936. https://doi.org/10.1186/1471-2458-11-936.

    Article  PubMed  PubMed Central  Google Scholar 

  60. • Olander E, Darwin Z, Atkinson L, Smith D, Gardner B. Beyond the ‘teachable moment’ - a conceptual analysis of women's perinatal behaviour change. Women Birth. 2016;29(3):e67–71. https://doi.org/10.1016/j.wombi.2015.11.005Pregnancy may offer opportunity and motivation for women to promote initiation and maintenance of improved health behaviors.

    Article  PubMed  Google Scholar 

  61. Bish C, Chu S, Shapiro-Mendoza C, Sharma A, Blanck H. Trying to lose or maintain weight during pregnancy-United States, 2003. Matern Child Health J. 2009;13(2):286–92. https://doi.org/10.1007/s10995-008-0349-x.

    Article  PubMed  Google Scholar 

  62. Bodnar L, Siega-Riz A, Simhan H, Himes K, Abrams B. Severe obesity, gestational weight gain, and adverse birth outcomes. Am J Clin Nutr. 2010;91(6):1642–8. https://doi.org/10.3945/ajcn.2009.29008.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  63. Tulipani S, Griffin J, Palau-Rodriguez M, Mora-Cubillos X, Bernal-Lopez R, Tinahones F, et al. Metabolomics-guided insights on bariatric surgery versus behavioral interventions for weight loss. Obesity (Silver Spring). 2016;24(12):2451–66. https://doi.org/10.1002/oby.21686.

    Article  CAS  Google Scholar 

  64. Frise C, Mackillop L, Joash K, Williamson C. Starvation ketoacidosis in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2013;167(1):1–7. https://doi.org/10.1016/j.ejogrb.2012.10.005.

    Article  PubMed  Google Scholar 

  65. Awwad J, Usta I, Succar J, Musallam K, Ghazeeri G, Nassar A. The effect of maternal fasting during Ramadan on preterm delivery: a prospective cohort study. BJOG. 2012;119(11):1379–86. https://doi.org/10.1111/j.1471-0528.2012.03438.x.

    Article  PubMed  CAS  Google Scholar 

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  1. Division of Maternal Fetal Medicine. Department of Obstetrics and Gynecology, Center for Women’s Reproductive Health at the University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, AL, 35233, USA

    Macie L. Champion & Lorie M. Harper

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Champion, M.L., Harper, L.M. Gestational Weight Gain: Update on Outcomes and Interventions. Curr Diab Rep 20, 11 (2020). https://doi.org/10.1007/s11892-020-1296-1

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