Skip to main content

Advertisement

SpringerLink
Log in

Pregnancy weight gain may affect perinatal outcomes, quality of life during pregnancy, and child-bearing expenses: an observational cohort study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

We aimed to examine the effect of gestational weight gain (GWG) on perinatal outcomes, quality of life (QoL) during pregnancy, and medical costs of childbirth.

Methods

The observational cohort comprised 2210 pregnant women who were classified into three groups based on their pre-pregnancy body mass index (BMI) and GWG in relation to the 2020 Institute of Medicine (IOM) recommendations. The data were collected on perinatal outcomes, urinary incontinence (UI) during pregnancy, changes in sexual function, and medical costs of hospitalization for delivery. Univariate and multivariable logistic regression models were employed to explore those associations.

Results

Only 42.1% of women met the 2020 IOM guidelines. After adjustments for potential confounding factors, women with above-normal GWG had adverse pregnancy outcomes, including a large fetal head circumference and macrosomia, and women with below-normal GWG were more likely to deliver low-birthweight fetuses preterm than women with normal GWG. Only 16.8% of women reported sexual activity during pregnancy. There were not significant differences in sexual activity and satisfaction, or QoL among the three GWG groups. Child-bearing expenses were higher for women with above-normal GWG than for women with normal GWG. Although the child-bearing expenses were higher for the above-normal GWG, the proportion of women with expenses above the median increased according to pre-pregnancy BMI.

Conclusion

Our results show that inappropriate GWG is associated with a greater risk of adverse perinatal outcomes and increased medical expenses for delivery. Healthcare providers are advised to counsel women to maintain their GWG following the 2020 IOM recommendations throughout pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

aOR:

Adjusted odds ratio

BMI:

Body mass index

CI:

Confidence interval

GWG:

Gestational weight gain

IOM:

Institute of Medicine

QoL:

Quality of life

SF-12:

12-Item short-form survey

UI:

Urinary incontinence

References

  1. Li C, Liu Y, Zhang W (2015) Joint and independent associations of gestational weight gain and pre-pregnancy body mass index with outcomes of pregnancy in Chinese women: a retrospective cohort study. PLoS ONE 10(8):e0136850. https://doi.org/10.1371/journal.pone.0136850

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Hung TH, Hsieh TT (2016) Pregestational body mass index, gestational weight gain, and risks for adverse pregnancy outcomes among Taiwanese women: a retrospective cohort study. Taiwan J Obstet Gynecol 55(4):575–581. https://doi.org/10.1016/j.tjog.2016.06.016

    Article  PubMed  Google Scholar 

  3. Horng HC, Huang BS, Lu YF et al (2018) Avoiding excessive pregnancy weight gain to obtain better pregnancy outcomes in Taiwan. Medicine (Baltimore) 97(4):e9711. https://doi.org/10.1097/MD.0000000000009711

    Article  Google Scholar 

  4. Hung TH, Chen SF, Hsu JJ, Hsieh TT (2015) Gestational weight gain and risks for adverse perinatal outcomes: A retrospective cohort study based on the 2009 Institute of Medicine guidelines. Taiwan J Obstet Gynecol 54(4):421–425. https://doi.org/10.1016/j.tjog.2015.06.010

    Article  PubMed  Google Scholar 

  5. Goldstein RF, Abell SK, Ranasinha S et al (2017) Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA 317(21):2207–2225. https://doi.org/10.1001/jama.2017.3635

    Article  PubMed  PubMed Central  Google Scholar 

  6. Institute of Medicine (2009) Weight gain during pregnancy: reexamining the guidelines (2020). The National Academies Press, Washington DC (reaffirmed 2020 by committee on Obstetric Practice)

  7. Sahrakorpi N, Koivusalo SB, Stach-Lempinen B, Eriksson JG, Kautiainen H, Roine RP (2017) The Burden of pregnancy; heavier for the heaviest? The changes in health related quality of life assessed by the 15D instrument during pregnancy and postpartum in different body mass index groups: a longitudinal survey. Acta Obstet Gynecol Scand 96(3):352–358. https://doi.org/10.1111/aogs.13068

    Article  PubMed  Google Scholar 

  8. Barbosa L, Boaviagem A, Moretti E, Lemos A (2018) Multiparity age and overweight/ obesity as risk factors for urinary incontinence in pregnancy: a systematic review and meta-analysis. Int Urogynecol J 29(10):1413–1427. https://doi.org/10.1007/s00192-018-3656-9

    Article  PubMed  Google Scholar 

  9. Staruch M, Kucharczyk A, Zawadzka K, Wielgos M, Szymusik I (2016) Sexual activity during pregnancy. Neuro Endocrinol Lett 37(1):53–58

    PubMed  Google Scholar 

  10. Chu SY, Bachman DJ, Callaghan WM et al (2008) Association between obesity during pregnancy and increased use of health care. N Engl J Med 358(14):1444–1453. https://doi.org/10.1056/NEJMoa0706786

    Article  CAS  PubMed  Google Scholar 

  11. Solmi F, Morris S (2018) Overweight and obese pre-pregnancy BMI is associated with higher hospital costs of childbirth in England. BMC Pregnancy Childbirth 18(1):253. https://doi.org/10.1186/s12884-018-1893-z

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ware JJ, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(4):220–233. https://doi.org/10.1097/00005650-199603000-00003

    Article  PubMed  Google Scholar 

  13. Torrisi G, Minini G, Bernasconi F et al (2012) A prospective study of pelvic floor dysfunctions related to delivery. Eur J Obstet Gynecol Reprod Biol 160(1):110–115. https://doi.org/10.1016/j.ejogrb.2011.10.010

    Article  PubMed  Google Scholar 

  14. World Health Organisation (2016) Overweight and obesity fact sheet June 2016. World Health Organisation, Geneva

    Google Scholar 

  15. Li N, Liu E, Guo J et al (2013) Maternal prepregnancy body mass index and gestational weight gain on pregnancy outcomes. PLoS ONE 8(12):e82310. https://doi.org/10.1371/journal.pone.0082310

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Tsai YL, Chong KM, Seow KM (2013) Following the 2009 American Institute of Medicine recommendations for normal body mass index and overweight women led to an increased risk of fetal macrosomia among Taiwanese women. Taiwan J Obstet Gynecol 52(3):341–346. https://doi.org/10.1016/j.tjog.2013.05.001

    Article  PubMed  Google Scholar 

  17. Hung TH, Hsieh TT (2015) The effects of implementing the International Association of Diabetes and Pregnancy Study Groups criteria for diagnosing gestational diabetes on maternal and neonatal outcomes. PLoS ONE 10(3):e0122261. https://doi.org/10.1371/journal.pone.0122261

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Truong YN, Yee LM, Caughey AB, Cheng YW (2015) Weight gain in pregnancy: does the Institute of Medicine have it right? Am J Obstet Gynecol 212(3):362.e1-e8. https://doi.org/10.1016/j.ajog.2015.01.027

    Article  Google Scholar 

  19. Johnson J, Clifton RG, Roberts JM et al (2013) Pregnancy outcomes with weight gain above or below the 2009 Institute of Medicine guidelines. Obstet Gynecol 121(5):969–975. https://doi.org/10.1097/AOG.0b013e31828aea03

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zavalza-Gomez AB (2011) Obesity and oxidative stress: a direct link to preeclampsia? Arch Gynecol Obstet 283(3):415–422. https://doi.org/10.1007/s00404-010-1753-1

    Article  CAS  PubMed  Google Scholar 

  21. Li Y, Liu QF, Zhang D et al (2015) Weight gain in pregnancy, maternal age and gestational age in relation to fetal macrosomia. Clin Nutr Res 4(2):104–109. https://doi.org/10.7762/cnr.2015.4.2.104

    Article  PubMed  PubMed Central  Google Scholar 

  22. Koyanagi A, Zhang J, Dagvadorj A et al (2013) Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey. Lancet 381(9865):476–483. https://doi.org/10.1016/S0140-6736(12)61605-5

    Article  PubMed  Google Scholar 

  23. Lipschuetz M, Cohen SM, Ein-Mor E et al (2015) A large head circumference is more strongly associated with unplanned cesarean or instrumental delivery and neonatal complications than high birthweight. Am J Obstet Gynecol 213(6):833.e1-e12. https://doi.org/10.1016/j.ajog.2015.07.045

    Article  Google Scholar 

  24. Hunskaar S (2008) A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn 27(8):749–757. https://doi.org/10.1002/nau.20635

    Article  PubMed  Google Scholar 

  25. Lin YH, Chang SD, Hsieh WC et al (2018) Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence, risk factors and impact on quality of life in Taiwanese women: an observational cohort study. Taiwan J Obstet Gynecol 57(3):340–345. https://doi.org/10.1016/j.tjog.2018.04.003

    Article  PubMed  Google Scholar 

  26. Hassan MK, Joshi AV, Madhavan SS, Amonkar MM (2003) Obesity and health-related quality of life: a cross-sectional analysis of the US population. Int J Obes Relat Metab Disord 27(10):1227–1232. https://doi.org/10.1038/sj.ijo.0802396

    Article  CAS  PubMed  Google Scholar 

  27. Ul-Haq Z, Mackay DF, Fenwick E, Pell JP (2012) Impact of metabolic comorbidity on the association between body mass index and health-related quality of life: a Scotland -wide cross-sectional study of 5,608 participants. BMC Public Health 12:143. https://doi.org/10.1186/1471-2458-12-143

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sintonen H (2001) The 15D instrument of health-related quality of life: properties and applications. Ann Med 33(5):328–336. https://doi.org/10.3109/07853890109002086

    Article  CAS  PubMed  Google Scholar 

  29. Fok WY, Chan LY, Yuen PM (2005) Sexual behavior and activity in Chinese pregnant women. Acta Obstet Gynecol Scand 84(10):934–938. https://doi.org/10.1111/j.0001-6349.2005.00743.x

    Article  PubMed  Google Scholar 

  30. Ribeiro MC, Nakamura MU, Torloni MR et al (2016) Maternal overweight and sexual function in pregnancy. Acta Obstet Gynecol Scand 95(1):45–51. https://doi.org/10.1111/aogs.12796

    Article  PubMed  Google Scholar 

  31. Thangaratinam S, Rogozinska E, Jolly K et al (2012) Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ 344:e2088. https://doi.org/10.1136/bmj.e2088

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Chang Gung Memorial Hospital and Chang Gung University for funding support. We also appreciate the Chang Gung Research Database (CGRD) for medical expenditure ascertainment support.

Funding

This work was supported by Chang Gung Memorial Hospital grants CMRPG3C1271 and BMRP412 (CC Liang) and was partially supported by BMRPB81 (SYH Chiu).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Branch, Tao-Yuan, Taiwan

    Ching-Chung Liang & Shuenn-Dhy Chang

  2. College of Medicine, Chang Gung University, Tao-Yuan, Taiwan

    Ching-Chung Liang & Shuenn-Dhy Chang

  3. Department of Health Care Management, College of Management, Chang Gung University, Tao-Yuan, Taiwan

    Ching-Chung Liang, Minston Chao & Sherry Yueh-Hsia Chiu

  4. Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Sherry Yueh-Hsia Chiu

Authors
  1. Ching-Chung Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Minston Chao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shuenn-Dhy Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sherry Yueh-Hsia Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Each author’s participation in the manuscript was as follows: CCL: Project development, data collection, management and manuscript writing; MC: Project development and data collection; SDC: Management and data collection; SYC: Project development, data analysis and manuscript writing.

Corresponding author

Correspondence to Sherry Yueh-Hsia Chiu.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest relevant to this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 52 KB)

Supplementary file2 (DOCX 848 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liang, CC., Chao, M., Chang, SD. et al. Pregnancy weight gain may affect perinatal outcomes, quality of life during pregnancy, and child-bearing expenses: an observational cohort study. Arch Gynecol Obstet 304, 599–608 (2021). https://doi.org/10.1007/s00404-021-05983-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-021-05983-2

Keywords

Search

Navigation