Excessive Weight Gain among Obese Women and Pregnancy Outcomes

ABSTRACT

We evaluated pregnancy outcomes in obese women with excessive weight gain during pregnancy. A retrospective study was performed on all obese women. Outcomes included rates of preeclampsia (PEC), gestational diabetes, cesarean delivery (CD), preterm delivery, low birth weight, very low birth weight, macrosomia, 5-minute Apgar score of <7, and neonatal intensive care unit (NICU) admission and were stratified by body mass index (BMI) groups class I (BMI 30 to 35.9 kg/m²), class II (36 to 39.9 kg/m²), and class III (≥40 kg/m²). Gestational weight change was abstracted from the mother's medical chart and was divided into four categories: weight loss, weight gain of up to 14.9 pounds, weight gain of 15 to 24.9 pounds, and weight gain of more than 25 pounds. A total 20,823 obese women were eligible for the study. Univariate analysis revealed higher rates of preeclampsia, gestational diabetes, Cesarean deliveries, preterm deliveries, low birth weight, macrosomia, and NICU admission in class II and class III obese women when compared with class I women. When different patterns of weight gain were used as in the logistic regression model, rates of PEC and CD were increased. Excessive weight gain among obese women is associated with adverse outcomes with a higher risk as BMI increases.

KEYWORDS

Obesity - pregnancy outcomes - weight gain during pregnancy

REFERENCES

• 1 Cogswell M E, Serdula M K, Hungerford D W, Yip R. Gestational weight gain among average-weight and overweight women—what is excessive?.  Am J Obstet Gynecol. 1995;  172(2 Pt 1) 705-712
• 2 Aly H, Hammad T, Nada A, Mohamed M, Bathgate S, El-Mohandes A. Maternal obesity, associated complications and risk of prematurity.  J Perinatol. 2009;  , August 20 (Epub ahead of print)
• 3 Yekta Z, Ayatollahi H, Porali R, Farzin A. The effect of pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes in urban care settings in Urmia-Iran.  BMC Pregnancy Childbirth. 2006;  6 15-22
• 4 Power M L, Cogswell M E, Schulkin J. Obesity prevention and treatment practices of U.S. obstetrician-gynecologists.  Obstet Gynecol. 2006;  108 961-968
• 5 Groth S. Are the Institute of Medicine recommendations for gestational weight gain appropriate for adolescents?.  J Obstet Gynecol Neonatal Nurs. 2007;  36 21-27
• 6 Hedderson M M, Weiss N S, Sacks D A et al.. Pregnancy weight gain and risk of neonatal complications: macrosomia, hypoglycemia, and hyperbilirubinemia.  Obstet Gynecol. 2006;  108 1153-1161
• 7 Duvekot J J. Pregnancy and obesity: practical implications.  Eur Clin Obstet Gynaecol. 2005;  1 74-88
• 8 Wells C S, Schwalberg R, Noonan G, Gabor V. Factors influencing inadequate and excessive weight gain in pregnancy: Colorado, 2000–2002.  Matern Child Health J. 2006;  10 55-62
• 9 Subcommittee on Nutritional Status and Weight Gain During Pregnancy, Institute of Medicine, National Academy of Sciences .Nutrition During Pregnancy. Washington, DC; National Academy Press 1990
• 10 Helms E, Coulson C C, Galvin S L. Trends in weight gain during pregnancy: a population study across 16 years in North Carolina.  Am J Obstet Gynecol. 2006;  194 e32-e34
• 11 Cogswell M E, Scanlon K S, Fein S B, Schieve L A. Medically advised, mother's personal target, and actual weight gain during pregnancy.  Obstet Gynecol. 1999;  94 616-622
• 12 Stotland N E, Haas J S, Brawarsky P, Jackson R A, Fuentes-Afflick E, Escobar G J. Body mass index, provider advice, and target gestational weight gain.  Obstet Gynecol. 2005;  105 633-638
• 13 Bianco A T, Smilen S W, Davis Y, Lopez S, Lapinski R, Lockwood C J. Pregnancy outcome and weight gain recommendations for the morbidly obese woman.  Obstet Gynecol. 1998;  91 97-102
• 14 Cedergren M I. Optimal gestational weight gain for body mass index categories.  Obstet Gynecol. 2007;  110 759-764
• 15 Kiel D W, Dodson E A, Artal R, Boehmer T K, Leet T L. Gestational weight gain and pregnancy outcomes in obese women: how much is enough?.  Obstet Gynecol. 2007;  110 752-758
• 16 DeVader S R, Neeley H L, Myles T D, Leet T L. Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index.  Obstet Gynecol. 2007;  110 745-751
• 17 Claesson I-M, Sydsjö G, Brynhildsen J et al.. Weight gain restriction for obese pregnant women: a case-control intervention study.  BJOG. 2008;  115 44-50