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Weight Gain During Pregnancy: Reexamining the Guidelines (2009)

Chapter: Appendix F: Data Tables

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Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
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APPENDIX F
Data Tables

APPROACH TO GATHERING EVIDENCE

In order to review the most relevant scientific literature available, the committee and staff conducted thorough searches of several online bibliographic databases, including Medline, Science Direct, and WorldCat/First Search. General searches on pregnancy, gestational weight gain, and outcomes of pregnancy were first conducted to identify primary literature. Using the results of the primary search, key search terms were developed and secondary searches were then conducted. Search terms were chosen based on relevance to the report outline and topics included in the previous Institute of Medicine (IOM) report, Nutrition During Pregnancy (IOM, 1990). Although initial searches were general, subsequent searches focused on retrieving studies that were not covered by the evidence-based review conducted by Viswanathan et al. (2008). To identify studies that fell outside of the scope of that report, searches were limited to publication dates prior to 1990 and after October 2007. Similar to the methodology used by Viswanathan et al. (2008), searches were limited to English. As the study progressed, focused searches were conducted as needed and general searches were carried out to identify newly published articles. See Box F-1 for an example of how searches were conducted.The focus of this appendix is literature that addresses the consequences of gestational weight gain. Table F-1 includes studies on the consequences of gestational weight gain for the mother and for the child, as discussed in Chapter 5, Consequences of Gestational Weight Gain for the Mother, and Chapter 6, Consequences

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

of Gestational Weight Gain for the Child. This table is not inclusive of all the literature covered in this report nor does the report address each of the studies listed in the table. The table only includes studies that examined the consequences of gestational weight gain that were considered by the committee throughout the duration of the project.

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

BOX F-1

Examples of Searches Using Key Words to Identify Relevant Literature (PubMed)

General search (limited to English)

#1 Search Pregnancy

#2 Search Weight Gain

#3 Search #1 and #2

#4 Search gestational weight

#5 Search #3 OR #4

#6 Search #5 AND obesity

#7 Search #5 AND BMI OR body mass index

Focused search: Consequences of GWG for the Mother (limited to publication date prior to 1990 or after October 2007 and English)

#8 Search #5 AND antepartum outcomes

#9 Search #5 AND consequences

#10 Search #1 AND maternal age

#11 Search #1 AND BMI OR body mass index

#12 Search #5 AND depression OR mental health

#13 Search #5 AND delivery OR cesarean section OR labor OR induced labor OR complications at delivery OR hemorrhage OR anesthesia OR coagulation OR forceps OR infection OR protracted labor

#14 Search #13 AND obesity OR BMI

#15 Search #7 AND weight retention OR postpartum weight

#16 Search #6 AND lactation

#17 Search #5 AND maternal health OR chronic disease OR morbidity

#18 Search #5 AND maternal mortality

Focused search: Consequences of GWG for the Child (limited to publication date prior to 1990 or after October 2007 and English)

#19 Search #5 AND child outcomes OR infant outcomes

#20 Search #5 AND small-for-gestational age OR SGA OR IUGR

#21 Search #5 AND large-for-gestational age OR LGA

#22 Search #20 AND cognitive development OR neurodevelopment OR academic performance OR school OR cognition OR neurology

#23 Search #21 AND obesity OR child obesity OR metabolic syndrome

#24 Search #5 AND preterm birth

#25 Search #5 AND fetal growth OR fetal development OR body composition

#26 Search #7 AND infant outcomes

#27 Search #5 AND child mental health

#28 Search #5 AND birth defects OR congenital anomalies

#29 Search #5 AND fetal death OR infant death OR neonatal death OR miscarriage OR stillbirth OR infant mortality

#30 Search #5 AND child health OR infant health OR asthma OR cancer OR chronic disease OR morbidity

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

STUDIES ON CONSEQUENCES OF GESTATIONAL WEIGHT GAIN FOR THE MOTHER AND CHILD

TABLE F-1 Consequences of Gestational Weight Gain

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Abrams et al., 1989

Design:

  • Cohort

  • Retrospective

Preterm birth: delivery between 26-37 weeks’ gestation

Country/Setting:

USA (Perinatal Nutrition Project, San Diego, CA)

Gestational age: maternal estimate of the last menstrual period, antenatal sonography before 28 weeks’ gestation, Dubowitz score, or a combination of these.

Total Study N:

2,163

Group Description:

G1: Preterm births

G2: Term births

Enrollment period:

Jan 1978 to Dec 1986

Prepregnancy weight: maternal recall at first visit (prepregnancy weight for height based on the 1959 Metropolitan Insurance standards of desirable weight).

Study Objective:

To examine the relationship between maternal weight gain and preterm delivery.

Group N:

G1: 118

G2: 2,045

Inclusion criteria:

  • Low income

  • Prepregnancy underweight or prepregnancy obesity

  • Low pregnancy weight gain

  • Anemia

  • History of obstetric complications

  • Concurrent medical complication

Total pregnancy weight gain: estimated by subtracting the prepregnancy weight from the last measured weight before delivery.

Exclusion criteria:

  • Antepartum death

  • Twin gestation

  • Major congenital anomalies

  • Induced deliveries (not preceded by spontaneous labor or rupture of membranes)

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Maternal weight gain

  • Preterm delivery

Results:

Women with low rate of weight gain (< 0.27 kg/wk) had a 60% higher risk for spontaneous preterm birth compared with those with average weight gain (0.27-0.52 kg/wk). They were also more than twice as likely to deliver preterm as women with a high rate of gain (> 0.52 kg/wk) (OR = 2.54; 95% CI 1.49, 4.88).

Maternal confounders/effect modifiers:

  • Dietary intake

  • Use of cigarettes, alcohol, and illicit drugs

  • Pre-pregnancy weight/height

  • Age

  • Income

  • Marital status

  • Race

  • Use of vitamin supplements

  • Whether or not pregnancy was planned

Infant and child confounders/effect modifiers:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Abrams and Laros, 1986

Design:

  • Cohort

Pregnancy weight gain = measured weight at last prenatal visit − reported prepregnancy weight

Total Study N:

2,946

Country/Setting:

USA (San Francisco, CA)

Low gain: total gain of < 7 kg

Excessive gain: total gain of > 20 kg

Group Description:

G1: Prepregnancy, underweight

G2: Prepregnancy, ideal weight

G3: Prepregnancy, moderately overweight

G4: Prepregnancy, very overweight

Enrollment period:

Sept 1980 to Dec 1983

Study Objective:

To study the effect of maternal weight gain on birth weight.

Group N:

G1: 268

G2: 1,535

G3: 901

G4: 224

Inclusion criteria:

  • Singleton pregnancies

  • ≥ 37 weeks’ gestation

  • Live infant was delivered at study hospital

Exclusion criteria:

  • Maternal transfers

  • Transports

  • Intrauterine transfusions

  • Fetal surgeries

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Total maternal weight gain

  • Infant birth weight

Results:

Mean weight gain (kg)

G1: 14.3

G2: 15.2

G3: 15.2

G4: 14.1

Maternal confounders/effect modifiers:

  • Race

  • Parity

  • Maternal age

  • Number of cigarettes smoked/day

  • Prepregnancy weight/height

  • SES

Birth weight (gm)

G1: 3,290

G2: 3,414

G3: 3,521

G4: 3,593

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Berkowitz, 1981

Design:

  • Case-control

Demographics:

G1:

Married: 64%

Race:

White, 65.7%

Black, 29.1%

Hispanic, 4.0%

Mean age: 24.9

Country/Setting:

USA

Total Study N:

488

Enrollment period:

1977

Group Description:

G1: preterm deliveries, < 37 weeks

G2: term deliveries, 37 weeks or later

Study Objective:

To study the epidemiology of preterm delivery.

G2:

Married: 77.3%

Race:

White, 72.8%

Black, 22.7%

Hispanic, 3.2%

Mean age: 26.2

Group N:

G1: 175

G2: 313

Inclusion criteria:

  • Singleton infants

  • Delivered before 37 wks gestation

  • Spoke English

  • Were interviewed during postpartum stay

  • Had not placed infant up for adoption

Exclusion criteria:

  • Deliveries that were induced or surgically assisted without prior spontaneous labor or spontaneous rupture of membranes

  • Women who were referred to outlying hospitals or physicians

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Risk factors associated with preterm delivery

Results:

The following risk factors carried the highest relative risk for a preterm delivery: Previous preterm (OR = 29.8)

Antepartum hemorrhage and placental abnormalities (OR = 25.9)

Third trimester urinary tract infection (OR = 6.2)

Low SES (OR = 5.5)

Previous pregnancy terminating in an induced abortion (OR = 4.6)

Inadequate GWG (OR = 4.3)

Maternal confounders/effect modifiers:

  • Race/ethnicity

  • Age

  • Marital status

  • SES

  • Age of menarche onset

  • Gravidity

  • Pregnancy order

  • Birth order

  • Range of menstrual cycles

  • Infertility history

  • History of induced abortion

Infant and child confounders/ effect modifiers:

NR

Other significant risk factors included: low pregravid weight, history of infertility, vaginal bleeding during pregnancy, lack of leisure time activity during pregnancy, alcohol consumption prior to third trimester, and negative attitude toward pregnancy.

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Billewicz and Thomson, 1957

Design:

  • Cohort

Weight was recorded at first antenatal visit and again 4-6 wks later. Most were weighed monthly from 28-30 wks, and more often during final weeks. Data from first trimester is sparse.

Total Study N:

4,214

Country/Setting:

UK

Group Description:

G1: Preeclampsia with albuminuria

G2: Other hypertensive complications

G3: Normotensive

Enrollment period:

1949-1954

Study Objective:

To examine the clinical significance of weight trends during pregnancy.

Group %:

G1: 6.5

G2: 25.4

G3: 68.1

Inclusion criteria:

  • Women pregnant with first child

  • Residents of Aberdeen, delivered at Aberdeen Maternity Hospital

Exclusion criteria:

  • Multiple gestations

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Preeclampsia with or without albuminuria

  • Other hypertensive complications

Results:

Women with preeclampsia tended to have an increased rate of gain as the pregnancy progressed, and was greater in all stages than in the normotensive group. The incidence of preeclampsia also increases as the rate of gain increases. Favorable outcomes in women with preeclampsia are seen when the rate of gain is moderate, at least in the second half of pregnancy.

Maternal confounders/effect modifiers:

  • Social class

  • Height

  • Age

Infant and child confounders/ effect modifiers:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Butte et al., 1984

Design:

  • 4 month Longitudinal

Maternal weight was measured between 10:00 am and 4:00 pm using a balance beam (clothed in bathing suits); maternal height was measured using an upright extension meter. Skinfold measurements were also taken at the triceps, biceps, suprailiac and subscapular sites. Body fat was calculated using water displacement.

Country/Setting:

USA

Total Study N:

45

Enrollment period:

NR

Group Description:

Middle-upper SES, presumably well-nourished women

Study Objective:

To examine the influence of maternal diet and body composition on lactational performance.

Inclusion criteria:

  • Healthy mothers and infants

  • Nonsmoking

  • 18-36 yrs of age

  • No chronic medications

  • Parity one or two

  • Intent of breastfeeding exclusively for at least 4 mos

  • Term deliveries

  • AGA infant

Exclusion criteria:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Milk production

  • Maternal dietary intake

  • Anthropometry

  • Body composition

  • Maternal energy balance

Results: Adequate GWG 14.4 (3.3 kg) was a good indicator of good nutritional status during pregnancy. Maternal weights were 16 (6%) [range 0-29%] above prepregnancy weights at the onset of lactation; maternal weights were then 5 (7%) [range − 10-21%] above prepregnancy weights after 4 mos of lactation. Mean weight loss of 3.8 (2.3 kg) occurred during the 1st month postpartum, followed by a mean weight loss of 0.67 (0.11 kg)/month. Over all, successful lactation is compatible with gradual weight loss (with energy intakes less than current NRC RDAs.

Maternal confounders/effect modifiers:

  • Education

  • Income

Infant and child confounders/ effect modifiers:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Chen et al., 2008

Design:

  • Cohort

  • Retrospective

Low weight gain = < 0.16 kg/wk

Country/Setting:

USA

Total Study N:

4,037,009

Enrollment period:

1995-2000

Group Description:

G1: Nulliparous women, under aged 10-15

G2: Nulliparous women, under aged 16-17

G3: Nulliparous women, under aged 18-19

G4: Nulliparous women, under aged 20-24

Study Objective:

To examine the association between teenage pregnancy and neonatal and postneonatal mortality.

Group N:

G1: 183,977 live births

G2: 674,026 live births

G3: 1,098,111 live births

G4: 2,080,895 live births

Inclusion criteria:

  • Singleton live births

  • 10-24 years of age

  • Nulliparous

Exclusion criteria:

  • Subjects with missing data on prenatal care and/or gestational age

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Neonatal and postneonatal mortality and morbidity

Maternal confounders/effect modifiers:

  • Education level (defined as appropriate or inappropriate for age)

  • Prenatal care (intensive, adequate, or inadequate)

  • Race

  • Tobacco and alcohol use during pregnancy

  • Mode of delivery

Infant and child confounders/effect modifiers:

  • Birth defect

  • Gestational age (< 32 wks, 32-36 weeks, ≥ 37 wks)

Results:

Teenage pregnancy (G1, G2, G3) was associated with increased neonatal mortality (OR: 1.20, 95% CI = 1.16-1.24) and postneonatal mortality (OR: 1.47, 95% CI = 1.41-1.54). There was still an association of increased risk of neonatal and postneonatal mortality after adjusting for GWG (OR 1.23, 95% CI = 1.19-1.28 and OR: 1.48, 95% CI = 1.42-1.55 respectively). No association was seen with gestational age at birth and neonatal mortality and teenage pregnancy (OR: 0.98, 95% CI = 0.95-1.02), but there was a significant association between gestational age at birth, teenage pregnancy, and postneonatal mortality (OR: 1.40, 95% CI = 1.34-1.46).

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Frentzen et al., 1988

Design:

  • Cohort

  • Retrospective

Race:

G1: 53% black, 45% white, 1 Hispanic woman

G2: 61% black, 39% white

Country/Setting:

USA (Florida)

Total Study N:

135

Enrollment period:

Jan 1982 to Dec 1984

Mean age at conception:

G1: 22.4

G2: 25.2

Group Description:

G1: Control (wt/ht 90-120% of standard)

G2: Overweight (wt/ht ≥ 135% of standard)

Study Objective:

To compare the influence of pregnancy weight gain on infant birth weight and outcome among indigent women who were highly overweight before pregnancy and those who were of average weight.

Group N:

G1:57

G2: 78

Inclusion criteria:

  • Delivered liveborn

  • Singleton infants

Exclusion criteria:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Apgar score ≤ 6 at 5 min

  • Admission to NICU

  • Birth weight (≤ 2,500 g and ≥ 4,000 g)

  • SGA, AGA, LGA

  • Preterm, Postterm

Results:

Mean GWG

G1: 14.2 kg (± SD 6.9)

G2: 11.2 kg (± SD 7.7)

Mean birth weight (g)

G1: 3,236 (± SD 689)

G2: 3,434 (± SD 565)

Apgar score ≤ 6 at 5 min

G1: 9%

G2: 3%

Admission to NICU

G1: 12%

G2: 6%

Birth weight ≤ 2,500 g

G1: 12%

G2: 3%

Birth weight ≥ 4,000 g

G1: 11%

G2: 14%

SGA

G1: 0

G2: 0

AGA

G1: 84%

G2: 73%

LGA

G1: 16%

G2: 27%

Preterm ≤ 37 wks

G1: 16%

G2: 11%

Postterm ≥ 42 wks

G1: 10%

G2: 11%

Maternal confounders/effect modifiers:

  • Maternal age

  • Parity

  • Smoking status

  • SES

Infant and child confounders/ effect modifiers:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Geelhoed et al., 2008

Design:

  • Cohort

  • Prospective

Measurements were taken at early visits (< 18 wks gestation), mid pregnancy (18-25 wks), and late pregnancy (> 25 wks).

Country/Setting:

Rotterdam, The Netherlands

Total Study N:

791

Pregravid weight was self-reported.

Enrollment period:

Apr 2002 to Jan 2006

Inclusion criteria:

  • Singleton infants

  • Aged 6 wks and 6 mos

Weight gain = late pregnancy weight − prepregnancy weight

Study Objective:

To examine the associations of maternal anthropometrics during pregnancy and left ventricular mass in infancy.

Exclusion criteria:

  • Multiple gestations

  • Pregnancies resulting in intrauterine or perinatal death

Author, year:

Haiek and Lederman, 1988

Design:

  • Cohort

Data obtained from a standard prenatal and intrapartum form included in the medical record.

Total Study N:

180

Country/Setting:

USA (New York, NY)

Group Description:

G1: Adult women, 19-30 y

G2: Teens, < 16 y

Enrollment period:

January 1981 to May 1985

Group N:

G1: 90

G2: 90

Study Objective:

To examine the relationship between maternal weight for height and term birth weight.

Inclusion criteria:

  • Gave birth at St. Luke’s Hospital

  • Live infants

  • Received prenatal care

Exclusion criteria:

  • Delivery occurred before 37 weeks’ gestation

  • Factors known to affect fetal growth were present

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Maternal anthropometrics

  • Infant cardiac structure

Results:

No associations were seen between maternal weight gain during pregnancy and LVM at 6 wks of age, however weight gain during pregnancy was positively correlated with postnatal LVM at 6 mos of age.

Maternal confounders/effect modifiers:

  • Age

  • Height

  • Prepregnancy weight

  • Prepregnancy BMI

  • Weight in late pregnancy

Infant and child confounders/ effect modifiers:

  • Gender

  • Birth weight/length

For each kg increase in weight during pregnancy, LVM at age 6 mos increased by 0.08 g (95% CI 0.02, 0.15).

Weight gain in late pregnancy is associated with larger LVM at 6 mos.

Outcomes Description:

Term birth weight

Results:

Mean birth weight was lower in the teen group than compared with the adult group. Birth weight also increased with increasing maternal prepregnancy weight, weight gain, and percent of standard weight for height at term for both groups. Overall, the teen group gave birth to smaller babies than the adult group.

Maternal confounders/effect modifiers:

  • Marital status

  • Education

  • Race

  • Date of registration for prenatal care

  • Number of prenatal visits

  • Height

  • Prepregnancy weight

  • Weight at delivery

  • Smoking and drinking habits

  • Obstetric history and complications

  • Type of delivery

  • Duration of pregnancy

Infant and child confounders/ effect modifiers:

  • NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Harrison et al., 1980

Design:

  • Cohort

  • Prospective

Maternal age, parity, race/ethnicity

Country/Setting:

USA (Arizona)

Total Study N:

327

Enrollment period:

Dec 1976 to June 1978

Inclusion criteria:

  • Delivered normal, singleton, full term infants at study hospital

Study Objective:

To examine the relationship between maternal obesity, weight gain, and infant birth weight.

Exclusion criteria:

  • Lived outside immediate geographic area

  • Addicted to alcohol or drugs

  • Refused follow-up

  • Diabetic

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Maternal weight

  • Birth weight

Results:

Obese mothers had a higher incidence of inadequate weight gain, as compared to nonobese mothers.

Maternal confounders/effect modifiers:

NR

Infant and child confounders/ effect modifiers:

NR

Massively obese mothers had a markedly higher risk of delivering an infant over 4 kg.

For women with gains over 12 lbs, maternal obesity was directly related to mean birth weight.

Mean birth weight was higher for infants of massively obese mothers when weight gain was adequate.

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Hedderson et al., 2008

Design:

  • Nested case-control

Age

< 25 yrs = G1: 6.4%, G2: 15.2%

25-29 yrs = G1: 11.6%, G2: 16.7%

30-34 yrs = G1: 36.3%, G2: 34.8%

≥ 35 yrs = G1: 45.8%, G2: 33.3%

Total Study N:

455

Country/Setting:

USA (Northern California)

Group Description:

G1: GDM Cases

G2: Controls

Race-ethnicity

Non-Hispanic White = G1:41.8%, G2: 64.2%

Hispanic = G1: 22.3%, G2: 10.8%

Asian = G1: 13.9%, G2: 5.9%

African-American = G1: 7.2%, G2: 11.8%

Enrollment period:

Jan 1, 1996 to June 30, 1998

Group N:

G1: 251

G2: 204

Study Objective:

To evaluate obesity and rate of weight change during 5 years prior to pregnancy and risk of GDM

Inclusion criteria:

  • Pregnancies resulting in a singleton, live birth

  • Women did not have recognized diabetes prior to pregnancy

  • Screening test performed at 24-28 wks’ gestation

Marital Status

Never married = G1: 13.7%, G2: 13.3%

Married = G1: 80.2%, G2: 73.9%

Widowed, Divorced, Separated = G1: 4.4%, G2: 3.0%

Education

≤ 12 yrs = G1: 37.5%, G2: 32.4%

13-15 yrs = G1: 29.9%, G2: 37.3%

16 yrs = G1: 20.7%, G2: 15.2%

≥ 17 yrs = G1: 10.8%, G2: 14.2%

Exclusion criteria:

  • Multiple births

  • History of GDM or diabetes

Parity

0 = G1: 40.2%, G2: 36.8%

1 = G1: 31.1%, G2: 39.2%

≥ 2 = G1: 28.7%, G2: 24.0%

Body weight was recorded at baseline and before pregnancy.

Baselines = earliest measured weight during a nonpregnancy state recorded in the medical record during the 5 yrs prior to study pregnancy but after age 18.

Prepregnancy weight = self-reported

Rate of weight change = change in body weight and prepregnancy weight divided by the time in years between two weights

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • GDM

  • Rate of weight gain

Results:

Gains of 1.1-2.2 kg/yr were associated with a small increased risk of GDM (OR 1.63, 85% CI 0.95-2.81). Gains of 2.3-10.0 kg/yr were associated with a 2.5-fold increased risk of GDM (OR 2.61, 95% CI 1.5-4.57) as compared with stable weight).

Maternal confounders/effect modifiers:

  • Age

  • Baseline BMI

  • Prepregnancy BMI

  • Parity

  • Education

  • Note of infertility (y or n)

  • Amenorrhea (y or n)

  • PCOS (y or no)

  • Hypothyroid (y or n)

  • Family history of diabetes (y or n)

  • Smoking prior to pregnancy (y or n)

Infant and child confounders/ effect modifiers:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Hediger et al., 1989

Design:

  • Cohort

Total study characteristics

Race:

Puerto Rican, 23.1%

Black, 40.6%

White, 36.3%

Country/Setting:

USA (Camden, NJ)

Total Study N:

1,790

Enrollment period:

NR

Group Description:

G1: Adequate weight gain

G2: Early inadequate weight gain (< 4.3 kg/wk by 24 weeks’ gestation)

G3: Late inadequate weight gain

G4: Both inadequate weight gain

Age:

≤ 15, 16.7%

16-17, 44.4%

18-19, 38.9%

Study Objective:

To examine the relationship between maternal weight gain in adolescents and birth weight and length of gestation.

BMI:

≤ 19.5, 27.6%

19.6-24.5, 55.8%

> 24.5, 16.6%

Group N:

G1: 955

G2: 304

G3: 387

G4: 144

Prenatal Care:

Inadequate, 5.5%

Intermediate, 64.4%

Adequate, 30.1%

Payment Status:

Medicaid, 75.9%

Private Insurance, 24.1%

Inclusion criteria:

  • Teens

  • Registered in Camden County Adolescent Family Life program

  • Initial OB/GYN exam before 24 weeks’ gestation

  • Delivered live born singleton infant

  • One of five affiliated hospitals

  • Delivery after 24 weeks’ gestation

Smoked: 32.5%

Prepregnant weight: recalled at entry to prenatal care (used to calculate prepregnancy BMI).

Weight during pregnancy was measured at each prenatal visit.

Total pregnancy weight gain: interview or abstracting from clinical prenatal records

Exclusion criteria:

  • Entered prenatal care after 24 weeks’ gestation

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Low birth weight (< 2,500 g)

  • Preterm delivery (before 37 weeks’ gestation)

  • SGA status (10th percentile)

Results:

Mean total weight gain = 14.8 ± 6.1 kg (range −3.8 to 43.9 kg)

Maternal confounders/effect modifiers:

  • Age

  • Ethnicity

  • Prepregnant weight

  • Measured height

  • Cigarette smoking

  • Weight gain during pregnancy

G2 was associated with a significantly increased risk of having an SGA infant (OR = 1.88, 95% CI 1.08-3.27).

Infant and child confounders/ effect modifiers:

NR

G3 was associated with preterm delivery, whether or not the total gain was adequate for gestation (OR = 1.69, 95% CI 1.12-2.55).

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Langford et al., 2008

Design:

  • Population-based Cohort

Study population was further divided into eight categories to represent 10-lb gain increments.

Country/Setting:

USA; Missouri birth certificate data

Total study N:

34,143

Prepregnancy BMI: height and weight reported on birth certificate (taken from medical records or self-reported).

Group Description:

G1: GWG below IOM recs (< 15 lbs)

G2: GWG within IOM recs (15-25 lbs)

G3: GWG above IOM recs (> 25 lbs)

Enrollment period:

1990-2004

Age:

G1:

18-24 yrs: 57.1%

25-30 yrs: 30.8%

31-35 yrs: 12.1%

G2:

18-24 yrs: 52.5%

25-30 yrs: 34.7%

31-35 yrs: 12.8%

G3:

18-24 yrs: 53.8%

25-30 yrs: 34.5%

31-35 yrs: 11.7%

Study Objective:

To examine the relationship between GWG and adverse maternal and infant outcomes for overweight women.

Group N:

G1: 1,787

G2: 7,205

G3: 25,151

Inclusion criteria:

  • Singleton, full term deliveries

  • Nulliparous

  • Missouri residents

  • Aged 18-35

  • Prepregnancy BMIs 26-29 kg/m2

Race/ethnicity

G1:

White, non-Hispanic: 78.8%

Black, non-Hispanic: 15.8%

G2:

White, non-Hispanic: 81.2%

Black, non-Hispanic: 14.3%

G3:

White, non-Hispanic: 84.0%

Black, non-Hispanic: 12.7%

Exclusion criteria:

  • NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

Adjusted relative risks

  • Preeclampsia

  • Cesarean section

  • Macrosomia

  • Low birth weight (LBW)

  • Perinatal death

Results:

Preeclampsia, RR (95% CI):

G1: 0.78 (0.61-0.99)

G2: Reference

G3: 1.71 (1.54-1.89)

G4: 0.72 (0.69-1.33)

G5: 0.83 (0.64-1.07)

G6: Reference

G7: 1.31 (1.15-1.50)

G8: 1.68 (1.47-1.91)

G9: 2.04 (1.78-2.34)

G10: 2.70 (2.31-3.15)

G11: 3.35 (2.82-3.98)

 

Macrosomia, RR (95% CI)

G1: 0.60 (0.47-0.77)

G2: 1.0

G3: 2.13 (1.94-2.33)

G4: 0.79 (1.46-1.36)

G5: 0.59 (0.45-0.78)

G6: Reference

G7: 1.54 (1.37-1.73)

G8: 2.05 (1.83-2.30)

G9: 2.72 (2.42-3.06)

G10: 3.11 (2.72-3.56)

G11: 3.73 (3.21-4.33)

Groups

G1: GWG below IOM recs

G2: GWG within IOM recs

G3: GWG above IOM recs

G4: GWG < 5 lbs

G5: GWG 6-14 lbs

G6: GWG 15-24 lbs

G7: GWG 25-34 lbs

G8: GWG 35-44 lbs

G9: GWG 45-54 lbs

G10: GWG 55-64 lbs

G11: GWG ≥ 65 lbs

C-Section, RR (95% CI):

G1: 0.92 (0.83-1.01)

G2: Reference

G3: 1.30 (1.24-1.36)

G4: 1.10 (NA)

G5: 0.90 (0.88-1.37)

G6: 1.0 (0.80-1.00)

G7: Reference

G8: 1.29 (1.07-1.21)

G9: 1.43 (1.22-1.37)

G10: 1.62 (1.34-1.52)

G11: 1.79 (1.50-1.75)

LBW:

G1: 1.71 (1.35-2.17)

G2: 1.0

G3: 0.60 (0.51-0.70)

G4: 1.83 (1.10-3.06)

G5: 1.65 (1.27-2.15)

G6: Reference

G7: 0.74 (0.61-0.91)

G8: 0.51 (0.41-0.63)

G9: 0.51 (0.39-0.67)

G10: 0.59 (0.42-0.85)

G11: 0.64 (0.41-1.00)

Maternal confounders/effect modifiers:

  • Age

  • Race/ethnicity

  • Education

  • Medicaid status

  • WIC status

  • Tobacco and alcohol use

  • Chronic hypertension

  • Cardiac disease

  • Insulin-dependent diabetes

  • Inadequate prenatal care

Perinatal death:

G1: 1.88 (0.77-4.62)

G2: 1.0

G3: 1.09 (0.62-1.92)

Infant and child confounders/effect modifiers:

  • Child’s sex

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Lof et al., 2008

Design:

  • Cohort

  • Prospective

Body weight was measured at gestational weeks 12, 25, and 33. GWG during the second (weeks 12-25) and third trimesters (weeks 25-33) was determined (kg/week).

Country/Setting:

Sweden

Total Study N:

223

Enrollment period:

Apr 2000 to Nov 2003

BMI was calculated as body weight in gestational week 12 and was divided by self-reported squared height.

Inclusion criteria:

  • Healthy women

Study Objective:

To examine the effects of pre-pregnancy physical activity and maternal BMI on GWG and birth weight.

Exclusion criteria:

  • History of hypertension, diabetes, or thyroid problems

Prepregnancy physical activity level, prepregnancy BMI, maternal age, parity, education, smoking status

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Gestational weight gain

  • Infant birth weight

Results:

BMI and GWG, but not pre-pregnancy physical activity level, were linked to birth weight. GWG during gestational weeks 12 and 33 was correlated with elevated birth weight.

Maternal confounders/effect modifiers:

  • Parity

  • Smoking status

  • Education level

  • Pregnancy physical activity level

Infant and child confounders/ effect modifiers:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Manios et al., 2008

Design:

  • Cross-sectional

Prepregnancy weight was self-reported.

Country/Setting:

Greece

Total Study N:

2,374

GWG was self-reported and categorized based on IOM recs.

Enrollment period:

Apr 2003 to July 2004

Inclusion criteria:

  • Greek preschool aged children, 12 to 60 mos

  • Participants in GENESIS (Growth, Exercise, ad Nutrition Epidemiological Study In preschoolers)

BMI categories: underweight (< 19.8); normal (19.8-26); overweight (> 26-29); obese (> 29)

Study Objective:

To examine the effect of maternal obesity on initiation and duration of breastfeeding.

Exclusion criteria:

NR

Author, year:

Mitchell and Lerner, 1989

Design:

  • Cohort

Initial weight/BMI: recorded at first prenatal visit

Total Study N:

152

Gestational weight gain: difference between weight at first prenatal visit (initial weight) and weight recorded at final antepartum visit (≤ 5 days before delivery).

Country/Setting:

USA

Inclusion criteria:

  • Singleton pregnancies

  • Patients at one private practice

  • Entered prenatal care prior to 12th week

  • Seen regularly throughout gestation

Enrollment period:

NR

Study Objective:

To compare pregnancy outcome in overweight and normal weight women.

Exclusion criteria:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Breastfeeding initiation and duration

Results:

A higher percentage of mothers with increased prepregnancy BMI or high GWG failed to initiate breastfeeding, as compared to normal weight mothers.

Maternal confounders/effect modifiers:

  • Parental age

  • Education level of population

  • Parental anthropometric data

  • Parity

  • Smoking and alcohol consumption during pregnancy

  • Weight status before, during and after pregnancy

With women who initiated breastfeeding, no significance differences were seen in breastfeeding duration in women with different gestational weight gains.

Infant and child confounders/ effect modifiers:

  • Feeding patterns

  • Gestational age

Outcomes description:

  • Brith weight

  • Gestational age

  • Apgar scores at 1 and 5 min

  • Incidence of infant or maternal complications

  • Gestational weight gain

Results:

A significant linear relationship was seen between maternal weight gain and birth weight in normal and overweight pregnancies. Infants of overweight mothers had higher birth weights at each weight gain level. Overweight mothers also gained significantly less weight than normal weight mothers.

Maternal confounders/effect modifiers:

  • Age

  • Height

  • Parity

  • Race

  • Smoking habits

Infant and child confounders/ effect modifiers:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Naeye, 1981

Design:

  • Cohort

Mothers of infants were placed into age categories: 10-14, 15-16, 17-19, and 20-32 years and grouped according to pregravid weight for height (recalled at first antenatal visit).

Country/Setting:

USA

Total Study N:

13,830

Enrollment period:

1959-1966

Inclusion criteria:

  • Black

  • Singleton infants

  • Maternal age of 10-32 years

Net pregnancy gain was calculated by subtracting the weight of the neonate and the placenta from the maternal weight at the end of the pregnancy.

Study Objective:

To determine whether the growth needs of young mothers compete with the growth needs of their fetuses for available nutrients.

Exclusion criteria:

  • Maternal diabetes mellitus

  • Placenta previa

  • Hydramnios

  • Oligohydramnios

  • Congenital malformations of the infant

Author, year:

Naeye, 1979

Design:

  • Cohort

Prepregnancy weight was recorded during interviews at first or second antenatal visits for medical care.

Country/Setting:

USA

Total Study N:

44,565

Total pregnancy gain was divided by the optimal weight gain value for the length of pregnancy (NAS guidelines). This was multiplied by 100 to give the mother’s weight gain in percent of the optimal value.

Enrollment period:

1959-1966

Inclusion criteria:

  • Singleton infants

Study Objective:

To determine if a 24 to 27 lb weight gain is optimal for all singleton pregnancies or requires modification for specific subgroups of mothers based on pregnancy outcome.

Exclusion criteria:

  • Hydramnios

  • Oligohydramnios

  • One or more maternal hematocrit values less than 20%

  • Diabetes

  • Heart disease

  • Tuberculosis

  • Alcoholism

  • Drug addiction

  • Uterine leiomyomas

  • Prepregnancy weigh and height not recorded

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Pregravid weight for height

  • Net pregnancy weight gain,

  • Birth weight and length

  • Head circumference

Results:

Mothers aged 10-16 years (normal or underweight before pregnancy) had growth retarded infants by comparison to older mothers. This was not seen in overweight young mothers.

Maternal confounders/effect modifiers:

  • Parity

  • Gynecologic age

  • Cigarette smoking

Infant and child confounders/effect modifiers:

NR

A greater percentage of young mothers (10-14 years) had acetonuria (2+ greater acetone of the urine).

Outcomes description:

  • Preterm delivery

  • Pregnancy/delivery complications

  • Fetal/placental complications

  • Neonatal mortality

Results:

Mothers who began pregnancy overweight had the fewest fetal and neonatal deaths with a 16 lb gain at term. The optimal weight gain for normally proportioned mothers was 20 lbs and 30 lbs for underweight mothers.

Maternal confounders/effect modifiers:

  • Parity

  • Gynecologic age

  • Cigarette smoking

Infant and child confounders/effect modifiers:

NR

For all three groups, perinatal mortality rates increased weight gain less or more than optimal values. Extreme gains (low or high) had modest influence on the occurrence of common placental and fetal disorders, but once a disorder was present, mortality rates increased significantly when mothers had extreme gains (low or high).

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Nohr et al., 2008

Design:

  • Cohort

  • Retrospective

Prepregnancy BMI: self-reported at first pregnancy interview.

Country/Setting:

Denmark (Danish National Birth Cohort)

BMI Categories: underweight (< 18.5); normal (18.5-25); overweight (25-30); obese (≥ 30).

Total Study N:

60,892

Group Description:

G1: Low GWG (< 10 kg)

G2: Medium GWG (10-15 kg)

G3: High GWG (16-19 kg)

G4: Very high GWG (≥ 20 kg)

Gestational weight gain: self-reported (postpartum interview 6 mos after birth)

Enrollment period:

1996-2002

Study Objective:

To examine the associations between prepregnancy BMI and gestational weight gain with pregnancy outcomes.

Groups % of N:

G1: 12.6%

G2: 44.7%

G3: 20.9%

G4: 21.9%

Inclusion criteria:

  • Liveborn, singleton infants

  • Delivered ≥ 37 wks gestation

  • Mothers participated in first pregnancy interview and first postpartum interview

Exclusion criteria:

  • Women with type 1 diabetes

  • Women younger than 18 years of age

  • Missing information on important study variables

  • Missing data on postpartum weight retention 6 mos after birth

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

Maternal outcomes:

  • Preeclampsia

  • GDM

  • Hypertensive disorders

  • Cesarean section before labor

  • Instrumental deliveries

  • Postpartum weight retention

  • Postpartum weight loss

Maternal Outcomes Results: OR (95% CI)

Preeclampsia

G1: 0.7 (0.6-0.9)

G2: Reference

G3: 1.6 (1.3-1.8)

G4: 2.8 (2.4-3.2)

Gestational diabetes

G1: 2.3 (1.9-2.8)

G2: Reference

G3: 0.8 (0.7-1.1)

G4: 1.1 (0.9-1.4)

Hypertensive disorders

G1: 1.0 (0.8-1.2)

G2: Reference

G3: 1.1 (0.9-1.4)

G4: 1.4 (1.1-1.7)

Cesarean section before labor

G1: 0.9 (0.8-1.0)

G2: Reference

G3: 1.0 (0.9-1.1)

G4: 1.2 (1.1-1.3)

Cesarean section during labor

G1: 0.8 (0.8-0.9)

G2: Reference

G3: 1.2 (1.1-1.3)

G4: 1.4 (1.3-1.5)

Instrumental deliveries

G1: 0.9 (0.8-1.0)

G2: Reference

G3: 1.1 (1.0-1.2)

G4: 1.2 (1.1-1.3)

Postpartum weight retention (5 kg +)

G1: 0.4 (0.3-0.4)

G2: Reference

G3: 2.3 (2.2-2.4)

G4: 6.2 (5.8-6.5)

Postpartum weight loss (2 kg +)

G1: 2.8 (2.7-3.0)

G2: Reference

G3: 0.5 (0.5-0.5)

G4: 0.3 (0.3-0.3)

Neonatal Outcomes Results: OR (95% CI)

SGA

G1: 1.8 (1.6-2.0)

G2: Reference

G3: 0.7 (0.7-0.8)

G4: 0.5 (0.5-0.5)

LGA

G1: 0.7 (0.6-0.8)

G2: Reference

G3: 1.6 (1.5-1.7)

G4: 2.6 (2.4-2.8)

Low Apgar Score

G1: 0.8 (0.6-1.1)

G2: Reference

G3: 1.2 (1.0-1.5)

G4: 1.3 (1.0-1.6)

Neonatal outcomes:

  • SGA

  • LGA

  • Apgar score

Maternal confounders/effect modifiers:

  • Age at conception

  • Parity

  • Lifestyle habits in the first part of pregnancy (smoking, alcohol intake, physical exercise)

  • Social status (education and occupation)

  • Duration of breastfeeding

Infant and child confounders/effect modifiers:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Papiernik and Kaminski, 1974

Design:

  • Case-control

Data was collected using medical records completed at prenatal consultation.

Total Study N:

365

Country/Setting:

France (Paris)

Groups were further divided by length of gestation:

G1: > 37 weeks (weight > 2,599 g)

G2: ≤ 37 weeks (weight > 2,500 g)

G3: ≤ 37 weeks (weight ≤ 2,500 g)

and > 35 weeks (weight > 2,000 g)

G4: ≤ 35 weeks (weight ≤ 2,000 g)

G5: > 37 weeks (weight ≤ 2,500 g)

Group Description:

G1: infant weighing < 2,500 g

G2: infant weighing > 2,500 g

Enrollment period:

1969

Study Objective:

To examine multiple factors in relationship to the risk of premature delivery.

Group N:

G1: 149

G2: 216

Subgroup N:

G1: 198 G3: 56 G5: 47

G2: 18 G4: 46

Inclusion criteria:

  • Delivered infant at the same obstetrical department

General Factors:

G1: Unwed: 10%

Weight < 45 kg: 6%

Height < 150 cm: 1%

> 2 children w/o domestic help: 3%

Age < 20 or > 40: 14%

Low SES: 12%

G2: Unwed: 11%

Weight < 45 kg: 6%

Height < 150 cm: 0%

> 2 children w/o domestic help: 6%

Age < 20 or > 40:22%

Low SES: 28

G3: Unwed: 14%

Weight < 45 kg: 5%

Height < 150 cm: 2%

> 2 children w/o domestic help: 2%

Age < 20 or > 40: 18%

Low SES: 18%

G4: Unwed: 9%

Weight < 45 kg: 2%

Height < 150 cm: 0%

> 2 children w/o domestic help: 13%

Age < 20 or > 40: 7%

Low SES: 31%

G5: Unwed: 13%

Weight < 45 kg: 15%

Height < 150 cm: 2%

> 2 children w/o domestic help: 4%

Age < 20 or > 40: 13%

Low SES: 21%

Exclusion criteria:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Risk of prematurity (32nd wk of gestation)

  • Length of gestation; obstetric risks

Results:

The principle factors of prematurity and/or intrauterine growth retardation were determined to be:

Pathology of the cervix or isthmus, unfavorable obstetrical and gynecological antecedent; signs of imminent delivery; low eight gain; fatigue; toxemia; short, thin women

Maternal confounders/effect modifiers:

  • Marital status

  • Weight/height

  • Having more than two children without domestic help

  • Age

  • Social class

  • Factors of fatigue

Infant and child confounders/effect modifiers:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Rodriquez et al., 2008

Design:

  • Follow-up of prospective cohort

Prepregnancy BMI: taken from medical chart at time of booking (rounded to the nearest whole number) by the midwife

Country/Setting:

Sweden and Denmark

Total Study N:

12,556

Maternal weight: recorded at delivery or in late gestation for all women and subtracted from prepregnancy weight to obtain GWG

Enrollment period:

Follow-up: 2001-2002 in Sweden, 1993-1994 in Denmark

Group Description:

School-aged children

Inclusion criteria:

  • Live born, singleton infants

Study Objective:

To examine the relationship between pregnancy weight and core symptoms of ADHD in offspring

Average weekly gain: divided weight gain by the number of completed gestational weight

Exclusion criteria:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Average weekly weight gain (stratified by prepregnancy BMI)

  • ADHD symptoms

Results:

GWG outside of the IOM guidelines was not related to ADHD symptoms (below recs: OR: 0.96, 95% CI 0.81,1.14; above recs: OR: 0.98, 95% CI 0.82,1.16).

Maternal confounders/effect modifiers:

  • Smoking status during pregnancy

  • Weight gain

  • Education

  • Family structure

  • Age

  • Cohort country of origin

Analyses found significant associations between prepregnancy overweight/obese and high ADHD symptoms scoring in offspring (OR range: 1.37 [95% CI 1.07, 1.75] to 1.89 [95% CI 1.13,3.15).

Infant and child confounders/ effect modifiers:

  • Gestational age

  • Birth weight

  • Sex

Offspring of overweight women who had high GWG had a 2-fold risk of ADHD symptoms (OR: 2.10, 95% CI 1.19, 3.72) when compared to normal weight women.

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Rudra et al., 2008

Design:

  • Cohort

  • Prospective

Pregravid BMI: using self-reported height and weight during the three months before pregnancy.

Country/Setting:

USA (Washington State)

Total Study N:

2,468

Weight gain during pregnancy = rate of gain between prepregnancy and 18-22 wks gestation

Enrollment period:

1996-2005

Inclusion criteria:

  • Attended prenatal care clinics affiliated with two hospitals

  • Started prenatal care before 20 wks gestation

  • 18 years of age or older

  • Speak or read English

  • Planned to carry pregnancy to term and to deliver at one of two affiliated hospitals

Weight gain rate in early pregnancy = [(weight at 18-22 wks − prepregnancy weight)/weeks’ gestation at weight measurement]

Study Objective:

To examine the relationship between prepregnancy weight and gestational weight gain and preterm delivery.

Preterm delivery = delivery before 37 completed weeks of gestation

Prepregnancy BMI:

Normal, 71.0%

Underweight, 4.0%

Overweight, 15.9%

Obese, 9.1%

Exclusion criteria:

  • Had early pregnancy loss

  • Multiple gestations

  • Missing prepregnancy weight or height data in interviews

  • Missing weight data mid-pregnancy

  • Extreme weight loss during pregnancy

Age:

18-20 yrs, 1.1%

21-35 yrs, 75.8%

36-48 yrs, 23.1%

Nulliparous, 63.1%

Race/ethnicity:

Non-Hispanic White, 85.1%

Non-Hispanic Black, 1.7%

Hispanic, 3.2%

Asian/Pacific Islander, 7.0%

Married, 91.1%

High School education, 95.8%

Household income:

< 30,000, 3.7%

30,000-69,999, 22.3%

≥ 70,000, 71.3%

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Preterm delivery

  • Weight gain rate

  • Prepregnancy BMIs

 

Maternal confounders/effect modifiers:

  • Maternal age

  • Parity

  • Race/ethnicity

  • Marital status

  • Education level

  • Income

  • Smoking status

  • Prenatal vitamin use

  • Prior preterm delivery

  • Prepregnancy hypertension

  • Prepregnancy diabetes

  • Preeclampsia

  • Pregnancy induced hypertension

  • Gestational diabetes

Results:

There was no association between spontaneous preterm delivery and BMI (before and after adjustment for age, race/ethnicity, and parity) (OR per 5 kg/m2 increase: 1.01, 95% CI 0.80-1.29).

There was an inverse association between early pregnancy weight gain and spontaneous preterm delivery (before and after adjustment for age, race/ethnicity, prepregnancy BMI, and parity) (OR per 0.1 kg/wk increase: 0.88, 95% CI 0.78-1.00). Early prepregnancy weight gain was not strongly associated with PPROM.

There was an association between PPROM and BMI (after adjustment for age, race/ethnicity, and parity) (OR per 5 kg/m2 increase: 1.12, 95% CI 0.87-1.43).

Infant and child confounders/ effect modifiers:

NR

Weight gain per week was associated with indicated preterm delivery(after adjustment for age, race/ethnicity, BMI, and parity) (OR per 0.1 kg/wk increase: 1.13, 95% CI 1.01-1.26).

There was also an association between indicated delivery and BMI (after adjustment for maternal characteristics and weight gain). Each 5 kg/m2 was associated with a 71% increase (95% CI 1.4-2.06). However, the association was weakened when adjustments for diabetes or hypertensive conditions were made.

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Scott et al., 1981

Design:

  • Cohort

  • Retrospective

Net pregnancy gain = Final weight – (prepregnancy weight, fetal weight, placental weight)

Country/Setting:

UK

Total Study N:

855

Enrollment period:

1964 to 1977

Group Description:

G1: SGA

G2: AGA

Study Objective:

To assess the relative contributions of different maternal factors in SGA pregnancies.

Group N:

G1: 488

G2: 367

Inclusion criteria:

  • Gave birth to an SGA infant in one of two study hospitals

  • Personally interviewed within 3 days of delivery

  • Babies examined by medical members of research team

  • Birth weight more than 2 SDs below the mean for gestational age and sex (British Perinatal Mortality Survey)

  • Had to be sure of dates, with a regular menstrual cycle not exceeding 32 days

  • Last period was not a withdrawal bleeding from the pill

  • Liveborn, singletons

Exclusion criteria:

  • Infants with major congenital anomalies

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • SGA

Results:

G1:

Mean maternal height: 159.4 cm

(OR: 2.03 [RR: 1.3-3.1])

Mean prepregnancy weight: 55.5 kg

(OR: 1.84 [RR: 1.2-2.8])

Mean net GWG: 7.3 kg

(OR: 1.78 (1.1-2.8])

Previous liveborn infant > 1 SD below mean: 64.0%

(OR: 7.98 [RR: 4.7-13.5])

Manual social classes: 67.5%

(OR: 1.08 [RR 0.8-1.5])

Smoking during pregnancy: 59.1%

(OR: 3.04 [RR 2.2-4.2])

Hypertension without preeclampsia: 28.5%

(OR: 2.84 [RR 1.9-4.2])

Preeclampsia: 10.5%

(OR: 15.78 [RR: 6.2-40.4])

Maternal confounders/effect modifiers:

  • Maternal height/weight (prepregnancy)

  • Previous live born infants more than 1 SD below mean

  • Manual social class

  • Smoking during pregnancy

  • Hypertension without preeclampsia

  • Preeclampsia

Infant and child confounders/ effect modifiers:

NR

G2:

Mean maternal height: 162.0 cm

Mean prepregnancy weight: 58.5 kg

Mean net GWG: 9.0 kg

Previous liveborn infant > 1

SD below mean: 15.2%

Manual social classes: 54.1%

Smoking during pregnancy: 32.4%

Hypertension without preeclampsia: 18.3%

Preeclampsia: 1.6%

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Segal et al., 2008

Design:

  • Cross-sectional

Prepregnancy BMI categories: normal (≤ 24); overweight (25-29.9); obese (≥ 30).

Country/Setting:

Canada

Total Study N:

86

Mean Age: 33.1 yrs

Mean prepregnancy BMI: 29.6 kg/m2

BMI Class:

Normal, 58.1%

Overweight, 27.9%

Obese, 14.0%

Nulliparous, 53.5%

Enrollment period:

NR

Inclusion criteria:

  • Healthy Caucasian women

  • Singleton pregnancies

  • Attended outpatient obstetrics study clinics

  • Had been referred for a 100-g oral glucose tolerance test (OGTT) following an abnormal result in a screening test.

  • Were recruited in late second/early third trimester

  • Women with normal glucose tolerance or impaired glucose tolerance

Study Objective:

To examine the maternal factors that determine infant birth weight.

Exclusion criteria:

  • Women diagnosed with GDM on the OGTT

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Obstetrical outcomes (infant birth weight, LGA)

Results:

Mean birth weight, 3,519 g

Macrosomic infants: 16.3%

LGA infants, 16.3%

Maternal confounders/effect modifiers:

  • Family history of diabetes (type 2 DM),

  • Age

  • Prepregnancy BMI

  • GWG preceding OGTT

  • Current smoking

  • Area under the glucose curve

  • Index of insulin sensitivity

  • Parity

  • Adipocentin

There was a positive association between prepregnancy BMI and birth weight (after adjustment for length of gestation) (r = 0.31, p = 0.0063). There was negative association between birth weight and maternal serum levels of adipocentin (r = −0.3, p = 0.0084).

Infant and child confounders/effect modifiers:

NR

Prepregnancy BMI was found to be a positive predictor of LGA (OR: 1.25, 95% CI 1.05-1.49). A positive association was also seen between GWG preceding the OGTT and LGA (OR: 1.14, 95% CI 0.98-1.34).

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Shepard et al., 1986

Design:

  • Cohort

  • Retrospective

Data was pulled from medical records.

Country/Setting:

USA

Proportional weight gain = weight gain/prepregnant weight

Total study N:

1,396

Enrollment period:

May 1980 to Aug 1982

Prepregnant Weight:

G1:

≤ 110 lbs: 4.2%

111-120 lbs: 18.6%

121-130 lbs: 18.6%

131-140 lbs: 28.8%

> 140 lbs: 29.7%

G2:

≤ 110 lbs: 8.2%

111-120 lbs: 19.7%

121-130 lbs: 30.7%

131-140 lbs: 19.3%

> 140 lbs: 22.1%

G3:

≤ 110 lbs: 14.5%

111-120 lbs: 28.9%

121-130 lbs: 23.4%

131-140 lbs: 19.3%

> 140 lbs: 14.0%

G4:

≤ 110 lbs: 27.3%

111-120 lbs: 30.3%

121-130 lbs: 21.2%

131-140 lbs: 12.7%

> 140 lbs: 8.5%

Group Description:

by proportional weight gain (weight gain/prepregnant weight)

G1: gains ≤ 15%

G2: gains 16-25%

G3: gains 26-35%

G4: gains > 35%

Study Objective:

To study maternal weight gain as a proportion of prepregnant weight and to examine its relationship to complications of pregnancy, labor, and delivery

Group N:

G1: 118

G2: 548

G3: 565

G4: 165

Inclusion criteria:

  • Delivered at study hospital

  • Obtained prenatal care at one of several study sites

  • Singleton infant delivered between 37-42 wks gestation

  • No history of diabetes, hypertension, CVD, seizure, thyroid problems

Exclusion criteria:

  • Infants delivered with severe congenital malformations

  • Women who lost weight during pregnancy

  • Women with missing height/weight information on medical records

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Maternal weight gain

  • Complications of pregnancy, labor, and delivery

Results:

Gestational hypertension:

G1: 4.2%

G2: 2.6%

G3: 4.1%

G4: 9.1%

Preeclampsia:

G1: 2.5%

G2: 1.8%

G3: 4.3%

G4: 7.0%

Vaginal bleeding:

G1:7.6%

G2: 5.1%

G3: 3.5%

G4: 3.0%

Cesarean delivery:

G1: 17.0%

G2:12.0%

G3: 16.8%

G4: 20.6%

Infant birth weight:

G1:

≤ 2,500 g: 1.7%

2,501-4,000 g: 94.9%

> 4,000 g: 3.4%

G2:

≤ 2,500 g: 1.1%

2,501-4,000 g: 90.0%

> 4,000 g: 8.9%

G3:

≤ 2,500 g: 0.4%

2,501-4,000 g: 86.2%

> 4,000 g: 13.5%

G4:

≤ 2,500 g: 1.2%

2,501-4,000 g: 77.6%

> 4,000 g: 21.2%

Maternal confounders/effect modifiers:

  • Marital status

  • Age

  • Race/ethnicity

  • Education level

  • Smoking status

  • Alcohol consumption

  • Gravidity

  • Prepregnant weight/height

Infant and child confounders/ effect modifiers:

  • Gestational age

  • Infant sex

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Tavris and Read, 1982

Design:

  • Cohort

  • Retrospective

Groups were compared by maternal weight gain categories: –24 to –16 lbs, 1-15 to –11 lbs, –10 to –6 lbs, –5 to –1 lbs, 0 to 4 lbs, 5 to 9 lbs, 10 to 14 lbs, 15 to 19 lbs, 20 to 24 lbs, 25 to 29 lbs, 30 to 34 lbs, ≥ 35 lbs.

Country/Setting:

USA (San Francisco, CA)

Total Study N:

2,590

Enrollment period:

Apr 1, 1964 to Apr 1966

Group Description:

G1: Fetal deaths

G2: Neonatal deaths

G3: Infant or childhood deaths

Study Objective:

To examine the effect of maternal weight gain on fetal, infant, and childhood death and on cognitive development.

Group N:

G1: 145

G2: 45

G3: 32

Inclusion criteria:

  • Pregnant members of the Kaiser Permanente Foundation Health Plan

Exclusion criteria:

  • Not weighed within 120 days following last menstrual period and again within 10 days of delivery

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Fetal and neonatal deaths

  • Other deaths before age 5

  • Cognitive development (Raven Colored Progressive Matrices test scores)

Results:

Low weight gain categories had a higher percentage of fetal and neonatal death than the high weight gain categories (p < 0.001). When confining delivery to 35 weeks’ or more, the relationship between gain and fetal and neonatal deaths was no longer significant.

Maternal confounders/effect modifiers:

  • Maternal age

  • Race

  • Parity

  • Education

  • Prepregnancy weight/height ratio

  • Time interval since last pregnancy

  • Paternal education

  • Annual income of parents

Raven Coloured Progressive Matrices scores at age 5 were better for children with mothers who gained between 5 and 29 lbs as compared with mothers who gained below 5 lbs or above 29 lbs.

Infant and child confounders/effect modifiers:

  • Gestational age at time of delivery

No significant differences in test scores were seen in the weight gain group of 5 to 29 lbs.

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Tenovuo et al., 1988

Design:

  • Cohort

  • Prospective

Gestational age = G1: 38.8 wks; G2: 38.8 wks

Birth weight = G1: 2,452 g; G2: 3,378 g

Birth length = G1: 46.6 cm; G2: 50.2 cm

Head circumference = 32.7 cm; G2: 34.5 cm

Maternal age = G1: 27 yrs; G2: 27 yrs

Paternal age = G1: 30 yrs; G2: 29 yrs

Maternal height = G1: 163 cm; G2: 165 cm

Paternal height = G1: 177 cm; G2: 179 cm

Country/Setting:

Finland

Total Study N:

236

Enrollment period:

1985

Group Description:

G1: Severely SGA neonates

G2: Control

Study Objective:

To determine the risk factors associated with severely SGA neonates.

Group N:

G1: 118

G2: 118

Inclusion criteria:

  • Born within study period within study area

Exclusion criteria:

NR

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Gestational age

  • Birth weight/length

  • Head circumference

Results:

Effects of Risk Factors, Odds Ratio (p value)

Previous SGA infant:

Mild = 2.69

Severe = 5.39 (0.008)

Low social class: 2.67 (0.054)

Low prepregnancy weight (kg): 1.04 (0.012)

Toxemia: 4.58 (0.004)

Smoking:

1-9 cigarettes/day = 1.58

> 10 cigarettes/day = 3.4 (0.042)

Poor GWG (kg): 1.10 (0.015)

Maternal confounders/effect modifiers:

  • Smoking

  • Previous SGA infant

  • Toxemia

  • Parity

  • Previous pregnancy-related complications

  • Social class

  • Maternal/paternal age and height

Infant and child confounders/ effect modifiers:

NR

The most important prepregnancy risk factors for SGA were low maternal prepregnancy weight and a maternal history of previous SGA infant.

The most important pregnancy-related risk factors for SGA were poor GWG, toxemia, and smoking.

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Tilton et al., 1989

Design:

  • Cohort

  • Retrospective

Obesity was defined as weight/height equivalent to 120% and over of standard weight at 20 wks of gestations.

Country/Setting:

Santiago, Chile

Total Study N:

326

Enrollment period:

NR

Mean age (yrs)

G1: 29.9; G2: 29.9

Mean weight at first visit (kg)

G1: 72.46; G2: 54.76

Mean height (cm)

G1: 156.1; G2: 156.1

Mean parity

G1: 1.12; G2: 1.15

Mean gestational age at first visit (wks)

G1: 11.7; G2: 11.4

Percent primiparous

G1: 30.7; G2: 32.5

Group Description:

G1: Obese

G2: Normal weight

Study Objective:

To examine the influence of obesity on obstetric performance, pregnancy outcome, and lactational performance.

Group N:

G1: 163

G2: 163

Inclusion criteria:

  • Obese gravidas

  • Singleton pregnancies

  • 20+ years of age

  • Had first prenatal visit no later than 18 weeks gestation

Prepregnancy risk factors:

Smoker

G1: 28.4%; G2: 15.63%

Previous cesarean

G1: 20.9%; G2: 16.0%

Chronic hypertension

G1: 3.7%; G2: 0.6%

Nephropathy

G1: 2.5%; G2: 2.5%

Cardiopathy

G1: 1.2%; G2: 0.6%

Chronic diabetes

G1: 0.6%

Exclusion criteria:

  • Lack of adequate match to obese group

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Obstetric performance

  • Pregnancy outcome

  • Lactational performance

Results:

Obese gravidas had significantly increased incidences of gestational hypertension, inadequate pregnancy weight gain, cesarean section, postpartum infections, and LGA infants.

Maternal confounders/effect modifiers:

  • Age

  • Height

  • Parity

  • Gestational age at first visit

Infant and child confounders/ effect modifiers:

  • Birth weight

  • Age-weight classification of infant

  • Postpartum infections

  • Mode of delivery

No significant increase was seen on obese gravidas for incidence of diabetes, toxemia, breech presentation, postpartum hemorrhage, infant morbidity, or lactational failure.

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Udal et al., 1978

Design:

  • Cohort

Prepregnant weight: obtained from maternal history or medical chart review.

Country/Setting:

USA (Arizona)

Total Study N:

109

Obese prepregnant weight > 120% of median weight for height.

Enrollment period:

NR

Group Description:

G1: Obese mothers

G2: Nonobese mothers

Weight at term: admitting obstetric nurse

Study Objective:

To examine the relationship between maternal and neonatal obesity.

Group N:

G1: 33

G2: 76

Neonatal fatness was calculated by the sum of eight skin fold measurements (SSFT).

Inclusion criteria:

  • Nondiabetic mothers

  • Infants born at 37-43 weeks’ gestation

  • Examined within 72 hours of birth

Race:

White, n = 98

Black, n = 5

American Indian, n = 6

Exclusion criteria:

  • Infants of diabetic mothers

  • Twins

  • Neonates with known congenital or metabolic abnormalities

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Neonatal obesity

Results:

Parameters of Infants Born to Mothers

Birth weight (gm) = G1: 3,471 ± 739; G2: 3,279 ± 494 (p value NS)

SSFTs (mm) = G1: 30.2 ± 9.1; G2: 26.0 ± 5.2 (p value < 0.05)

Head circumference (cm) = G1: 34.7 ± 1.9; G2; 34.3 ± 1.3 (p value NS)

Length (cm) = G1: 50.5 ± 3.3; G2: 50.2 ± 2.2 (p value NS)

Maternal confounders/effect modifiers:

  • GWG

  • Parity

  • Prepregnancy weight/height

  • Cigarette smoking

  • Family history of diabetes

  • Gestational age

Infant and child confounders/ effect modifiers:

  • Gestational age

  • Birth weight

  • Bilateral mid-arm circumference

  • Eight skin fold thickness measurements

LGA infants tended to have higher skin fold thickness measurements (sum of eight skin fold measurements) and obese mothers had infants with significantly increased skin fold thickness measurements.

GWG was associated with increased neonatal fatness and length, while prepregnancy weight for height was associated with neonatal fatness independent of length.

GWG (kg) = 26 ± 18 in fatter LGA infants as compared to 14 ± 7 in other LGA infants (p value < 0.01).

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Varma, 1984

Design:

  • Cohort

  • Retrospective

Maternal booking weight: recorded under standardized conditions in clinic, every 4 wks up to 28 wks then every 2 wks from 28-36 wks and weekly from 36 wks-delivery.

Country/Setting:

UK (London)

Total Study N:

3,002

Enrollment period:

1978-1980

Group Description:

G1: GWG ≤ 2.5 kg

G2: GWG 2.5-5.9 kg

G3: GWG 6.0-10.9 kg

G4: GWG 11.0-15.9 kg

G5: 16.0-20.9 kg

G6: 21+ kg

Study Objective:

To assess the relationship between maternal weight at booking in the first trimester and the total weight gain during pregnancy and birth weight, complications, and mode of delivery.

Group N:

G1: 182

G2: 272

G3: 1,114

G4: 1,028

G5: 252

G6: 154

Inclusion criteria:

  • Seen in antenatal clinic during first trimester

Exclusion criteria:

  • Diabetes

  • Multiple pregnancy

  • Polyhydramnios

  • Gastrointestinal disorders

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Total weight gain

  • Maternal weight

  • Pregnancy complications

  • Mode of delivery

  • Birth weight

  • Fetal status in labor (cardiotocographic tracing and fetal scalp pH)

 

Maternal confounders/effect modifiers:

NR

Infant and child confounders/ effect modifiers:

NR

Results:

Preeclampsia

G1: 8.8%

G2: 5.9%

G3: 9.7%

G4: 9.7%

G5: 10.3%

G6: 11.1%

Preexisting hypertension

G1: 4.4%

G2: 4.4%

G3: 6.1%

G4: 6.8%

G5: 11.9%

G6: 13.9%

IUGR

G1: 29.7%

G2: 14.7%

G3: 5.8%

G4: 7.0%

G5: 6.3%

G6: 6.9%

Premature Labor

G1: 8.8%

G2: 4.4%

G3: 2.5%

G4: 2.5%

G5: 2.4%

G6: 4.1%

Antepartum hemorrhage

G1: 5.5%

G2: 3.3%

G3: 2.5%

G4: 3.1%

G5: 3.2%

G6: 3.5%

Fetal distress in labor

G1: 12.1%

G2: 5.1%

G3: 4.1%

G4: 4.9%

G5: 6.3%

G6: 6.3%

Normal delivery

G1: 73.6%

G2: 73.5%

G3: 72.4%

G4: 68.6%

G5: 69.8%

G6: 55.6%

Forceps delivery

G1: 13.2%

G2: 14.7%

G3: 13.1%

G4: 16.9%

G5: 17.4%

G6: 27.8%

C-Section

G1: 13.2%

G2: 11.8%

G3: 14.5%

G4: 14.4%

G5: 15.1%

G6: 16.6%

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Voldner et al., 2008

Design:

  • Cohort

  • Prospective

BMI and maternal anthropometric measures were collected at each visit.

Country/Setting:

Norway

Gestational age, gender of child, parity, maternal age, maternal height, smoking habits, marital status, education level, work outside the home

Total Study N:

553

Enrollment period:

2002-2005

Inclusion criteria:

  • Healthy women

  • Singleton pregnancies

  • Scandinavian heritage

  • Delivered at study hospital

Study Objective:

To examine the modifiable determinants of fetal macrosomia, specifically lifestyle-related factors.

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Macrosomic infant (≥ 4,200 g)

Results:

Weight gain < 10.2 kg

Univariate analyses: OR = 1.0

Multivariate analyses: OR = 1.0

Weight gain ≥ 10.2 kg

Univariate analyses: OR = 1.7 (95% CI 1.0-2.8; p value 0.04)

Multivariate analyses: OR = 1.7 (95% CI 0.9-3.2; p value 0.09)

Maternal confounders/effect modifiers:

  • Maternal BMI

  • Maternal subcutaneous fat at visit one

  • Weight gain in pregnancy

  • Plasma glucose values (visit one and three)

  • Intake of energy and energy providing nutrients

  • Smoking and level of physical activity before and during pregnancy

BMI, weight gain, plasma glucose and gestational age were independent determinants of macrosomia (if physical activity was left out of the analysis). Once physical activity was included (low level, prepregnancy), this became a significant determinant for macrosomia (OR 2.9, 95% CI 1.9, 7.3).

Infant and child confounders/ effect modifiers:

  • Gestational age

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Wolff et al., 2008

Design:

  • Randomized control trial

Weight, height, blood pressure and heart rate were measured at inclusion and at 27 and 36 weeks’ gestation.

Country/Setting:

Denmark

Total Study N:

50

Prepregnancy weight, weight gain from 36 weeks’ gestation until delivery, and postpartum weight (1st, 2nd, and 3rd weeks), were self reported. Weight at 4 weeks postpartum was measured at the department.

Enrollment period:

NR

Group Description:

G1: Intervention (nondiabetic obese pregnant women)

G2: Control

Study Objective:

To examine the effects of dietary counseling on GWG and glucose metabolism in obese pregnant women.

Group N:

G1: 23

G2: 27

Total GWG was calculated as the difference between self-reported prepregnancy weight and weight just before delivery.

Inclusion criteria:

  • Obese pregnant women (BMI ≥ 30 kg/m2)

  • Nondiabetic

  • 15 ± 3 weeks’ gestation at enrollment

G1: received 10 one-hour consultations with a trained dietician during the pregnancy; were instructed to eat a healthy diet; and limit energy intake based on individual requirements (estimated by energetic cost of fetal growth).

Exclusion criteria:

  • Smoked

  • Age < 18 years or > 45 years

  • Multiple pregnancy

  • Medical complications known to affect fetal growth or weight gain

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Dietary intake and weight development

  • Glucose metabolism

  • Birth outcome

 

Maternal confounders/effect modifiers:

NR

Infant and child confounders/ effect modifiers:

NR

Results:

G1: Average GWG = 6.6 ± 5.5 kg

G2: Average GWG = 13.3 ± 7.5 kg

(mean difference of 6.7 kg; 95% CI 2.6-10.8, P = 0.002)

Placental weight (g)

G1: 701 ± 131

G2: 771 ± 161

Head circumference (cm)

G1: 35 ± 1

G2: 36 ± 2

Abdominal circumference (cm)

G1: 35 ± 1

G2: 34 ± 2

GDM

G1: 0 (0%)

G2: 3 (10%)

Pregnancy-induced hypertension

G1: 1 (4%)

G2: 4 (1%)

Preeclampsia

G1: 0 (0%)

G2: 1 (4%)

Prolonged pregnancy

G1: 3 (13%)

G2: 4 (15%)

Cesarean delivery

G1: 2 (9%)

G2: 3 (11%)

G1: Average gain/wk = 0.26 ± 0.15 kg/wk

G2: Average gain/wk = 0.44 ± 0.21 kg/wk

(mean difference of 0.18 kg/wk (95% CI 0.07-0.30, P = 0.02)

G1 also had a 20% reduction in both s-insulin and s-leptin as compared to G2 at week 27.

Birth weight (g)

G1: 3,757 ± 617

G2: 3,895 ± 485

Infant length (cm)

G1: 52 ± 3

G2: 53 ± 2

Gestational age (days)

G1: 281 ± 13

G2: 280 ± 11

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Study Description

Study Design/Patient Population/Inclusion-Exclusion Criteria

Protocol Including: Pregravid Weight (how measured), Total Weight Gain (how measured), and Baseline Characteristics

Author, year:

Wrotniak et al., 2008

Design:

  • Cohort

  • Retrospective

Prepregnancy weight was self-reported at enrollment.

Country/Setting:

USA

(National Collaborative Perinatal Project)

GWG and height were measured at time of delivery and were used to calculate GWG.

Total Study N:

10,226

Inclusion criteria:

  • Singleton, term pregnancies

Median Prepregnancy BMI: 21.9 kg/m2

Median Age: 23 yrs

Race:

Black, 47.4%

White, 50.5%

Hispanic, 1.3%

Other, 0.8%

Enrollment period:

1595 to 1972

Exclusion criteria:

  • Mothers with GDM

  • Gestational age < 37 weeks or > 42 weeks

Study Objective:

To examine the association of GWG with offspring overweight at 7 years of age.

NR = Not reported.

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Outcomes/Results/Confounders

Outcomes description:

  • Offspring overweight status

  • GWG

Results:

Median GWG: 9.5 kg

Median birth weight: 3,230 g

Median gestational age: 40 wks

Median BMI at 7 yr assessment: 15.7 kg/m2

Overweight status at 7 yr assessment (BMI at or above 95th percentile): 5.7%

Maternal confounders/effect modifiers:

  • Race

  • Age

  • Prepregnancy BMI

  • Number of cigarettes smoked/day

Infant and child confounders/effect modifiers:

  • Sex

  • First-born status

  • Study site

  • Gestational age

Adjusted Association between GWG and overweight at 7 yrs

GWG by 1 kg of weight gain:

OR 1.03 (95% CI 1.02, 1.05)

Excessive GWG vs Recommended GWG (IOM):

OR 1.48 (95% CI 1.06, 2.06)

Insufficient weight gain vs Recommended weight gain (IOM):

OR 0.88 (95% CI 0.68, 1.14)

The association between GWG and overweight in offspring was strongest for women underweight before pregnancy.

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

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Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
×

Nohr E. A., M. Vaeth, J. L. Baker, T. Sorensen, J. Olsen and K. M. Rasmussen. 2008. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. American Journal of Clinical Nutrition 87(6): 1750-1759.

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Varma T. R. 1984. Maternal weight and weight gain in pregnancy and obstetric outcome. International Journal of Gynaecology and Obstetrics 22(2): 161-166.

Voldner N., K. F. Froslie, K. Bo, L. Haakstad, C. Hoff, K. Godang, J. Bollerslev and T. Henriksen. 2008. Modifiable determinants of fetal macrosomia: role of lifestyle-related factors. Acta Obstetricia et Gynecologica Scandinavica 87(4): 423-429.

Wolff S., J. Legarth, K. Vangsgaard, S. Toubro and A. Astrup. 2008. A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. International Journal of Obesity (London) 32(3): 495-501.

Wrotniak B. H., J. Shults, S. Butts and N. Stettler. 2008. Gestational weight gain and risk of overweight in the offspring at age 7 y in a multicenter, multiethnic cohort study. American Journal of Clinical Nutrition 87(6): 1818-1824.

Suggested Citation:"Appendix F: Data Tables." Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press. doi: 10.17226/12584.
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Next: Appendix G: Consultant Reports »
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As women of childbearing age have become heavier, the trade-off between maternal and child health created by variation in gestational weight gain has become more difficult to reconcile. Weight Gain During Pregnancy responds to the need for a reexamination of the 1990 Institute of Medicine guidelines for weight gain during pregnancy. It builds on the conceptual framework that underscored the 1990 weight gain guidelines and addresses the need to update them through a comprehensive review of the literature and independent analyses of existing databases. The book explores relationships between weight gain during pregnancy and a variety of factors (e.g., the mother's weight and height before pregnancy) and places this in the context of the health of the infant and the mother, presenting specific, updated target ranges for weight gain during pregnancy and guidelines for proper measurement. New features of this book include a specific range of recommended gain for obese women.

Weight Gain During Pregnancy is intended to assist practitioners who care for women of childbearing age, policy makers, educators, researchers, and the pregnant women themselves to understand the role of gestational weight gain and to provide them with the tools needed to promote optimal pregnancy outcomes.

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