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
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.
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 |
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:
|
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:
|
||
Total pregnancy weight gain: estimated by subtracting the prepregnancy weight from the last measured weight before delivery. |
||
Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
Infant and child confounders/effect modifiers: NR |
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:
|
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 |
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Enrollment period: Sept 1980 to Dec 1983 |
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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:
|
||
Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
Results: Mean weight gain (kg) G1: 14.3 G2: 15.2 G3: 15.2 G4: 14.1 |
Maternal confounders/effect modifiers:
|
Birth weight (gm) G1: 3,290 G2: 3,414 G3: 3,521 G4: 3,593 |
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:
|
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. |
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G2: Married: 77.3% Race: White, 72.8% Black, 22.7% Hispanic, 3.2% Mean age: 26.2 |
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Group N: G1: 175 G2: 313 |
||
Inclusion criteria:
|
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Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
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. |
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:
|
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 |
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Group Description: G1: Preeclampsia with albuminuria G2: Other hypertensive complications G3: Normotensive |
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Enrollment period: 1949-1954 |
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Study Objective: To examine the clinical significance of weight trends during pregnancy. |
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Group %: G1: 6.5 G2: 25.4 G3: 68.1 |
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Inclusion criteria:
|
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Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
Infant and child confounders/ effect modifiers: NR |
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:
|
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:
|
||
Exclusion criteria: NR |
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
Infant and child confounders/ effect modifiers: NR |
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:
|
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 |
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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:
|
||
Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
Maternal confounders/effect modifiers:
|
Infant and child confounders/effect modifiers:
|
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). |
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:
|
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) |
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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:
|
||
Exclusion criteria: NR |
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
Infant and child confounders/ effect modifiers: NR |
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:
|
Measurements were taken at early visits (< 18 wks gestation), mid pregnancy (18-25 wks), and late pregnancy (> 25 wks). |
Country/Setting: Rotterdam, The Netherlands |
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Total Study N: 791 |
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Pregravid weight was self-reported. |
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Enrollment period: Apr 2002 to Jan 2006 |
Inclusion criteria:
|
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:
|
||
Author, year: Haiek and Lederman, 1988 |
Design:
|
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 |
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Enrollment period: January 1981 to May 1985 |
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Group N: G1: 90 G2: 90 |
||
Study Objective: To examine the relationship between maternal weight for height and term birth weight. |
||
Inclusion criteria:
|
||
Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
Infant and child confounders/ effect modifiers:
|
||
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:
|
Infant and child confounders/ effect modifiers:
|
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:
|
Maternal age, parity, race/ethnicity |
Country/Setting: USA (Arizona) |
||
Total Study N: 327 |
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Enrollment period: Dec 1976 to June 1978 |
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Inclusion criteria:
|
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Study Objective: To examine the relationship between maternal obesity, weight gain, and infant birth weight. |
||
Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
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 |
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Massively obese mothers had a markedly higher risk of delivering an infant over 4 kg. |
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For women with gains over 12 lbs, maternal obesity was directly related to mean birth weight. |
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Mean birth weight was higher for infants of massively obese mothers when weight gain was adequate. |
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:
|
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 |
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Country/Setting: USA (Northern California) |
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Group Description: G1: GDM Cases G2: Controls |
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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% |
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Enrollment period: Jan 1, 1996 to June 30, 1998 |
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Group N: G1: 251 G2: 204 |
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Study Objective: To evaluate obesity and rate of weight change during 5 years prior to pregnancy and risk of GDM |
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Inclusion criteria:
|
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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% |
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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% |
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Exclusion criteria:
|
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Parity 0 = G1: 40.2%, G2: 36.8% 1 = G1: 31.1%, G2: 39.2% ≥ 2 = G1: 28.7%, G2: 24.0% |
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Body weight was recorded at baseline and before pregnancy. |
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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. |
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Prepregnancy weight = self-reported |
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Rate of weight change = change in body weight and prepregnancy weight divided by the time in years between two weights |
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
Infant and child confounders/ effect modifiers: NR |
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:
|
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% |
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Study Objective: To examine the relationship between maternal weight gain in adolescents and birth weight and length of gestation. |
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BMI: ≤ 19.5, 27.6% 19.6-24.5, 55.8% > 24.5, 16.6% |
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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% |
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Inclusion criteria:
|
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Smoked: 32.5% |
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Prepregnant weight: recalled at entry to prenatal care (used to calculate prepregnancy BMI). Weight during pregnancy was measured at each prenatal visit. |
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Total pregnancy weight gain: interview or abstracting from clinical prenatal records |
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Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
Results: Mean total weight gain = 14.8 ± 6.1 kg (range −3.8 to 43.9 kg) |
Maternal confounders/effect modifiers:
|
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 |
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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). |
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:
|
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). |
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Group Description: G1: GWG below IOM recs (< 15 lbs) G2: GWG within IOM recs (15-25 lbs) G3: GWG above IOM recs (> 25 lbs) |
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Enrollment period: 1990-2004 |
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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% |
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Study Objective: To examine the relationship between GWG and adverse maternal and infant outcomes for overweight women. |
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Group N: G1: 1,787 G2: 7,205 G3: 25,151 |
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Inclusion criteria:
|
||
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% |
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Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description: Adjusted relative risks
|
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) |
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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 |
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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) |
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Maternal confounders/effect modifiers:
|
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Perinatal death: G1: 1.88 (0.77-4.62) G2: 1.0 G3: 1.09 (0.62-1.92) |
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Infant and child confounders/effect modifiers:
|
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:
|
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 |
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Total Study N: 223 |
||
Enrollment period: Apr 2000 to Nov 2003 |
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BMI was calculated as body weight in gestational week 12 and was divided by self-reported squared height. |
||
Inclusion criteria:
|
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Study Objective: To examine the effects of pre-pregnancy physical activity and maternal BMI on GWG and birth weight. |
Exclusion criteria:
|
|
Prepregnancy physical activity level, prepregnancy BMI, maternal age, parity, education, smoking status |
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
Infant and child confounders/ effect modifiers: NR |
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:
|
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:
|
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:
|
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:
|
||
Enrollment period: NR |
||
Study Objective: To compare pregnancy outcome in overweight and normal weight women. |
||
Exclusion criteria: NR |
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
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:
|
||
Outcomes description:
|
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:
|
Infant and child confounders/ effect modifiers: NR |
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:
|
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:
|
|
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:
|
||
Author, year: Naeye, 1979 |
Design:
|
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:
|
|
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:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
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:
|
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:
|
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). |
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:
|
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:
|
||
Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description: Maternal outcomes:
|
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:
|
||
Maternal confounders/effect modifiers:
|
||
Infant and child confounders/effect modifiers: NR |
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:
|
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:
|
||
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 |
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
Infant and child confounders/effect modifiers: NR |
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:
|
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:
|
||
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 |
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
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:
|
||
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. |
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:
|
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:
|
|
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:
|
||
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% |
Outcomes/Results/Confounders |
||
Outcomes description:
|
|
Maternal confounders/effect modifiers:
|
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. |
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:
|
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:
|
||
Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
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% |
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:
|
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:
|
|
Study Objective: To examine the maternal factors that determine infant birth weight. |
||
Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
Results: Mean birth weight, 3,519 g Macrosomic infants: 16.3% LGA infants, 16.3% |
Maternal confounders/effect modifiers:
|
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). |
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:
|
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:
|
||
Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
Infant and child confounders/ effect modifiers:
|
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:
|
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:
|
||
Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
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:
|
|
No significant differences in test scores were seen in the weight gain group of 5 to 29 lbs. |
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:
|
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:
|
||
Exclusion criteria: NR |
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
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. |
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:
|
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:
|
||
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:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
Infant and child confounders/ effect modifiers:
|
||
No significant increase was seen on obese gravidas for incidence of diabetes, toxemia, breech presentation, postpartum hemorrhage, infant morbidity, or lactational failure. |
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:
|
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:
|
Race: White, n = 98 Black, n = 5 American Indian, n = 6 |
|
Exclusion criteria:
|
Outcomes/Results/Confounders |
||
Outcomes description:
|
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:
|
Infant and child confounders/ effect modifiers:
|
||
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). |
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:
|
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 |
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Enrollment period: 1978-1980 |
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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 |
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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. |
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Group N: G1: 182 G2: 272 G3: 1,114 G4: 1,028 G5: 252 G6: 154 |
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Inclusion criteria:
|
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Exclusion criteria:
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Outcomes/Results/Confounders |
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Outcomes description:
|
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Maternal confounders/effect modifiers: NR |
Infant and child confounders/ effect modifiers: NR |
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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% |
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:
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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 |
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Total Study N: 553 |
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Enrollment period: 2002-2005 |
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Inclusion criteria:
|
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Study Objective: To examine the modifiable determinants of fetal macrosomia, specifically lifestyle-related factors. |
Outcomes/Results/Confounders |
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Outcomes description:
|
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:
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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:
|
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:
|
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 |
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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. |
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Enrollment period: NR |
Group Description: G1: Intervention (nondiabetic obese pregnant women) G2: Control |
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Study Objective: To examine the effects of dietary counseling on GWG and glucose metabolism in obese pregnant women. |
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Group N: G1: 23 G2: 27 |
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Total GWG was calculated as the difference between self-reported prepregnancy weight and weight just before delivery. |
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Inclusion criteria:
|
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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). |
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Exclusion criteria:
|
Outcomes/Results/Confounders |
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Outcomes description:
|
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Maternal confounders/effect modifiers: NR |
Infant and child confounders/ effect modifiers: NR |
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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%) |
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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) |
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G1 also had a 20% reduction in both s-insulin and s-leptin as compared to G2 at week 27. |
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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 |
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:
|
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. |
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Total Study N: 10,226 |
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Inclusion criteria:
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Median Prepregnancy BMI: 21.9 kg/m2 Median Age: 23 yrs Race: Black, 47.4% White, 50.5% Hispanic, 1.3% Other, 0.8% |
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Enrollment period: 1595 to 1972 |
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Exclusion criteria:
|
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Study Objective: To examine the association of GWG with offspring overweight at 7 years of age. |
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NR = Not reported. |
Outcomes/Results/Confounders |
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Outcomes description:
|
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:
|
Infant and child confounders/effect modifiers:
|
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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) |
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The association between GWG and overweight in offspring was strongest for women underweight before pregnancy. |
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