Gestational weight gain and obesity: Is 20 pounds too much?

Michelle A. Kominiarek, Neil S. Seligman, Cara Dolin, Weihua Gao, Vincenzo Berghella, Matthew Hoffman, Judith U. Hibbard

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objective: To compare maternal and neonatal outcomes in obese women according to weight change and obesity class. Study Design: Cohort study from the Consortium on Safe Labor of 20,950 obese women with a singleton, term live birth from 2002-2008. Risk for adverse outcomes was calculated by multiple logistic regression analysis for weight change categories (weight loss [<0 kg], low [0-4.9 kg], normal [5.0-9.0 kg], high weight gain [>9.0 kg]) in each obesity class (I 30.0-34.9 kg/m2, II 35.0-39.9 kg/m2, and III ≥40 kg/m2) and by predicted probabilities with weight change as a continuous variable. Results: Weight loss was associated with decreased cesareans for class I women (nulliparas odds ratio [OR], 0.21; 95% confidence interval [CI], 0.11-0.42; multiparas OR, 0.61; 95% CI, 0.45-0.83) and increased small for gestational age infants (class I OR, 1.8; 95% CI, 1.3-2.5; class II OR, 2.2; 95% CI, 1.5-3.2; class III OR, 1.7; 95% CI, 1.1-2.6). High weight gain was associated with increased large for gestational age infants (class I OR, 2.4; 95% CI, 1.9-2.9; class II OR, 1.7; 95% CI, 1.3-2.1; class III OR, 1.6; 95% CI, 1.3-2.1). As weight change increased, the predicted probability for cesareans and large for gestational age infants increased. The predicted probability of low birthweight never exceeded 4% for all obesity classes, but small for gestational age infants increased with decreased weight change. The lowest average predicted probability of adverse outcomes (cesarean, postpartum hemorrhage, small for gestational age, large for gestational age, neonatal care unit admission) occurred when women (class I, II, III) lost weight. Conclusion: Optimal maternal and neonatal outcomes appear to occur when weight gain is less than current Institute of Medicine recommendations for obese women. Further study of long-term outcomes is needed with respect to gestational weight changes.

Original languageEnglish (US)
Pages (from-to)214.e1-214.e11
JournalAmerican Journal of Obstetrics and Gynecology
Volume209
Issue number3
DOIs
StatePublished - Jan 1 2013

Fingerprint

Weight Gain
Obesity
Odds Ratio
Confidence Intervals
Weights and Measures
Gestational Age
Small for Gestational Age Infant
Weight Loss
Mothers
Term Birth
Postpartum Hemorrhage
National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division
Live Birth
Cohort Studies
Logistic Models
Regression Analysis

Keywords

  • gestational weight gain
  • maternal
  • neonatal outcomes
  • obesity
  • pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Kominiarek, M. A., Seligman, N. S., Dolin, C., Gao, W., Berghella, V., Hoffman, M., & Hibbard, J. U. (2013). Gestational weight gain and obesity: Is 20 pounds too much? American Journal of Obstetrics and Gynecology, 209(3), 214.e1-214.e11. https://doi.org/10.1016/j.ajog.2013.04.035
Kominiarek, Michelle A. ; Seligman, Neil S. ; Dolin, Cara ; Gao, Weihua ; Berghella, Vincenzo ; Hoffman, Matthew ; Hibbard, Judith U. / Gestational weight gain and obesity : Is 20 pounds too much?. In: American Journal of Obstetrics and Gynecology. 2013 ; Vol. 209, No. 3. pp. 214.e1-214.e11.
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abstract = "Objective: To compare maternal and neonatal outcomes in obese women according to weight change and obesity class. Study Design: Cohort study from the Consortium on Safe Labor of 20,950 obese women with a singleton, term live birth from 2002-2008. Risk for adverse outcomes was calculated by multiple logistic regression analysis for weight change categories (weight loss [<0 kg], low [0-4.9 kg], normal [5.0-9.0 kg], high weight gain [>9.0 kg]) in each obesity class (I 30.0-34.9 kg/m2, II 35.0-39.9 kg/m2, and III ≥40 kg/m2) and by predicted probabilities with weight change as a continuous variable. Results: Weight loss was associated with decreased cesareans for class I women (nulliparas odds ratio [OR], 0.21; 95{\%} confidence interval [CI], 0.11-0.42; multiparas OR, 0.61; 95{\%} CI, 0.45-0.83) and increased small for gestational age infants (class I OR, 1.8; 95{\%} CI, 1.3-2.5; class II OR, 2.2; 95{\%} CI, 1.5-3.2; class III OR, 1.7; 95{\%} CI, 1.1-2.6). High weight gain was associated with increased large for gestational age infants (class I OR, 2.4; 95{\%} CI, 1.9-2.9; class II OR, 1.7; 95{\%} CI, 1.3-2.1; class III OR, 1.6; 95{\%} CI, 1.3-2.1). As weight change increased, the predicted probability for cesareans and large for gestational age infants increased. The predicted probability of low birthweight never exceeded 4{\%} for all obesity classes, but small for gestational age infants increased with decreased weight change. The lowest average predicted probability of adverse outcomes (cesarean, postpartum hemorrhage, small for gestational age, large for gestational age, neonatal care unit admission) occurred when women (class I, II, III) lost weight. Conclusion: Optimal maternal and neonatal outcomes appear to occur when weight gain is less than current Institute of Medicine recommendations for obese women. Further study of long-term outcomes is needed with respect to gestational weight changes.",
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Kominiarek, MA, Seligman, NS, Dolin, C, Gao, W, Berghella, V, Hoffman, M & Hibbard, JU 2013, 'Gestational weight gain and obesity: Is 20 pounds too much?', American Journal of Obstetrics and Gynecology, vol. 209, no. 3, pp. 214.e1-214.e11. https://doi.org/10.1016/j.ajog.2013.04.035

Gestational weight gain and obesity : Is 20 pounds too much? / Kominiarek, Michelle A.; Seligman, Neil S.; Dolin, Cara; Gao, Weihua; Berghella, Vincenzo; Hoffman, Matthew; Hibbard, Judith U.

In: American Journal of Obstetrics and Gynecology, Vol. 209, No. 3, 01.01.2013, p. 214.e1-214.e11.

Research output: Contribution to journalArticle

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T2 - Is 20 pounds too much?

AU - Kominiarek, Michelle A.

AU - Seligman, Neil S.

AU - Dolin, Cara

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AU - Hoffman, Matthew

AU - Hibbard, Judith U.

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N2 - Objective: To compare maternal and neonatal outcomes in obese women according to weight change and obesity class. Study Design: Cohort study from the Consortium on Safe Labor of 20,950 obese women with a singleton, term live birth from 2002-2008. Risk for adverse outcomes was calculated by multiple logistic regression analysis for weight change categories (weight loss [<0 kg], low [0-4.9 kg], normal [5.0-9.0 kg], high weight gain [>9.0 kg]) in each obesity class (I 30.0-34.9 kg/m2, II 35.0-39.9 kg/m2, and III ≥40 kg/m2) and by predicted probabilities with weight change as a continuous variable. Results: Weight loss was associated with decreased cesareans for class I women (nulliparas odds ratio [OR], 0.21; 95% confidence interval [CI], 0.11-0.42; multiparas OR, 0.61; 95% CI, 0.45-0.83) and increased small for gestational age infants (class I OR, 1.8; 95% CI, 1.3-2.5; class II OR, 2.2; 95% CI, 1.5-3.2; class III OR, 1.7; 95% CI, 1.1-2.6). High weight gain was associated with increased large for gestational age infants (class I OR, 2.4; 95% CI, 1.9-2.9; class II OR, 1.7; 95% CI, 1.3-2.1; class III OR, 1.6; 95% CI, 1.3-2.1). As weight change increased, the predicted probability for cesareans and large for gestational age infants increased. The predicted probability of low birthweight never exceeded 4% for all obesity classes, but small for gestational age infants increased with decreased weight change. The lowest average predicted probability of adverse outcomes (cesarean, postpartum hemorrhage, small for gestational age, large for gestational age, neonatal care unit admission) occurred when women (class I, II, III) lost weight. Conclusion: Optimal maternal and neonatal outcomes appear to occur when weight gain is less than current Institute of Medicine recommendations for obese women. Further study of long-term outcomes is needed with respect to gestational weight changes.

AB - Objective: To compare maternal and neonatal outcomes in obese women according to weight change and obesity class. Study Design: Cohort study from the Consortium on Safe Labor of 20,950 obese women with a singleton, term live birth from 2002-2008. Risk for adverse outcomes was calculated by multiple logistic regression analysis for weight change categories (weight loss [<0 kg], low [0-4.9 kg], normal [5.0-9.0 kg], high weight gain [>9.0 kg]) in each obesity class (I 30.0-34.9 kg/m2, II 35.0-39.9 kg/m2, and III ≥40 kg/m2) and by predicted probabilities with weight change as a continuous variable. Results: Weight loss was associated with decreased cesareans for class I women (nulliparas odds ratio [OR], 0.21; 95% confidence interval [CI], 0.11-0.42; multiparas OR, 0.61; 95% CI, 0.45-0.83) and increased small for gestational age infants (class I OR, 1.8; 95% CI, 1.3-2.5; class II OR, 2.2; 95% CI, 1.5-3.2; class III OR, 1.7; 95% CI, 1.1-2.6). High weight gain was associated with increased large for gestational age infants (class I OR, 2.4; 95% CI, 1.9-2.9; class II OR, 1.7; 95% CI, 1.3-2.1; class III OR, 1.6; 95% CI, 1.3-2.1). As weight change increased, the predicted probability for cesareans and large for gestational age infants increased. The predicted probability of low birthweight never exceeded 4% for all obesity classes, but small for gestational age infants increased with decreased weight change. The lowest average predicted probability of adverse outcomes (cesarean, postpartum hemorrhage, small for gestational age, large for gestational age, neonatal care unit admission) occurred when women (class I, II, III) lost weight. Conclusion: Optimal maternal and neonatal outcomes appear to occur when weight gain is less than current Institute of Medicine recommendations for obese women. Further study of long-term outcomes is needed with respect to gestational weight changes.

KW - gestational weight gain

KW - maternal

KW - neonatal outcomes

KW - obesity

KW - pregnancy

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