Gestational Weight Gain-for-Gestational Age Z-Score Charts Applied across U.S. Populations

Stephanie A. Leonard*, Jennifer A. Hutcheon, Lisa M. Bodnar, Lucia Catherine Petito, Barbara Abrams

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: Gestational weight gain may be a modifiable contributor to infant health outcomes, but the effect of gestational duration on gestational weight gain has limited the identification of optimal weight gain ranges. Recently developed z-score and percentile charts can be used to classify gestational weight gain independent of gestational duration. However, racial/ethnic variation in gestational weight gain and the possibility that optimal weight gain differs among racial/ethnic groups could affect generalizability of the z-score charts. The objectives of this study were (1) to apply the weight gain z-score charts in two different U.S. populations as an assessment of generalisability and (2) to determine whether race/ethnicity modifies the weight gain range associated with minimal risk of preterm birth. Methods: The study sample included over 4 million live, singleton births in California (2007–2012) and Pennsylvania (2003–2013). We implemented a noninferiority margin approach in stratified subgroups to determine weight gain ranges for which the adjusted predicted marginal risk of preterm birth (gestation <37 weeks) was within 1 or 2 percentage points of the lowest observed risk. Results: There were minimal differences in the optimal ranges of gestational weight gain between California and Pennsylvania births, and among several racial/ethnic groups in California. The optimal ranges decreased as severity of prepregnancy obesity increased in all groups. Conclusions: The findings support the use of weight gain z-score charts for studying gestational age-dependent outcomes in diverse U.S. populations and do not support weight gain recommendations tailored to race/ethnicity.

Original languageEnglish (US)
Pages (from-to)161-171
Number of pages11
JournalPaediatric and Perinatal Epidemiology
Issue number2
StatePublished - Mar 2018


  • ethnic groups
  • gestational age
  • growth charts
  • pregnancy
  • premature birth
  • weight gain

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Epidemiology


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