Patterns of Gestational Weight Gain in Women with Overweight or Obesity and Risk of Large for Gestational Age

Timing of gestational weight gain (GWG) may influence perinatal outcomes differently. This study aimed to find associations of latent GWG patterns with risk of large for gestational age (LGA) in women with overweight or obesity. Methods: A total of 4,438 women with overweight or obesity were included in the analyses. Latent trajectories of GWG associated with LGA were identified by trajectory analysis. GWG, risk of LGA and early pregnancy factors were compared between these identified groups. Results: This study identified four distinct GWG trajectory groups associated with LGA, each group including, respectively, 78.6, 19.0, 1.4, and 0.9% of the participants. Group 1 presented a typical curve with lower GWG in early pregnancy and relatively higher GWG in mid- and late pregnancy. Women in group 2 showed sustained high GWG and high LGA prevalence than women in group 1 (48.24 vs. 21.56%, p < 0.0001). A catch-up in GWG after low weight gain did not result in significantly higher risk of LGA in group 3 compared to group 1. On the other hand, a rapid GWG in the first two-thirds of pregnancy followed by a strict weight control was associated with elevated risk of LGA in group 4 than group 1 (62.50 vs. 21.56%, p < 0.0001). Conclusions: Women affected by overweight or obesity combined with high GWG in early mid-pregnancy were at elevated risk of LGA. Early clinical recognition of a poor GWG trajectory will enable early intervention in high-risk groups.