Am J Perinatol
DOI: 10.1055/a-2211-4945
Original Article

Weight Loss, Stability, and Low Weight Gain during Pregnancy among Individuals with Obesity: Associations with Adverse Perinatal Outcomes: An Observational Study

1   Department of Nutritional Sciences, School of Human Ecology, College of Natural Sciences, University of Texas at Austin, Austin, Texas
2   Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas
3   Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas
,
Amy R. Nichols
1   Department of Nutritional Sciences, School of Human Ecology, College of Natural Sciences, University of Texas at Austin, Austin, Texas
,
2   Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas
,
Alison Cahill
2   Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, Texas
,
Jaimie N. Davis
1   Department of Nutritional Sciences, School of Human Ecology, College of Natural Sciences, University of Texas at Austin, Austin, Texas
3   Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas
,
Saralyn F. Foster
1   Department of Nutritional Sciences, School of Human Ecology, College of Natural Sciences, University of Texas at Austin, Austin, Texas
,
Rachel R. Rickman
1   Department of Nutritional Sciences, School of Human Ecology, College of Natural Sciences, University of Texas at Austin, Austin, Texas
,
Fei Xu
4   Division of Research, Kaiser Permanente Northern California, Oakland, California
,
Monique M. Hedderson
4   Division of Research, Kaiser Permanente Northern California, Oakland, California
› Author Affiliations
Funding This work was supported with externally peer-reviewed grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to the University of Texas at Austin (NIH R00HD086304 and P2CHD042849). This work was also supported by a Kaiser Permanente Northern California Community Benefit Grant and National Institute of Diabetes and Digestive and Kidney Diseases grant R01DK118455. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in the conduct of the research or writing the paper.

Abstract

Objective The safety of weight loss and low weight gain during pregnancy remains unclear. To determine how different patterns of gestational weight gain (GWG), including weight loss, stability, and low GWG relate to perinatal outcomes by prepregnancy obesity class.

Study Design The study population included 29,408 singleton livebirths among pregnant people with obesity from Kaiser Permanente Northern California (2008–2013). Clinically measured GWG was grouped into meaningful categories (Adequate: reference, met 2009 National Academy of Medicine [NAM] Guidelines [5–9.1 kg], Excessive [>9.1 kg], Low [1–4.9 kg], Stable [±1 kg], Weight Loss [>1 kg]) or GWG Z-score quintiles. Modified Poisson regression was used to estimate risk of adverse outcomes, stratified by obesity class. Electronic health record data were used to define outcomes, including cesarean delivery, preterm birth, admission to the neonatal intensive care unit, small- and large-for-gestational age infants.

Results Prevalence of weight stability and weight loss was 3.8 and 3.4%, respectively. Compared with those who gained within NAM, increased risk of small-for-gestational age was observed among those with weight loss among obesity class I (Risk Ratio (RR): 1.57, 95% confidence interval [CI]: 1.12, 2.19), obesity class II (RR: 2.18, 95% CI: 1.52, 3.13), and obesity class III (RR: 1.72, 95% CI: 1.21, 2.45). Weight loss was associated with a decreased risk of cesarean delivery among obesity class III, compared with NAM.

Conclusion Weight loss during pregnancy is associated with increased risk of small-for-gestational age among all obesity classes, but not other adverse perinatal outcomes and may reduce risk of cesarean delivery. Low weight gain and weight stability are not associated with risk of adverse outcomes among those with class III obesity. GWG guidelines may need to vary by obesity class.

Key Points

  • Weight loss during pregnancy is associated with increased risk of small-for-gestational age among all obesity classes; but weight loss was not associated with other adverse perinatal outcomes.

  • Among class III, low weight gain and weight stability are not associated with adverse perinatal outcomes.

  • GWG guidelines may need to vary by obesity class.

Availability of Data and Material

Data described in the manuscript, code book, and analytic code will not be made available because of the electronic health record data and confidential nature of the data collected.


Authors' Contribution

E.M.W. conceptualized this analysis, led data analysis, interpretation, and manuscript development. M.M.H. was responsible for the database creation and contributed to study design, analysis planning and provided critical feedback on the manuscript development. F.X. supported data acquisition and database management. A.R.N. was responsible for data management and supported data interpretation. S.F.F., R.R.R., L.H., J.N.D., and A.C. supported data interpretation. All authors were involved in writing the paper and had final approval of the submitted and published versions.


Ethical Approval

This study was approved by the Kaiser Permanente Northern California (#1276863) and was deemed nonhuman subjects research by The University of Texas at Austin Institutional Review Board (2018-07-0119). A waiver of informed consent was granted because the research involved minimal risk to the patients.


Supplementary Material



Publication History

Received: 21 August 2023

Accepted: 10 November 2023

Accepted Manuscript online:
15 November 2023

Article published online:
23 December 2023

© 2023. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
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