Download PDF
Am J Perinatol 2024; 41(11): 1577-1585
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

Elizabeth M. Widen 
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
,
Lorie Harper 
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.
› Further Information
Also available at
    Permissions and Reprints

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.

Keywords

pregnancy - weight loss - gestational weight gain - infant - perinatal

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' Contributions

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.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Driscoll AK, Gregory ECW. Increases in prepregnancy obesity: United States, 2016–2019. In: NCHS Data Brief, no 392. Hyattsville, MD: National Center for Health Statistics; 2020
    Google Scholar
  • 2 Viswanathan M, Siega-Riz AM, Moos MK. et al. Outcomes of maternal weight gain. Evid Rep Technol Assess (Full Rep) 2008; (168) 1-223
    PubMedGoogle Scholar
  • 3 Bodnar LM, Siega-Riz AM, Simhan HN, Himes KP, Abrams B. Severe obesity, gestational weight gain, and adverse birth outcomes. Am J Clin Nutr 2010; 91 (06) 1642-1648
    CrossrefPubMedGoogle Scholar
  • 4 Wilkins EG, Sun B, Thomas AS. et al Low gestational weight gain (+2.0 to 4.9 kg) for singleton-term gestations associated with favorable perinatal outcomes for all prepregnancy obesity classes. AJOG Glob Rep 2023; 3 (03) 100246
    CrossrefPubMedGoogle Scholar
  • 5 Wang L, Zhang X, Chen T. et al. Association of gestational weight gain with infant morbidity and mortality in the United States. JAMA Netw Open 2021; 4 (12) e2141498-e2141498
    CrossrefPubMedGoogle Scholar
  • 6 Leonard SA, Hutcheon JA, Bodnar LM, Petito LC, Abrams B. Gestational weight gain-for-gestational age Z-Score charts applied across U.S. populations. Paediatr Perinat Epidemiol 2018; 32 (02) 161-171
    CrossrefPubMedGoogle Scholar
  • 7 Faucher MA, Barger MK. Gestational weight gain in obese women by class of obesity and select maternal/newborn outcomes: a systematic review. Women Birth 2015; 28 (03) e70-e79
    CrossrefPubMedGoogle Scholar
  • 8 Siega-Riz AM, Bodnar LM, Stotland NE, Stang J. The current understanding of gestational weight gain among women with obesity and the need for future research. NAM Perspect 2020 Jan 6; 2020:10.31478/202001a
    PubMedGoogle Scholar
  • 9 Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004; 103 (02) 219-224
    CrossrefPubMedGoogle Scholar
  • 10 Cox Bauer CM, Bernhard KA, Greer DM, Merrill DC. Maternal and neonatal outcomes in obese women who lose weight during pregnancy. J Perinatol 2016; 36 (04) 278-283
    CrossrefPubMedGoogle Scholar
  • 11 Bogaerts A, Ameye L, Martens E, Devlieger R. Weight loss in obese pregnant women and risk for adverse perinatal outcomes. Obstet Gynecol 2015; 125 (03) 566-575
    CrossrefPubMedGoogle Scholar
  • 12 Blomberg M. Maternal and neonatal outcomes among obese women with weight gain below the new Institute of Medicine recommendations. Obstet Gynecol 2011; 117 (05) 1065-1070
    CrossrefPubMedGoogle Scholar
  • 13 Petersen JM, Hutcheon JA, Bodnar LM, Parker SE, Ahrens KA, Werler MM. Weight gain patterns among pregnancies with obesity and small- and large-for-gestational-age births. Obesity (Silver Spring) 2023; 31 (04) 1133-1145
    CrossrefPubMedGoogle Scholar
  • 14 Mustafa HJ, Seif K, Javinani A. et al. Gestational weight gain below instead of within the guidelines per class of maternal obesity: a systematic review and meta-analysis of obstetrical and neonatal outcomes. Am J Obstet Gynecol MFM 2022; 4 (05) 100682
    CrossrefPubMedGoogle Scholar
  • 15 Catalano PM, Mele L, Landon MB. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Inadequate weight gain in overweight and obese pregnant women: what is the effect on fetal growth?. Am J Obstet Gynecol 2014; 211 (02) 137.e1-137.e7
    CrossrefPubMedGoogle Scholar
  • 16 Hutcheon JA, Bodnar LM. Good practices for observational studies of maternal weight and weight gain in pregnancy. Paediatr Perinat Epidemiol 2018; 32 (02) 152-160
    CrossrefPubMedGoogle Scholar
  • 17 Aris IM, Kleinman KP, Belfort MB, Kaimal A, Oken E. A 2017 US reference for singleton birth weight percentiles using obstetric estimates of gestation. Pediatrics 2019; 144 (01) 2019
    PubMedGoogle Scholar
  • 18 Hutcheon JA, Platt RW, Abrams B, Himes KP, Simhan HN, Bodnar LM. A weight-gain-for-gestational-age z score chart for the assessment of maternal weight gain in pregnancy. Am J Clin Nutr 2013; 97 (05) 1062-1067
    CrossrefPubMedGoogle Scholar
  • 19 Hutcheon JA, Platt RW, Abrams B, Himes KP, Simhan HN, Bodnar LM. Pregnancy weight gain charts for obese and overweight women. Obesity (Silver Spring) 2015; 23 (03) 532-535
    CrossrefPubMedGoogle Scholar
  • 20 Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: National Academies Press; 2009
    Google Scholar
  • 21 Most J, Amant MS, Hsia DS. et al. Evidence-based recommendations for energy intake in pregnant women with obesity. J Clin Invest 2019; 129 (11) 4682-4690
    CrossrefPubMedGoogle Scholar
  • 22 Bodnar LM, Khodyakov D, Parisi SM, Himes KP, Burke JG, Hutcheon JA. Rating the seriousness of maternal and child health outcomes linked with pregnancy weight gain. Paediatr Perinat Epidemiol 2021; 35 (04) 459-468
    CrossrefPubMedGoogle Scholar