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Am J Perinatol
DOI: 10.1055/a-2597-8542
Original Article

Association of Gestational Weight Gain with Adverse Pregnancy Outcomes in Individuals with Obesity

Kazuma Onishi 
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
2   Department of Reproductive Medicine, Asada Ladies Clinic, Nagoya, Aichi, Japan
,
Tetsuya Kawakita 
1   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
› Author Affiliations Funding None.
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Abstract

Objective

This study aimed to determine optimal gestational weight gain (GWG) considering adverse infant and maternal outcomes among individuals with obesity, with detailed classification for body mass index (BMI) of 40 kg/m2 or higher.

Study Design

This study was a population-based retrospective cohort study, using U.S. birth certificate data from 2017 to 2021. We included nulliparous individuals with singleton pregnancies delivering live births between 370/7 and 416/7 weeks' gestation, excluding those with pregestational diabetes or hypertension, gestational diabetes, preeclampsia, major fetal anomalies, or chromosomal disorders. The study focused on three main outcomes: primary cesarean delivery, small for gestational age (SGA), and large for gestational age (LGA). GWG was evaluated in 2-kg increments, from weight loss >8 kg to gains ≥28 kg. Prepregnancy BMI was stratified into four categories: BMI of 30 to <35, 35 to <40, 40 to <50, and ≥50 kg/m2. Odds ratios and absolute risk reduction were used to identify GWG ranges with balanced risks for three outcomes within each BMI category.

Results

Among 1,677,968 individuals with obesity, increased GWG was associated with higher absolute risks of cesarean delivery and LGA and lower risk of SGA across all BMI categories. Optimal GWG ranges varied by prepregnancy BMI: >12 to ≤14 kg for BMI of 30 to <35 kg/m2; >10 to ≤12 kg for BMI of 35 to <40 kg/m2; >6 to ≤10 kg for BMI of 40 to <50 kg/m2; >0 to ≤8 kg for BMI of 50 kg/m2 or higher.

Conclusion

We identified higher upper and lower GWG limits for individuals with BMI of 30 to 50 kg/m2, and lower limits for those with BMI ≥50 kg/m2, compared with the guidelines recommended by the U.S. National Academy of Medicine. These findings suggest the need to tailor GWG recommendations based on the severity of obesity.

Key Points

  • Optimal GWG varies by obesity class, requiring tailored guidelines.

  • Those with BMI ≥50 kg/m may need lower target for gestational gain than current recommendation.

  • The optimal GWG range could be changed based on the outcomes of interest.

Keywords

cesarean delivery - intensive care unit - large for gestational age - neonatal death - neonatal intensive care unit - obesity - small for gestational age - weight loss

Supplementary Material



Publication History

Received: 26 December 2024

Accepted: 29 April 2025

Accepted Manuscript online:
01 May 2025

Article published online:
21 May 2025

© 2025. Thieme. All rights reserved.

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  • References

  • 1 Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017–2018. 2020 :1–8. NCHS Data Brief. 1941–4935. Feb. Accessed December 17, 2024
    PubMedSearch in Google Scholar
  • 2 McDonald SD, Han Z, Mulla S, Beyene J. Knowledge Synthesis Group. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ 2010; 341: c3428
    CrossrefPubMedSearch in Google Scholar
  • 3 QuickStats: rate of cesarean delivery, by maternal prepregnancy body mass index category* - United States, 2020. MMWR Morb Mortal Wkly Rep 2021; 70 (48) 1686
    CrossrefPubMedSearch in Google Scholar
  • 4 Goldstein RF, Abell SK, Ranasinha S. et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA 2017; 317 (21) 2207-2225
    CrossrefPubMedSearch in Google Scholar
  • 5 Voerman E, Santos S, Inskip H. et al; LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group. Association of gestational weight gain with adverse maternal and infant outcomes. JAMA 2019; 321 (17) 1702-1715
    CrossrefPubMedSearch in Google Scholar
  • 6 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
    CrossrefPubMedSearch in Google Scholar
  • 7 DeVader SR, Neeley HL, Myles TD, Leet TL. Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index. Obstet Gynecol 2007; 110 (04) 745-751
    PubMedSearch in Google Scholar
  • 8 Kominiarek MA, Saade G, Mele L. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Association between gestational weight gain and perinatal outcomes. Obstet Gynecol 2018; 132 (04) 875-881
    CrossrefPubMedSearch in Google Scholar
  • 9 Institute of M, National Research Council Committee to Reexamine IOMPWG. The National Academies Collection: Reports funded by National Institutes of Health. 2009 . Weight Gain During Pregnancy: Reexamining the Guidelines. Accessed December 17, 2024.
    PubMedSearch in Google Scholar
  • 10 Kim T, Burn SC, Bangdiwala A, Pace S, Rauk P. Neonatal morbidity and maternal complication rates in women with a delivery body mass index of 60 or higher. Obstet Gynecol 2017; 130 (05) 988-993
    CrossrefPubMedSearch in Google Scholar
  • 11 Nichols AR, Burns N, Xu F. et al. Novel approaches to examining weight changes in pregnancies affected by obesity. Am J Clin Nutr 2023; 117 (05) 1026-1034
    CrossrefPubMedSearch in Google Scholar
  • 12 Widen EM, Nichols AR, Harper L. et al. Weight loss, stability, and low weight gain during pregnancy among individuals with obesity: associations with adverse perinatal outcomes: an observational study. Am J Perinatol 2024; 41 (11) 1577-1585
    PubMedSearch in Google Scholar
  • 13 Bodnar LM, Johansson K, Himes KP. et al. Gestational weight gain below recommendations and adverse maternal and child health outcomes for pregnancies with overweight or obesity: a United States cohort study. Am J Clin Nutr 2024; 120 (03) 638-647
    PubMedSearch in Google Scholar
  • 14 Aboukhater D, Hayasaka M, Martins J, Saade G, Kawakita T. Reevaluating optimal weight changes across the stages of pregnancy. Am J Obstet Gynecol 2025;
    CrossrefPubMedSearch in Google Scholar
  • 15 User Guide to the 2021 Natality Public Use File. CDC. Accessed May 28, 2023 at: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/natality/UserGuide2021.pdf
    PubMedSearch in Google Scholar
  • 16 National Vital Statistics System Birth Data. Centers for Disease Control and Prevention. Accessed December 22, 2022 at: https://www.cdc.gov/nchs/nvss/births.htm
    PubMed
  • 17 Huang X, Fan D, Li W. et al. Optimal gestational weight change associated with improved perinatal outcomes in women with gestational diabetes mellitus: a population-based study in the United States. Am J Clin Nutr 2024; 120 (03) 737-745
    PubMedSearch in Google Scholar
  • 18 Badon SE, Dublin S, Nance N. et al. Gestational weight gain and adverse pregnancy outcomes by pre-pregnancy BMI category in women with chronic hypertension: a cohort study. Pregnancy Hypertens 2021; 23: 27-33
    PubMedSearch in Google Scholar
  • 19 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) e20190076
    CrossrefPubMedSearch in Google Scholar
  • 20 Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996; 87 (02) 163-168
    CrossrefPubMedSearch in Google Scholar
  • 21 Mother's Worksheet for Child's Birth Certificate. 2016. Accessed April 19, 2025 at: https://www.cdc.gov/nchs/data/dvs/moms-worksheet-2016.pdf
    PubMedSearch in Google Scholar
  • 22 Kiel DW, Dodson EA, Artal R, Boehmer TK, Leet TL. Gestational weight gain and pregnancy outcomes in obese women: how much is enough?. Obstet Gynecol 2007; 110 (04) 752-758
    CrossrefPubMedSearch in Google Scholar
  • 23 Hutcheon JA, Bodnar LM, Platt RW. Using perinatal morbidity scoring tools as a primary study outcome. J Epidemiol Community Health 2017; 71 (11) 1090-1093
    PubMedSearch in Google Scholar
  • 24 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
    CrossrefPubMedSearch in Google Scholar
  • 25 Obesity: preventing and managing the global epidemic. Report of a WHO consultation. Vol. 894. 2000 :i–xii, 1–253. World Health Organ Tech Rep Ser. 0512–3054 (Print) 0512–3054. Accessed December 17, 2024.
    PubMedSearch in Google Scholar
  • 26 Buck Louis GM, Grewal J, Albert PS. et al. Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies. Am J Obstet Gynecol 2015; 213 (04) 449.e1-449.e41
    CrossrefPubMedSearch in Google Scholar
  • 27 Pandey S, Shetty A, Hamilton M, Bhattacharya S, Maheshwari A. Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Hum Reprod Update 2012; 18 (05) 485-503
    CrossrefPubMedSearch in Google Scholar
  • 28 Palatnik A, De Cicco S, Zhang L, Simpson P, Hibbard J, Egede LE. The association between advanced maternal age and diagnosis of small for gestational age. Am J Perinatol 2020; 37 (01) 37-43
    Thieme ConnectPubMedSearch in Google Scholar
  • 29 Gould JB, Davey B, Stafford RS. Socioeconomic differences in rates of cesarean section. N Engl J Med 1989; 321 (04) 233-239
    PubMedSearch in Google Scholar
  • 30 Cedergren MI. Optimal gestational weight gain for body mass index categories. Obstet Gynecol 2007; 110 (04) 759-764
    CrossrefPubMedSearch in Google Scholar
  • 31 Strauss RS. Adult functional outcome of those born small for gestational age: twenty-six-year follow-up of the 1970 British Birth Cohort. JAMA 2000; 283 (05) 625-632
    CrossrefPubMedSearch in Google Scholar
  • 32 Jung E, Romero R, Yeo L. et al. The etiology of preeclampsia. Am J Obstet Gynecol 2022; 226 (2S): S844-S866
    CrossrefPubMedSearch in Google Scholar
  • 33 Bodnar LM, Abrams B, Bertolet M. et al. Validity of birth certificate-derived maternal weight data. Paediatr Perinat Epidemiol 2014; 28 (03) 203-212
    PubMedSearch in Google Scholar
  • 34 Park S, Sappenfield WM, Bish C, Bensyl DM, Goodman D, Menges J. Reliability and validity of birth certificate prepregnancy weight and height among women enrolled in prenatal WIC program: Florida, 2005. Matern Child Health J 2011; 15 (07) 851-859
    PubMedSearch in Google Scholar
  • 35 Preston SH, Fishman E, Stokes A. Effects of categorization and self-report bias on estimates of the association between obesity and mortality. Ann Epidemiol 2015; 25 (12) 907-11.e1 , 2
    PubMedSearch in Google Scholar
  • 36 Wright CS, Weiner M, Localio R, Song L, Chen P, Rubin D. Misreport of gestational weight gain (GWG) in birth certificate data. Matern Child Health J 2012; 16 (01) 197-202
    PubMedSearch in Google Scholar
  • 37 Northam S, Knapp TR. The reliability and validity of birth certificates. J Obstet Gynecol Neonatal Nurs 2006; 35 (01) 3-12
    CrossrefPubMedSearch in Google Scholar