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CC BY-NC-ND 4.0 · AJP Rep 2017; 07(03): e145-e150
DOI: 10.1055/s-0037-1604076
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Evaluation of Institute of Medicine Guidelines for Gestational Weight Gain in Women with Chronic Hypertension

Anne M. Siegel
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Alan T. Tita
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Hannah Machemehl
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Joseph R. Biggio
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
,
Lorie M. Harper
1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Center for Women's Reproductive Health at the University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
Further Information

Publication History

07 March 2017

25 May 2017

Publication Date:
12 July 2017 (online)

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Abstract

Objective To assess the impact of gestational weight gain (GWG) outside the Institute of Medicine (IOM) recommendations on perinatal outcomes in pregnancies complicated by chronic hypertension (HTN).

Methods The study consisted of a retrospective cohort of all singletons with HTN from 2000 to 2014. Maternal outcomes examined were superimposed preeclampsia and cesarean delivery. Neonatal outcomes were small for gestational age (SGA), large for gestational age (LGA), and preterm birth (PTB). Groups were compared using analysis of variance and chi-squared test for trend. Backward stepwise logistic regression was adjusted for confounding factors.

Results Of 702 subjects, 106 (15.1%) gained within, 176 (25.0%) gained less, and 420 (59.8%) gained more weight than the IOM recommendations. After adjusting for confounders, GWG above IOM recommendations remained associated with LGA (adjusted odds ratio [AOR]: 2.53, confidence interval [CI] 95%:1.29–4.95). Weight gain less than recommended was associated with a decreased risk of superimposed preeclampsia (AOR: 0.49, CI 95%: 0.26–0.93) without increasing the risk of SGA (AOR: 1.03, CI 95%: 0.57–1.86).

Conclusion Women with pregnancies complicated by chronic HTN should be counseled regarding the association of LGA with excessive GWG. Additionally, they should be counseled that weight gain below recommendations may be associated with a decreased risk of superimposed preeclampsia; however, this association deserves further investigation.

Keywords

hypertension - gestational weight gain - preeclampsia - pregnancy

Note

The findings were presented at the 36th Annual Society of Maternal Fetal Medicine Pregnancy meeting in Atlanta, GA from February 2 to 6, 2016 at a poster session.


 

  • References

  • 1 Sibai BM. Chronic hypertension in pregnancy. Obstet Gynecol 2002; 100 (02) 369-377
    PubMedGoogle Scholar
  • 2 Institute of Medicine. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press; 2009
    Google Scholar
  • 3 Liu J, Wang XF, Wang Y, Wang HW, Liu Y. The incidence rate, high-risk factors, and short- and long-term adverse outcomes of fetal growth restriction: a report from Mainland China. Medicine (Baltimore) 2014; 93 (27) e210
    CrossrefPubMedGoogle Scholar
  • 4 Veerbeek JH, Nikkels PG, Torrance HL. , et al. Placental pathology in early intrauterine growth restriction associated with maternal hypertension. Placenta 2014; 35 (09) 696-701
    CrossrefPubMedGoogle Scholar
  • 5 Chandrasekaren S, Levine LD, Durnwald CP. et al. Excessive weight gain and hypertensive disorders of pregnancy in the obese patient. J Matern Fetal Neonatal Med 2015; 28 (08) 964-968
    CrossrefPubMedGoogle Scholar
  • 6 Thorsdottir I, Torfadottir JE, Birgisdottir BE, Geirsson RT. Weight gain in women of normal weight before pregnancy: complications in pregnancy or delivery and birth outcome. Obstet Gynecol 2002; 99 (5, Pt 1): 799-806
    PubMedGoogle Scholar
  • 7 Jensen DM, Ovesen P, Beck-Nielsen H. , et al. Gestational weight gain and pregnancy outcomes in 481 obese glucose-tolerant women. Diabetes Care 2005; 28 (09) 2118-2122
    CrossrefPubMedGoogle Scholar
  • 8 The American College of Obstetrics and Gynecologists. Optimizing Protocols in Obstetrics. Key Elements for the Management of Hypertensive Crisis in Pregnancy (In-patient). Series 4. 2013 . Available at http://www.acog.org/-/media/Districts/District-II/MembersOnly/PDFs/Optimizing-Protocols-In-OB-HTN-Series-3--Version1.pdf
    PubMedGoogle Scholar
  • 9 Molteni RA, Stys SJ, Battaglia FC. Relationship of fetal and placental weight in human beings: fetal/placental weight ratios at various gestational ages and birth weight distributions. J Reprod Med 1978; 21 (05) 327-334
    PubMedGoogle Scholar
  • 10 Salmani D, Purushothaman S, Somashekara SC. , et al. Study of structural changes in placenta in pregnancy-induced hypertension. J Nat Sci Biol Med 2014; 5 (02) 352-355
    CrossrefPubMedGoogle Scholar
  • 11 Barton JR, Joy SD, Rhea DJ, Sibai AJ, Sibai BM. The influence of gestational weight gain on the development of gestational hypertension in obese women. Am J Perinatol 2015; 32 (07) 615-620
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Madi JM, Araújo BF, Zatti H. , et al. Chronic hypertension and pregnancy at a tertiary-care and university hospital. Hypertens Pregnancy 2012; 31 (03) 350-356
    CrossrefPubMedGoogle Scholar