ABSTRACT
Reports by the Institute of Medicine (IOM) recommend that gestational weight gain
goals should be modified according to prepregnancy body mass index (BMI), which could
result in better maternal and infant outcomes. The authors assessed whether the risk
of the pregnancy outcomes such as rate of cesarean section to primiparous and multiparous
women, macrosomia, and breastfeeding at 10 weeks postpartum can be modified by following
the IOM guidelines for gestational weight gain irrespective of prepregnancy BMI. Staff
from the New Jersey Pregnancy Risk Assessment Monitoring System interviewed a sample
of women who delivered live births in New Jersey during 2002 through 2005 (n = 7661).
In New Jersey, 18% of mothers were obese, 13% were overweight, and 16% were underweight.
In logistic regression analyses, after controlling for maternal characteristics, the
effect of prepregnancy obesity and weight gain more than 34 lb independently and significantly
increased the risk of all four adverse outcomes. For no outcomes was the 25- to 34-pound
weight gain category significantly distinguishable from the 16- to 24-pound reference
category. These results strongly support the idea that the IOM weight gain recommendation
(education during preconception regarding the importance of optimal BMI at the start
of pregnancy) will help to achieve better pregnancy outcomes in obese and overweight
women.
KEYWORDS
Prepregnancy weight - cesarean section - macrosomia - pregnancy weight gain - obesity
- breastfeeding - interaction effect
REFERENCES
- 1
Galtier-Dereure F, Boegner C, Bringer J.
Obesity and pregnancy: complications and cost.
Am J Clin Nutr.
2000;
71(suppl)
1242S-1248S
- 2
Weiss J L, Malone F D, Emig D et al..
Obesity, obstetric complications and cesarean delivery rate: a population-based screening
study.
Am J Obstet Gynecol.
2004;
190
1091-1097
- 3
Baeten J M, Bukusi E A, Lambe M.
Pregnancy complications and outcomes among overweight and obese nulliparous women.
Am J Public Health.
2001;
91
436-440
- 4
Siega-Riz A M, Evenson K R, Dole N.
Pregnancy-related weight gain: a link to obesity?.
Nutr Rev.
2004;
62
S105-S111
- 5
Bianco A T, Smilen S W, Davis Y.
Pregnancy outcome and weight gain recommendations for the morbidly obese woman.
Obstet Gynecol.
1998;
91
97-102
- 6
Dandolu V, Jain N J, Hernandez E, Kruse L.
Shoulder dystocia at non-instrumental vaginal delivery: relation to episiotomy.
Am J Perinatol.
2006;
23
439-444
- 7
Johnson J WC, Longmate J A, Frentzen B.
Excessive maternal weight and pregnancy outcome.
Am J Obstet Gynecol.
1992;
167
353-372
- 8
Cedergren M I.
Maternal morbid obesity and the risk of adverse pregnancy outcome.
Obstet Gynecol.
2004;
103
219-224
- 9
Abrams B, Altman S L, Pickett K E.
Pregnancy weight gain: still controversial.
Am J Clin Nutr.
2000;
71(suppl)
1233S-1241S
- 10 Institute of Medicine .Subcommittee on Nutritional Status and Weight Gain During
Pregnancy. Nutrition During Pregnancy. Washington, DC; National Academy Press 1990
- 11
Scotland N E, Hopkins L M, Caughey A B.
Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas.
Obstet Gynecol.
2004;
104
671-673
- 12
Brennand E A, Dannenbaum D, Willows N D.
Pregnancy outcomes of First Nation's women in relation to pregravid weight and pregnancy
weight gain.
J Obstet Gynaecol Can.
2005;
27
936-944
- 13
Usha Kiran T S, Hemmadi S, Evans B J.
Outcomes of pregnancy in a woman with an increased body mass index.
BJOG.
2005;
112
768-772
- 14
Cnattingius R, Cnattingius S, Notzon F C.
Obstacles to reducing cesarean rates in a low-cesarean setting: The effect of maternal
age, height and weight.
Obstet Gynecol.
1998;
92
501-506
- 15
Young T K, Woodmansee B.
Factors that are associated with cesarean delivery in a large private practice: the
importance of prepregnancy body mass index and weight gain.
Am J Obstet Gynecol.
2002;
187
312-320
- 16
Thorsdottir I, Torfadottir J E, Birgisdottir B E.
Weight gain in women of normal weight before pregnancy: complications in pregnancy
or delivery and birth outcome.
Obstet Gynecol.
2002;
99
799-806
- 17
Dietz P M, Callaghan W M, Cogswell B M, Ferre C, Schieve L A.
Combined effects of prepregnancy body mass index and weight gain during pregnancy
on the risk of preterm delivery.
Epidemiology.
2006;
17
170-177
- 18
Truck D.
Breast feeding: health benefits for child and mother.
Archives de Pediatrie.
2005;
12S3
S145-S165
- 19
Gillman M W, Rifas-Shiman S L, Frazier A L et al..
Breast-feeding and overweight in adolescence.
Epidemiology.
2006;
17
112-114
- 20
Owen C G, Martin R M, Whincup P H, Davey Smith G, Cook D G.
Effect of infant feeding on the risk of obesity across the life course: a quantitative
review of the published evidence.
Pediatrics.
2005;
115
1367-1377
- 21
Rasmussen K M, Kjolhede C L.
Prepregnant overweight and obesity diminish the prolactin response to suckling in
the first week postpartum.
Pediatrics.
2004;
113
e465-e471
- 22
Hilson J A, Rasmussen K M, Kjolhede C L.
Excessive weight gain during pregnancy is associated with earlier termination of breast-feeding
among white women.
J Nutr.
2006;
136
140-146
- 23
Maldonado G, Greenland S.
Simulation study of confounder-selection strategies.
Am J Epidemiol.
1993;
138
923-936
Neetu J JainBHMS MPH
New Jersey Department of Health and Senior Services, MCH Epidemiology Program
P.O. Box 364, Trenton, NJ 08625-0364