Kominiarek MA, et al. - In a large, geographically diverse cohort with prospectively collected data, researchers investigated whether there was an association between gestational weight gain and maternal and neonatal outcomes. Findings suggested an association of gestational weight gain below or above guidelines with a variety of adverse pregnancy outcomes.

Methods

• For this investigation, trained chart abstractors at 25 hospitals obtained maternal and neonatal data for all deliveries on randomly selected days over 3 years (2008–2011).
• In this retrospective cohort study, gestational weight gain was derived utilizing weight at delivery minus prepregnancy or first-trimester weight and categorized as below, within, or above the Institute of Medicine (IOM) guidelines.
• Among women in the gestational weight gain categories in unadjusted and adjusted analyses with odds ratios (ORs) and 95% CI reported, maternal (primary or repeat cesarean delivery, third- or fourth-degree lacerations, severe postpartum hemorrhage, hypertensive disease of pregnancy) and neonatal (preterm birth, shoulder dystocia, macrosomia, hypoglycemia) outcomes were compared.
• Age, race-ethnicity, tobacco use, insurance type, parity, prior cesarean delivery, pregestational diabetes, hypertension, and hospital type were the included covariates.

Results

• Of the 29,861 women included, 51% had gestational weight gain above and 21% had gestational weight gain below the guidelines.
• An association was found between gestational weight gain above the IOM guidelines and cesarean delivery in both nulliparous women (adjusted OR 1.44, 95% CI 1.31–1.59) and multiparous women (adjusted OR 1.26, 95% CI 1.13–1.41) and hypertensive diseases of pregnancy in nulliparous and multiparous women combined (adjusted OR 1.84, 95% CI 1.66–2.04).
• Gestational weight gain above the IOM guidelines was related to shoulder dystocia (adjusted OR 1.74, 95% CI 1.41–2.14), macrosomia (adjusted OR 2.66, 95% CI 2.03–3.48), and neonatal hypoglycemia (adjusted OR 1.60, 95% CI 1.16–2.22) for the neonatal outcomes.
• Findings suggested an association of gestational weight gain below the guidelines with spontaneous (adjusted OR 1.50, 95% CI 1.31–1.73) and indicated (adjusted OR 1.34, 95% CI 1.12–1.60) preterm birth.