Annals of Epidemiology
Volume 21, Issue 2 , Pages 78-85, February 2011

Gestational Weight Gain and Birth Outcome in Relation to Prepregnancy Body Mass Index and Ethnicity

  • David A. Savitz, PhD

      Affiliations

    • Disease Prevention and Public Health Institute, Mount Sinai School of Medicine, New York, NY
    • Corresponding Author InformationAddress correspondence to: David A. Savitz, PhD, Disease Prevention and Public Health Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1057, New York, NY 10029. Tel.: 212-824-7025; Fax: 212-996-0407.
    • ,
  • Cheryl R. Stein, PhD

      Affiliations

    • Disease Prevention and Public Health Institute, Mount Sinai School of Medicine, New York, NY
    • ,
  • Anna Maria Siega-Riz, PhD

      Affiliations

    • Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
    • ,
  • Amy H. Herring, ScD

      Affiliations

    • Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC

Received 24 February 2010; accepted 10 June 2010. published online 12 August 2010.

Purpose

The obesity epidemic raises concerns about the impact of excessive and insufficient weight gain during pregnancy.

Methods

We examined the association between gestational weight gain (GWG) and preterm birth, term small- and large-for-gestational-age (SGA and LGA), term birthweight, and term primary Cesarean delivery, considering prepregnancy body mass index (BMI) and ethnicity in a cohort of 33,872 New York City residents who gave birth between 1995 and 2003 and delivered in hospitals elsewhere in New York State.

Results

Preterm birth (<37 weeks’ gestation) showed a modest U-shaped relationship, with projected GWG of <10 kg and 20+ kg associated with odds ratios of 1.4 and 1.3, respectively, relative to 10 to 14 kg. The pattern was stronger for preterm birth <32 weeks’ and for underweight women with low GWG and overweight/obese women with high GWG. Term SGA decreased and term LGA and birthweight increased monotonically with increasing GWG. Primary Cesarean delivery followed the same pattern as LGA, but less strongly.

Conclusions

Although the study is limited by potential selection bias and measurement error, our findings support the contention that GWG may be a modifiable predictor of pregnancy outcome that warrants further investigation, particularly randomized trials, to assess whether the relation is causal.

Key Words: Birth Weight, Cesarean Delivery, Fetal Growth Retardation, Fetal Macrosomia, Infant, Small-for-Gestational Age, Premature Birth, Weight Gain

Selected Abbreviations and Acronyms: GWG, gestational weight gain, BMI, body mass index, LGA, large-for-gestational-age, SGA, small-for-gestational-age, CI, confidence interval

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 This commissioned paper received funding from the Institute of Medicine (IOM), in connection with the Committee to Reexamine IOM Pregnancy Weight Guidelines. The responsibility for the content of this paper rests with the authors alone and does not necessarily represent the views or endorsement of the Institute of Medicine or the National Academy of Sciences. The development of the data resource was supported by Grant R21 HD050739 from the National Institute of Child Health and Human Development.

PII: S1047-2797(10)00159-6

doi:10.1016/j.annepidem.2010.06.009

Annals of Epidemiology
Volume 21, Issue 2 , Pages 78-85, February 2011

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