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Longitudinal changes in gestational weight gain and the association with intrauterine fetal growth.
Eur J Obstet Gynecol Reprod Biol. 2015 Jul; 190:41-7.EJ

Abstract

OBJECTIVE

Total pregnancy weight gain has been associated with infant birthweight; however, most prior studies lacked repeat ultrasound measurements. Understanding of the longitudinal changes in maternal weight gain and intrauterine changes in fetal anthropometrics is limited.

STUDY DESIGN

Prospective data from 1314 Scandinavian singleton pregnancies at high-risk for delivering small-for-gestational-age (SGA) were analyzed. Women had ≥1 (median 12) antenatal weight measurements. Ultrasounds were targeted at 17, 25, 33, and 37 weeks of gestation. Analyses involved a multi-step process. First, trajectories were estimated across gestation for maternal weight gain and fetal biometrics [abdominal circumference (AC, mm), biparietal diameter (BPD, mm), femur length (FL, mm), and estimated fetal weight (EFW, g)] using linear mixed models. Second, the association between maternal weight changes (per 5 kg) and corresponding fetal growth from 0 to 17, 17 to 28, and 28 to 37 weeks was estimated for each fetal parameter adjusting for prepregnancy body mass index, height, parity, chronic diseases, age, smoking, fetal sex, and weight gain up to the respective period as applicable. Third, the probability of fetal SGA, EFW <10th percentile, at the 3rd ultrasound was estimated across the spectrum of maternal weight gain rate by SGA status at the 2nd ultrasound.

RESULTS

From 0 to 17 weeks, changes in maternal weight were most strongly associated with changes in BPD [β=0.51 per 5 kg (95%CI 0.26, 0.76)] and FL [β=0.46 per 5 kg (95%CI 0.26, 0.65)]. From 17 to 28 weeks, AC [β=2.92 per 5 kg (95%CI 1.62, 4.22)] and EFW [β=58.7 per 5 kg (95%CI 29.5, 88.0)] were more strongly associated with changes in maternal weight. Increased maternal weight gain was significantly associated with a reduced probability of intrauterine SGA; for a normal weight woman with SGA at the 2nd ultrasound, the probability of fetal SGA with a weight gain rate of 0.29 kg/w (10th percentile) was 59%, compared to 38% with a rate of 0.67 kg/w (90th percentile).

CONCLUSION

Among women at high-risk for SGA, maternal weight gain was associated with fetal growth throughout pregnancy, but had a differential relationship with specific biometrics across gestation. For women with fetal SGA identified mid-pregnancy, increased antenatal weight gain was associated with a decreased probability of fetal SGA approximately 7 weeks later.

Authors+Show Affiliations

Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA. Electronic address: hinklesn@mail.nih.gov.Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Intramural

Language

eng

PubMed ID

25978857

Citation

Hinkle, Stefanie N., et al. "Longitudinal Changes in Gestational Weight Gain and the Association With Intrauterine Fetal Growth." European Journal of Obstetrics, Gynecology, and Reproductive Biology, vol. 190, 2015, pp. 41-7.
Hinkle SN, Johns AM, Albert PS, et al. Longitudinal changes in gestational weight gain and the association with intrauterine fetal growth. Eur J Obstet Gynecol Reprod Biol. 2015;190:41-7.
Hinkle, S. N., Johns, A. M., Albert, P. S., Kim, S., & Grantz, K. L. (2015). Longitudinal changes in gestational weight gain and the association with intrauterine fetal growth. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 190, 41-7. https://doi.org/10.1016/j.ejogrb.2015.04.006
Hinkle SN, et al. Longitudinal Changes in Gestational Weight Gain and the Association With Intrauterine Fetal Growth. Eur J Obstet Gynecol Reprod Biol. 2015;190:41-7. PubMed PMID: 25978857.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Longitudinal changes in gestational weight gain and the association with intrauterine fetal growth. AU - Hinkle,Stefanie N, AU - Johns,Alicia M, AU - Albert,Paul S, AU - Kim,Sungduk, AU - Grantz,Katherine L, Y1 - 2015/04/22/ PY - 2015/02/10/received PY - 2015/04/08/revised PY - 2015/04/14/accepted PY - 2015/5/16/entrez PY - 2015/5/16/pubmed PY - 2016/2/26/medline KW - Fetal growth KW - Growth restriction KW - Small-for-gestational-age KW - Weight gain SP - 41 EP - 7 JF - European journal of obstetrics, gynecology, and reproductive biology JO - Eur. J. Obstet. Gynecol. Reprod. Biol. VL - 190 N2 - OBJECTIVE: Total pregnancy weight gain has been associated with infant birthweight; however, most prior studies lacked repeat ultrasound measurements. Understanding of the longitudinal changes in maternal weight gain and intrauterine changes in fetal anthropometrics is limited. STUDY DESIGN: Prospective data from 1314 Scandinavian singleton pregnancies at high-risk for delivering small-for-gestational-age (SGA) were analyzed. Women had ≥1 (median 12) antenatal weight measurements. Ultrasounds were targeted at 17, 25, 33, and 37 weeks of gestation. Analyses involved a multi-step process. First, trajectories were estimated across gestation for maternal weight gain and fetal biometrics [abdominal circumference (AC, mm), biparietal diameter (BPD, mm), femur length (FL, mm), and estimated fetal weight (EFW, g)] using linear mixed models. Second, the association between maternal weight changes (per 5 kg) and corresponding fetal growth from 0 to 17, 17 to 28, and 28 to 37 weeks was estimated for each fetal parameter adjusting for prepregnancy body mass index, height, parity, chronic diseases, age, smoking, fetal sex, and weight gain up to the respective period as applicable. Third, the probability of fetal SGA, EFW <10th percentile, at the 3rd ultrasound was estimated across the spectrum of maternal weight gain rate by SGA status at the 2nd ultrasound. RESULTS: From 0 to 17 weeks, changes in maternal weight were most strongly associated with changes in BPD [β=0.51 per 5 kg (95%CI 0.26, 0.76)] and FL [β=0.46 per 5 kg (95%CI 0.26, 0.65)]. From 17 to 28 weeks, AC [β=2.92 per 5 kg (95%CI 1.62, 4.22)] and EFW [β=58.7 per 5 kg (95%CI 29.5, 88.0)] were more strongly associated with changes in maternal weight. Increased maternal weight gain was significantly associated with a reduced probability of intrauterine SGA; for a normal weight woman with SGA at the 2nd ultrasound, the probability of fetal SGA with a weight gain rate of 0.29 kg/w (10th percentile) was 59%, compared to 38% with a rate of 0.67 kg/w (90th percentile). CONCLUSION: Among women at high-risk for SGA, maternal weight gain was associated with fetal growth throughout pregnancy, but had a differential relationship with specific biometrics across gestation. For women with fetal SGA identified mid-pregnancy, increased antenatal weight gain was associated with a decreased probability of fetal SGA approximately 7 weeks later. SN - 1872-7654 UR - https://www.unboundmedicine.com/medline/citation/25978857/Longitudinal_changes_in_gestational_weight_gain_and_the_association_with_intrauterine_fetal_growth_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0301-2115(15)00126-8 DB - PRIME DP - Unbound Medicine ER -