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Joint and Independent Associations of Gestational Weight Gain and Pre-Pregnancy Body Mass Index with Outcomes of Pregnancy in Chinese Women: A Retrospective Cohort Study.
PLoS One 2015; 10(8):e0136850Plos

Abstract

OBJECTIVE

To explore the joint and independent effects of gestational weight gain (GWG) and pre-pregnancy body mass index (BMI) on pregnancy outcomes in a population of Chinese Han women and to evaluate pregnant women's adherence to the 2009 Institute of Medicine (IOM) gestational weight gain guidelines.

METHODS

This was a multicenter, retrospective cohort study of 48,867 primiparous women from mainland China who had a full-term singleton birth between January 1, 2011 and December 30, 2011. The independent associations of pre-pregnancy BMI, GWG and categories of combined pre-pregnancy BMI and GWG with outcomes of interest were examined using an adjusted multivariate regression model. In addition, women with pre-pregnancy hypertension were excluded from the analysis of the relationship between GWG and delivery of small-for-gestational-age (SGA) infants, and women with gestational diabetes (GDM) were excluded from the analysis of the relationship between GWG and delivery of large-for-gestational-age (LGA) infants.

RESULTS

Only 36.8% of the women had a weight gain that was within the recommended range; 25% and 38.2% had weight gains that were below and above the recommended range, respectively. The contribution of GWG to the risk of adverse maternal and fetal outcomes was modest. Women with excessive GWG had an increased likelihood of gestational hypertension (adjusted OR 2.55; 95% CI = 1.92-2.80), postpartum hemorrhage (adjusted OR 1.30; 95% CI = 1.17-1.45), cesarean section (adjusted OR 1.31; 95% CI = 1.18-1.36) and delivery of an LGA infant (adjusted OR 2.1; 95% CI = 1.76-2.26) compared with women with normal weight gain. Conversely, the incidence of GDM (adjusted OR 1.64; 95% CI = 1.20-1.85) and SGA infants (adjusted OR 1.51; 95% CI = 1.32-1.72) was increased in the group of women with inadequate GWG. Moreover, in the obese women, excessive GWG was associated with an apparent increased risk of delivering an LGA infant. In the women who were underweight, poor weight gain was associated with an increased likelihood of delivering an SGA infant. After excluding the mothers with GDM or gestational hypertension, the ORs for delivery of LGA and SGA infants decreased for women with high GWG and increased for women with low GWG.

CONCLUSIONS

GWG above the recommended range is common in this population and is associated with multiple unfavorable outcomes independent of pre-pregnancy BMI. Obese women may benefit from avoiding weight gain above the range recommended by the 2009 IOM. Underweight women should avoid low GWG to prevent delivering an SGA infant. Pregnant women should therefore be monitored to comply with the IOM recommendations and should have a balanced weight gain that is within a range based on their pre-pregnancy BMI.

Authors+Show Affiliations

Department of Obstetrics, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26313941

Citation

Li, Chunming, et al. "Joint and Independent Associations of Gestational Weight Gain and Pre-Pregnancy Body Mass Index With Outcomes of Pregnancy in Chinese Women: a Retrospective Cohort Study." PloS One, vol. 10, no. 8, 2015, pp. e0136850.
Li C, Liu Y, Zhang W. Joint and Independent Associations of Gestational Weight Gain and Pre-Pregnancy Body Mass Index with Outcomes of Pregnancy in Chinese Women: A Retrospective Cohort Study. PLoS ONE. 2015;10(8):e0136850.
Li, C., Liu, Y., & Zhang, W. (2015). Joint and Independent Associations of Gestational Weight Gain and Pre-Pregnancy Body Mass Index with Outcomes of Pregnancy in Chinese Women: A Retrospective Cohort Study. PloS One, 10(8), pp. e0136850. doi:10.1371/journal.pone.0136850.
Li C, Liu Y, Zhang W. Joint and Independent Associations of Gestational Weight Gain and Pre-Pregnancy Body Mass Index With Outcomes of Pregnancy in Chinese Women: a Retrospective Cohort Study. PLoS ONE. 2015;10(8):e0136850. PubMed PMID: 26313941.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Joint and Independent Associations of Gestational Weight Gain and Pre-Pregnancy Body Mass Index with Outcomes of Pregnancy in Chinese Women: A Retrospective Cohort Study. AU - Li,Chunming, AU - Liu,Yajun, AU - Zhang,Weiyuan, Y1 - 2015/08/27/ PY - 2015/02/19/received PY - 2015/07/17/accepted PY - 2015/8/28/entrez PY - 2015/8/28/pubmed PY - 2016/5/25/medline SP - e0136850 EP - e0136850 JF - PloS one JO - PLoS ONE VL - 10 IS - 8 N2 - OBJECTIVE: To explore the joint and independent effects of gestational weight gain (GWG) and pre-pregnancy body mass index (BMI) on pregnancy outcomes in a population of Chinese Han women and to evaluate pregnant women's adherence to the 2009 Institute of Medicine (IOM) gestational weight gain guidelines. METHODS: This was a multicenter, retrospective cohort study of 48,867 primiparous women from mainland China who had a full-term singleton birth between January 1, 2011 and December 30, 2011. The independent associations of pre-pregnancy BMI, GWG and categories of combined pre-pregnancy BMI and GWG with outcomes of interest were examined using an adjusted multivariate regression model. In addition, women with pre-pregnancy hypertension were excluded from the analysis of the relationship between GWG and delivery of small-for-gestational-age (SGA) infants, and women with gestational diabetes (GDM) were excluded from the analysis of the relationship between GWG and delivery of large-for-gestational-age (LGA) infants. RESULTS: Only 36.8% of the women had a weight gain that was within the recommended range; 25% and 38.2% had weight gains that were below and above the recommended range, respectively. The contribution of GWG to the risk of adverse maternal and fetal outcomes was modest. Women with excessive GWG had an increased likelihood of gestational hypertension (adjusted OR 2.55; 95% CI = 1.92-2.80), postpartum hemorrhage (adjusted OR 1.30; 95% CI = 1.17-1.45), cesarean section (adjusted OR 1.31; 95% CI = 1.18-1.36) and delivery of an LGA infant (adjusted OR 2.1; 95% CI = 1.76-2.26) compared with women with normal weight gain. Conversely, the incidence of GDM (adjusted OR 1.64; 95% CI = 1.20-1.85) and SGA infants (adjusted OR 1.51; 95% CI = 1.32-1.72) was increased in the group of women with inadequate GWG. Moreover, in the obese women, excessive GWG was associated with an apparent increased risk of delivering an LGA infant. In the women who were underweight, poor weight gain was associated with an increased likelihood of delivering an SGA infant. After excluding the mothers with GDM or gestational hypertension, the ORs for delivery of LGA and SGA infants decreased for women with high GWG and increased for women with low GWG. CONCLUSIONS: GWG above the recommended range is common in this population and is associated with multiple unfavorable outcomes independent of pre-pregnancy BMI. Obese women may benefit from avoiding weight gain above the range recommended by the 2009 IOM. Underweight women should avoid low GWG to prevent delivering an SGA infant. Pregnant women should therefore be monitored to comply with the IOM recommendations and should have a balanced weight gain that is within a range based on their pre-pregnancy BMI. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/26313941/Joint_and_Independent_Associations_of_Gestational_Weight_Gain_and_Pre_Pregnancy_Body_Mass_Index_with_Outcomes_of_Pregnancy_in_Chinese_Women:_A_Retrospective_Cohort_Study_ L2 - http://dx.plos.org/10.1371/journal.pone.0136850 DB - PRIME DP - Unbound Medicine ER -