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Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis.
JAMA. 2017 Jun 06; 317(21):2207-2225.JAMA

Abstract

Importance

Body mass index (BMI) and gestational weight gain are increasing globally. In 2009, the Institute of Medicine (IOM) provided specific recommendations regarding the ideal gestational weight gain. However, the association between gestational weight gain consistent with theIOM guidelines and pregnancy outcomes is unclear.

Objective

To perform a systematic review, meta-analysis, and metaregression to evaluate associations between gestational weight gain above or below the IOM guidelines (gain of 12.5-18 kg for underweight women [BMI <18.5]; 11.5-16 kg for normal-weight women [BMI 18.5-24.9]; 7-11 kg for overweight women [BMI 25-29.9]; and 5-9 kg for obese women [BMI ≥30]) and maternal and infant outcomes.

Data Sources and Study Selection

Search of EMBASE, Evidence-Based Medicine Reviews, MEDLINE, and MEDLINE In-Process between January 1, 1999, and February 7, 2017, for observational studies stratified by prepregnancy BMI category and total gestational weight gain.

Data Extraction and Synthesis

Data were extracted by 2 independent reviewers. Odds ratios (ORs) and absolute risk differences (ARDs) per live birth were calculated using a random-effects model based on a subset of studies with available data.

Main Outcomes and Measures

Primary outcomes were small for gestational age (SGA), preterm birth, and large for gestational age (LGA). Secondary outcomes were macrosomia, cesarean delivery, and gestational diabetes mellitus.

Results

Of 5354 identified studies, 23 (n = 1 309 136 women) met inclusion criteria. Gestational weight gain was below or above guidelines in 23% and 47% of pregnancies, respectively. Gestational weight gain below the recommendations was associated with higher risk of SGA (OR, 1.53 [95% CI, 1.44-1.64]; ARD, 5% [95% CI, 4%-6%]) and preterm birth (OR, 1.70 [1.32-2.20]; ARD, 5% [3%-8%]) and lower risk of LGA (OR, 0.59 [0.55-0.64]; ARD, -2% [-10% to -6%]) and macrosomia (OR, 0.60 [0.52-0.68]; ARD, -2% [-3% to -1%]); cesarean delivery showed no significant difference (OR, 0.98 [0.96-1.02]; ARD, 0% [-2% to 1%]). Gestational weight gain above the recommendations was associated with lower risk of SGA (OR, 0.66 [0.63-0.69]; ARD, -3%; [-4% to -2%]) and preterm birth (OR, 0.77 [0.69-0.86]; ARD, -2% [-2% to -1%]) and higher risk of LGA (OR, 1.85 [1.76-1.95]; ARD, 4% [2%-5%]), macrosomia (OR, 1.95 [1.79-2.11]; ARD, 6% [4%-9%]), and cesarean delivery (OR, 1.30 [1.25-1.35]; ARD, 4% [3%-6%]). Gestational diabetes mellitus could not be evaluated because of the nature of available data.

Conclusions and Relevance

In this systematic review and meta-analysis of more than 1 million pregnant women, 47% had gestational weight gain greater than IOM recommendations and 23% had gestational weight gain less than IOM recommendations. Gestational weight gain greater than or less than guideline recommendations, compared with weight gain within recommended levels, was associated with higher risk of adverse maternal and infant outcomes.

Authors+Show Affiliations

Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia2Monash Diabetes and Endocrine Units, Monash Health, Victoria, Australia.Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia2Monash Diabetes and Endocrine Units, Monash Health, Victoria, Australia.Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia.Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia.Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia.Kaiser Permanente, Southern California, Los Angeles4Ambry Genetics, Aliso Viejo, California.Tianjin Women's and Children's Health Center, Tianjin, China.Pennington Biomedical Research Center, Baton Rouge, Louisiana.University Hospital, Messina, Italy.Department of Biochemistry, Copenhagen University Hospital, Righospitalet, Copenhagen, Denmark.Department of Obstetrics and Gynecology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.Norwegian Institute of Public Health, Oslo, Norway.Michigan State University, East Lansing.Dankook University College of Medicine, Seoul, Republic of Korea.Department of Development and Regeneration KU Leuven, University of Leuven, Leuven, Belgium14Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium15Faculty of Health and Social Work, Research Unit Healthy Living, UC Leuven-Limburg, Leuven, Belgium.Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium17Department of Obstetrics, Gynaecology and Fertility, GZA Campus Sint-Augustinus, Wilrijk, Belgium.University of California, Irvine.Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia2Monash Diabetes and Endocrine Units, Monash Health, Victoria, Australia.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

28586887

Citation

Goldstein, Rebecca F., et al. "Association of Gestational Weight Gain With Maternal and Infant Outcomes: a Systematic Review and Meta-analysis." JAMA, vol. 317, no. 21, 2017, pp. 2207-2225.
Goldstein RF, Abell SK, Ranasinha S, et al. Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis. JAMA. 2017;317(21):2207-2225.
Goldstein, R. F., Abell, S. K., Ranasinha, S., Misso, M., Boyle, J. A., Black, M. H., Li, N., Hu, G., Corrado, F., Rode, L., Kim, Y. J., Haugen, M., Song, W. O., Kim, M. H., Bogaerts, A., Devlieger, R., Chung, J. H., & Teede, H. J. (2017). Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis. JAMA, 317(21), 2207-2225. https://doi.org/10.1001/jama.2017.3635
Goldstein RF, et al. Association of Gestational Weight Gain With Maternal and Infant Outcomes: a Systematic Review and Meta-analysis. JAMA. 2017 Jun 6;317(21):2207-2225. PubMed PMID: 28586887.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis. AU - Goldstein,Rebecca F, AU - Abell,Sally K, AU - Ranasinha,Sanjeeva, AU - Misso,Marie, AU - Boyle,Jacqueline A, AU - Black,Mary Helen, AU - Li,Nan, AU - Hu,Gang, AU - Corrado,Francesco, AU - Rode,Line, AU - Kim,Young Ju, AU - Haugen,Margaretha, AU - Song,Won O, AU - Kim,Min Hyoung, AU - Bogaerts,Annick, AU - Devlieger,Roland, AU - Chung,Judith H, AU - Teede,Helena J, PY - 2017/6/7/entrez PY - 2017/6/7/pubmed PY - 2017/7/14/medline SP - 2207 EP - 2225 JF - JAMA JO - JAMA VL - 317 IS - 21 N2 - Importance: Body mass index (BMI) and gestational weight gain are increasing globally. In 2009, the Institute of Medicine (IOM) provided specific recommendations regarding the ideal gestational weight gain. However, the association between gestational weight gain consistent with theIOM guidelines and pregnancy outcomes is unclear. Objective: To perform a systematic review, meta-analysis, and metaregression to evaluate associations between gestational weight gain above or below the IOM guidelines (gain of 12.5-18 kg for underweight women [BMI <18.5]; 11.5-16 kg for normal-weight women [BMI 18.5-24.9]; 7-11 kg for overweight women [BMI 25-29.9]; and 5-9 kg for obese women [BMI ≥30]) and maternal and infant outcomes. Data Sources and Study Selection: Search of EMBASE, Evidence-Based Medicine Reviews, MEDLINE, and MEDLINE In-Process between January 1, 1999, and February 7, 2017, for observational studies stratified by prepregnancy BMI category and total gestational weight gain. Data Extraction and Synthesis: Data were extracted by 2 independent reviewers. Odds ratios (ORs) and absolute risk differences (ARDs) per live birth were calculated using a random-effects model based on a subset of studies with available data. Main Outcomes and Measures: Primary outcomes were small for gestational age (SGA), preterm birth, and large for gestational age (LGA). Secondary outcomes were macrosomia, cesarean delivery, and gestational diabetes mellitus. Results: Of 5354 identified studies, 23 (n = 1 309 136 women) met inclusion criteria. Gestational weight gain was below or above guidelines in 23% and 47% of pregnancies, respectively. Gestational weight gain below the recommendations was associated with higher risk of SGA (OR, 1.53 [95% CI, 1.44-1.64]; ARD, 5% [95% CI, 4%-6%]) and preterm birth (OR, 1.70 [1.32-2.20]; ARD, 5% [3%-8%]) and lower risk of LGA (OR, 0.59 [0.55-0.64]; ARD, -2% [-10% to -6%]) and macrosomia (OR, 0.60 [0.52-0.68]; ARD, -2% [-3% to -1%]); cesarean delivery showed no significant difference (OR, 0.98 [0.96-1.02]; ARD, 0% [-2% to 1%]). Gestational weight gain above the recommendations was associated with lower risk of SGA (OR, 0.66 [0.63-0.69]; ARD, -3%; [-4% to -2%]) and preterm birth (OR, 0.77 [0.69-0.86]; ARD, -2% [-2% to -1%]) and higher risk of LGA (OR, 1.85 [1.76-1.95]; ARD, 4% [2%-5%]), macrosomia (OR, 1.95 [1.79-2.11]; ARD, 6% [4%-9%]), and cesarean delivery (OR, 1.30 [1.25-1.35]; ARD, 4% [3%-6%]). Gestational diabetes mellitus could not be evaluated because of the nature of available data. Conclusions and Relevance: In this systematic review and meta-analysis of more than 1 million pregnant women, 47% had gestational weight gain greater than IOM recommendations and 23% had gestational weight gain less than IOM recommendations. Gestational weight gain greater than or less than guideline recommendations, compared with weight gain within recommended levels, was associated with higher risk of adverse maternal and infant outcomes. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/28586887/Association_of_Gestational_Weight_Gain_With_Maternal_and_Infant_Outcomes:_A_Systematic_Review_and_Meta_analysis_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2017.3635 DB - PRIME DP - Unbound Medicine ER -