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Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials.
BMC Pregnancy Childbirth. 2019 Sep 02; 19(1):322.BP

Abstract

BACKGROUND

High Body Mass Index (BMI) and gestational weight gain (GWG) affect an increasing number of pregnancies. The Institute of Medicine (IOM) has issued recommendations on the optimal GWG for women according to their pre-pregnancy BMI (healthy, overweight or obese). It has been shown that pregnant women rarely met the recommendations; however, it is unclear by how much. Previous studies also adjusted the analyses for various women's characteristics making their comparison challenging.

METHODS

We analysed individual participant data (IPD) of healthy women with a singleton pregnancy and a BMI of 18.5 kg/m2 or more from the control arms of 36 randomised trials (16 countries). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to describe the association between GWG outside (above or below) the IOM recommendations (2009) and risks of caesarean section, preterm birth, and large or small for gestational age (LGA or SGA) infants. The association was examined overall, within the BMI categories and by quartile of GWG departure from the IOM recommendations. We obtained aOR using mixed-effects logistic regression, accounting for the within-study clustering and a priori identified characteristics.

RESULTS

Out of 4429 women (from 33 trials) meeting the inclusion criteria, two thirds gained weight outside the IOM recommendations (1646 above; 1291 below). The median GWG outside the IOM recommendations was 3.1 kg above and 2.7 kg below. In comparison to GWG within the IOM recommendations, GWG above was associated with increased odds of caesarean section (aOR 1.50; 95%CI 1.25, 1.80), LGA (2.00; 1.58, 2.54), and reduced odds of SGA (0.66; 0.50, 0.87); no significant effect on preterm birth was detected. The relationship between GWG below the IOM recommendation and caesarean section or LGA was inconclusive; however, the odds of preterm birth (1.94; 1.31, 2.28) and SGA (1.52; 1.18, 1.96) were increased.

CONCLUSIONS

Consistently with previous findings, adherence to the IOM recommendations seem to help achieve better pregnancy outcomes. Nevertheless, even in the context of clinical trials, women find it difficult to adhere to them. Further research should focus on identifying ways of achieving a healthier GWG as defined by the IOM recommendations.

Authors+Show Affiliations

Meta-Analysis Group, MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK. e.rogozinska@ucl.ac.uk. Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. e.rogozinska@ucl.ac.uk.Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS) CIBER Epidemiology and Public Health, Madrid, Spain.Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, DK-2200, Copenhagen, Denmark.Department of Development and Regeneration, KU Leuven, Herestraat 49 - Box 805, B-3000, Leuven, Belgium. Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium.Rua Tessália Vieira de Camargo, 126 Cidade Universitária Zeferino Vaz, São Paulo, Campinas, CEP, 13083-887, Brazil. Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.Women's and Children's Hospital, Women's and Children's Health Network, Women's and Babies Division, 72 King William St, North Adelaide, SA, 5006, Australia. The Robinson Research Institute, School of Medicine, Department of Obstetrics and Gynaecology, University of Adelaide, Norwich Centre, 55 King William St, North Adelaide, SA, 5006, Australia.Obstetrics and Gynecology Unit, Mother Infant Department, University of Modena and Reggio Emilia, largo del Pozzo 71, 41124, Modena, Italy.Clinical Nutrition Research Unit, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, DK-2900 Hellerup, Copenhagen, Denmark.Department of Sports Medicine, Norwegian School of Sports Sciences, Sognsveien 220, 0863, Oslo, Norway.Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.Steno Diabetes Center Odense and Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Kløvervænget 6/4, 5000, Odense, Denmark. Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.Unit of Health Sciences, Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland.Department of Obstetrics and Gynaecology, Nursing and Health Sciences, Monash University, Melbourne, Victoria, 3800, Australia.The Robinson Research Institute, School of Medicine, Department of Obstetrics and Gynaecology, University of Adelaide, Norwich Centre, 55 King William St, North Adelaide, SA, 5006, Australia. Deputy Vice-Chancellor Research Office, Deakin University, Geelong, Australia.Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Denmark. Obstetric Clinic, JMC, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.Department of Laboratory Medicine Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 11, 7006, Trondheim, Norway. Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, 3010, Australia. Department of Perinatal Medicine, Mercy Hospital for Women, Postboks 8905, N-7491, Trondheim, Norway.Rua Tessália Vieira de Camargo, 126 Cidade Universitária Zeferino Vaz, São Paulo, Campinas, CEP, 13083-887, Brazil. Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway. Department of Clinical Service, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.Monash Centre for Health Research and Implementation, School of Public Health, Monash University and Monash Health, 246 Clayton Rd, Clayton, VIC, 3124, Australia.Institute of Sports Science, University of Graz, Mozartgasse 14,, 8010, Graz, Austria. Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Sdr. Boulevard 29, DK-5000, Odense, Denmark.Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. Multidisciplinary Evidence Synthesis Hub, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. Multidisciplinary Evidence Synthesis Hub, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31477075

Citation

Rogozińska, Ewelina, et al. "Gestational Weight Gain Outside the Institute of Medicine Recommendations and Adverse Pregnancy Outcomes: Analysis Using Individual Participant Data From Randomised Trials." BMC Pregnancy and Childbirth, vol. 19, no. 1, 2019, p. 322.
Rogozińska E, Zamora J, Marlin N, et al. Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials. BMC Pregnancy Childbirth. 2019;19(1):322.
Rogozińska, E., Zamora, J., Marlin, N., Betrán, A. P., Astrup, A., Bogaerts, A., Cecatti, J. G., Dodd, J. M., Facchinetti, F., Geiker, N. R. W., Haakstad, L. A. H., Hauner, H., Jensen, D. M., Kinnunen, T. I., Mol, B. W. J., Owens, J., Phelan, S., Renault, K. M., Salvesen, K. Å., ... Thangaratinam, S. (2019). Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials. BMC Pregnancy and Childbirth, 19(1), 322. https://doi.org/10.1186/s12884-019-2472-7
Rogozińska E, et al. Gestational Weight Gain Outside the Institute of Medicine Recommendations and Adverse Pregnancy Outcomes: Analysis Using Individual Participant Data From Randomised Trials. BMC Pregnancy Childbirth. 2019 Sep 2;19(1):322. PubMed PMID: 31477075.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials. AU - Rogozińska,Ewelina, AU - Zamora,Javier, AU - Marlin,Nadine, AU - Betrán,Ana Pilar, AU - Astrup,Arne, AU - Bogaerts,Annick, AU - Cecatti,Jose G, AU - Dodd,Jodie M, AU - Facchinetti,Fabio, AU - Geiker,Nina R W, AU - Haakstad,Lene A H, AU - Hauner,Hans, AU - Jensen,Dorte M, AU - Kinnunen,Tarja I, AU - Mol,Ben W J, AU - Owens,Julie, AU - Phelan,Suzanne, AU - Renault,Kristina M, AU - Salvesen,Kjell Å, AU - Shub,Alexis, AU - Surita,Fernanda G, AU - Stafne,Signe N, AU - Teede,Helena, AU - van Poppel,Mireille N M, AU - Vinter,Christina A, AU - Khan,Khalid S, AU - Thangaratinam,Shakila, AU - ,, Y1 - 2019/09/02/ PY - 2018/04/23/received PY - 2019/08/22/accepted PY - 2019/9/4/entrez PY - 2019/9/4/pubmed PY - 2019/9/4/medline KW - Body mass index KW - Gestational weight gain KW - Individual participant data KW - Institute of Medicine SP - 322 EP - 322 JF - BMC pregnancy and childbirth JO - BMC Pregnancy Childbirth VL - 19 IS - 1 N2 - BACKGROUND: High Body Mass Index (BMI) and gestational weight gain (GWG) affect an increasing number of pregnancies. The Institute of Medicine (IOM) has issued recommendations on the optimal GWG for women according to their pre-pregnancy BMI (healthy, overweight or obese). It has been shown that pregnant women rarely met the recommendations; however, it is unclear by how much. Previous studies also adjusted the analyses for various women's characteristics making their comparison challenging. METHODS: We analysed individual participant data (IPD) of healthy women with a singleton pregnancy and a BMI of 18.5 kg/m2 or more from the control arms of 36 randomised trials (16 countries). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to describe the association between GWG outside (above or below) the IOM recommendations (2009) and risks of caesarean section, preterm birth, and large or small for gestational age (LGA or SGA) infants. The association was examined overall, within the BMI categories and by quartile of GWG departure from the IOM recommendations. We obtained aOR using mixed-effects logistic regression, accounting for the within-study clustering and a priori identified characteristics. RESULTS: Out of 4429 women (from 33 trials) meeting the inclusion criteria, two thirds gained weight outside the IOM recommendations (1646 above; 1291 below). The median GWG outside the IOM recommendations was 3.1 kg above and 2.7 kg below. In comparison to GWG within the IOM recommendations, GWG above was associated with increased odds of caesarean section (aOR 1.50; 95%CI 1.25, 1.80), LGA (2.00; 1.58, 2.54), and reduced odds of SGA (0.66; 0.50, 0.87); no significant effect on preterm birth was detected. The relationship between GWG below the IOM recommendation and caesarean section or LGA was inconclusive; however, the odds of preterm birth (1.94; 1.31, 2.28) and SGA (1.52; 1.18, 1.96) were increased. CONCLUSIONS: Consistently with previous findings, adherence to the IOM recommendations seem to help achieve better pregnancy outcomes. Nevertheless, even in the context of clinical trials, women find it difficult to adhere to them. Further research should focus on identifying ways of achieving a healthier GWG as defined by the IOM recommendations. SN - 1471-2393 UR - https://www.unboundmedicine.com/medline/citation/31477075/Gestational_weight_gain_outside_the_Institute_of_Medicine_recommendations_and_adverse_pregnancy_outcomes:_analysis_using_individual_participant_data_from_randomised_trials_ L2 - https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2472-7 DB - PRIME DP - Unbound Medicine ER -
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