(01-06-10) Severe obesity, gestational weight gain, and adverse birth outcomes1,2,3

Lisa M Bodnar, Anna Maria Siega-Riz, Hyagriv N Simhan, Katherine P Himes and Barbara Abrams

1 From the Department of Epidemiology Graduate School of Public Health (LMB)the Department of Obstetrics GynecologyReproductive Sciences School of Medicine (LMB HNSKPH) University of Pittsburgh Pittsburgh PA; the Magee-Womens Research Institute Pittsburgh PA (LMB HNSKPH); the Departments of EpidemiologyNutrition Gillings School of Global Public Health University of North Carolina Chapel Hill NC (AMS-R);the Division of Epidemiology School of Public Health University of California Berkeley CA (BA).
2 Supported by National Institutes of Health grants K01 MH074092 and R01 HD056999 (to LMB) and R01 HD041663 and R01 HD052732 (to HNS).
3 Address correspondence to LM Bodnar, Department of Epidemiology, University of Pittsburgh, A742 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261. E-mail: [email protected] .
Background: The 2009 Institute of Medicine (IOM) Committee to Reevaluate Gestational Weight Gain Guidelines concluded that there were too few data to inform weight-gain guidelines by obesity severity. Therefore, the committee recommended a single range, 5?9 kg at term, for all obese women.
Objective: We explored associations between gestational weight gain and small-for-gestational-age (SGA) births, large-for-gestational-age (LGA) births, spontaneous preterm births (sPTBs), and medically indicated preterm births (iPTBs) among obese women who were stratified by severity of obesity.
Design: We studied a cohort of singleton, live-born infants without congenital anomalies born to obesity class 1 (prepregnancy body mass index [BMI (in kg/m2)]: 30?34.9; n = 3254), class 2 (BMI: 35?39.9; n = 1451), and class 3 (BMI: 40; n = 845) mothers. We defined the adequacy of gestational weight gain as the ratio of observed weight gain to IOM-recommended gestational weight gain.
Results: The prevalence of excessive gestational weight gain declined, and weight loss increased, as obesity became more severe. Generally, weight loss was associated with an elevated risk of SGA, iPTB, and sPTB, and a high weight gain tended to increase the risk of LGA and iPTB. Weight gains associated with probabilities of SGA and LGA of 10% and a minimal risk of iPTB and sPTB were as follows: 9.1?13.5 kg (obesity class 1), 5.0?9 kg (obesity class 2), 2.2 to <5.0 kg (obesity class 3 white women), and <2.2 kg (obesity class 3 black women).
Conclusion: These data suggest that the range of gestational weight gain to balance risks of SGA, LGA, sPTB, and iPTB may vary by severity of obesity.

Source: Am J Clin Nutr 91: 1642-1648, 2010.

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