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Evidence summaries

Association of Gestational Weight Gain with Maternal and Infant Outcomes

Higher than recommended gestational weight gain appears to increase the risk of macrosomia and large for gestational age, and may increase caeserean section rate compared with recommended gestational weight gain. Level of evidence: "B"

The quality of evidence is upgraded by large magnitude of effect and consistent findings.

Summary

A meta-analysis 1 included including 23 trials (n=1 309 136 ) evaluated the Institute of Medicine (IOM) guidelines (see below table T1) and maternal and infant outcomes. Gestational weight gain (GWG) was below or above IOM guidelines in 23% and 47% of pregnancies, respectively. GWG below the recommendations was associated with higher risk of small for gestational age (SMA) (OR 1.53, 95% CI 1.44 to 1.64), absolute risk difference (ARD) 5% and preterm birth (OR 1.70, 95% CI 1.32 to 2.20), ARD, 5%, and lower risk of large for gestational age (LGA) (OR 0.59, 95% CI 0.55 to 0.64), ARD -2%, and macrosomia (OR 0.60, 95% CI 0.52 to 0.68), ARD -2%. GWG above the recommendations was associated with lower risk of SGA (OR 0.66, 95% CI 0.63 to 0.69), ARD -3% and preterm birth (OR 0.77, 95% CI 0.69 to 0.86), ARD -2% and higher risk of LGA (OR 1.85, 95% CI 1.76 to 1.95), ARD 4%, macrosomia (OR 1.95, 95% CI 1.79 to 2.11), ARD 6%, and caesarean delivery (OR 1.30, 95% CI 1.25 to 1.35), ARD 4%. Gestational diabetes (GDM) could not be evaluated.

Recommended weight gain in pregnancy (IOM guideline 2009)

BMI before pregnancyRecommended weight gain (kg)
<18.512.5 - 18.0
18.5 - 24.911.5 - 16.0
25.0 - 29.97.0 - 11.5
≥305.9 - 9.0

Another meta-analysis 3 analyzed individual participant data (IPD) of healthy women with a singleton pregnancy and a BMI of 18.5 or more from the control arms of 36 randomised trials (16 countries). Out of 4429 women (from 33 trials), 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 to 1.80), LGA (aOR 2.00, 95% CI 1.58 to 2.54), and reduced odds of SGA (0.66, 95% CI 0.50 to 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 (aOR 1.94, 95% CI 1.31 to 2.28) and SGA (aOR 1.52, 95% CI 1.18 to 1.96) were increased.

A systematic review and meta-analysis 4 evaluating the association of different types of diet and physical activity-based antenatal lifestyle interventions with gestational weight gain (GWG) and maternal and neonatal outcomes included 117 RCTs with a total of 34 546 women. Compared with routine care, diet was associated with less GWG (-2.63 kg; 95% CI, -3.87 to -1.40) than physical activity (-1.04 kg; 95% CI, -1.33 to -0.74) or mixed interventions (eg, unstructured lifestyle support, written information with weight monitoring, or behavioral support alone) (-0.74 kg; 95% CI, -1.06 to -0.43). Diet was associated with reduced risk of GDM (OR, 0.61; 95% CI, 0.45 to 0.82), preterm delivery (OR, 0.43; 95% CI, 0.22 to 0.84), large for gestational age neonate (OR, 0.19; 95% CI, 0.08 to 0.47), neonatal intensive care admission (OR, 0.68; 95% CI, 0.48 to 0.95), and total adverse maternal (OR, 0.75; 95% CI, 0.61 to 0.92) and neonatal outcomes (OR, 0.44; 95% CI, 0.26 to 0.72). Physical activity was associated with reduced GWG and reduced risk of GDM (OR, 0.60; 95% CI, 0.47 to 0.75), hypertensive disorders (OR, 0.66; 95% CI, 0.48 to 0.90), cesarean section (OR, 0.85; 95% CI, 0.75 to 0.95), and total adverse maternal outcomes (OR, 0.78; 95% CI, 0.71 to 0.86). Diet with physical activity was associated with reduced GWG (-1.35 kg; 95% CI, -1.95 to -0.75) and GDM (OR, 0.72; 95% CI, 0.54 to 0.96) and total adverse maternal outcomes (OR, 0.81; 95% CI, 0.69 to 0.95).

A retrospective observational study 2 assessed whether weight control after GDM diagnosis improves outcomes (n=546). Higher total gestational weight gain was associated with caesarean section (OR 1.05, 95% CI 1.02 to 1.08, P < 0.001) and LGA (OR 1.08, 95% CI 1.03 to 1.12, P < 0.001). Higher late gestational weight gain (28-36 weeks; n = 144) was associated with LGA (OR 1.17, 95% CI 1.01 to 1.37, P < 0.05), instrumental deliveries (OR 1.26, 95% CI 1.03 to 1.55, P < 0.01), higher total daily insulin doses (36 weeks; beta coefficient 4.37, 95% CI 1.92-6.82, P < 0.001).

Clinical comments

Note

Date of latest search: 2020-05-22

    References

    • 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. [PubMed]
    • Aiken CEM, Hone L, Murphy HR et al. Improving outcomes in gestational diabetes: does gestational weight gain matter? Diabet Med 2019;36(2):167-176. [PubMed]
    • Rogozinska 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. [PubMed]
    • Teede HJ, Bailey C, Moran LJ et al. Association of Antenatal Diet and Physical Activity-Based Interventions With Gestational Weight Gain and Pregnancy Outcomes: A Systematic Review and Meta-analysis. JAMA Intern Med 2022;182(2):106-114. [PubMed]

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