Association of gestational weight gain with maternal and infant outcomes

A systematic review and meta-analysis

Rebecca F. Goldstein, Sally K. Abell, Sanjeeva Ranasinha, Marie Misso, Jacqueline A. Boyle, Mary Helen Black, Nan Li, Gang Hu, Francesco Corrado, Line Rode, Young Ju Kim, Margaretha Haugen, Won O. Song, Min Hyoung Kim, Annick Bogaerts, Roland Devlieger, Judith H. Chung, Helena J. Teede

Research output: Contribution to journalArticleResearchpeer-review

171 Citations (Scopus)

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 the IOM 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 [BMI18.5-24.9]; 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 = 1309136 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.

Original languageEnglish
Pages (from-to)2207-2225
Number of pages19
JournalJAMA
Volume317
Issue number21
DOIs
Publication statusPublished - 6 Jun 2017

Cite this

Goldstein, Rebecca F. ; Abell, Sally K. ; Ranasinha, Sanjeeva ; Misso, Marie ; Boyle, Jacqueline A. ; Black, Mary Helen ; Li, Nan ; Hu, Gang ; Corrado, Francesco ; Rode, Line ; Kim, Young Ju ; Haugen, Margaretha ; Song, Won O. ; Kim, Min Hyoung ; Bogaerts, Annick ; Devlieger, Roland ; Chung, Judith H. ; Teede, Helena J. / Association of gestational weight gain with maternal and infant outcomes : A systematic review and meta-analysis. In: JAMA. 2017 ; Vol. 317, No. 21. pp. 2207-2225.
@article{d14bc0a269b741a69513085874700573,
title = "Association of gestational weight gain with maternal and infant outcomes: A systematic review and meta-analysis",
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 the IOM 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 [BMI18.5-24.9]; 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 = 1309136 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.",
author = "Goldstein, {Rebecca F.} and Abell, {Sally K.} and Sanjeeva Ranasinha and Marie Misso and Boyle, {Jacqueline A.} and Black, {Mary Helen} and Nan Li and Gang Hu and Francesco Corrado and Line Rode and Kim, {Young Ju} and Margaretha Haugen and Song, {Won O.} and Kim, {Min Hyoung} and Annick Bogaerts and Roland Devlieger and Chung, {Judith H.} and Teede, {Helena J.}",
year = "2017",
month = "6",
day = "6",
doi = "10.1001/jama.2017.3635",
language = "English",
volume = "317",
pages = "2207--2225",
journal = "JAMA",
issn = "0098-7484",
publisher = "American Medical Association (AMA)",
number = "21",

}

Goldstein, RF, Abell, SK, Ranasinha, S, Misso, M, Boyle, JA, Black, MH, Li, N, Hu, G, Corrado, F, Rode, L, Kim, YJ, Haugen, M, Song, WO, Kim, MH, Bogaerts, A, Devlieger, R, Chung, JH & Teede, HJ 2017, 'Association of gestational weight gain with maternal and infant outcomes: A systematic review and meta-analysis', JAMA, vol. 317, no. 21, pp. 2207-2225. https://doi.org/10.1001/jama.2017.3635

Association of gestational weight gain with maternal and infant outcomes : A systematic review and meta-analysis. / Goldstein, Rebecca F.; Abell, Sally K.; Ranasinha, Sanjeeva; Misso, Marie; Boyle, Jacqueline A.; Black, Mary Helen; Li, Nan; Hu, Gang; Corrado, Francesco; Rode, Line; Kim, Young Ju; Haugen, Margaretha; Song, Won O.; Kim, Min Hyoung; Bogaerts, Annick; Devlieger, Roland; Chung, Judith H.; Teede, Helena J.

In: JAMA, Vol. 317, No. 21, 06.06.2017, p. 2207-2225.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Association of gestational weight gain with maternal and infant outcomes

T2 - 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 - 2017/6/6

Y1 - 2017/6/6

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 the IOM 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 [BMI18.5-24.9]; 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 = 1309136 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.

AB - 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 the IOM 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 [BMI18.5-24.9]; 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 = 1309136 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.

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DO - 10.1001/jama.2017.3635

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