Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes

Analysis using individual participant data from randomised trials

Ewelina Rogozińska, Javier Zamora, Nadine Marlin, Ana Pilar Betrán, Arne Astrup, Annick Bogaerts, Jose G. Cecatti, Jodie M. Dodd, Fabio Facchinetti, Nina R.W. Geiker, Lene A.H. Haakstad, Hans Hauner, Dorte M. Jensen, Tarja I. Kinnunen, Ben W.J. Mol, Julie Owens, Suzanne Phelan, Kristina M. Renault, Kjell Salvesen, Alexis Shub & 8 others Fernanda G. Surita, Signe N. Stafne, Helena Teede, Mireille N.M. Van Poppel, Christina A. Vinter, Khalid S. Khan, Shakila Thangaratinam, for the i-WIP (International Weight Management in Pregnancy) Collaborative Group

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Article number322
Number of pages12
JournalBMC Pregnancy and Childbirth
Volume19
Issue number1
DOIs
Publication statusPublished - 2 Sep 2019

Keywords

  • Body mass index
  • Gestational weight gain
  • Individual participant data
  • Institute of Medicine

Cite this

Rogozińska, E., Zamora, J., Marlin, N., Betrán, A. P., Astrup, A., Bogaerts, A., ... for the i-WIP (International Weight Management in Pregnancy) Collaborative Group (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, Ewelina ; Zamora, Javier ; Marlin, Nadine ; Betrán, Ana Pilar ; Astrup, Arne ; Bogaerts, Annick ; Cecatti, Jose G. ; Dodd, Jodie M. ; Facchinetti, Fabio ; Geiker, Nina R.W. ; Haakstad, Lene A.H. ; Hauner, Hans ; Jensen, Dorte M. ; Kinnunen, Tarja I. ; Mol, Ben W.J. ; Owens, Julie ; Phelan, Suzanne ; Renault, Kristina M. ; Salvesen, Kjell ; Shub, Alexis ; Surita, Fernanda G. ; Stafne, Signe N. ; Teede, Helena ; Van Poppel, Mireille N.M. ; Vinter, Christina A. ; Khan, Khalid S. ; Thangaratinam, Shakila ; for the i-WIP (International Weight Management in Pregnancy) Collaborative Group. / Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes : Analysis using individual participant data from randomised trials. In: BMC Pregnancy and Childbirth. 2019 ; Vol. 19, No. 1.
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title = "Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: Analysis using individual participant data from randomised trials",
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.",
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author = "Ewelina Rogozińska and Javier Zamora and Nadine Marlin and Betr{\'a}n, {Ana Pilar} and Arne Astrup and Annick Bogaerts and Cecatti, {Jose G.} and Dodd, {Jodie M.} and Fabio Facchinetti and Geiker, {Nina R.W.} and Haakstad, {Lene A.H.} and Hans Hauner and Jensen, {Dorte M.} and Kinnunen, {Tarja I.} and Mol, {Ben W.J.} and Julie Owens and Suzanne Phelan and Renault, {Kristina M.} and Kjell Salvesen and Alexis Shub and Surita, {Fernanda G.} and Stafne, {Signe N.} and Helena Teede and {Van Poppel}, {Mireille N.M.} and Vinter, {Christina A.} and Khan, {Khalid S.} and Shakila Thangaratinam and {for the i-WIP (International Weight Management in Pregnancy) Collaborative Group} and Arri Coomarasamy and Roland Devlieger and {El Beltagy}, Nermean and Kym Guelfi and Cheryce Harrison and Janette Khoury and Riitta Luoto and Siv M{\o}rkved and Narges Motahari and Fionnuala McAuliffe and Maria Perales and Elisabetta Petrella and Lucilla Poston and Kathrin Rauh and Sagedal, {Linda R.} and Scudeller, {T{\^a}nia T.} and Shen, {Gary X.} and Serena Tonstad and Ingvild Vistad and Marcia Vitolo and Seonae Yeo",
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language = "English",
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journal = "BMC Pregnancy and Childbirth",
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Rogozińska, E, Zamora, J, Marlin, N, Betrán, AP, Astrup, A, Bogaerts, A, Cecatti, JG, Dodd, JM, Facchinetti, F, Geiker, NRW, Haakstad, LAH, Hauner, H, Jensen, DM, Kinnunen, TI, Mol, BWJ, Owens, J, Phelan, S, Renault, KM, Salvesen, K, Shub, A, Surita, FG, Stafne, SN, Teede, H, Van Poppel, MNM, Vinter, CA, Khan, KS, Thangaratinam, S & for the i-WIP (International Weight Management in Pregnancy) Collaborative Group 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, vol. 19, no. 1, 322. https://doi.org/10.1186/s12884-019-2472-7

Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes : Analysis using individual participant data from randomised trials. / Rogozińska, Ewelina; Zamora, Javier; Marlin, Nadine; Betrán, Ana Pilar; Astrup, Arne; Bogaerts, Annick; Cecatti, Jose G.; Dodd, Jodie M.; Facchinetti, Fabio; Geiker, Nina R.W.; Haakstad, Lene A.H.; Hauner, Hans; Jensen, Dorte M.; Kinnunen, Tarja I.; Mol, Ben W.J.; Owens, Julie; Phelan, Suzanne; Renault, Kristina M.; Salvesen, Kjell; Shub, Alexis; Surita, Fernanda G.; Stafne, Signe N.; Teede, Helena; Van Poppel, Mireille N.M.; Vinter, Christina A.; Khan, Khalid S.; Thangaratinam, Shakila; for the i-WIP (International Weight Management in Pregnancy) Collaborative Group.

In: BMC Pregnancy and Childbirth, Vol. 19, No. 1, 322, 02.09.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes

T2 - 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

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 - for the i-WIP (International Weight Management in Pregnancy) Collaborative Group

AU - Coomarasamy, Arri

AU - Devlieger, Roland

AU - El Beltagy, Nermean

AU - Guelfi, Kym

AU - Harrison, Cheryce

AU - Khoury, Janette

AU - Luoto, Riitta

AU - Mørkved, Siv

AU - Motahari, Narges

AU - McAuliffe, Fionnuala

AU - Perales, Maria

AU - Petrella, Elisabetta

AU - Poston, Lucilla

AU - Rauh, Kathrin

AU - Sagedal, Linda R.

AU - Scudeller, Tânia T.

AU - Shen, Gary X.

AU - Tonstad, Serena

AU - Vistad, Ingvild

AU - Vitolo, Marcia

AU - Yeo, Seonae

PY - 2019/9/2

Y1 - 2019/9/2

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.

AB - 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.

KW - Body mass index

KW - Gestational weight gain

KW - Individual participant data

KW - Institute of Medicine

UR - http://www.scopus.com/inward/record.url?scp=85071749301&partnerID=8YFLogxK

U2 - 10.1186/s12884-019-2472-7

DO - 10.1186/s12884-019-2472-7

M3 - Article

VL - 19

JO - BMC Pregnancy and Childbirth

JF - BMC Pregnancy and Childbirth

SN - 1471-2393

IS - 1

M1 - 322

ER -