Impact of Gestational Weight Gain on Perinatal Outcomes in Obese Women.

Objective This study aims to evaluate perinatal outcomes, according to gestational weight gain (GWG) in obese women. Study Design A retrospective cohort of perinatal outcomes in obese women who gained below, within, or above the 2009 Institute of Medicine guidelines and delivered ≥ 36 weeks. Additionally, outcomes, according to the rate of GWG (kg/week; minimal [< 0.16], moderate [0.16-0.49], or excessive [> 0.49]) were compared among women delivering preterm. Results Overall, 5,651 obese women delivered ≥ 36 weeks. GWG above guidelines was associated with increased cesarean section (adjusted odds ratio [aOR]: 1.44, 95% confidence interval [CI]: 1.21-1.72), gestational hypertension (aOR: 1.58, 95% CI: 1.21-2.06), and macrosomia (birth weight ≥ 4,000 g) (aOR: 2.08, 95% CI: 1.62-2.67). GWG below recommendations was associated with less large for gestational age infants (aOR: 0.60, 95% CI: 0.47-0.75). A total of 6,663 women delivered ≥ 20 weeks. Minimal weekly GWG was associated with increased spontaneous preterm birth (aOR: 1.56, 95% CI: 1.23-1.98) and more small for gestational age (SGA) infants (aOR: 1.55, 95% CI: 1.19-2.01). Excessive weekly GWG was associated with increased indicated preterm birth (aOR: 1.61, 95% CI: 1.29-2.01), cesarean section (aOR: 1.39, 95% CI: 1.20-1.61), preeclampsia (aOR: 1.83, 95% CI: 1.49-2.26), neonatal intensive care unit admission (aOR: 1.33, 95% CI: 1.08-1.63), and macrosomia (aOR: 2.40, 95% CI: 1.94-2.96). Conclusions Obese women with excessive GWG had worse outcomes than women with GWG within recommendations. Limited GWG was associated with increased spontaneous preterm birth and SGA infants.

Durst JK ，Sutton AL ，Cliver SP ，Tita AT ，Biggio JR ... -  《-》

[Relationship between the risk of emergency cesarean section for nullipara with the prepregnancy body mass index or gestational weight gain].

Zhao RF ，Zhang WY ，Zhou L 《-》

Weight gain after diagnosis of gestational diabetes mellitus and its association with adverse pregnancy outcomes: a cohort study.

Zheng W ，Huang W ，Liu C ，Yan Q ，Zhang L ，Tian Z ，Yuan X ，Li G ... -  《BMC Pregnancy and Childbirth》

Outcomes of gestational weight gain outside the Institute of Medicine Guidelines.

Asvanarunat E 《-》

Evaluating gestational weight gain recommendations in pregestational diabetes.

The Institute of Medicine (IOM) does not provide recommendations for gestational weight gain (GWG) specific to women with pregestational diabetes. We aimed to assess the impact of GWG outside the IOM recommendations on perinatal outcomes. We performed a retrospective cohort study of all singletons with pregestational diabetes from 2008 through 2013. Women were classified as GWG within, less than, or greater than IOM recommendations for body mass index per week of pregnancy. Maternal outcomes examined were cesarean delivery, preeclampsia, and percentage of visits with glycemic control (>50% blood sugars at goal). Neonatal outcomes were birthweight, small for gestational age (<10th percentile), large for gestational age (LGA) (>90th percentile), macrosomia (>4000 g), preterm delivery (<37 weeks), and birth injury (shoulder dystocia, fracture, brachial plexus injury, cephalohematoma). Groups were compared using analysis of variance and χ(2) test, as appropriate. Backwards stepwise logistic regression was used to adjust for confounding factors. Of 340 subjects, 37 (10.9%) were within, 64 (18.8%) less than, and 239 (70.3%) greater than IOM recommendations. The incidence of cesarean delivery, preeclampsia, glycemic control, preterm delivery, and birth injury were not significantly different between GWG groups. The incidence of LGA and macrosomia increased as GWG category increased (adjusted odds ratio [AOR], 3.08; 95% confidence interval [CI], 1.13-8.39 and AOR, 4.02; 95% CI, 1.16-13.9, respectively) without decreasing the incidence of small for gestational age (AOR, 0.34; 95% CI, 0.10-1.19). Increases in the risk in LGA and macrosomia were not explained by differences in glycemic control by GWG groups. Women with pregestational diabetes mellitus should be counseled to gain within the IOM recommendations to avoid LGA and macrosomic newborns.

Siegel AM ，Tita A ，Biggio JR ，Harper LM ... -  《-》