TABLE 22Gestational Weight Gain and SGA by BMI Status

Author, Year
Country, Setting
Sample Size
Baseline BMI
Quality
Pregravid Weight (How Measured)
Total Weight Gain (How Measured)
Definition of GroupsResultsConfounders and Effect Modifiers Included in Analysis
Caulfield et al., 1998116

USA, hospital obstetric database

3,870

All weights/BMI

Good
Pregravid weight:
Self-report

Total weight gain:
Routine prenatal care or maternity records
ORs and 95% CIs for SGA per 50g/wk increase in rate of weight gain by BMI

G1: Underweight
G2: Normal weight
G3: Overweight
G1: 0.87 (0.78–0.97)
G2: 0.90 (0.84–0.96)
G3: 0.93 (0.86–1.01)
Maternal age, race, parity, pregravid BMI, height, hypertension, provider type, smoking, infant sex
Cedergren, 200658

Sweden, Medical Birth Registry

245,526

All weights/BMI

Fair
Pregravid weight:
Self-report

Total weight gain:
Routine prenatal care or maternity records
ORs and 95% CIs for SGA (< 2 SD below the mean)

Weight gain < 8 kg
G1: BMI < 20
G2: BMI 20–24.9
G3: BMI 25–29.9
G4: BMI 30–34.9
G5: BMI ≥ 35

Weight gain > 16 kg
G6: BMI < 20
G7: BMI 20–24.9
G8: BMI 25–29.9
G9: BMI 30–34.9
G10: BMI ≥ 35

Weight gain 8–16 kg (Reference)
G1: 2.35 (1.92–2.88)
G2: 1.99 (1.77–2.23)
G3: 1.75 (1.48–2.07)
G4: 1.68 (1.26–2.25)
G5: 1.71 (1.03–2.85)

G6: 0.50 (0.41–0.61)
G7: 0.50 (0.45–0.56)
G8: 0.57 (0.47–0.68)
G9: 0.61 (0.40–0.93)
G10: 0.50 (0.20–1.24)
Maternal age, parity, smoking, year of birth
Cheng et al., 2004124

USA, birth certificate registry

14,114

All weights/BMI

Fair
Pregravid weight:
Self-report

Total weight gain:
Not stated
95% CIs of SGA for low weight gain (< 0.2 kg/wk) by BMI

G1: Underweight
G2: Normal weight
G3: Overweight
G4: Obese
G1: (1.2–2.4)
G2: (1.9–2.7)
G3: (1.6–2.9)
G4: (1.4–2.1)
Maternal age, education, Medicaid status, pregravid BMI, smoking, previous SGA, adequacy of prenatal care, maternal cardiac disease, preeclampsia, year of birth of second infant
Zhou and Olsen, 1997108

Denmark, two communities

Cohort

7,122

Fair
Pregravid weight:
Self-report

Total weight gain:
Routine prenatal care or maternity records
% Growth retardation (birthweight < 3,000g and placental weight > 490g) by weight gain category and BMI

Weight gain < 11 kg
G1: Underweight (Reference)
G2: Normal
G3: Overweight

Weight gain 12–15 kg
G4: Underweight
G5: Normal
G6: Overweight

Weight gain > 16 kg
G7: Underweight
G8: Normal
G9: Overweight
G1: 1.0
G2: 0.6 (0.4–0.8)
G3: 0.6 (0.4–1.1)

G4: 0.3 (0.2–0.5)
G5: 0.4 (0.3–0.6)
G6: 0.4 (0.1–1.0)

G7: 0.3 (0.2–0.5)
G8: 0.2 (0.1–0.3)
G9: 0.2 (0.1–0.6)
Maternal age, parity, alcohol, diabetes, term delivery, smoking, gestational age, infant sex
Kabiru and Raynor, 200451

USA, hospital

5,131

All weights/BMI

Poor
Pregravid weight:
Measured at first prenatal visit

Total weight gain:
Routine prenatal care or maternity records
% SGA
G1: No change in BMI category
G2: 1 category increase in BMI
G3: > 1 category increase in BMI

% SGA among overweight
G4: No change in BMI category
G5: 1 category increase in BMI
G6: > 1 category increase in BMI
G1: 19.5%
G2: 13.5%
G3: 9.5%
G4: 14.2%
G5: 9.9%
G6: 11.5%
N/A
Wataba et al., 200661

Japan, academic medical center

21,718

All weights/BMI

Poor
Pregravid weight:
Not stated

Total weight gain:
Routine prenatal care or maternity records
ORs and 95% CIs for SGA

Parous, Low BMI (< 18)
G1: WG < 0.15 kg/wk
G2: WG 0.15–0.20 kg/wk
G3: WG 0.20–0.25 kg/wk
G4: WG 0.25–0.30 kg/wk (Reference)

Parous, Medium BMI (18–23.9)
G5: WG < 0.15 kg/wk
G6: WG 0.15–0.20 kg/wk
G7: WG 0.20–0.25 kg/wk (Reference)

Parous, High BMI (> 24)
G8: WG < 0.15 kg/wk
G9: WG 0.15–0.20 kg/wk (Reference)

Nulliparous, Low BMI (< 18)
G10: WG < 0.15 kg/wk
G11: WG 0.15–0.20 kg/wk
G12: WG 0.20–0.25 kg/wk
G13: WG 0.25–0.30 kg/wk (Reference)

Nulliparous, Medium BMI (18–23.9)
G14: WG < 0.15 kg/wk
G15: WG 0.15–0.20 kg/wk
G16: WG 0.20–0.25 kg/wk
G17: WG 0.25–0.30 (Reference)

Nulliparous, High BMI (> 24)
G18: WG < 0.05 kg/wk
G19: WG 0.15–0.20 kg/wk (Reference)
G1: 5.42 (2.86–10.27)
G2: 2.78 (1.53–5.06)
G3: 1.39 (0.82–2.42)
G4: 1.0

G5: 2.21 (1.67–2.93)
G6: 1.68 (1.23–2.07)
G7: 1.0

G8: 2.82 (1.17–6.78)
G9: 1.0

G10: 6.20 (2.72–14.09)
G11: 2.58 (1.14–5.87)
G12: 2.46 (1.19–5.08)
G13: 1.0

G14: 2.64 (1.88–3.71)
G15: 1.60 (1.15–2.23)
G16: 1.39 (1.03–1.87)
G17: 1.0

G18: 7.06 (2.11–23.61)
G19: 1.0
Preeclampsia, C-section, 1-minute Apgar score < 4

BMI, body mass index; cat, category; CI, confidence interval; g, gram; G, group; kg, kilogram; kg/wk, kilogram per week; lbs, pounds; med, medium; OR, odds ratio; SD, standard deviation; SGA, small-for-gestational age.

From: E, Results from the Evidence-Based Report on Outcomes of Maternal Weight Gain

Cover of Weight Gain During Pregnancy
Weight Gain During Pregnancy: Reexamining the Guidelines.
Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines; Rasmussen KM, Yaktine AL, editors.
Washington (DC): National Academies Press (US); 2009.
Copyright © 2009, National Academy of Sciences.

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