TABLE 32Weight Change Relative to IOM Thresholds and Birthweight

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
Nielsen, 2006153

USA, prenatal clinics

African-Americans only

815

All weight/BMIs

Good
Pregravid weight:
Self-reported

Total weight gain:
Prenatal records, measured
G1: < IOM
G2: lower half IOM range
G3: Upper half IOM range
G4: > IOM
Adjusted birthweight
BMI < 19.8
G1: 2,986 g
G2: 3,167 g
G3: 3,198 g
G4: 3,277 g
All significantly different from each other except G2 & G3
BMI 19.8–26
G1: 3,018 g
G2: 3,166 g
G3: 3,255 g
G4: 3,318 g
All significantly different from each other
BMI > 26
G1: 3,127 g
G2: 3,351 g
G3: 3,384 g
G4: 3,434 g
G1 significantly different from the others, G2, G3 & G4 not significantly different from each other
Parity, pregravid BMI, preeclampsia, time between last weight measure and delivery, height, smoking, infant sex
Hickey et al., 199720

USA, public health programs

5,198

All wt/BMI (using IOM definitions)

Fair
Pregravid weight:
Self-reported

Total weight gain:
Measured weights-prenatal records
G1: Below IOM range
G2: Lower end of IOM range
G3: Upper end of IOM range
G4: Gain above IOM range
BMI < 19.8
G1:
Black: 2,840
White: 3,002

G2:
Black: 2,995
White: 3,151

G3:
Black: 3,017
White: 3,200

G4:
Black: 3,163
White: 3,353
BMI 19.8–26.0
G1:
Black: 3,052
White: 3,176

G2:
Black: 3,105
White: 3,199

G3:
Black: 3,180
White: 3,307

G4:
Black: 3,228
White: 3,389
BMI > 26.0
G1:
Black: 3,126
White: 3,385

G2:
Black: 3,192
White: 3,376

G3:
Black: 3,312
White: 3,402
G4:
Black: 3,300
White: 3,504
Age, education, height, street drugs, alcohol use, time between last prenatal weight observation and delivery, smoking, gestational age, infant sex
Hickey et al., 1996155

USA, prenatal clinics

415

Under & Normal weight

Fair
Pregravid BMI:
Self-reported

Total weight gain:
Prenatal records
G1: First trimester < 2.6 kg for underwt (BMI < 19.8) & < 1.6 kg for normal wt (BMI 19.8–26)

G2: Second trimester < 0.38 kg/wk for underwt & < 0.37 kg/wk for normal wt

G3: < 0.38 kg/wk for underwt & < 0.37 kg/wk for normal wt
Association of low trimester gain with birthwt
G1: all women −18 g P = .65
Black −15 g P = .76
White −42 g P = .53

G2: All women −166g P = < .001
Black −164 g P = .005
White −158 g P = .05

G3: All women −111g P = .008
Black −77 g P = .14
White −194 g P = .004
No association with low weight gain in only the first or second trimester.
G3: All −164 g P = .01
Black −80 g P = .38
White −300 g P = .005

Association with low weight gain during more than one trimester

G1 & G2: All −236 g P = .01
Black −265 g P = .04
White −169 g P = .25
G1 & G3: No significant diff

G2 & G3: All −206 g P = .01
Black −178 g P = .08
White −268 g P = .06

G1, G2 & G3: All −284 g P = .002
Black −252 g P = .03
White −379 g P = .008
Age, race, pregravid BMI, height, alcohol use, third trimester number of weeks between last weight observation and delivery, history of previous infant < 2,750 g, smoking, gestational age, infant sex
Hickey et al., 1993156

USA, prenatal clinics

1,168

All weight/BMIs

Fair
Pregravid BMI:
Self-reported

Total weight gain:
Prenatal records
BMI ≤ 29
G1: gain < range
G2: gain in the range
G3: gain > range

BMI > 29
G4: gain < 6.0 kg
G5: gain > 6.0 kg
Adjusted Birthwt
BMI ≤ 29
G1:
Black: 3,027
White: 3,246

G2:
Black: 3,177
White: 3,233

G3:
Black: 3,293
White: 3,523
BMI > 29
G4:
Black: 3,214
White: 3,500

G5:
Black: 3,553
White: 3,596
Maternal height, education, parity, marital status, smoking, alcohol use, hypertension, GDM, gestational age at delivery, socioeconomic status, time between last weight and delivery
Luke et al., 1996104

USA, clinic

487

All weight/BMIs

Fair
Pregravid weight:
Self-reported

Total weight gain:
Prenatal records, measured
G1: Gain < IOM
G2: gain equal to IOM
G3: gain > IOM
Adjusted birthweight
G1:
BMI < 19.8 2,873 g*
BMI 19.8–26.0 3,157 g*
BMI > 26 3,138 g

G2:
BMI < 19.8 3,190 g
BMI 19.8–26 3,298 g
BMI > 26 3,338 g

G3:
BMI < 19.8 3,489 g*
BMI 19.8–26 3,494 g*
BMI > 26 3,347 g

* significantly different from gains within range within each BMI grouping
Maternal age, parity, black ethnicity, smoking, gestational duration, fetal sex
May, 2007157

USA, WIC clinic

233

All weight/BMI

Fair
Pregravid weight:
Self reported

Total gestational weight gain:
Self-reported
G1: Below IOM
G2: Greater IOM
Betas from multiple linear regression
G1: −162 g
G2: −153 g
Maternal BMI, smoking, gestational age at delivery
Ogunyemi et al., 199860

USA, Hospital

582

All weight/BMIs (using IOM definitions)

Fair
Pregravid weight:
Self-reported

Total gestational weight gain:
Prenatal records, measured
G1: Low < IOM
G2: Normal = IOM
G3: High > IOM
Birthweight
G1: 3,029
G2: 3,210
G3: 3,283 (P < 0.01)
NR
Scholl et al., 1995158

USA Camden Study

274

Normal weight BMI 19.8–26

air
Pregravid weight:
Self-reported

Total weight gain:
Prenatal records, measured
Rate between 20–36 wks
G1: low rate < 0.34 kg/wk
G2: moderate rate 0.34– 0.68 kg/wk
G3: Excessive rate > 0.68 kg/wk
Birthweight (g):
G1: 3,049 (56.94) P < 0.05, low vs. moderate plus excessive weight gain
G2: 3,208 (36.33)
G3: 3,191 (49.46)
NR
Stevens-Simon and McAnarney, 1992154

USA African-American adolescent maternity program

141

All BMI

Fair
Pregravid weight:
Self-reported

Total weight gain:
Prenatal records, measured
G1: slow < 0.23 kg/wk
G2: average 0.23–4 kg/wk
G3: rapid > 0.4 kg/wk
Birthweight (g):
G1: 2,745 (694)
G2: 3,097 (457)
G3: 3,351 (482) P < 0.0001
No difference in pregravid by weight gain groups
NR
Bianco et al., 199854

USA, medical center

11,926

Nonobese (BMI 19–27) and morbidly obese (BMI > 35)

Poor
Pregravid weight:
Self-report

Total weight gain:
Measured
Maternal weight gain categories among morbidly obese:
G1: Weight loss/no change
G2: 1–15 lbs
G3: 16–25 lbs
G4: 26–35 lbs
G5: > 35 lbs
G1: 3,302 g
G2: 3,192 g
G3: 3,337 g
G4: 3,506 g
G5: 3,453 g
P = < 0.05
NR

&, and; AOR, adjusted odds ratio; birthwt, birthweight; BMI, body mass index; g, gram; G, group; GDM, gestational diabetes mellitus; IOM, Institute of Medicine; kg/wk, kilogram per week; NR, not/none reported; OR, odds ratio; underwt, underweight; USA, United States of America; WIC, The Special Supplemental Nutrition Program for Women, Infants, and Children.

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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