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Am J Clin Nutr. 2010 Sep;92(3):644-51. doi: 10.3945/ajcn.2010.29726. Epub 2010 Jul 14.

Gestational weight gain in obese mothers and associations with fetal growth.

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Emory University, Atlanta, GA, USA.



In 2009, the Institute of Medicine recommended gestational weight gains (GWGs) of 5-9 kg for all obese women. Recommendations by severity of obesity were not specified because of a lack of available data.


Our objective was to examine associations between GWG and fetal growth in obese women and assess interactions with obesity severity.


We used 2004-2006 Pregnancy Nutrition Surveillance System data from 122,327 obese mothers [prepregnant body mass index (BMI; in kg/m(2)) ge 30]. We used logistic regression to estimate measures of fetal growth including small-for-gestational-age, which was defined as birth weight (BW) lt 2 SDs below the sex and race-ethnicity-specific mean BW (SGA(2SD)), and macrosomia (BW ge 4500 g). We tested for interactions between obesity severity (class I: BMI of 30-34.9; class II: BMI of 35.0-39.9; class III: BMI ge 40) and GWG.


Obesity severity modified associations between GWG and fetal growth. Compared with weight gains of 5-9 kg, weight loss in class I women significantly increased the odds of SGA(2SD), whereas a GWG from 0.1 to 4.9 kg was not associated with SGA(2SD) and did not decrease the odds of macrosomia. In class II and III women, compared with weight gains of 5-9 kg, a GWG from minus 4.9 to +4.9 kg was not associated with SGA(2SD) but did decrease the odds of macrosomia.


Our study suggests a GWG below the Institute of Medicine guidelines may be associated with more favorable BW for all obese women, and GWG may need to be further defined by obesity severity.

[Indexed for MEDLINE]

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