Inadequate weight gain in overweight and obese pregnant women: what is the effect on fetal growth?

Objective We sought to evaluate inadequate gestational weight gain and fetal growth among overweight and obese women. Study Design We conducted an analysis of prospective singleton term pregnancies in which 1053 overweight and obese women gained >5 kg (14.4 ± 6.2 kg) or 188 who either lost or gai...

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Published in:	American journal of obstetrics and gynecology 2014-08, Vol.211 (2), p.137.e1-137.e7
Main Authors:	Catalano, Patrick M., MD, Mele, Lisa, ScM, Landon, Mark B., MD, Ramin, Susan M., MD, Reddy, Uma M., MD, MPH, Casey, Brian, MD, Wapner, Ronald J., MD, Varner, Michael W., MD, Rouse, Dwight J., MD, Thorp, John M., MD, Saade, George, MD, Sorokin, Yoram, MD, Peaceman, Alan M., MD, Tolosa, Jorge E., MD, MSCE
Format:	Article
Language:	eng
Subjects:	Adult Birth Weight - physiology Body Fat Distribution Body Height - physiology Body Mass Index Cephalometry Female fetal anthropometry Fetal Development - physiology gestational diabetes gestational weight loss Glucose Tolerance Test Humans Infant, Newborn Infant, Small for Gestational Age - physiology Male Obesity - physiopathology Obstetrics and Gynecology Overweight - physiopathology Pregnancy Retrospective Studies Weight Gain - physiology
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Summary:	Objective We sought to evaluate inadequate gestational weight gain and fetal growth among overweight and obese women. Study Design We conducted an analysis of prospective singleton term pregnancies in which 1053 overweight and obese women gained >5 kg (14.4 ± 6.2 kg) or 188 who either lost or gained ≤5 kg (1.1 ± 4.4 kg). Birthweight, fat mass, and lean mass were assessed using anthropometry. Small for gestational age (SGA) was defined as ≤10th percentile of a standard US population. Univariable and multivariable analysis evaluated the association between weight change and neonatal morphometry. Results There was no significant difference in age, race, smoking, parity, or gestational age between groups. Weight loss or gain ≤5 kg was associated with SGA, 18/188 (9.6%) vs 51/1053 (4.9%); (adjusted odds ratio, 2.6; 95% confidence interval, 1.4–4.7; P = .003). Neonates of women who lost or gained ≤5 kg had lower birthweight (3258 ± 443 vs 3467 ± 492 g, P < .0001), fat mass (403 ± 175 vs 471 ± 193 g, P < .0001), and lean mass (2855 ± 321 vs 2995 ± 347 g, P < .0001), and smaller length, percent fat mass, and head circumference. Adjusting for diabetic status, prepregnancy body mass index, smoking, parity, study site, gestational age, and sex, neonates of women who gained ≤5 kg had significantly lower birthweight, lean body mass, fat mass, percent fat mass, head circumference, and length. There were no significant differences in neonatal outcomes between those who lost weight and those who gained ≤5 kg. Conclusion In overweight and obese women weight loss or gain ≤5 kg is associated with increased risk of SGA and decreased neonatal fat mass, lean mass, and head circumference.
ISSN:	0002-9378 1097-6868