Gestational weight gain in women with systemic lupus erythematosus

Abstract

Objective The objective of this study was to estimate the proportion of pregnant women with systemic lupus erythematosus meeting Institute of Medicine guidelines for gestational weight gain and determine correlates of adherence to guidelines. Methods Singleton, live births in the Hopkins Lupus Pregnancy Cohort 1987-2015 were included. Pre-pregnancy weight was the weight recorded 12 months prior to pregnancy/first trimester. Final weight was the last weight recorded in the third trimester. Adherence to Institute of Medicine guidelines (inadequate, adequate, or excessive) was based on pre-pregnancy body mass index. Fisher's exact test and analysis of variance determined factors associated with not meeting guidelines. Stepwise selection estimated predictors of gestational weight gain. Results Of the 211 pregnancies, 34%, 24% and 42% had inadequate, adequate and excessive gestational weight gain, respectively. In exploratory analyses, differences in Institute of Medicine adherence were observed by pre-pregnancy body mass index, race, elevated creatinine during pregnancy and pre-pregnancy blood pressure. Odds of inadequate and excessive gestational weight gain increased 12% with each 1 kg/m² increase in pre-pregnancy body mass index. Lower maternal education was associated with increased odds of inadequate and excessive gestational weight gain. Conclusions As in the general population, most women with systemic lupus erythematosus did not meet Institute of Medicine guidelines. Our results identified predictors of gestational weight gain to aid in targeted interventions to improve guideline adherence in this population.

Keywords: gestational weight gain; pregnancy; systemic lupus erythematosus.

Figure 1

Study population for the Hopkins Lupus Pregnancy Cohort, 1987 to February 2015.

Figure 2

Proportion of pregnancies with systemic lupus erythematosus meeting Institute of Medicine recommendations for gestational weight gain based on maternal pre pregnancy body mass index^a in the Hopkins Lupus Pregnancy Cohort (n=211) ^aPre pregnancy body mass index classified as underweight (<18.5 kg/m²), normal weight (18.5 24.9 kg/m²), overweight (25.0 29.9 kg/m²), and obese (≥30 kg/m²)

Figure 3

Mean predicted change in weight during pregnancy from mixed effects models with a random effect for individuals^a, stratified by pre-pregnancy BMI^b for women with SLE in the Hopkins Lupus Pregnancy Cohort (n=211). ^aMean weight change = 4.3358 + 0.3928(gestational age) + 0.0077 (gestational age²) − 0.5002 (overweight) − 3.1870 (obese) − 0.0223(gestational age × overweight) − 0.1603(gestational age × obese) 0.0005 (gestational age² × overweight) + 0.0005 (gestational age² × obese) ^bunderweight and normal weight women were combined due to small sample size