Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Aug 31;16(1):153.
doi: 10.1186/s12916-018-1128-1.

Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women

Rebecca F Goldstein  1   2 , Sally K Abell  1   2 , Sanjeeva Ranasinha  1 , Marie L Misso  1 , Jacqueline A Boyle  1 , Cheryce L Harrison  1 , Mary Helen Black  3 , Nan Li  4 , Gang Hu  5 , Francesco Corrado  6 , Hanne Hegaard  7 , Young Ju Kim  8 , Margaretha Haugen  9 , Won O Song  10 , Min Hyoung Kim  11 , Annick Bogaerts  12   13   14 , Roland Devlieger  15   16 , Judith H Chung  17 , Helena J Teede  18   19
Affiliations
Meta-Analysis

Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women

Rebecca F Goldstein et al. BMC Med. .

Abstract

Background: The association between Institute of Medicine (IOM) guidelines and pregnancy outcomes across ethnicities is uncertain. We evaluated the associations of gestational weight gain (GWG) outside 2009 IOM guidelines, with maternal and infant outcomes across the USA, western Europe and east Asia, with subgroup analyses in Asia. The aim was to explore ethnic differences in maternal prepregnancy body mass index (BMI), GWG and health outcomes across these regions.

Methods: Systematic review, meta-analysis and meta-regression of observational studies were used for the study. MEDLINE, MEDLINE In-Process, Embase and all Evidence-Based Medicine (EBM) Reviews were searched from 1999 to 2017. Studies were stratified by prepregnancy BMI category and total pregnancy GWG. Odds ratio (ORs) 95% confidence intervals (CI) applied recommended GWG within each BMI category as the reference. Primary outcomes were small for gestational age (SGA), preterm birth and large for gestational age (LGA). Secondary outcomes were macrosomia, caesarean section and gestational diabetes.

Results: Overall, 5874 studies were identified and 23 were included (n = 1,309,136). Prepregnancy overweight/obesity in the USA, Europe and Asia was measured at 42%, 30% and 10% respectively, with underweight 5%, 3% and 17%. GWG below guidelines in the USA, Europe and Asia was 21%, 18% and 31%, and above was 51%, 51% and 37% respectively. Applying regional BMI categories in Asia showed GWG above guidelines (51%) was similar to that in the USA and Europe. GWG below guidelines was associated with a higher risk of SGA (USA/Europe [OR 1.51; CI 1.39, 1.63]; Asia [1.63; 1.45, 1.82]) and preterm birth (USA/Europe [1.35; 1.17, 1.56]; Asia [1.06; 0.78, 1.44]) than GWG within guidelines. GWG above guidelines was associated with a higher risk of LGA (USA/Europe [1.93; 1.81, 2.06]; Asia [1.68; 1.51 , 1.87]), macrosomia (USA/Europe [1.87; 1.70, 2.06]; Asia [2.18; 1.91, 2.49]) and caesarean (USA/Europe [1.26; 1.21, 1.33]; Asia [1.37; 1.30, 1.45]). Risks remained elevated when regional BMI categories were applied for GWG recommendations. More women in Asia were categorised as having GWG below guidelines using World Health Organization (WHO) (60%) compared to regional BMI categories (16%), yet WHO BMI was not accompanied by increased risks of adverse outcomes.

Conclusions: Women in the USA and western Europe have higher prepregnancy BMI and higher rates of GWG above guidelines than women in east Asia. However, when using regional BMI categories in east Asia, rates of GWG above guidelines are similar across the three continents. GWG outside guidelines is associated with adverse outcomes across all regions. If regional BMI categories are used in east Asia, IOM guidelines are applicable in the USA, western Europe and east Asia.

Keywords: Caesarean section; Gestational diabetes; Ggestational weight gain; Large for gestational age; Macrosomia; Maternal and infant outcomes; Obesity; Pregnancy; Preterm birth; Small for gestational age.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

This systematic review and meta-analysis includes previously published observational studies. We could not influence the design of the prior studies upon which this work is based and cannot comment on individual ethics approval or consent. Patients were not involved in the conduct of our epidemiological study, and there is no identifiable data.

Competing interests

Author/Professor Boyle reports personal fees from Pfizer, outside the submitted work. The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow Diagram of study selection process
Fig. 2
Fig. 2
a Pooled odds ratio for individual outcomes for USA and Europe combined vs Asia, for the association between GWG below guidelines with adverse outcomes. b Pooled odds ratio for individual outcomes for USA and Europe combined vs Asia, for the association between GWG above guidelines with adverse outcomes
See this image and copyright information in PMC

References

    1. Walker LO, Hoke MM, Brown A. Risk factors for excessive or inadequate gestational weight gain among Hispanic women in a U.S.-Mexico border state. J Obstet Gynecol Neonatal Nurs. 2009;38(4):418–429. - PubMed
    1. Weisman CS, Hillemeier MM, Downs DS, Chuang CH, Dyer AM. Preconception predictors of weight gain during pregnancy: prospective findings from the Central Pennsylvania Women's Health Study. Women's Health Issues. 2010;20(2):126–132. - PMC - PubMed
    1. Viswanathan M, Siega-Riz AM, Moos MK, Deierlein A, Mumford S, Knaack J, et al. Outcomes of maternal weight gain. Evid Rep Technol Assess. 2008;168:1–223. - PMC - PubMed
    1. Rasmussen K, Yaktine AL, editors. Institute of Medicine and National Research Council Committee to reexamine IOM pregnancy weight guidelines. Weight gain during pregnancy: reexamining the guidelines. Washington DC: National Academic Press; 2009.
    1. Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017;317(21):2207–2225. - PMC - PubMed

Publication types