Meta-Analysis

. 2019 Jul;126(8):984-995.

doi: 10.1111/1471-0528.15661. Epub 2019 Mar 20.

Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts

S Santos^{1

2}, E Voerman^{1

2}, P Amiano^{3

4

5}, H Barros^{6

7}, L J Beilin⁸, A Bergström^{9

10}, M-A Charles^{11

12}, L Chatzi^{13

14

15}, C Chevrier¹⁶, G P Chrousos¹⁷, E Corpeleijn¹⁸, O Costa¹⁹, N Costet¹⁶, S Crozier²⁰, G Devereux²¹, M Doyon²², M Eggesbø²³, M P Fantini²⁴, S Farchi²⁵, F Forastiere²⁵, V Georgiu¹⁴, K M Godfrey^{20

26}, D Gori²⁴, V Grote²⁷, W Hanke²⁸, I Hertz-Picciotto²⁹, B Heude^{11

12}, M-F Hivert^{22

30

31}, D Hryhorczuk³², R-C Huang³³, H Inskip^{20

26}, A M Karvonen³⁴, L C Kenny^{35

36}, B Koletzko²⁷, L K Küpers^{18

37

38

39}, H Lagström⁴⁰, I Lehmann⁴¹, P Magnus⁴², R Majewska⁴³, J Mäkelä⁴⁴, Y Manios⁴⁵, F M McAuliffe⁴⁶, S W McDonald⁴⁷, J Mehegan⁴⁸, E Melén^{9

49}, M Mommers⁵⁰, C S Morgen^{51

52}, G Moschonis⁵³, D Murray^{35

54}, C Ní Chaoimh^{35

55}, E A Nohr⁵⁶, A-M Nybo Andersen⁵², E Oken³⁰, Ajjm Oostvogels⁵⁷, A Pac⁴³, E Papadopoulou⁵⁸, J Pekkanen^{34

59}, C Pizzi⁶⁰, K Polanska²⁸, D Porta²⁵, L Richiardi⁶⁰, S L Rifas-Shiman³⁰, N Roeleveld⁶¹, L Ronfani⁶², A C Santos^{6

7}, M Standl⁶³, H Stigum⁶⁴, C Stoltenberg^{65

66}, E Thiering^{63

67}, C Thijs⁵⁰, M Torrent⁶⁸, S C Tough^{47

69}, T Trnovec⁷⁰, S Turner⁷¹, Mmhj van Gelder^{61

72}, L van Rossem⁷³, A von Berg⁷⁴, M Vrijheid^{5

75

76}, Tgm Vrijkotte⁵⁷, J West⁷⁷, A H Wijga⁷⁸, J Wright⁷⁷, O Zvinchuk⁷⁹, Tia Sørensen^{52

80}, D A Lawlor^{37

38}, R Gaillard^{1

2}, Vwv Jaddoe^{1

2

81}

Affiliations

¹ The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
² Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
³ Public Health Division of Gipuzkoa, San Sebastián, Spain.
⁴ BioDonostia Research Institute, San Sebastián, Spain.
⁵ CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
⁶ EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
⁷ Department of Public Health and Forensic Sciences and Medical Education, Unit of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
⁸ Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia.
⁹ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
¹⁰ Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
¹¹ INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Villejuif, France.
¹² Paris Descartes University, Villejuif, France.
¹³ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁴ Faculty of Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece.
¹⁵ Department of Genetics and Cell Biology, Maastricht University, Maastricht, the Netherlands.
¹⁶ Inserm UMR 1085, Irset - Research Institute for Environmental and Occupational Health, Rennes, France.
¹⁷ First Department of Pediatrics, Athens University Medical School, 'Aghia Sophia' Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.
¹⁸ Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
¹⁹ Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain.
²⁰ MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
²¹ Liverpool School of Tropical Medicine, Liverpool, UK.
²² Centre de Recherche du Centre Hospitalier de l'Universite de Sherbrooke, Sherbrooke, QC, Canada.
²³ Department of Exposure and Environmental Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
²⁴ The Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
²⁵ Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
²⁶ NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
²⁷ Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-Universität Munich, Munich, Germany.
²⁸ Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland.
²⁹ Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA, USA.
³⁰ Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA.
³¹ Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA.
³² Center for Global Health, University of Illinois College of Medicine, Chicago, IL, USA.
³³ Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
³⁴ Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland.
³⁵ Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland.
³⁶ Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland.
³⁷ MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, University of Bristol, Bristol, UK.
³⁸ Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.
³⁹ Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
⁴⁰ Department of Public Health, University of Turku, Turku, Finland.
⁴¹ Department of Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research - UFZ, Leipzig, Germany.
⁴² Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway.
⁴³ Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland.
⁴⁴ Turku Centre for Biotechnology, University of Turku and Abo Akademi University, Turku, Finland.
⁴⁵ Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
⁴⁶ UCD Perinatal Research Centre, Obstetrics& Gynaecology, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland.
⁴⁷ Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁴⁸ UCD Perinatal Research Centre, School of Public Health and Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
⁴⁹ Sach's Children Hospital, Stockholm, Sweden.
⁵⁰ Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
⁵¹ National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
⁵² Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark.
⁵³ Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Vic, Australia.
⁵⁴ Paediatrics & Child Health, University College Cork, Cork, Ireland.
⁵⁵ Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.
⁵⁶ Research Unit for Gynaecology and Obstetrics, Institute for Clinical Research, University of Southern Denmark, Odense, Denmark.
⁵⁷ Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, the Netherlands.
⁵⁸ Department of Environmental Exposures and Epidemiology, Domain of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
⁵⁹ Department of Public Health, University of Helsinki, Helsinki, Finland.
⁶⁰ Department of Medical Sciences, University of Turin, Turin, Italy.
⁶¹ Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
⁶² Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy.
⁶³ Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.
⁶⁴ Department of Non-communicable Diseases, Norwegian Institute of Public Health, Oslo, Norway.
⁶⁵ Norwegian Institute of Public Health, Oslo, Norway.
⁶⁶ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
⁶⁷ Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
⁶⁸ Ib-salut, Area de Salut de Menorca, Menorca, Spain.
⁶⁹ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁷⁰ Department of Environmental Medicine, Slovak Medical University, Bratislava, Slovak Republic.
⁷¹ Child Health, Royal Aberdeen Children's Hospital, Aberdeen, UK.
⁷² Radboud REshape Innovation Center, Radboud University Medical Center, Nijmegen, the Netherlands.
⁷³ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁷⁴ Department of Pediatrics, Research Institute, Marien-Hospital Wesel, Wesel, Germany.
⁷⁵ ISGlobal, Institute for Global Health, Barcelona, Spain.
⁷⁶ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
⁷⁷ Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.
⁷⁸ National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
⁷⁹ Department of Medical and Social Problems of Family Health, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine.
⁸⁰ Section of Metabolic Genetics, Faculty of Health and Medical Sciences, The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.
⁸¹ Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.

PMID: 30786138
PMCID: PMC6554069
DOI: 10.1111/1471-0528.15661

Meta-Analysis

Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts

S Santos et al. BJOG. 2019 Jul.

. 2019 Jul;126(8):984-995.

doi: 10.1111/1471-0528.15661. Epub 2019 Mar 20.

Authors

Affiliations

¹ The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
² Department of Pediatrics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
³ Public Health Division of Gipuzkoa, San Sebastián, Spain.
⁴ BioDonostia Research Institute, San Sebastián, Spain.
⁵ CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
⁶ EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
⁷ Department of Public Health and Forensic Sciences and Medical Education, Unit of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
⁸ Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia.
⁹ Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
¹⁰ Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
¹¹ INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), ORCHAD Team, Villejuif, France.
¹² Paris Descartes University, Villejuif, France.
¹³ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁴ Faculty of Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece.
¹⁵ Department of Genetics and Cell Biology, Maastricht University, Maastricht, the Netherlands.
¹⁶ Inserm UMR 1085, Irset - Research Institute for Environmental and Occupational Health, Rennes, France.
¹⁷ First Department of Pediatrics, Athens University Medical School, 'Aghia Sophia' Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.
¹⁸ Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
¹⁹ Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain.
²⁰ MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
²¹ Liverpool School of Tropical Medicine, Liverpool, UK.
²² Centre de Recherche du Centre Hospitalier de l'Universite de Sherbrooke, Sherbrooke, QC, Canada.
²³ Department of Exposure and Environmental Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
²⁴ The Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
²⁵ Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
²⁶ NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
²⁷ Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilian-Universität Munich, Munich, Germany.
²⁸ Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland.
²⁹ Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA, USA.
³⁰ Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA.
³¹ Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA.
³² Center for Global Health, University of Illinois College of Medicine, Chicago, IL, USA.
³³ Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
³⁴ Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland.
³⁵ Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland.
³⁶ Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland.
³⁷ MRC Integrative Epidemiology Unit, Oakfield House, Oakfield Grove, University of Bristol, Bristol, UK.
³⁸ Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.
³⁹ Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
⁴⁰ Department of Public Health, University of Turku, Turku, Finland.
⁴¹ Department of Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research - UFZ, Leipzig, Germany.
⁴² Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway.
⁴³ Department of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland.
⁴⁴ Turku Centre for Biotechnology, University of Turku and Abo Akademi University, Turku, Finland.
⁴⁵ Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
⁴⁶ UCD Perinatal Research Centre, Obstetrics& Gynaecology, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland.
⁴⁷ Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁴⁸ UCD Perinatal Research Centre, School of Public Health and Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
⁴⁹ Sach's Children Hospital, Stockholm, Sweden.
⁵⁰ Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
⁵¹ National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
⁵² Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark.
⁵³ Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Vic, Australia.
⁵⁴ Paediatrics & Child Health, University College Cork, Cork, Ireland.
⁵⁵ Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland.
⁵⁶ Research Unit for Gynaecology and Obstetrics, Institute for Clinical Research, University of Southern Denmark, Odense, Denmark.
⁵⁷ Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, the Netherlands.
⁵⁸ Department of Environmental Exposures and Epidemiology, Domain of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
⁵⁹ Department of Public Health, University of Helsinki, Helsinki, Finland.
⁶⁰ Department of Medical Sciences, University of Turin, Turin, Italy.
⁶¹ Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
⁶² Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy.
⁶³ Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.
⁶⁴ Department of Non-communicable Diseases, Norwegian Institute of Public Health, Oslo, Norway.
⁶⁵ Norwegian Institute of Public Health, Oslo, Norway.
⁶⁶ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
⁶⁷ Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
⁶⁸ Ib-salut, Area de Salut de Menorca, Menorca, Spain.
⁶⁹ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁷⁰ Department of Environmental Medicine, Slovak Medical University, Bratislava, Slovak Republic.
⁷¹ Child Health, Royal Aberdeen Children's Hospital, Aberdeen, UK.
⁷² Radboud REshape Innovation Center, Radboud University Medical Center, Nijmegen, the Netherlands.
⁷³ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
⁷⁴ Department of Pediatrics, Research Institute, Marien-Hospital Wesel, Wesel, Germany.
⁷⁵ ISGlobal, Institute for Global Health, Barcelona, Spain.
⁷⁶ Universitat Pompeu Fabra (UPF), Barcelona, Spain.
⁷⁷ Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK.
⁷⁸ National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
⁷⁹ Department of Medical and Social Problems of Family Health, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine.
⁸⁰ Section of Metabolic Genetics, Faculty of Health and Medical Sciences, The Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark.
⁸¹ Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.

PMID: 30786138
PMCID: PMC6554069
DOI: 10.1111/1471-0528.15661

Abstract

Objective: To assess the separate and combined associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain with the risks of pregnancy complications and their population impact.

Design: Individual participant data meta-analysis of 39 cohorts.

Setting: Europe, North America, and Oceania.

Population: 265 270 births.

Methods: Information on maternal pre-pregnancy BMI, gestational weight gain, and pregnancy complications was obtained. Multilevel binary logistic regression models were used.

Main outcome measures: Gestational hypertension, pre-eclampsia, gestational diabetes, preterm birth, small and large for gestational age at birth.

Results: Higher maternal pre-pregnancy BMI and gestational weight gain were, across their full ranges, associated with higher risks of gestational hypertensive disorders, gestational diabetes, and large for gestational age at birth. Preterm birth risk was higher at lower and higher BMI and weight gain. Compared with normal weight mothers with medium gestational weight gain, obese mothers with high gestational weight gain had the highest risk of any pregnancy complication (odds ratio 2.51, 95% CI 2.31- 2.74). We estimated that 23.9% of any pregnancy complication was attributable to maternal overweight/obesity and 31.6% of large for gestational age infants was attributable to excessive gestational weight gain.

Conclusions: Maternal pre-pregnancy BMI and gestational weight gain are, across their full ranges, associated with risks of pregnancy complications. Obese mothers with high gestational weight gain are at the highest risk of pregnancy complications. Promoting a healthy pre-pregnancy BMI and gestational weight gain may reduce the burden of pregnancy complications and ultimately the risk of maternal and neonatal morbidity.

Tweetable abstract: Promoting a healthy body mass index and gestational weight gain might reduce the population burden of pregnancy complications.

Keywords: Birthweight; body mass index; pregnancy complications; preterm birth; weight gain.

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Figures

**Figure 1.**
Maternal pre-pregnancy body mass index and the risks of pregnancy complications^a ^aValues are odds ratios (95% confidence intervals) on a log scale from multilevel binary logistic regression models that reflect the risk of pregnancy complications per pre-pregnancy body mass index group compared with the reference group (largest group, 20.0-22.4 kg/m²). The bars represent the percentage of each pregnancy complication per body mass index group. Mothers diagnosed with pre-eclampsia were excluded from the models for gestational hypertension. The reference group for the analyses on pre-eclampsia comprises the mothers without both pre-eclampsia and gestational hypertension. The reference group for the analyses on small and large size for gestational age at birth is appropriate size for gestational age at birth. Models are adjusted for maternal age, educational level, parity, and smoking habits during pregnancy. Models for birth complications are additionally adjusted for child’s sex. Excel’s trendline function was used to fit the curve to the data. The risks of pregnancy complications per kg/m² were: gestational hypertension OR 1.11 (95% CI: 1.11, 1.12), pre-eclampsia OR 1.11 (95% CI: 1.11, 1.12), gestational diabetes OR 1.12 (95% CI: 1.12, 1.13), preterm birth OR 1.02 (95% CI: 1.01, 1.02), small size for gestational age at birth OR 0.96 (95% CI: 0.95, 0.96), and large size for gestational age at birth: OR 1.08 (95% CI 1.08, 1.08).

**Figure 2.**
Gestational weight gain and the risks of pregnancy complications^a ^aValues are odds ratios (95% confidence intervals) on a log scale from multilevel binary logistic regression models that reflect the risk of pregnancy complications per gestational weight gain group compared with the reference group (largest group, −1.0 to −0.1 SD). The bars represent the percentage of each pregnancy complication per gestational weight gain group. Mothers diagnosed with pre-eclampsia were excluded from the models for gestational hypertension. The reference group for the analyses on pre-eclampsia comprises the mothers without both pre-eclampsia and gestational hypertension. The reference group for the analyses on small and large size for gestational age at birth is appropriate size for gestational age at birth. Models are adjusted for maternal age, educational level, parity, smoking habits during pregnancy and maternal pre-pregnancy body mass index. Models for birth complications are additionally adjusted for child’s sex. Excel’s trendline function was used to fit the curve to the data. The risks of pregnancy complications per SD increase in gestational weight gain were: gestational hypertension OR 1.12 (95% CI: 1.09, 1.14), pre-eclampsia OR 1.07 (95% CI: 1.05, 1.10), gestational diabetes OR 1.14 (95% CI: 1.10, 1.18), preterm birth OR 1.09 (95% CI: 1.07, 1.11), small size for gestational age at birth OR 0.73 (95% CI: 0.72, 0.74), and large size for gestational age at birth OR 1.53 (95% CI 1.51, 1.55).

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Comment in

Healthy weight in pregnancy: time for a shift in approach?
Brown AP, Reynolds RM, Denison FC. Brown AP, et al. BJOG. 2019 Jul;126(8):996. doi: 10.1111/1471-0528.15793. Epub 2019 Apr 29. BJOG. 2019. PMID: 30968995 Free PMC article. No abstract available.

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Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts

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Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts

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