Gestational Weight Gain Charts by Gestational Age and Body Mass Index for Chinese Women: A Population-Based Follow-up Study

Abstract

Background: Establishment of an unbiased association between gestational weight gain (GWG) and perinatal health is urgently needed in China, which has the largest population in the world. Our study aimed to create weight-gain-for-gestational-age charts using early pregnancy body mass index (BMI) to present selected percentiles of GWG in China.

Methods: A population-based follow-up study was conducted based on the Maternal and Newborn Health Monitoring System, which recruited 132,835 pregnant women between October 2013 and September 2016 in 12 districts/counties of 6 provinces in China. Multilevel analyses and restricted cubic splines were performed to model the longitudinal repeated maternal weight gain measurements and obtain smoothed curves for GWG. The internal and external validation of each model was also assessed.

Results: To develop models of GWG, 34,288 women were included. Smoothed percentiles of GWG in the 3rd, 10th, 50th, 90th, and 97th percentiles were estimated for each week of gestation. The median figures for GWG were 15.0 kg, 14.4 kg, 13.5 kg, and 12.1 kg in underweight, normal weight, overweight, and obese women, respectively, at 40 weeks. Of all the weight measurements, more than 70% and 95% fell within the expected 1 to 2 standard deviations, respectively. To accomplish external validation of the models, 20,458 women were included. The specificities of measurements in the 5th, 10th, 15th, 25th, 75th, 85th, 90th, and 95th percentiles in four BMI categories were between 90% and 100%.

Conclusions: The population-based gestational weight gain Z-score charts performed well in providing guidance regarding expected gestational weight gain in Chinese women.

Keywords: Chinese BMI standard; Z-score charts; gestational weight gain; internal and external validation; weight management.

Figure 1.. Flowchart for selecting women for study of gestational weight gain of China, 2013–2015.

Figure 2.. Smoothed percentiles of gestational weight gain at 3^rd, 10^th, 50^th, 90^th, and 97^th percentiles estimated from multilevel linear regression in 34,288 Chinese women within four BMI categories. BMI, body mass index.

Figure 3.. Fitted means and SDs of gestational weight gain for women estimated from multilevel linear regression overlaid on observed measurements in 34,288 Chinese women within four BMI categories. Dotted lines and lines denote the fitted mean ± 1 SD and 2 SD. BMI, body mass index; SD, standard deviation.