Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials

doi:10.1186/s12884-019-2472-7

Meta-Analysis

. 2019 Sep 2;19(1):322.

doi: 10.1186/s12884-019-2472-7.

Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials

Ewelina Rogozińska^{1

2}, Javier Zamora^{3

4}, Nadine Marlin⁵, Ana Pilar Betrán⁶, Arne Astrup⁷, Annick Bogaerts^{8

9}, Jose G Cecatti^{10

11}, Jodie M Dodd^{12

13}, Fabio Facchinetti¹⁴, Nina R W Geiker¹⁵, Lene A H Haakstad¹⁶, Hans Hauner¹⁷, Dorte M Jensen^{18

19}, Tarja I Kinnunen²⁰, Ben W J Mol²¹, Julie Owens^{13

22}, Suzanne Phelan²³, Kristina M Renault^{24

25}, Kjell Å Salvesen^{26

27}, Alexis Shub^{28

29}, Fernanda G Surita^{10

11}, Signe N Stafne^{30

31}, Helena Teede³², Mireille N M van Poppel^{33

34}, Christina A Vinter³⁵, Khalid S Khan^{3

36}, Shakila Thangaratinam^{3

36}; International Weight Management in Pregnancy (i-WIP) Collaborative Group

Collaborators, Affiliations

Collaborators

International Weight Management in Pregnancy (i-WIP) Collaborative Group:
Arne Astrup, Ruben C Barakat, Annick Bogaerts, Jose G Cecatti, Jodie M Dodd, Arri Coomarasamy, Roland Devlieger, Nermean El Beltagy, Fabio Facchinetti, Nina R W Geiker, Kym Guelfi, Lene A H Haakstad, Cheryce Harrison, Hans Hauner, Dorte M Jensen, Tarja I Kinnunen, Khalid S Khan, Janette Khoury, Riitta Luoto, Ben W Mol, Siv Mørkved, Narges Motahari, Fionnuala McAuliffe, Julie Owens, Maria Perales, Elisabetta Petrella, Suzanne Phelan, Lucilla Poston, Mireille van Poppel, Kathrin Rauh, Kristina M Renault, Ewelina Rogozińska, Linda R Sagedal, Kjell A Salvesen, Tânia T Scudeller, Gary X Shen, Alexis Shub, Signe N Stafne, Fernanda Surita, Helena Teede, Shakila Thangaratinam, Serena Tonstad, Christina A Vinter, Ingvild Vistad, Marcia Vitolo, Seonae Yeo

Affiliations

¹ Meta-Analysis Group, MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK. e.rogozinska@ucl.ac.uk.
² Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. e.rogozinska@ucl.ac.uk.
³ Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁴ Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS) CIBER Epidemiology and Public Health, Madrid, Spain.
⁵ Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁶ Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
⁷ Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, DK-2200, Copenhagen, Denmark.
⁸ Department of Development and Regeneration, KU Leuven, Herestraat 49 - Box 805, B-3000, Leuven, Belgium.
⁹ Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium.
¹⁰ Rua Tessália Vieira de Camargo, 126 Cidade Universitária Zeferino Vaz, São Paulo, Campinas, CEP, 13083-887, Brazil.
¹¹ Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
¹² Women's and Children's Hospital, Women's and Children's Health Network, Women's and Babies Division, 72 King William St, North Adelaide, SA, 5006, Australia.
¹³ The Robinson Research Institute, School of Medicine, Department of Obstetrics and Gynaecology, University of Adelaide, Norwich Centre, 55 King William St, North Adelaide, SA, 5006, Australia.
¹⁴ Obstetrics and Gynecology Unit, Mother Infant Department, University of Modena and Reggio Emilia, largo del Pozzo 71, 41124, Modena, Italy.
¹⁵ Clinical Nutrition Research Unit, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, DK-2900 Hellerup, Copenhagen, Denmark.
¹⁶ Department of Sports Medicine, Norwegian School of Sports Sciences, Sognsveien 220, 0863, Oslo, Norway.
¹⁷ Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
¹⁸ Steno Diabetes Center Odense and Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Kløvervænget 6/4, 5000, Odense, Denmark.
¹⁹ Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
²⁰ Unit of Health Sciences, Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland.
²¹ Department of Obstetrics and Gynaecology, Nursing and Health Sciences, Monash University, Melbourne, Victoria, 3800, Australia.
²² Deputy Vice-Chancellor Research Office, Deakin University, Geelong, Australia.
²³ Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
²⁴ Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Denmark.
²⁵ Obstetric Clinic, JMC, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
²⁶ Department of Laboratory Medicine Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 11, 7006, Trondheim, Norway.
²⁷ Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
²⁸ Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, 3010, Australia.
²⁹ Department of Perinatal Medicine, Mercy Hospital for Women, Postboks 8905, N-7491, Trondheim, Norway.
³⁰ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
³¹ Department of Clinical Service, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
³² Monash Centre for Health Research and Implementation, School of Public Health, Monash University and Monash Health, 246 Clayton Rd, Clayton, VIC, 3124, Australia.
³³ Institute of Sports Science, University of Graz, Mozartgasse 14,, 8010, Graz, Austria.
³⁴ Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
³⁵ Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Sdr. Boulevard 29, DK-5000, Odense, Denmark.
³⁶ Multidisciplinary Evidence Synthesis Hub, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

PMID: 31477075
PMCID: PMC6719382
DOI: 10.1186/s12884-019-2472-7

Meta-Analysis

Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials

Ewelina Rogozińska et al. BMC Pregnancy Childbirth. 2019.

. 2019 Sep 2;19(1):322.

doi: 10.1186/s12884-019-2472-7.

Authors

Collaborators

International Weight Management in Pregnancy (i-WIP) Collaborative Group:
Arne Astrup, Ruben C Barakat, Annick Bogaerts, Jose G Cecatti, Jodie M Dodd, Arri Coomarasamy, Roland Devlieger, Nermean El Beltagy, Fabio Facchinetti, Nina R W Geiker, Kym Guelfi, Lene A H Haakstad, Cheryce Harrison, Hans Hauner, Dorte M Jensen, Tarja I Kinnunen, Khalid S Khan, Janette Khoury, Riitta Luoto, Ben W Mol, Siv Mørkved, Narges Motahari, Fionnuala McAuliffe, Julie Owens, Maria Perales, Elisabetta Petrella, Suzanne Phelan, Lucilla Poston, Mireille van Poppel, Kathrin Rauh, Kristina M Renault, Ewelina Rogozińska, Linda R Sagedal, Kjell A Salvesen, Tânia T Scudeller, Gary X Shen, Alexis Shub, Signe N Stafne, Fernanda Surita, Helena Teede, Shakila Thangaratinam, Serena Tonstad, Christina A Vinter, Ingvild Vistad, Marcia Vitolo, Seonae Yeo

Affiliations

¹ Meta-Analysis Group, MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 90 High Holborn, 2nd Floor, London, WC1V 6LJ, UK. e.rogozinska@ucl.ac.uk.
² Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. e.rogozinska@ucl.ac.uk.
³ Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁴ Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS) CIBER Epidemiology and Public Health, Madrid, Spain.
⁵ Pragmatic Clinical Trials Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁶ Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
⁷ Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, DK-2200, Copenhagen, Denmark.
⁸ Department of Development and Regeneration, KU Leuven, Herestraat 49 - Box 805, B-3000, Leuven, Belgium.
⁹ Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium.
¹⁰ Rua Tessália Vieira de Camargo, 126 Cidade Universitária Zeferino Vaz, São Paulo, Campinas, CEP, 13083-887, Brazil.
¹¹ Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil.
¹² Women's and Children's Hospital, Women's and Children's Health Network, Women's and Babies Division, 72 King William St, North Adelaide, SA, 5006, Australia.
¹³ The Robinson Research Institute, School of Medicine, Department of Obstetrics and Gynaecology, University of Adelaide, Norwich Centre, 55 King William St, North Adelaide, SA, 5006, Australia.
¹⁴ Obstetrics and Gynecology Unit, Mother Infant Department, University of Modena and Reggio Emilia, largo del Pozzo 71, 41124, Modena, Italy.
¹⁵ Clinical Nutrition Research Unit, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, DK-2900 Hellerup, Copenhagen, Denmark.
¹⁶ Department of Sports Medicine, Norwegian School of Sports Sciences, Sognsveien 220, 0863, Oslo, Norway.
¹⁷ Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany.
¹⁸ Steno Diabetes Center Odense and Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Kløvervænget 6/4, 5000, Odense, Denmark.
¹⁹ Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
²⁰ Unit of Health Sciences, Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland.
²¹ Department of Obstetrics and Gynaecology, Nursing and Health Sciences, Monash University, Melbourne, Victoria, 3800, Australia.
²² Deputy Vice-Chancellor Research Office, Deakin University, Geelong, Australia.
²³ Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
²⁴ Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Denmark.
²⁵ Obstetric Clinic, JMC, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
²⁶ Department of Laboratory Medicine Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Olav Kyrres gate 11, 7006, Trondheim, Norway.
²⁷ Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
²⁸ Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, 3010, Australia.
²⁹ Department of Perinatal Medicine, Mercy Hospital for Women, Postboks 8905, N-7491, Trondheim, Norway.
³⁰ Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
³¹ Department of Clinical Service, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
³² Monash Centre for Health Research and Implementation, School of Public Health, Monash University and Monash Health, 246 Clayton Rd, Clayton, VIC, 3124, Australia.
³³ Institute of Sports Science, University of Graz, Mozartgasse 14,, 8010, Graz, Austria.
³⁴ Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
³⁵ Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Sdr. Boulevard 29, DK-5000, Odense, Denmark.
³⁶ Multidisciplinary Evidence Synthesis Hub, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

PMID: 31477075
PMCID: PMC6719382
DOI: 10.1186/s12884-019-2472-7

Abstract

Background: High Body Mass Index (BMI) and gestational weight gain (GWG) affect an increasing number of pregnancies. The Institute of Medicine (IOM) has issued recommendations on the optimal GWG for women according to their pre-pregnancy BMI (healthy, overweight or obese). It has been shown that pregnant women rarely met the recommendations; however, it is unclear by how much. Previous studies also adjusted the analyses for various women's characteristics making their comparison challenging.

Methods: We analysed individual participant data (IPD) of healthy women with a singleton pregnancy and a BMI of 18.5 kg/m² or more from the control arms of 36 randomised trials (16 countries). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to describe the association between GWG outside (above or below) the IOM recommendations (2009) and risks of caesarean section, preterm birth, and large or small for gestational age (LGA or SGA) infants. The association was examined overall, within the BMI categories and by quartile of GWG departure from the IOM recommendations. We obtained aOR using mixed-effects logistic regression, accounting for the within-study clustering and a priori identified characteristics.

Results: Out of 4429 women (from 33 trials) meeting the inclusion criteria, two thirds gained weight outside the IOM recommendations (1646 above; 1291 below). The median GWG outside the IOM recommendations was 3.1 kg above and 2.7 kg below. In comparison to GWG within the IOM recommendations, GWG above was associated with increased odds of caesarean section (aOR 1.50; 95%CI 1.25, 1.80), LGA (2.00; 1.58, 2.54), and reduced odds of SGA (0.66; 0.50, 0.87); no significant effect on preterm birth was detected. The relationship between GWG below the IOM recommendation and caesarean section or LGA was inconclusive; however, the odds of preterm birth (1.94; 1.31, 2.28) and SGA (1.52; 1.18, 1.96) were increased.

Conclusions: Consistently with previous findings, adherence to the IOM recommendations seem to help achieve better pregnancy outcomes. Nevertheless, even in the context of clinical trials, women find it difficult to adhere to them. Further research should focus on identifying ways of achieving a healthier GWG as defined by the IOM recommendations.

Keywords: Body mass index; Gestational weight gain; Individual participant data; Institute of Medicine.

PubMed Disclaimer

Conflict of interest statement

FGS is a member of the editorial board (Associate Editor) of BMC Pregnancy and Childbirth. The remaining authors declare that they have no competing interests.

Figures

**Fig. 1**
Distribution of kilograms of gestational weight gain outside the Institute of Medicine recommendations (2009)

**Fig. 2**
Quartiles of gestational weight gain outside the Institute of Medicine recommendations (2009) and pregnancy complications

See this image and copyright information in PMC

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References

1. Institute of Medicine . Weight gain during pregnancy - reexamining the guidelines. In: Rasmussen KM, Yaktine AL, editors. Technical Guidelines. Washington (DC): Institute of Medicine and National Research Council, The National Academies Press; 2009. - PubMed
1. Cedergren MI. Optimal gestational weight gain for body mass index categories. Obstet Gynecol. 2007;110:759–764. doi: 10.1097/01.AOG.0000279450.85198.b2. - DOI - PubMed
1. Ferraro ZM, Contador F, Tawfiq A, Adamo KB, Gaudet L. Gestational weight gain and medical outcomes of pregnancy. Obstet Med. 2015;8(3):133–137. doi: 10.1177/1753495X15591320. - DOI - PMC - PubMed
1. DeVader SR, Neeley HL, Myles TD, Leet TL. Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index. Obstet Gynecol. 2007;110(4):745–751. doi: 10.1097/01.AOG.0000284451.37882.85. - DOI - PubMed
1. Margerison Zilko CE, Rehkopf D, Abrams B. Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes. Am J Obstet Gynecol. 2010;202(6):574 e1–574 e8. doi: 10.1016/j.ajog.2009.12.007. - DOI - PubMed

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[1] Institute of Medicine . Weight gain during pregnancy - reexamining the guidelines. In: Rasmussen KM, Yaktine AL, editors. Technical Guidelines. Washington (DC): Institute of Medicine and National Research Council, The National Academies Press; 2009. - PubMed

[2] Institute of Medicine . Weight gain during pregnancy - reexamining the guidelines. In: Rasmussen KM, Yaktine AL, editors. Technical Guidelines. Washington (DC): Institute of Medicine and National Research Council, The National Academies Press; 2009. - PubMed

[3] Cedergren MI. Optimal gestational weight gain for body mass index categories. Obstet Gynecol. 2007;110:759–764. doi: 10.1097/01.AOG.0000279450.85198.b2. - DOI - PubMed

[4] Cedergren MI. Optimal gestational weight gain for body mass index categories. Obstet Gynecol. 2007;110:759–764. doi: 10.1097/01.AOG.0000279450.85198.b2. - DOI - PubMed

[5] Ferraro ZM, Contador F, Tawfiq A, Adamo KB, Gaudet L. Gestational weight gain and medical outcomes of pregnancy. Obstet Med. 2015;8(3):133–137. doi: 10.1177/1753495X15591320. - DOI - PMC - PubMed

[6] Ferraro ZM, Contador F, Tawfiq A, Adamo KB, Gaudet L. Gestational weight gain and medical outcomes of pregnancy. Obstet Med. 2015;8(3):133–137. doi: 10.1177/1753495X15591320. - DOI - PMC - PubMed

[7] DeVader SR, Neeley HL, Myles TD, Leet TL. Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index. Obstet Gynecol. 2007;110(4):745–751. doi: 10.1097/01.AOG.0000284451.37882.85. - DOI - PubMed

[8] DeVader SR, Neeley HL, Myles TD, Leet TL. Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index. Obstet Gynecol. 2007;110(4):745–751. doi: 10.1097/01.AOG.0000284451.37882.85. - DOI - PubMed

[9] Margerison Zilko CE, Rehkopf D, Abrams B. Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes. Am J Obstet Gynecol. 2010;202(6):574 e1–574 e8. doi: 10.1016/j.ajog.2009.12.007. - DOI - PubMed

[10] Margerison Zilko CE, Rehkopf D, Abrams B. Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes. Am J Obstet Gynecol. 2010;202(6):574 e1–574 e8. doi: 10.1016/j.ajog.2009.12.007. - DOI - PubMed

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Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials

Collaborators

Affiliations

Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials

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Collaborators

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Abstract

Conflict of interest statement

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Conflict of interest statement

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