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Association Between Gestational Weight Gain and Adverse Obstetric and Neonatal Outcomes Among Overweight Women Aisha Langford Saint Louis University School of Public Health December 7, 2006
Background • ~47% of U.S. women are overweight (25.0 – 29.99 kg/m2) • Overweight women have increased risk for: • Preeclampsia • Cesarean-section • Macrosomic babies • Fetal death National Center for Health Statistics 2006, Baeten et al 2001, Callaway et al2006
IOM Guidelines • In 1990, gestational weight guidelines were established to reduce adverse pregnancy outcomes • Overweight women (26.0 – 29.0 kg/m2) recommended to gain 15 - 25 lbs during pregnancy
Existing Research • IOM guidelines appropriate for normal weight women • Overweight women who gained within IOM recommendations reduced their risk for high birth weight (HBW) and pre-term birth • High gestational weight gain is associated with short and long-term weight retention • Only 30-40% of women met recommendations Cogswell et al 1995, Dietz et al 2006, Linne et al 2004, Abrams et al 2000
Study Question • Is there an association between gestational weight gain and adverse obstetric and neonatal outcomes among overweight women? • What amount of gestational weight gain minimizes risk? • Hypothesis: Meeting IOM guidelines reduces risk of poor outcomes.
Study Design • Population-based cohort study • MO birth certificate data from 1990 to 2004 (residents only) • Exposure Categories: • Did not meet recommendations (<15 lbs) • Met recommendations (15 - 25 lbs) • Exceeded recommendations (>25 lbs)
35,576 singleton, full-term (> 37 wks) deliveries to overweight nulliparous 18-35 34,143 women without missing demographic or exposure data <15 lbs 1787 5% 15-25 lbs 7205 21% > 25 lbs 25151 74% Eligibility Criteria • *BMI is self-reported
Adverse Outcomes • Preeclampsia (hypertension after 20th week) • C-section (emergency and elective) • Macrosomia (> 4000 grams) • Low birth weight (<2500 grams) • Perinatal death (at > 37 weeks – 28 days of life)
Analysis • Bivariate analysis with chi-square • Risk % • Measure of Association – Relative Risk • Stratified analysis to identify confounders • Mantel Haenszel pooled estimator of relative risk • 95% Confidence Interval (CI) for precision
Demographic Characteristics *p<.05
Demographic Characteristics *p<.05
Demographic Characteristics *p<.05
Adverse Outcomes * Adjusted for age ** Reference group
Adverse Outcomes by 10lb Categories C-Section Risk %
Adverse Outcomes by 10lb Categories C-Section Risk % Macrosomia
Adverse Outcomes by 10lb Categories C-Section Risk % Macrosomia Preeclampsia
Adverse Outcomes by 10lb Categories C-Section Risk % Macrosomia Preeclampsia LBW
Strengths First study to evaluate multiple outcomes Extended time period (1990-2004) Limitations Low power for perinatal death Misclassification bias of exposure Birth certificate data
Conclusions • Current IOM recommendations (15-25 lbs) for overweight women are appropriate • Overweight women should not gain more than 25lbs • Gaining 6-14lbs may reduce risk of preeclampsia, c-section and macrosomia • Findings are consistent with previous work on HBW and LBW
Public Health Implications • Pre-conception planning and monitoring through pregnancy for overweight women • Increased risk of developing obesity • Further research on gestational weight gain in overweight women
Acknowledgements • Corinne Joshu, MA • Thomas Myles, MD • Jen Jen Chang, PhD • Terry Leet, PhD • Anjali Deshpande, PhD
Sensitivity Analysis • Of 35,576 eligible women, 1433 were excluded • Chi-square statistic used to compare missing data with complete data • Missing more likely to be 18-24, non-Hispanic white, <high school, enrolled in Medicaid and WIC
Adverse Outcomes * Adjusted for age ** Reference group
Adverse Outcomes *Adjusted for age
Adverse Outcomes *Adjusted for age
Demographic Characteristics *p<.05 † Majority 18-24, Non-Hispanic white with high school education
