TY - JOUR

T1 - Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes

T2 - Analysis using individual participant data from randomised trials

AU - Rogozińska, Ewelina

AU - Zamora, Javier

AU - Marlin, Nadine

AU - Betrán, Ana Pilar

AU - Astrup, Arne

AU - Bogaerts, Annick

AU - Cecatti, Jose G

AU - Dodd, Jodie M

AU - Facchinetti, Fabio

AU - Geiker, Nina Rica Wium

AU - Haakstad, Lene A H

AU - Hauner, Hans

AU - Jensen, Dorte Møller

AU - Kinnunen, Tarja I

AU - Mol, Ben W J

AU - Owens, Julie

AU - Phelan, Suzanne

AU - Renault, Kristina Martha

AU - Salvesen, Kjell Åsmund

AU - Shub, Alexis

AU - Surita, Fernanda G

AU - Stafne, Signe N

AU - Teede, Helena

AU - van Poppel, Mireille N M

AU - van Poppel, Mireille N M

AU - Vinter, Christina A

AU - Khan, Khalid S

AU - Thangaratinam, Shakila

AU - International Weight Management in Pregnancy (i-WIP) Collaborative Group

N1 - CURIS 2019 NEXS 283

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

KW - Faculty of Science

KW - Gestational weight gain

KW - Body mass index

KW - Institute of Medicine

KW - Individual participant data

U2 - 10.1186/s12884-019-2472-7

DO - 10.1186/s12884-019-2472-7

M3 - Journal article

C2 - 31477075

VL - 19

JO - B M C Pregnancy and Childbirth

JF - B M C Pregnancy and Childbirth

SN - 1471-2393

M1 - 322

ER -