Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004–2013

Autoři: U. Vivian Ukah aff001;  Hamideh Bayrampour aff002;  Yasser Sabr aff003;  Neda Razaz aff004;  Wee-Shian Chan aff005;  Kenneth I. Lim aff006;  Sarka Lisonkova aff006
Působiště autorů: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada aff001;  Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada aff002;  Department of Obstetrics and Gynaecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia aff003;  Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden aff004;  Department of Medicine, University of British Columbia and BC Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada aff005;  Department of Obstetrics and Gynaecology, University of British Columbia, BC Children’s Hospital, and BC Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada aff006;  School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada aff007
Vyšlo v časopise: Association between gestational weight gain and severe adverse birth outcomes in Washington State, US: A population-based retrospective cohort study, 2004–2013. PLoS Med 16(12): e1003009. doi:10.1371/journal.pmed.1003009
Kategorie: Research Article



Suboptimal weight gain during pregnancy is a potentially modifiable risk factor. We aimed to investigate the association between suboptimal gestational weight gain and severe adverse birth outcomes by pre-pregnancy body mass index (BMI) categories, including obesity class I to III.

Methods and findings

We conducted a population-based study of pregnant women with singleton hospital births in Washington State, US, between 2004 and 2013. Optimal, low, and excess weight gain in each BMI category was calculated based on weight gain by gestational age as recommended by the American College of Obstetricians and Gynecologists and the Institute of Medicine. Primary composite outcomes were (1) maternal death and/or severe maternal morbidity (SMM) and (2) perinatal death and/or severe neonatal morbidity. Logistic regression was used to obtain adjusted odds ratios (AORs) and 95% confidence intervals. Overall, 722,839 women with information on pre-pregnancy BMI were included. Of these, 3.1% of women were underweight, 48.1% had normal pre-pregnancy BMI, 25.8% were overweight, and 23.0% were obese. Only 31.5% of women achieved optimal gestational weight gain. Women who had low weight gain were more likely to be African American and have Medicaid health insurance, while women with excess weight gain were more likely to be non-Hispanic white and younger than women with optimal weight gain in each pre-pregnancy BMI category. Compared with women who had optimal weight gain, those with low gestational weight gain had a higher rate of maternal death, 7.97 versus 2.63 per 100,000 (p = 0.027). In addition, low weight gain was associated with the composite adverse maternal outcome (death/SMM) in women with normal pre-pregnancy BMI and in overweight women (AOR 1.12, 95% CI 1.04–1.21, p = 0.004, and AOR 1.17, 95% CI 1.04–1.32, p = 0.009, respectively) compared to women in the same pre-pregnancy BMI category who had optimal weight gain. Similarly, excess gestational weight gain was associated with increased rates of death/SMM among women with normal pre-pregnancy BMI (AOR 1.20, 95% CI 1.12–1.28, p < 0.001) and obese women (AOR 1.12, 95% CI 1.01–1.23, p = 0.019). Low gestational weight gain was associated with perinatal death and severe neonatal morbidity regardless of pre-pregnancy BMI, including obesity classes I, II, and III, while excess weight gain was associated with severe neonatal morbidity only in women who were underweight or had normal BMI prior to pregnancy. Study limitations include the ascertainment of pre-pregnancy BMI using self-report, and lack of data availability for the most recent years.


In this study, we found that most women do not achieve optimal weight gain during pregnancy. Low weight gain was associated with increased risk of severe adverse birth outcomes, and in particular with maternal death and perinatal death. Excess gestational weight gain was associated with severe adverse birth outcomes, except for women who were overweight prior to pregnancy. Weight gain recommendations for this group may need to be reassessed. It is important to counsel women during pregnancy about specific risks associated with both low and excess weight gain.

Klíčová slova:

Birth – Body Mass Index – Labor and delivery – Morbid obesity – Morbidity – Obesity – Pregnancy – Weight gain


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