Associations of Prepregnancy Morbid Obesity and Prenatal Depression with Gestational Weight Gain

Pregnancy outcomes and infant growth and development are influenced by various prenatal and postnatal factors. Gestational weight gain (GWG) is an important indicator of pregnancy management and outcomes. Information about the interaction between prenatal obesity and depression on GWG among low-income women is limited. There also is a lack of information about morbid obesity and GWG. The purpose of this study was to examine the associations of prepregnancy weight status, including morbid obesity as a separate group, and prenatal depression with GWG using electronic medical records in an academic prenatal clinic serving a largely low-income population.

Retrospective data were obtained from existing electronic medical records for pregnant women receiving care from an academic outpatient obstetrics/gynecology clinic, largely serving the low-income population of eastern North Carolina between January 2012 and May 2013 (N = 410).

Approximately 74% of the study sample was low-income women (either Medicaid insured or uninsured). There was a high prevalence of obesity (28.3%), morbid obesity (14.1%), and prenatal depression (17.8%). A majority of women exceeded Institute of Medicine GWG recommendations (45%), whereas 30% fell below recommendations and 25% met the recommendations. Morbidly obese women had a lower than recommended average weight gain and were less likely to exceed recommendations than to meet them (odds ratio 0.32, 95% confidence interval 0.15-0.70, P = 0.004). Consistent with other findings, obese and overweight women had a higher than recommended average weight gain.

GWG recommendations should continue to incorporate prepregnancy weight status. Separate recommendations should be considered for morbidly obese women, who tend to fall below current recommendations. Further studies are needed to understand the difference in weight gain or loss among overweight, obese, and morbidly obese women and to help inform prenatal care interventions aimed at promoting healthy weight gain.