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Published on: June 13, 2021
Gestational weight gain and delivery outcomes: A population-based cohort study
Huiling Xu1, Elizabeth V Arkema1, Sven Cnattingius1
1Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Excessive gestational weight gain increases risks for cesarean delivery, labor induction, and postpartum hemorrhage, particularly in normal and overweight women. Low gestational weight gain reduces cesarean delivery risk across most body mass index groups.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Public Health
Background:
- Gestational weight gain (GWG) is a critical, modifiable factor influencing maternal and infant health.
- The precise impact of GWG on various delivery outcomes remains incompletely understood.
- Early-pregnancy body mass index (BMI) is a key factor potentially modifying the GWG-delivery outcome relationship.
Purpose of the Study:
- To examine the association between GWG and delivery outcomes.
- To stratify these associations by early-pregnancy BMI categories.
- To provide evidence for optimizing GWG recommendations for diverse maternal profiles.
Main Methods:
- Utilized a large cohort of singleton livebirths (n=174,953) from the Stockholm-Gotland obstetric registry (2008-2014).
- Standardized total GWG using gestational-age-specific z-scores based on Swedish charts.
- Employed logistic regression with marginal standardization to estimate risk ratios (RR) and 95% confidence intervals (CI) for delivery outcomes, adjusting for confounders.
Main Results:
- Above-average GWG (z-score ≥ 0.50 SD) was linked to increased risks of cesarean delivery, labor induction, and postpartum hemorrhage, with varying magnitudes across BMI groups.
- Below-average GWG (z-score < -0.50 SD) was associated with a reduced risk of cesarean delivery in most BMI categories.
- Specific risks were elevated for cesarean delivery and labor induction in obese women with higher GWG.
Conclusions:
- Higher GWG is associated with increased risks of cesarean delivery, labor induction, and postpartum hemorrhage in women with normal and overweight BMI.
- Obese women experiencing higher GWG face elevated risks for cesarean delivery and labor induction.
- Lower GWG demonstrates a protective effect against cesarean delivery across most BMI strata, excluding underweight women.
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