Trends in Gestational Weight Gain and Prepregnancy Obesity in South Carolina, 2015-2021
Sarah E Simpson1, Angela M Malek2, Chun-Che Wen2
1Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, Ste 302, Charleston, SC 29425 (simpsose@musc.edu).
Insights
The COVID-19 pandemic minimally impacted gestational weight gain trends but slightly altered prepregnancy obesity rates, with varied effects across racial and ethnic groups in South Carolina. High rates of obesity and weight gain persist, underscoring the need for maternal weight management programs.
Area of Science:
- Maternal Health
- Public Health
- Epidemiology
Background:
- Prepregnancy obesity and gestational weight gain are critical factors influencing maternal and infant outcomes.
- Understanding trends in these areas, particularly across diverse populations, is essential for targeted public health interventions.
- The COVID-19 pandemic may have influenced lifestyle behaviors and healthcare access, potentially impacting weight trends during pregnancy.
Purpose of the Study:
- To examine trends in prepregnancy obesity and gestational weight gain in South Carolina.
- To analyze racial and ethnic differences in these trends before and during the COVID-19 pandemic.
- To assess the pandemic's specific impact on weight management among pregnant women.
Main Methods:
- Utilized linked hospital discharge codes and birth certificates for over 300,000 births in South Carolina (2015-2021).
- Defined prepregnancy obesity using BMI ≥ 30 kg/m² and categorized gestational weight gain as inadequate, adequate, or excessive per 2009 Institute of Medicine guidelines.
- Employed generalized linear models to estimate risks associated with weight gain and obesity, controlling for relevant factors.
Main Results:
- Inadequate gestational weight gain trends attenuated during the pandemic across all groups (RR=0.99).
- Excessive gestational weight gain prevalence remained high and stable across all racial and ethnic groups.
- Prepregnancy obesity increased prepandemic; post-pandemic increases were noted only in 'other' racial/ethnic groups, while Hispanic, Black, and White women saw attenuation.
Conclusions:
- The COVID-19 pandemic had a limited effect on gestational weight gain trends but a small, differential impact on prepregnancy obesity trends across racial and ethnic groups.
- High prevalence of prepregnancy obesity and abnormal gestational weight gain persists among pregnant women in South Carolina.
- Effective weight management programs for women of childbearing age and pregnant individuals are crucial due to the associated risks for adverse maternal and infant outcomes.
Introduction:
We examined trends in prepregnancy obesity and gestational weight gain, with a focus on racial and ethnic differences, before and during the COVID-19 pandemic in South Carolina.
Methods:
Hospital and emergency department discharge codes were linked to birth certificates. Prepregnancy obesity was defined as a body mass index (kg/m2) of 30 or higher. Gestational weight gain was defined as inadequate, adequate, or excessive based on the 2009 Institute of Medicine guidelines. A generalized linear model with a multinomial distribution and glogit link estimated the risk of inadequate weight gain and excessive weight gain with adequate weight gain as the reference group. The generalized linear model with a modified Poisson distribution and log link estimated prepregnancy obesity risk with nonobese as the reference group.
Results:
Our study included 306,344 full-term, singleton live births among 239,597 mothers from 2015 through 2021. The prevalence of inadequate weight gain increased across all racial and ethnic groups prepandemic (relative risk [RR] = 1.02; 95% CI, 1.01-1.02) and attenuated during the pandemic (RR = 0.99; 95% CI, 0.96-1.01). The prevalence of excessive weight gain was high and remained stable across all races and ethnicities before and during the pandemic. The prevalence of prepregnancy obesity increased across all racial and ethnic groups prepandemic; the prevalence after the start of the pandemic increased only among women of "other" races and ethnicities (RR = 1.12; 95% CI, 1.05-1.19) while attenuating among Hispanic, non-Hispanic Black, and non-Hispanic White women.
Conclusion:
The COVID-19 pandemic did not alter trends of gestational weight gain; however, it did have a small effect on trends in prepregnancy obesity, with differential effects across racial and ethnic groups. The prevalence of prepregnancy obesity, inadequate weight gain, and excessive weight gain remains high among pregnant women in South Carolina. Obesity and weight gain are risk factors for many adverse maternal and infant pregnancy outcomes. Their high prevalence indicates the importance of developing effective weight management programs for women of childbearing age and pregnant women.
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