Methods for modeling gestational weight gain: empirical application using electronic health record data from a safety...

Area of Science:

• Perinatal research
• Maternal health
• Obesity medicine

Background:

• Gestational weight gain (GWG) quantification is crucial but underdeveloped in clinical settings, especially for underserved groups.
• Existing GWG metrics may not accurately reflect diverse populations.
• Six distinct GWG metrics were evaluated for their utility.

Purpose of the Study:

• To compare six different gestational weight gain (GWG) metrics.
• To analyze GWG variations across pre-pregnancy BMI categories.
• To inform the development of refined GWG guidelines and metrics for diverse populations.

Main Methods:

• Utilized clinical data from 44,801 pregnant individuals.
• Included extensive longitudinal measures and diverse demographic representation.
• Compared six GWG metrics: total GWG, linear rate, adherence, AUC, and z-scores across BMI classifications.

Main Results:

• Higher pre-pregnancy BMI correlated with lower total GWG, but trimester-specific patterns differed.
• Observed first-trimester weight loss in obesity classes and gain in underweight individuals.
• Greatest BMI-related GWG variation occurred in the second trimester, reflected in AUC and z-score metrics.

Conclusions:

• GWG metrics vary across BMI categories, impacting underserved subgroups like women of color and those with larger body sizes or lower incomes.
• Findings support developing BMI-category-specific GWG guidelines, particularly for obesity subclasses and underweight.
• Further research is essential for safe first-trimester weight loss levels and obesity class-specific recommendations.