Beyond Obesity, The impact of excessive gestational weight gain on obstetrical Outcomes: A Belgian retrospective...

In 2023, obesity affected 20 % of pregnant individuals in Wallonia and 16.4 % in Brussels. While obesity has been widely studied, the impact of gestational weight gain (GWG) on pregnancy outcomes remains less explored.

To assess the impact of excessive GWG on perinatals outcomes in obese and non-obese women in a Belgian university hospital population.

This retrospective cohort study was conducted between 2013 and 2022, including 15 790 women who delivered at ≥ 37 weeks of gestation. Participants were categorized based on pre-pregnancy BMI (obese vs non obese) and GWG (inadequate, recommended or excessive, according to IOM criteria) in six subgroups. Multivariate logistic regression analyses, adjusted for relevant confounders, were used to assess associations between GWG and perinatal complications. Sensitivity analyses were carried out based on the Belgian proposal by Devlieger aimed at reducing weight gain.

Excessive GWG significantly increased the risk of labor induction (aOR 1.78, [1.56-2.03]), cesarean delivery (aOR 1.84, [1.56-2.18]), postpartum hemorrhage (aOR 1.52, [1.22-1.91]), macrosomia (aOR 1.96, [1.63-2.35]), and shoulder dystocia (aOR 1.81, [1.29-2.52]) in obese women. Elevated risks were also observed in non-obese women with excessive GWG. Conversely, obese women with recommended GWG had comparatively lower complication rates. Stricter GWG targets, as proposed by Devlieger, were associated with a trend toward lower cesarean rates in obese women.

Excessive GWG is an independent risk factor for adverse perinatal outcomes. Structured nutritional counseling and adherence to GWG recommendations should be promoted for all women, especially those with obesity.