Trends in Gestational Weight Gain From 2007 to 2019: A Prospective Cohort Study
Belle Martin1, David E Cantonwine2, Lyndsey A Darrow1
1School of Public Health, University of Nevada, Reno, Reno, Nevada, USA.
Insights
Fewer women are meeting gestational weight gain (GWG) guidelines, with a significant increase in those gaining above recommendations. This trend was observed across various maternal characteristics, highlighting a concerning shift in GWG patterns.
Area of Science:
- Maternal Health
- Pregnancy Outcomes
- Public Health Research
Background:
- Gestational weight gain (GWG) is crucial for maternal and infant health.
- National Academy of Medicine guidelines for GWG were established in 1990 and revised in 2009.
- Temporal trends in GWG following the 2009 guideline revision remain understudied.
Purpose of the Study:
- To evaluate temporal trends in total gestational weight gain (GWG).
- To assess changes in GWG adherence to 2009 guidelines over time.
- To analyze GWG trends stratified by maternal characteristics.
Main Methods:
- Prospective cohort study in Boston (2007-2019) with 3675 participants.
- Used mixed-effect models with 29,037 serial weight measures to predict delivery weight.
- Categorized GWG as below, within, or above 2009 BMI-specific guidelines; analyzed trends using regression models.
Main Results:
- Proportion of participants within GWG guidelines decreased from 46% (2007-2008) to 24% (2018-2019).
- Proportion gaining above guidelines increased from 40% to 73%, notably in normal BMI and non-Hispanic Black/White women.
- Geometric mean GWG increased from 8.3 kg to 10.9 kg.
Conclusions:
- Evidence suggests fewer women are meeting revised GWG guidelines.
- There is a significant increase in women gaining weight above recommendations.
- Findings highlight a critical need to re-evaluate and address current GWG trends.
Background:
Gestational weight gain (GWG), the maternal weight gained between pre-pregnancy and delivery, is an important risk factor for adverse maternal and infant health outcomes. In 1990, the National Academy of Medicine released GWG recommendations based on pre-pregnancy body mass index (BMI). These guidelines were revised in 2009, yet few studies have assessed temporal trends in GWG following the change.
Objectives:
To evaluate temporal trends in total GWG within a large, ongoing pregnancy cohort.
Methods:
We used data from a prospective cohort in Boston, Massachusetts, of 3675 participants with deliveries between 2007 and 2019. Using 29,037 serial weight measures (median = 7/participant), we fit mixed-effect models to predict weight at delivery. Total GWG (kg) was defined as the difference between the model-predicted weight at delivery and self-reported pre-pregnancy weight. We categorised GWG as below, within or above the 2009 BMI-specific guidelines. We analysed proportional trends in GWG categories: (a) overall and (b) stratified by maternal characteristics (pre-pregnancy BMI, race/ethnicity, educational level and parity). We analysed trends in covariate-adjusted geometric mean (GMs) of GWG using multiple linear regression.
Results:
The proportion of participants gaining weight within the GWG guidelines decreased from 46% in 2007-2008 to 24% in 2018-2019, which was driven by an increase in those gaining above the guidelines (40% to 73%). Across maternal characteristics, the largest increases of proportions above the guidelines were among those of normal pre-pregnancy BMI (19% to 62%) and of non-Hispanic Black (48% to 85%) or non-Hispanic White (37% to 74%) race/ethnicity. Consistently, GMs increased from 8.3 kg (95% confidence interval [CI] 6.3, 10.8) in 2007-2008 to 10.9 kg (95% CI 7.9, 14.9) in 2018-2019.
Conclusions:
Results from this large cohort study provide evidence that fewer women have been meeting the revised GWG guidelines and more have been gaining above the recommendations.
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