Pregnancy Weight Gain and Longer-Term Maternal Cardiometabolic Conditions

We aimed to establish how weight gain patterns across successive pregnancies relate to longer-term maternal cardiometabolic health.

Obstetric records of all nulliparous pregnancies in Stockholm and Gotland (Sweden, 2008-2015) were linked with hospital discharges, outpatient visits, and prescription dispensations until 2019. Total pregnancy weight gain (kg) was standardized for gestational age and early pregnancy body mass index and classified as ≤ -1, > -1 and < +1 (reference), and ≥ +1 Z scores. Postpartum cardiometabolic conditions (type 2 diabetes, hypertension, cardiovascular diseases) were identified using International Classification of Diseases, Tenth Revision codes and medications. Hazard ratios were estimated using a Cox proportional hazards model.

Among 58 333 individuals, 5.9% (n=3440) developed a cardiometabolic condition, with a median onset of 4 years [interquartile range, 2-6]. Hazard ratios were higher for those gaining ≥ +1 Z score (19.4 kg at 40 weeks in normal-weight individuals) in the first pregnancy (hazard ratio, 1.29 [95% CI, 1.19-1.40]). Among individuals developing conditions after the second pregnancy, risks were increased for those with high weight gain in the first pregnancy, but not the second (hazard ratios, 1.30 [95% CI, 1.13-1.50] versus 1.05 [95% CI, 0.88-1.26], respectively), compared with those gaining > -1 and < +1 Z score in both pregnancies.

Individuals with high weight gain in their first pregnancy were 30% more likely to develop a cardiometabolic condition than those with lower weight gain. Preventing excessive weight gain in the first pregnancy may be key to reducing maternal cardiometabolic risk.