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From page 389... ... appendix E Results from the Evidence-Based Report* on Outcomes of Maternal Weight Gain The purpose of this systematic evidence-based review, requested by the Agency for Healthcare Research and Quality (AHRQ) Read the entire page →
From page 390... ... 390 WEIGHT GAIN DURING PREGNANCY lines or weight loss in pregnancy contribute to antepartum or postpartum complications or longer-term maternal and fetal com plications? How do these relationships vary by sociodemographic characteristics (i.e., race and age) Read the entire page →
From page 391... ... APPENDIX E 391 TABLE 1. Inclusion/exclusion Criteria for Gestational Weight Gain Category Criteria Study population Women of any age with singleton pregnancies Study settings KQ 1, KQ 2, KQ 4: Developed nations: United States, Canada, Western and geography Europe, Japan, Australia, New Zealand KQ 3: United States KQ 5: All countries Time period January 1990 through October 2007 Publication English only languages Admissible Admissible designs evidence (study Controlled trials (n ≥ 40) , nonrandomized controlled trials (n ≥ 40) Read the entire page →
From page 392... ... 392 WEIGHT GAIN DURING PREGNANCY for randomized controlled trials (RCTs) or nonrandomized cohorts with comparisons or fewer than 100 subjects for case series; and (4) Read the entire page →
From page 393... ... APPENDIX E 393 Our searches in MEDLINE® produced 715 unduplicated records. Searches in other databases yielded in 190 new records from CINAHL and 4 from Embase. Read the entire page →
From page 394... ... 394 WEIGHT GAIN DURING PREGNANCY of 1,085 articles, we retained 150 articles that we determined were relevant to address our KQs and met our inclusion/exclusion criteria (Table 1) Read the entire page →
From page 395... ... APPENDIX E 395 of the first author. A list of abbreviations and acronyms used in the tables appears at the beginning of that appendix. Read the entire page →
From page 396... ... 396 WEIGHT GAIN DURING PREGNANCY TABLE 3. Scoring Algorithm for Subdomains and Overall Quality Rating for Individual Studies Definition and Scoring Algorithm Rating Score algorithm for background (presented in the context of previous research, hypothesis clearly described) • oth elements present B Good • either present N Poor • ne of two elements present O Fair Score algorithm for sample definition (explicitly stated inclusion/exclusion criteria, uniform application of criteria, clear description of recruitment strategy, clear description of characteristics of the participants, power analysis or some other basis noted for determining the adequacy of study sample size) Read the entire page →
From page 397... ... APPENDIX E 397 TABLE 3. Continued Definition and Scoring Algorithm Rating • oth elements clearly present B Good • either element present N Poor • ny other score A Fair Score algorithm for interpretation (results interpreted appropriately based on study design and statistics, clinically useful, appropriate presentation, presented in the context of prior research, and conclusion supported by results) • ll elements clearly present A Good • onclusions not supported by results C Poor • ny other score A Fair Score algorithm for overall quality • or more good ratings and no poor ratings on subdomains 5 Good • or more poor ratings on subdomains 3 Poor • 5 good ratings and < 3 poor ratings on subdomains; 5 or more good ratings < Fair and any poor ratings resulting in further bias. Read the entire page →
From page 398... ... 398 WEIGHT GAIN DURING PREGNANCY flaws in research design. Studies with negative results have sufficiently large samples to have adequate statistical power. Read the entire page →
From page 399... ... APPENDIX E 399 Appendix C provides the detailed evidence tables for KQs 1, 3, and 5. Our summary tables below feature groups of studies addressing each outcome; we present these text tables only when we have three or more studies pertaining to that particular outcome. Read the entire page →
From page 400... ... 400 WEIGHT GAIN DURING PREGNANCY and heartburn in gestation,45 and some increased risk of stretch marks with increased weight gain.43,44 Detailed results A prospective cohort study in Sweden examined symptoms across pregnancy and attempted to document the prevalence and frequency of 27 pregnancy symptoms while controlling for biomedical factors.41 A cohort of 476 nulliparous women was assessed six times during gestation (gestational ages of 10, 12, 20, 28, 32, and 36 weeks) Read the entire page →
From page 401... ... APPENDIX E 401 marks (P < .05) but the analysis did not account for any confounders or effect modifiers. Read the entire page →
From page 402... ... TABLE 4. Gestational Weight Gain and Abnormal Glucose Control 402 Author, Year Country, Setting Pregravid Weight (How Sample Size Measured) Confounders and Baseline BMI Total Weight Gain (How Effect Modifiers Quality Measured) Read the entire page →
From page 403... ... Edwards et al., 199655 Pregravid weight: Pregravid wt 19.8-26.0 Incidence gestational Maternal age, parity, Self-report BMI: diabetes: race, prenatal smoking, US Minnesota, births at G1: < 11.5 kg gain G1: 2.3% prenatal alcohol use, specific medical center Total weight gain: G2: 11.6-16 kg gain G2: 3.3% prenatal illicit drug Last prenatal assessment 1,343 divided between obese G3: > 16 kg gain G3: 2.9% use, pregravid health, women (BMI > 29) matched (P = .759) Read the entire page →
From page 404... ... TABLE 4. Continued 404 Author, Year Country, Setting Pregravid Weight (How Sample Size Measured) Confounders and Baseline BMI Total Weight Gain (How Effect Modifiers Quality Measured) Read the entire page →
From page 405... ... Brennand et al., 200549 Pregravid weight: G1: "Low weight gain" Incidence GDM: None reported Measured weight ≤ 14 G2: "Acceptable weight G1: 38.6% Quebec, Canada, First wk GA used as proxy gain" G2: 27.3% Nation's People (Cree) G3: "Excessive weight gain" G3: 19.3% Total weight: 603 (P = 0.011) Read the entire page →
From page 406... ... 406 WEIGHT GAIN DURING PREGNANCY tolerance test (GTT) Read the entire page →
From page 407... ... APPENDIX E 407 range of weight gain included in the reference category was large (14-28 pounds) especially given that nearly 50 percent of the sample entered into the reported pregnancies with BMIs > 26.0. Read the entire page →
From page 408... ... 408 WEIGHT GAIN DURING PREGNANCY TABLE 5. Gestational Weight Gain and Pregnancy-Induced Hypertension Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 409... ... APPENDIX E 409 Confounders and Effect Modifiers Results Included in Analysis Preeclampsia by Preeclampsia by Age, parity, smoking BMI for weight gain BMI for weight gain in early pregnancy, < 8 kg (reference gain > 16 kg (reference year of birth 8-16 kg) Read the entire page →
From page 410... ... 410 WEIGHT GAIN DURING PREGNANCY TABLE 5. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 411... ... APPENDIX E 411 Confounders and Effect Modifiers Results Included in Analysis Estimated OR (95% CI) preeclampsia Maternal age, parity, smoking, G1: 0.74 (0.37-1.48) Read the entire page →
From page 412... ... 412 WEIGHT GAIN DURING PREGNANCY TABLE 5. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 413... ... APPENDIX E 413 Confounders and Effect Modifiers Results Included in Analysis OR (95% CI) gestational HTN Results of 2 G1: 1 hour OGTT, age, G2: 2.1 (0.8-5.7) Read the entire page →
From page 414... ... 414 WEIGHT GAIN DURING PREGNANCY Although these women were more likely to experience obstetrical complications than a control population (BMIs 19-27) , gestational weight gain did not affect the complication rate. Read the entire page →
From page 415... ... APPENDIX E 415 were randomly selected for each case and matched for year of delivery. Multiple logistic regression found an inverse relationship between gestational weight gain and gallbladder disease. Read the entire page →
From page 416... ... 416 WEIGHT GAIN DURING PREGNANCY weight and total weight gain, were assessed through a questionnaire administered to most of the subjects within 72 hours of giving birth. Results for rate of weight gain In the Danish cohort study, women with a weekly weight gain of less than 275 grams per week had an adjusted hazards ratio for PROM of 1.5 (95% CI, 1.2-1.7) Read the entire page →
From page 417... ... APPENDIX E 417 Results The author examined the effects of low (< 8 kg) and high weight gain (> 16 kg) Read the entire page →
From page 418... ... TABLE 6. Gestational Weight Gain and Induction of Labor 418 Author, Date Country, Setting Pregravid Weight Sample Size (How Measured) Confounders and Effect Baseline BMI Total Weight Gain Modifiers Included in Quality (How Measured) Read the entire page →
From page 419... ... Jensen et al., 200559 Pregravid weight: G1: < 5.0 kg OR for induction of labor Age, pregravid BMI, 2 hour Records or self-report G2: GWG 5.0-9.9 kg G1: 1.0 OGTT result, smoking, Denmark, university of pregravid BMI G3: GWG 10.0-14.9 kg G2: 2.7 gestational age hospitals Total weight gain: G4: GWG ≥ 15 kg (95% CI, 1.3-5.7) 481 Last prenatal assessment G3: 2.8 (95% CI, 1.3-5.9) Read the entire page →
From page 420... ... 420 WEIGHT GAIN DURING PREGNANCY sociation between gestational weight gain and increase in the risk of failed induction compared with all other delivery routes.25,51 Length of labor Study characteristics Three cohort studies, set in Finland and the United States, examined the association between gestational weight gain and labor (Table 7, Evidence Table 10) .68-70 Two studies focused on length of labor,68,69 one on labor abnormalities.70 The definition of gestational weight gain differed across studies. Read the entire page →
From page 421... ... TABLE 7. Gestational Weight Gain and Length of Labor Author, Date Country, Setting Pregravid Weight (How Sample Size Measured) Confounders and Effect Baseline BMI Total Weight Gain Definition of Modifiers Included in Quality (How Measured) Read the entire page →
From page 422... ... TABLE 7. Continued 422 Author, Date Country, Setting Pregravid Weight (How Sample Size Measured) Confounders and Effect Baseline BMI Total Weight Gain Definition of Modifiers Included in Quality (How Measured) Read the entire page →
From page 423... ... APPENDIX E 423 All 21 studies examined cesarean delivery as an outcome. Five examined instrumental delivery in addition to cesarean delivery.25,51,58,68,69 Eight studies reported on cesarean delivery without providing further definition.4,25,49,54,58,59,74,76 The studies that offered some detail varied in their definition; these studies defined cesarean delivery as failure to progress,51 unscheduled cesarean,67,70 cesarean including elective and emergency,52 elective cesarean and emergency cesarean,61,68 cephalopelvic disproportion/ failure to progress, fetal distress, breech, and other indications,73 cesarean delivery for cephalic presentation,77 and cesarean delivery for singleton cephalic presentation separately analyzed for primary and repeat cesareans, with and without labor.78 A key consideration in assessing the risk of cesarean delivery is the route of previous delivery; with the declining prevalence of vaginal birth after cesarean (VBAC) Read the entire page →
From page 424... ... 424 WEIGHT GAIN DURING PREGNANCY TABLE 8. Gestational Weight Gain and Mode of Delivery Author, Date Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 425... ... APPENDIX E 425 Confounders and Effect Results Modifiers Included in Analysis AOR for weight gain AOR for weight gain < 8 kg Maternal age, parity, smoking < 8 kg for cesarean section for instrumental delivery in early pregnancy, and year compared with weight gain compared with weight gain of birth 8-16 kg (95% CI) Read the entire page →
From page 426... ... 426 WEIGHT GAIN DURING PREGNANCY TABLE 8. Continued Author, Date Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 427... ... APPENDIX E 427 Confounders and Effect Results Modifiers Included in Analysis Greater weight gain in pregnancy was not associated Prepregnancy BMI category, significantly with route of delivery total prenatal weight gain category, induction of labor, newborn birthweight ≥ 4,000 g, gestational age > 41 weeks, and race/ethnicity AOR for primiparous AOR for multiparous Maternal age, pregravid BMI, cesarean delivery (from cesarean delivery (from parity, education, race/ model including interaction model including interaction ethnicity, US/foreign origin, term for overweight/obese + term for overweight/obese + interaction terms for pregravid > 25 lbs weight gain) > 25 lbs weight gain) Read the entire page →
From page 428... ... 428 WEIGHT GAIN DURING PREGNANCY TABLE 8. Continued Author, Date Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 429... ... APPENDIX E 429 Confounders and Effect Results Modifiers Included in Analysis Compared with women who gained 15-25 lbs during their Age, race, parity, education, pregnancies, those who gained less weight had significantly poverty (enrollment in lower odds of preeclampsia, cesarean delivery, and LGA Medicaid, WIC, food stamp births, but higher odds for SGA births programs) , tobacco use, chronic hypertension Magnitude differed by obesity classification, even after adjusting for known or suspected confounders AOR for cesarean delivery (95% CI) Read the entire page →
From page 430... ... 430 WEIGHT GAIN DURING PREGNANCY TABLE 8. Continued Author, Date Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 431... ... APPENDIX E 431 Confounders and Effect Results Modifiers Included in Analysis G1: Proportional Gain: Low-Average (19.5-22.4) , Preeclampsia, gestational Adjusted Relative Risk > median diabetes, placental problems, (95% CI) Read the entire page →
From page 432... ... 432 WEIGHT GAIN DURING PREGNANCY TABLE 8. Continued Author, Date Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 433... ... APPENDIX E 433 Confounders and Effect Results Modifiers Included in Analysis Cesarean % NA G1: 25.8% G2: 26.8% G3: 28.8% G4: 35.0% G5: 33.8% (P = NS) Cesarean section (%) Read the entire page →
From page 434... ... 434 WEIGHT GAIN DURING PREGNANCY TABLE 8. Continued Author, Date Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 435... ... APPENDIX E 435 Confounders and Effect Results Modifiers Included in Analysis OR for cesarean delivery 2-h OGTT result, maternal (95% CI) age, prepregnancy BMI, G1: 1.0 gestational age (continuous G2: 2.4 (1.1-5.3) Read the entire page →
From page 436... ... 436 WEIGHT GAIN DURING PREGNANCY TABLE 8. Continued Author, Date Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 437... ... APPENDIX E 437 Confounders and Effect Results Modifiers Included in Analysis For nulliparous, low BMI For nulliparous, high BMI Parity, baseline BMI women: women: Higher risk of cesarean No increased risk delivery for women with For parous, medium BMI weight gain ≥ 0.4 kg/week women: (AOR: 2.30 [95% CI, Higher risk of cesarean 1.06-4.98] compared with delivery for women with women gaining 0.25 weight gain 0.25-0.3 kg/ 0.3 kg/week) Read the entire page →
From page 438... ... 438 WEIGHT GAIN DURING PREGNANCY weight gain of 8 to 16 kg.58 The study found no statistically significant risk of cesarean delivery for low or normal BMI categories but significantly higher risk with higher weight gain for overweight, obese, and morbidly obese women.58 One study examined the effects of pregravid weight, gestational weight gain, and the interaction between the two as predictors of cesarean delivery for primiparous and multiparous women (defined in two different ways) Read the entire page →
From page 440... ... 440 WEIGHT GAIN DURING PREGNANCY these results corroborate findings from the fair study is hard to determine given the differences in the reference category, but both studies imply that increased risks of cesarean are pronounced among overweight and obese women. A third study, also of poor quality, examined differences in route of delivery between women with normal prepregnancy weight and weight gain during pregnancy with those with abnormal weight gain (≥ 20 kg or ≤ 5 kg) Read the entire page →
From page 441... ... APPENDIX E 441 Results for instrumental delivery Five studies examined instrumental delivery in addition to cesarean delivery.25,51,58,68,69 Two found no association.25,68 Of the remaining studies, one found a higher risk of instrumental delivery with increased weight gain only for normal BMI and overweight women,58 and a second found this only for overweight women.51 A third study, limited to women of normal weight, examined differences in the rate of vacuum extraction and forceps delivery by amount of weight gain; it found a higher rate of vacuum extraction with excessive weight gain but no difference in rate of forceps delivery.69 Results controlling for confounding Studies varied in their adjustment for confounding factors. Seven studies controlled for route of previous delivery by limiting their sample to primary cesarean51,71,72,75 or primigravidas.69,73,74 Three studies included multigravidas but accounted for previous cesarean delivery in the analysis.76-78 The remaining 11 studies did not control for route of previous delivery.4,25,49,52,54,58,59,61,67,68,70 Of the 10 studies that controlled for route of previous delivery, five studies examined underlying health risks (e.g., preeclampsia, pregnancyinduced hypertension) Read the entire page →
From page 442... ... 442 WEIGHT GAIN DURING PREGNANCY weight and weight at delivery. BMI categories were defined as follows: normal, BMI 20 to 24.9; overweight, BMI 25 to 29.9; obese I, BMI 30 to 34.9; obese II, BMI 35 to 39.9; morbid obesity, BMI ≥ 40. Read the entire page →
From page 443... ... TABLE 9. Gestational Weight Gain and Shoulder Dystocia Author, Date Country, Setting Pregravid Weight Sample Size (How Measured) Confounders and Effect Baseline BMI Total Weight Gain Modifiers Included in Quality (How Measured) Read the entire page →
From page 444... ... TABLE 9. Continued 444 Author, Date Country, Setting Pregravid Weight Sample Size (How Measured) Confounders and Effect Baseline BMI Total Weight Gain Modifiers Included in Quality (How Measured) Read the entire page →
From page 445... ... APPENDIX E 445 Results The three studies found rates of shoulder dystocia ranging from 0.6 percent to 1.4 percent.51,68,80 Two studies reported no statistically significant differences in rates of shoulder dystocia between weight gain groups.51,68 The Irish case-control investigation found that higher gestational weight gain during pregnancy was a significant predictor of shoulder dystocia (OR, 2.0; 95% CI, 1.6-2.2; P = 0.015) Read the entire page →
From page 446... ... 446 WEIGHT GAIN DURING PREGNANCY to 30 pounds, after adjusting for maternal age, maternal race or ethnicity, maternal education, Medicaid status, tobacco use, alcohol use, maternal height, prior pregnancy, adequacy of prenatal care, child's sex, and child's birth year.25 The poor study showed similar results, with an unadjusted OR of CPD of 1.85 (95% CI, 1.63-2.06) for normal-weight women gaining > 35 pounds compared with women gaining < 30 pounds. Read the entire page →
From page 447... ... APPENDIX E 447 Birth Outcomes Preterm birth Study characteristics Twelve studies (Table 10, Evidence Table 17) examined the relationship between weight gain and birth outcomes.23,59,65,71,82-89 These include eight cohort studies,59,65,82-86,89 two case-control studies,87,88 and two cross-sectional studies.23,71 The majority of the studies defined preterm birth as delivery occurring prior to 37 weeks of gestation; the one exception defined it as delivery between 24 and 35 weeks of gestation.87 Each study defined weight gain differently. Read the entire page →
From page 448... ... 448 WEIGHT GAIN DURING PREGNANCY TABLE 10. Gestational Weight Gain and Preterm Birth Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 449... ... APPENDIX E 449 Confounders and Effect Modifiers Included in Results Analysis AOR (95% CI) for cases with preterm delivery versus controls Parity, marital status, language, age, education, G1: 1.56 (0.94-2.58) Read the entire page →
From page 450... ... 450 WEIGHT GAIN DURING PREGNANCY TABLE 10. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 451... ... APPENDIX E 451 Confounders and Effect Modifiers Included in Results Analysis HR (95% CI) : Pregravid BMI, age, G1: 2.1 (1.5-3.0) Read the entire page →
From page 452... ... 452 WEIGHT GAIN DURING PREGNANCY TABLE 10. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 453... ... APPENDIX E 453 Confounders and Effect Modifiers Included in Results Analysis Reference category of rate of weight gain: 0.35-< 0.46 kg/wk None RD of preterm birth varied by prepregnant BMI and gestational weight gain. Overall, women gaining 0.26-0.46 kg/wk had the lowest RD of preterm birth. Read the entire page →
From page 454... ... 454 WEIGHT GAIN DURING PREGNANCY TABLE 10. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 455... ... APPENDIX E 455 Confounders and Effect Modifiers Included in Results Analysis AOR (95% CI) for cases with spontaneous preterm delivery Pregravid BMI, pregravid versus controls: weight, height, age, parity, smoking, social G1: 5.63 (2.35-13.8) Read the entire page →
From page 456... ... 456 WEIGHT GAIN DURING PREGNANCY est and greatest rates of weight gain, < 0.10 kg per week and ≥ 0.65 kg per week, respectively. The lowest risks of preterm delivery occurred among women gaining between 0.26 and 0.46 kg per week (the 25th through the 74th percentiles) Read the entire page →
From page 457... ... APPENDIX E 457 33 weeks) , late (34-36 weeks) Read the entire page →
From page 458... ... 458 WEIGHT GAIN DURING PREGNANCY and 35 weeks' gestation) with gestational weight gain ≤ 0.37 kg per week in the second and third trimesters; however, the odds were greater among women with pregravid BMI ≤ 19.5 compared to those with BMI > 19.5. Read the entire page →
From page 459... ... APPENDIX E 459 teen studies adjusted their analyses for multiple confounders, including maternal age, BMI, smoking, glucose levels, race, marital status, and parity.48,55,59,70,75,90-93,97-103,105 Overview of results The results for four good,48,98,103,106 12 fair,55,65, 70,75,92,93,97,99-102,104,105 and nine poor54,59,68,83,90,91,94-96 studies consistently demonstrate an association between higher gestational weight gain and birthweight. Results from categorical measures of weight gain. Read the entire page →
From page 460... ... TABLE 11. Total Gestational Weight Gain (categorical) and Infant Birthweight 460 Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Read the entire page →
From page 461... ... Zaren et al., 199799 Pregravid weight: β is estimated change in G1: β = -131 (P = 0.0001) Maternal age, height, Self-report infant BW (g) Read the entire page →
From page 462... ... TABLE 11. Continued 462 Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Confounders and Effect Baseline BMI Total Weight Gain Modifiers Included in Quality (How Measured) Read the entire page →
From page 463... ... Shapiro et al., 200094 Pregravid weight: Infant BW for groups G1: 3,363 g N/A Routine prenatal care defined by BMI and G2: 3,636 g USA, community hospital weight gain G3: 3,565 g Total weight gain: 159 G4: 3,774 g Routine prenatal care or G1: Low BMI (< 25) , Low All weight/BMI maternity records gain (< 35 lbs) Read the entire page →
From page 464... ... 464 WEIGHT GAIN DURING PREGNANCY born to women who gained < 35 lbs. One study among morbidly obese women (BMI > 35) Read the entire page →
From page 465... ... APPENDIX E 465 TABLE 12. Total Gestational Weight Gain (continuous) and Infant Birthweight Author, Year Country, Setting Pregravid Weight Confounders and Sample Size (How Measured) Read the entire page →
From page 466... ... 466 WEIGHT GAIN DURING PREGNANCY TABLE 12. Continued Author, Year Country, Setting Pregravid Weight Confounders and Sample Size (How Measured) Effect Modifiers Baseline BMI Total Weight Gain Definition of Included in Quality (How Measured) Read the entire page →
From page 467... ... APPENDIX E 467 TABLE 12. Continued Author, Year Country, Setting Pregravid Weight Confounders and Sample Size (How Measured) Effect Modifiers Baseline BMI Total Weight Gain Definition of Included in Quality (How Measured) Read the entire page →
From page 468... ... 468 WEIGHT GAIN DURING PREGNANCY TABLE 12. Continued Author, Year Country, Setting Pregravid Weight Confounders and Sample Size (How Measured) Effect Modifiers Baseline BMI Total Weight Gain Definition of Included in Quality (How Measured) Read the entire page →
From page 469... ... APPENDIX E 469 TABLE 12. Continued Author, Year Country, Setting Pregravid Weight Confounders and Sample Size (How Measured) Effect Modifiers Baseline BMI Total Weight Gain Definition of Included in Quality (How Measured) Read the entire page →
From page 470... ... 470 WEIGHT GAIN DURING PREGNANCY TABLE 13. Continuous Gestational Weight Gain by Trimester and Infant Birthweight Author, Year Confounders Country, Setting Pregravid Weight and Effect Sample Size (How Measured) Modifiers Baseline BMI Total Weight Gain Included in Quality (How Measured) Read the entire page →
From page 471... ... APPENDIX E 471 in net weight gain raised infant birthweight as follows: for underweight women, 41.9 g; for women of normal weight, 19.2 g; and for obese women, 9.1 g.104 Each kilogram of net weight gain associated with an increase of 111.2 g in birthweight in another study.83 The fourth study, which considered proportional gestational weight gain (total gestational weight gain divided by pregravid weight) found that for mothers with BMIs of 19.5 to 22.4, those who gained above the median proportional gestational weight gain had infants who were 322 g heavier than the infants of mothers who gained below the median. Read the entire page →
From page 472... ... 472 WEIGHT GAIN DURING PREGNANCY TABLE 14. Net and Proportional Gestational Weight Gain and Infant Birthweight Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 473... ... APPENDIX E 473 Confounders and Effect Modifiers Included Results in Analysis G1: β = 15.4 g ± 2.2 Maternal race, parity, pregravid BMI, height, (P < 0.0001) pregravid weight, marital status, education, tobacco/alcohol/drug use, pregnancy-induced hypertension, gestational age, macrosomia, infant sex G1: β = 41.9 g ± 7.5 Maternal age, parity, black ethnicity, (P < 0.01) Read the entire page →
From page 474... ... 474 WEIGHT GAIN DURING PREGNANCY TABLE 15. Total Gestational Weight Gain and Low Birthweight (LBW) Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Read the entire page →
From page 475... ... APPENDIX E 475 Confounders and Effect Modifiers Included Results in Analysis G1: 38.2 N/A G2: 61.8 G3: 22.1 G4: 77.9 G1: 2.1 (1.6-2.6) Maternal age, maternal race, height, smoking, G2: 0.5 (0.4-0.6) Read the entire page →
From page 476... ... 476 WEIGHT GAIN DURING PREGNANCY TABLE 15. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 477... ... APPENDIX E 477 Confounders and Effect Modifiers Included Results in Analysis G1: 0.90 (0.85-0.95) Maternal age, pregravid weight, height, distantia cristarum G1: 1.26 (0.57-2.75) Read the entire page →
From page 478... ... 478 WEIGHT GAIN DURING PREGNANCY TABLE 15. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 479... ... APPENDIX E 479 Confounders and Effect Modifiers Included Results in Analysis G1: 2 N/A G2: 11.1 G3: 8.3 G4: 5.2 G5: 3.8 G1: 2.43 (1.45-4.05) Maternal age, maternal race, marital status, G2: 0.63 (0.47-0.85) Read the entire page →
From page 480... ... 480 WEIGHT GAIN DURING PREGNANCY TABLE 16. Other Gestational Weight Gain Measures and LBW Author, Year Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 481... ... APPENDIX E 481 Confounders and Effect Modifiers Included Results in Analysis G1: 1.0 (Reference) Maternal race, parity, pregravid BMI, height, G2: 0.51 (0.27-0.98) Read the entire page →
From page 482... ... 482 WEIGHT GAIN DURING PREGNANCY gaining 14.9 to 23.5 pounds, the OR was 0.51 (95% CI, 0.27-0.98) Read the entire page →
From page 483... ... TABLE 17. Gestational Weight Gain and Macrosomia > 4,500 g Author, Year Pregravid Weight Country, Setting (How Measured) Sample Size Total Weight Confounders and Baseline BMI Gain (How Effect Modifiers Quality Measured) Read the entire page →
From page 484... ... TABLE 17. Continued 484 Author, Year Pregravid Weight Country, Setting (How Measured) Sample Size Total Weight Confounders and Baseline BMI Gain (How Effect Modifiers Quality Measured) Read the entire page →
From page 485... ... Zhou and Olsen, Pregravid weight: OR and 95% CI, for macrosomia by G1: 1.0 G6: 27.1 Maternal age, 1997108 Self-report GWG categories and BMI G2: 52.8 (3.3-220) parity, alcohol, (0.3-22.9) Read the entire page →
From page 486... ... 486 WEIGHT GAIN DURING PREGNANCY and obese women.108 However, the confidence intervals from this study are very imprecise. A fair-quality study in Norway showed similar results, with increasing ORs as weight gain increased. Read the entire page →
From page 487... ... TABLE 18. Gestational Weight Gain and Macrosomia > 4,000g Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Confounders and Effect Quality (How Measured) Read the entire page →
From page 488... ... TABLE 18. Continued 488 Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Confounders and Effect Quality (How Measured) Read the entire page →
From page 489... ... Takimoto et al., 2006111 Pregravid weight: ORs and 95% CI, for G1: 0.31 (0.20-0.47) Maternal age, parity, pregravid Medical records macrosomia G2: 0.49 (0.34-0.70) Read the entire page →
From page 490... ... 490 WEIGHT GAIN DURING PREGNANCY a higher risk of macrosomia for women gaining more than 16 kg as compared to women gaining less than 10 kg (OR, 3.37; 95% CI, 3.22-3.53) .112 Similar results were noted in a fair-quality U.S. Read the entire page →
From page 491... ... APPENDIX E 491 categories. A fair-quality study of obese women4 observed lower odds of LGA among women who gained less than the reference group (15-25 pounds) Read the entire page →
From page 492... ... 492 WEIGHT GAIN DURING PREGNANCY TABLE 19. Gestational Weight Gain and LGA Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 493... ... APPENDIX E 493 Confounders and Effect Modifiers Included Results in Analysis G1: 1.08 (1.03-1.12) Maternal age, pregravid BMI, smoking, gestational hyperglycaemia G1: 1.08 (0.81-1.44) Read the entire page →
From page 494... ... 494 WEIGHT GAIN DURING PREGNANCY TABLE 19. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 495... ... APPENDIX E 495 Confounders and Effect Modifiers Included Results in Analysis G1: Relative risks for LGA similar between Pregravid BMI, fasting plasma glucose non-diabetic and GDM groups G2: GDM group has 2 times higher risk that non-diabetics Numerical results not reported. Read the entire page →
From page 496... ... 496 WEIGHT GAIN DURING PREGNANCY TABLE 19. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 497... ... APPENDIX E 497 Confounders and Effect Modifiers Included Results in Analysis G1: 1.0 Maternal age, pregravid BMI, gestational G2: 2.4 (1.1-5.3) age, 2 hour OGTT, parity, smoking, ethnicity, G3: 2.1 (1.1-4.8) Read the entire page →
From page 498... ... 498 WEIGHT GAIN DURING PREGNANCY TABLE 20. Gestational Weight Gain and LGA by BMI Status Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 499... ... APPENDIX E 499 Confounders and Effect Modifiers Included Results in Analysis G1: 1.25 (1.11-1.41) Maternal age, race, parity, pregravid BMI, G2: 1.14 (1.08-1.20) Read the entire page →
From page 500... ... 500 WEIGHT GAIN DURING PREGNANCY TABLE 20. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 501... ... APPENDIX E 501 Confounders and Effect Modifiers Included Results in Analysis G1: 2.25 (1.03-4.94) Preeclampsia, C-section, 1-minute Apgar G2: 1.41 (1.31-1.76) Read the entire page →
From page 502... ... 502 WEIGHT GAIN DURING PREGNANCY TABLE 21. Gestational Weight Gain and SGA Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 503... ... APPENDIX E 503 Confounders and Effect Modifiers Included Results in Analysis G1: 2.06 (1.62-2.63) Maternal age, maternal race, parity, G2: 1.82 (1.35-2.47) Read the entire page →
From page 504... ... 504 WEIGHT GAIN DURING PREGNANCY TABLE 21. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 505... ... APPENDIX E 505 Confounders and Effect Modifiers Included Results in Analysis G1: Odds of SGA are lower for women in Maternal age, maternal race, maternal this group education, poverty, smoking, parity, chronic G2: Odds of SGA are higher for women in hypertension this group Numerical value for ORs not reported in study G1: 1.32 (1.20-1.44) Pregravid weight, infant sex, smoking, parity, maternal diabetes, height, previous LBW infant, severe pregnancy-induced hypertension G1: 0.93 (P = NS) Read the entire page →
From page 506... ... 506 WEIGHT GAIN DURING PREGNANCY TABLE 21. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 507... ... APPENDIX E 507 Confounders and Effect Modifiers Included Results in Analysis G1: 2.87 (2.56-3.21) Maternal age, parity, pregravid weight, G2: 1.49 (1.35-1.66) Read the entire page →
From page 508... ... 508 WEIGHT GAIN DURING PREGNANCY TABLE 21. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 509... ... APPENDIX E 509 Confounders and Effect Modifiers Included Results in Analysis G1: 1% N/A G2: 6% G3: 35% G4: 43% G5: 13% G6: 2% G7: 3% G8: 14% G9: 32% G10: 34% G11: 14% G12: 3% G13: 0% G14: 2% G15: 42% G16: 29% G17: 20% G18: 7% No significant difference in rates of SGA Maternal age, pregravid BMI, gestational by maternal weight gain group. Numerical age, 2 hour OGTT, parity, smoking, ethnicity, results not reported in article. Read the entire page →
From page 510... ... 510 WEIGHT GAIN DURING PREGNANCY TABLE 22. Gestational Weight Gain and SGA by BMI Status Author, Year Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 511... ... APPENDIX E 511 Confounders and Effect Modifiers Included Results in Analysis G1: 0.87 (0.78-0.97) Maternal age, race, parity, pregravid BMI, G2: 0.90 (0.84-0.96) Read the entire page →
From page 512... ... 512 WEIGHT GAIN DURING PREGNANCY TABLE 22. Continued Author, Year Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 513... ... APPENDIX E 513 Confounders and Effect Modifiers Included Results in Analysis G1: 1.0 Maternal age, parity, alcohol, diabetes, term G2: 0.6 (0.4-0.8) delivery, smoking, gestational age, infant sex G3: 0.6 (0.4-1.1) Read the entire page →
From page 514... ... 514 WEIGHT GAIN DURING PREGNANCY TABLE 22. Continued Author, Year Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 515... ... APPENDIX E 515 Confounders and Effect Modifiers Included Results in Analysis G1: 5.42 (2.86-10.27) Preeclampsia, C-section, 1-minute Apgar G2: 2.78 (1.53-5.06) Read the entire page →
From page 516... ... 516 WEIGHT GAIN DURING PREGNANCY the two highest weight gain categories. One study, using data from the Swedish Medical Birth Registry, observed higher rates of SGA (here defined as < 2 SD below the mean) Read the entire page →
From page 517... ... APPENDIX E 517 the risk decreasing with increasing BMI.116 Specifically, the ORs of SGA for each 50 g per week increase in maternal weight were as follows: 0.87 (95% CI, 0.78-0.97) for underweight mothers; 0.90 (95% CI, 0.84-0.96) Read the entire page →
From page 518... ... 518 WEIGHT GAIN DURING PREGNANCY TABLE 23. Gestational Weight Gain and Apgar Scores Author, Date Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 519... ... APPENDIX E 519 Confounders and Effect Modifiers Included in Results Analysis No association between low weight gain and Apgar score (< 7) , BMI, maternal age, despite BMI of mother parity, smoking in early pregnancy, year of birth Increased OR for gestational weight gain on 1-minute and 5- Prepregnancy weight minute Apgar score ≤ 7, persists after adjusting (no further details quartile, height (tertile) Read the entire page →
From page 520... ... 520 WEIGHT GAIN DURING PREGNANCY gestational weight gain, after adjusting for prepregnancy weight quartile, height (tertile) , BMI category, race, parity, hypertension, and other variables entered by stepwise regression model, but the authors provided no further details on the magnitude of the effect.70 One poor-quality study examined associations between 1-minute Apgar scores > 4 and rates of weekly weight gain (7 categories) Read the entire page →
From page 521... ... TABLE 24. Gestational Weight Gain and Perinatal Mortality Author, Date Country, Setting Sample Size Confounders and Effect Baseline BMI Pregravid Weight (How Measured) Modifiers Included in Quality Total Weight Gain (How Measured) Read the entire page →
From page 522... ... TABLE 24. Continued 522 Author, Date Country, Setting Sample Size Confounders and Effect Baseline BMI Pregravid Weight (How Measured) Modifiers Included in Quality Total Weight Gain (How Measured) Read the entire page →
From page 523... ... APPENDIX E 523 gain on stillbirth within groups defined by BMI.126 It found increased risks of stillbirth with pregravid obesity and overweight status. This association between higher pregravid weight and stillbirth persisted after the investigators excluded women with obesity-related diseases (diabetes, preeclampsia, and other hypertensive disorders) Read the entire page →
From page 524... ... 524 WEIGHT GAIN DURING PREGNANCY the following complications: macrosomia (birthweight > 4,500 g) , hypoglycemia (at least one plasma glucose < 40 mg/dL) Read the entire page →
From page 525... ... APPENDIX E 525 women was 29.1 and most were nulliparas. Most of the women gained between 8.5 and 12.5 kg (mean, 10.5 kg) Read the entire page →
From page 526... ... 526 WEIGHT GAIN DURING PREGNANCY BMI, date of delivery, pregnancy-induced hypertension, mode of delivery, length of first stage of labor, length of second stage of labor, gestational age, and birthweight. Using weight gain of 11.5 to 16 kg as a reference, the authors reported that gestational weight gain less than 7 kg was associated with neonatal seizure (AOR, 10.66; 95% CI, 2.17-52.36) Read the entire page →
From page 527... ... APPENDIX E 527 analysis done separately for mothers with GDM and controls, total gestational weight gain significantly predicted infant's BMI such that a 1 kg increase in weight gain was associated with a 0.06 and 0.05 increase in BMI for GDM and control infants, respectively, after controlling for pregravid BMI and glucose values. The difference between the results of these two studies lies in the fact that once the weight of the infant is removed from total weight gain, an important product of conception is missing from the measure of weight gain and thus the strength of the association is reduced.131 Other infant growth characteristics Study characteristics Six studies examined the association between gestational weight gain and various other infant growth characteristics (Evidence Table 31, Table 25) Read the entire page →
From page 528... ... 528 WEIGHT GAIN DURING PREGNANCY TABLE 25. Gestational Weight Gain and Other Infant Growth Measures Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 529... ... APPENDIX E 529 Confounders and Effect Modifiers Included Results in Analysis G1: β = 0.21 Maternal age, parity, pregravid BMI, height, (P < 0.0003) infant sex, gestational age G2: β = 0.05 PI (P < 0.4) Read the entire page →
From page 530... ... 530 WEIGHT GAIN DURING PREGNANCY TABLE 25. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 531... ... APPENDIX E 531 Confounders and Effect Modifiers Included Results in Analysis G1: β = 0.35 (P = 0.49) Maternal age, pregravid BMI, previous SGA, G2: β = 0.88 (P = 0.02) Read the entire page →
From page 532... ... 532 WEIGHT GAIN DURING PREGNANCY 15 months postpartum,132 3 years of age,24 and 2 and 5 years for the Avon longitudinal study of pregnancy and childhood (ALSPAC) in England.133 All three included only singleton births. Read the entire page →
From page 533... ... TABLE 26. Gestational Weight Gain and Childhood Weight Status Pregravid Author, Year Weight (How Country, Setting Measured) Sample Size Total Weight Baseline BMI Gain (How Definition Confounders and Effect Modifiers Quality Measured) Read the entire page →
From page 534... ... TABLE 26. Continued 534 Pregravid Author, Year Weight (How Country, Setting Measured) Sample Size Total Weight Baseline BMI Gain (How Definition Confounders and Effect Modifiers Quality Measured) Read the entire page →
From page 535... ... APPENDIX E 535 to 1987, examined the effect of maternal prenatal lifestyle factors on children's hospitalizations with infectious diseases (Evidence Table 33) .135 After excluding stillbirths, multiple births, and children with congenital malformations, the authors followed 10,440 newborns from 6 months to 12 years. Read the entire page →
From page 536... ... 536 WEIGHT GAIN DURING PREGNANCY TABLE 27. Gestational Weight Gain and Postpartum Weight Retention Author, Year Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 537... ... APPENDIX E 537 Confounders and Effect Modifiers Results Included in Analysis G1: Mean change (95% CI) in BMI at 21 years Baseline income, secondary postpartum: 5.06 kg/m2 (4.85-5.27) Read the entire page →
From page 538... ... 538 WEIGHT GAIN DURING PREGNANCY TABLE 27. Continued Author, Year Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 539... ... APPENDIX E 539 Confounders and Effect Modifiers Results Included in Analysis Regression of current weight on total number of Weight at ages 20 to 24, current pregnancies showed a 1.3 kg/pregnancy increase in age current weight (P = 0.03) with no difference between G1 and G2 (P = 0.60) Read the entire page →
From page 540... ... 540 WEIGHT GAIN DURING PREGNANCY TABLE 27. Continued Author, Year Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 541... ... APPENDIX E 541 Confounders and Effect Modifiers Results Included in Analysis Regression model of weight retention (kg) at 6 weeks Standard weight for height postpartum as the dependent variable and G1-G5 as (based on 1983 Metropolitan independent variables: Life Insurance Tables) Read the entire page →
From page 542... ... 542 WEIGHT GAIN DURING PREGNANCY TABLE 27. Continued Author, Year Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 543... ... APPENDIX E 543 Confounders and Effect Modifiers Results Included in Analysis G1: Patterns of changes in body weight (kg) and None fat mass follow a monotonous trend; body weight and fatness increased during gestation, decreased substantially at 6 weeks postpartum, and then stayed the same or slightly decreased until 6 months postpartum G2: Showed similar pattern to G1. Read the entire page →
From page 544... ... 544 WEIGHT GAIN DURING PREGNANCY tum105,141,145 and with interpregnancy weight gains.137-139 There is evidence to suggest that pattern of weight gain influences weight retention; a higher percentage of weight gained within the first 20 weeks of gestation is retained at 6 weeks postpartum compared to weight gains later in pregnancy.105 Additionally, weight retention differs across pregravid BMI strata,138,143 with overweight and obese women retaining more weight compared to normal weight women. Postpartum weight retention seems to be especially problematic for obese women, who may be at risk for increases in fat mass and central adiposity in the postpartum period.143 In the long term, the effect of gestational weight gain on weight retention is less conclusive; two studies144,146 found little to no association between gestational weight gain and weight at 2.5 and 21 years after the index pregnancy and one study136 found that women who became overweight at 15 years followup had higher gestational weight gains compared to women who remained normal weight. Read the entire page →
From page 545... ... APPENDIX E 545 Another study measured body weight, body fat mass (kg) , and skinfold thickness (sum of five skinfold thicknesses) Read the entire page →
From page 546... ... 546 WEIGHT GAIN DURING PREGNANCY no significant differences between normal-weight women and overweight women in the amount of weight retained from prepregnancy to 6 months and 1 year postpartum. Postpartum weight retention in the medium term One good-quality study144 found no association between gestational weight gain and weight retention at two and half years postpartum in a small cohort of women with low antenatal risks enrolled in the Antenatal Care Project (United Kingdom) Read the entire page →
From page 547... ... APPENDIX E 547 of morbidly obese women, who were not morbidly obese prior to their first pregnancy, and population-based controls.139 The mean gestational weight gain and net weight retention for all pregnancies was 14.2 kg and 5.7 kg, respectively, for women who became morbidly obese, and 12.5 kg and 3.4 kg, respectively, for the controls. Women who became morbidly obese gained significantly more weight during their first pregnancy than controls (16.4 kg vs. Read the entire page →
From page 548... ... 548 WEIGHT GAIN DURING PREGNANCY during pregnancy that the IOM laid out in its 1990 document.1 The recommendations specific to BMI weight status groups and certain sociodemographic or physical characteristics are as follows: • 28 to 40 pounds for women with low BMI (< 19.8) ; • 25 to 35 pounds for women with normal BMI (19.8-26) Read the entire page →
From page 549... ... TABLE 28. Weight Change Relative to IOM Thresholds and Gestational Diabetes Mellitus Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Confounders and Baseline BMI Total Weight Gain Effect Modifiers Quality (How Measured) Read the entire page →
From page 550... ... TABLE 28. Continued 550 Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Confounders and Baseline BMI Total Weight Gain Effect Modifiers Quality (How Measured) Read the entire page →
From page 551... ... APPENDIX E 551 risk of developing GDM because of methodological problems with most studies addressing this topic. Detailed results Obese women, independent of weight gain, had increased risks of developing GDM in three studies (1 of good quality,3 1 of poor quality54) Read the entire page →
From page 552... ... 552 WEIGHT GAIN DURING PREGNANCY of fair quality (Evidence Table 38, Table 29) .4,25,53,55 Two studies included obese women;4,55 three included women of normal weight.25,53,55 Overview of results The evidence of an association between high weight gains and increased risk of preeclampsia is inconclusive. Read the entire page →
From page 553... ... TABLE 29. Weight Change Relative to IOM Thresholds and Preeclampsia Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Confounders and Baseline BMI Total Weight Gain Effect Modifiers Quality (How Measured) Read the entire page →
From page 554... ... TABLE 29. Continued 554 Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Confounders and Baseline BMI Total Weight Gain Effect Modifiers Quality (How Measured) Read the entire page →
From page 555... ... TABLE 30. Weight Change Relative to IOM Thresholds and Cesarean Delivery Author, Year Country, Setting Pregravid Weight Confounders and Sample Size (How Measured) Effect Modifiers Baseline BMI Total Weight Gain Definition of Included in Quality (How Measured) Read the entire page →
From page 556... ... TABLE 30. Continued 556 Author, Year Country, Setting Pregravid Weight Confounders and Sample Size (How Measured) Effect Modifiers Baseline BMI Total Weight Gain Definition of Included in Quality (How Measured) Read the entire page →
From page 557... ... Kiel et al., 20074 Pregravid BMI: G1: Wt loss For all three classes of obese women, risks of cesarean Age, race, parity, Self-reported > 10 lbs delivery rise above an OR of 1 when weight gain education, poverty USA-Missouri, birth G2: Wt loss exceeds 25 pounds (enrollment in certificate Total weight gain: 2-9 lbs medicaid, WIC, Birth certificate 120, 170 G3: No change food stamp G4: 2-9 lbs programs) , tobacco Obese BMI > 30 G5: 10-14 lbs use, chronic Fair G6: 15-25 lbs hypertension G7: 26-35 lbs G8: > 35 lbs Parker and Abrams, Pregravid weight: G1: Below AOR for all women weight gain > IOM (G2) Read the entire page →
From page 558... ... TABLE 30. Continued 558 Author, Year Country, Setting Pregravid Weight Confounders and Sample Size (How Measured) Effect Modifiers Baseline BMI Total Weight Gain Definition of Included in Quality (How Measured) Read the entire page →
From page 559... ... APPENDIX E 559 association between weight gain and risk of cesarean delivery. For underweight women, two studies reported a moderate to strong association between weight gain above IOM recommendations and risk for cesarean delivery;118,149 for nonobese women, one of these studies reported a moderate association.118 Three studies reported that the risk of cesarean delivery was higher for obese or morbidly obese women than for nonobese women.54,55,150 One study suggested that these risks increase within classes of obesity with gains greater than 25 pounds.4 The one study that examined the interaction between weight gain of 25-34 pounds and pregravid overweight or obese status did find a significant effect for multiparous women but not primiparous.77 Birth Outcomes Preterm birth Study characteristics Four studies, all rated fair, reported on the association between weight gain according to the IOM guidelines and preterm birth defined as < 37 completed weeks of gestation (Evidence Table 40, Table 31) Read the entire page →
From page 560... ... 560 WEIGHT GAIN DURING PREGNANCY TABLE 31. Weight Change Relative to IOM Thresholds and Preterm Birth (< 37 weeks) Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Read the entire page →
From page 561... ... APPENDIX E 561 Confounders and Effect Results Modifiers Included in Analysis OR (95% CI) for spontaneous preterm Age, race, pregravid BMI, G1: 1.27 (0.7-2.3) Read the entire page →
From page 562... ... 562 WEIGHT GAIN DURING PREGNANCY TABLE 31. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 563... ... APPENDIX E 563 Confounders and Effect Results Modifiers Included in Analysis Crude OR of spontaneous preterm birth Age, race, parity, pregravid BMI, G1:2.6 (95% CI 2.1-3.2) history of previous PTB, year of G3:1.0 (95% CI 0.8-1.2) Read the entire page →
From page 564... ... 564 WEIGHT GAIN DURING PREGNANCY crude and adjusted analyses. High rate of weight gain, defined as > 0.52 kg per week, was not associated with risk of preterm birth. Read the entire page →
From page 565... ... APPENDIX E 565 found, overall, that black women gaining above the IOM guidelines experienced significantly higher birthweights (a range of 73 g to 330 g) than those who gained less weight.20,60,153,156 Among white women,20,156 weight gain above the IOM guidelines was also associated with higher birthweights for those with a BMI ≤ 2920,156 but not > 29 in one study.156 This increase in birthweight was close to 200 g.20,156 In three of these studies,20,153,156 the analyses were adjusted for multiple confounders listed in Table 32. Read the entire page →
From page 566... ... 566 WEIGHT GAIN DURING PREGNANCY TABLE 32. Weight Change Relative to IOM Thresholds and Birthweight Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 567... ... APPENDIX E 567 Confounders and Effect Modifiers Results Included in Analysis Adjusted birthweight Parity, pregravid BMI < 19.8 BMI 19.8-26 BMI > 26 BMI, preeclampsia, G1: 2,986 g G1: 3,018 g G1: 3,127 g time between last G2: 3,167 g G2: 3,166 g G2: 3,351 g weight measure and G3: 3,198 g G3: 3,255 g G3: 3,384 g delivery, height, G4: 3,277 g G4: 3,318 g G4: 3,434 g smoking, infant sex All significantly All significantly G1 significantly different from each different from each different from the other except G2 & other others, G2,G3 & G3 G4 not significantly different from each other BMI < 19.8 BMI 19.8-26.0 BMI > 26.0 Age, education, G1: G1: G1: height, street Black: 2,840 Black: 3,052 Black: 3,126 drugs, alcohol use, White: 3,002 White: 3,176 White: 3,385 time between last prenatal weight G2: G2: G2: observation and Black: 2,995 Black: 3,105 Black: 3,192 delivery, smoking, White: 3,151 White: 3,199 White: 3,376 gestational age, G3: G3: G3: infant sex Black: 3,017 Black: 3,180 Black: 3,312 White: 3,200 White: 3,307 White: 3,402 G4: G4: G4: Black: 3,163 Black: 3,228 Black: 3,300 White: 3,353 White: 3,389 White: 3,504 Association of low No association with G1 & G3: No Age, race, pregravid trimester gain with low weight gain significant diff BMI, height, birthwt in only the first or alcohol use, third G2 & G3: All -206 g G1: all women -18 g second trimester. trimester number of P = .01 P = .65 G3: All -164 g P weeks between last Black -178 g P = .08 Black -15 g P = .76 = .01 weight observation White -268 g P = .06 White -42 g P = .53 Black -80 g P = .38 and delivery, history White -300 g P = G1, G2 & G3: All of previous infant G2: All women .005 -284 g P = .002 < 2,750 g, smoking, -166g P = < .001 Black -252 g P = .03 gestational age, Black -164 g P = Association with low White -379 g P = infant sex .005 weight gain during .008 White -158 g P = .05 more than one trimester G3: All women -111g P = .008 G1 & G2: All -236 g Black -77 g P = .14 P = .01 White -194 g P = Black -265 g P = .04 .004 White -169 g P = .25 continued Read the entire page →
From page 568... ... 568 WEIGHT GAIN DURING PREGNANCY TABLE 32. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 569... ... APPENDIX E 569 Confounders and Effect Modifiers Results Included in Analysis Adjusted Birthwt Maternal height, BMI ≤ 29 BMI > 29 education, parity, G1: G4: marital status, Black: 3,027 Black: 3,214 smoking, alcohol White: 3,246 White: 3,500 use, hypertension, GDM, gestational G2: G5: age at delivery, Black: 3,177 Black: 3,553 socioeconomic White: 3,233 White: 3,596 status, time between G3: last weight and Black: 3,293 delivery White: 3,523 Adjusted birthweight Maternal age, G1: parity, black BMI < 19.8 2,873 g* ethnicity, smoking, BMI 19.8-26.0 3,157 g* Read the entire page →
From page 570... ... 570 WEIGHT GAIN DURING PREGNANCY TABLE 32. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 571... ... APPENDIX E 571 Confounders and Effect Modifiers Results Included in Analysis Birthweight (g) Read the entire page →
From page 572... ... 572 WEIGHT GAIN DURING PREGNANCY TABLE 33. Weight Change Relative to IOM Thresholds and Low Birthweight (< 2,500 g) Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Read the entire page →
From page 573... ... APPENDIX E 573 Confounders and Effect Modifiers Included Results in Analysis G1: 17.3% Maternal age, pregravid BMI, infant sex, G2: 10.0% race, parity, prenatal alcohol use, prenatal G3: 12.3% illicit drug use, adequacy of prenatal care, gestational hypertension, GDM, gestational G4: 10.5% age G5: 7.8% G6: 2.6% G7: 17.5% G8: 3.5% G9: 3.6% G10: 12.4% G11: 6.0% G12: 5.3% G13: 16.0% G14: 11.1% G15: 8.3% G16: 4.0% G17: 6.0% P = 0.003 for G13-G17 G18: 14.2% G19: 5.4% G20: 4.9% P = 0.001 for G18-G20 For obese women, compared to nonsmokers who gained 7-11.5 kg, smokers who gained < 7 kg were at significantly higher risk of LBW: AOR: 7.7 (95% CI, 1.5-40.0) continued Read the entire page →
From page 574... ... 574 WEIGHT GAIN DURING PREGNANCY TABLE 33. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 575... ... APPENDIX E 575 Confounders and Effect Modifiers Included Results in Analysis Within every BMI-race ethnicity stratum, Age, height, education, trimester of the the odds of delivering a LBW infant tended special supplemental nutrition program for to decrease as weight gain increased. This WIC trend was statistically significant for all strata; however, the trend diminished with increasing BMI. Read the entire page →
From page 576... ... 576 WEIGHT GAIN DURING PREGNANCY TABLE 33. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 577... ... APPENDIX E 577 Confounders and Effect Modifiers Included Results in Analysis AOR (95% CI) for low birthweight: Age, race, height, smoking, gestational age, G1: 2.1 (1.6-2.6) Read the entire page →
From page 578... ... 578 WEIGHT GAIN DURING PREGNANCY TABLE 33. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 579... ... APPENDIX E 579 Confounders and Effect Modifiers Included Results in Analysis G1:12.8% Age, parity, pregravid BMI, GDM, pregnancyG2: 8.9% induced hypertension, prenatal adequacy, G3: 7.9% alcohol use, drug use, smoking, gestational G4: 6.8% age G5: 8.7% P (for G1-G5) Read the entire page →
From page 580... ... 580 WEIGHT GAIN DURING PREGNANCY TABLE 33. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 581... ... APPENDIX E 581 Confounders and Effect Modifiers Included Results in Analysis AOR (95% CI) for very low birthweight: Age, parity, pregravid BMI, preeclampsia, G1: 1.8 (0.6-4.7) Read the entire page →
From page 582... ... 582 WEIGHT GAIN DURING PREGNANCY TABLE 33. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 583... ... APPENDIX E 583 Confounders and Effect Modifiers Included Results in Analysis Distribution of LBW,%: Race, parity, clinic service, substance abuse, G1: 2.0 preexisting medical condition G2: 11.1 G3: 8.3 G4: 5.2 G5: 3.8 P = NS AOR (95% CI) for very low birthweight Ethnicity, intendedness of pregnancy, (500-1,499g) Read the entire page →
From page 584... ... 584 WEIGHT GAIN DURING PREGNANCY Overview of results Evidence from twelve articles (2 good,159,160 7 fair,2,20,55,60,77,127,154,161 and 3 poor54,162,163) supports an association between weight gain less than the IOM guidelines and LBW for both underweight and normal-weight women; evidence is less conclusive about any association for women with higher body weight. Read the entire page →
From page 585... ... APPENDIX E 585 the second and third trimesters.161 Low rate of weight gain in the second and third trimesters was associated with an increased risk of term LBW or intrauterine growth restriction (IUGR) in both data sets. Read the entire page →
From page 586... ... 586 WEIGHT GAIN DURING PREGNANCY TABLE 34. Weight Change Relative to IOM Thresholds and Large-forGestational-Age Infant Weight Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 587... ... APPENDIX E 587 Confounders and Effect Modifiers Results Included in Analysis AOR (95% CI) for LGA and rate of weight gain (per 50 g/wk) Read the entire page →
From page 588... ... 588 WEIGHT GAIN DURING PREGNANCY TABLE 34. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 589... ... APPENDIX E 589 Confounders and Effect Modifiers Results Included in Analysis AOR (95% CI) for LGA: Age, race, G1: 0.40 (0.37-0.44) Read the entire page →
From page 590... ... 590 WEIGHT GAIN DURING PREGNANCY TABLE 34. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 591... ... APPENDIX E 591 Confounders and Effect Modifiers Results Included in Analysis Unadjusted Rates of LGA: Age, race, parity, G1: 3.85 P < 0.001 vs. G2 pregravid BMI, G2: 6.62 pregnancy-induced G3:13.76 P < 0.001 vs. Read the entire page →
From page 592... ... 592 WEIGHT GAIN DURING PREGNANCY TABLE 34. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 593... ... APPENDIX E 593 Confounders and Effect Modifiers Results Included in Analysis Within every BMI-race ethnicity stratum, the odds of delivering a Age, height, > 4,500g infant tended to increase as weight gain increased. This education, trimester trend was statistically significant for all strata; however, the trend of the Special diminished with decreasing BMI. Read the entire page →
From page 594... ... 594 WEIGHT GAIN DURING PREGNANCY TABLE 34. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 595... ... APPENDIX E 595 Confounders and Effect Modifiers Results Included in Analysis Birthweight > 4,500g,% Age, parity, height, G1: 4.3 gestational age, G2: 4.1 (P < 0.05 between groups) birthweight G3: 9.1 (P < 0.05 between groups) Read the entire page →
From page 596... ... 596 WEIGHT GAIN DURING PREGNANCY TABLE 34. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 597... ... APPENDIX E 597 Confounders and Effect Modifiers Results Included in Analysis AOR (95% CI) for birthweight ≥ 4,000g: Preeclampsia, G1: 0.8 (0.4-1.6) Read the entire page →
From page 598... ... 598 WEIGHT GAIN DURING PREGNANCY among obese smokers.55,159 In a study that grouped women into classes of obesity,4 the odds of LGA increased with weight gains above 25 pounds for all classes of obesity. Two studies examined the impact of rate of weight gain according to the IOM guidelines on having an LGA infant.116,154 One good study defined the rate of weight gain in increments of 50 g per week.116 The AORs associated with having an LGA infant for each increment were as follows: 1.25 for normal-weight women, 1.14 for overweight women, and 1.13 for obese women. Read the entire page →
From page 599... ... APPENDIX E 599 significant increased risk in the two studies of fair quality.55,164 Normalweight women who gained below the guidelines were at decreased risk in one study.164 For obese women, one study found no difference in the risk of macrosomia with weight gains either above or below the IOM guidelines;164 the other found that those who gained above the IOM guidelines had 2.8 times the risk for a macrosomic infant relative to those who gained within the recommended range.55 For underweight and overweight women, weight gains above or below the IOM guidelines were not associated with delivering a macrosomic infant,164 although women with weight gains above the guidelines appeared to have a slightly increased risk. Fetal growth (small for gestational age) Read the entire page →
From page 600... ... 600 WEIGHT GAIN DURING PREGNANCY TABLE 35. Weight Change Relative to IOM Thresholds and Small-for-Gestational-Age Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 601... ... APPENDIX E 601 Confounders and Effect Modifiers Results Included in Analysis AOR (95% CI) for SGA and rate of weight gain (per 50 g/wk) Read the entire page →
From page 602... ... 602 WEIGHT GAIN DURING PREGNANCY TABLE 35. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 603... ... APPENDIX E 603 Confounders and Effect Modifiers Results Included in Analysis SGA,%: Parity, pregravid G1: 22.3 BMI, time between G2: 15.6 last weight measure G3: 11.5 and delivery, height P < 0.01 for G1-G3 AOR (95% CI) Read the entire page →
From page 604... ... 604 WEIGHT GAIN DURING PREGNANCY TABLE 35. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 605... ... APPENDIX E 605 Confounders and Effect Modifiers Results Included in Analysis For Obese Class I: AOR (95% CI) for SGA were significantly greater Age, race, parity, (> 1.00, G6 was reference) Read the entire page →
From page 606... ... 606 WEIGHT GAIN DURING PREGNANCY TABLE 35. Continued Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 607... ... APPENDIX E 607 Confounders and Effect Modifiers Results Included in Analysis Unadjusted rates of SGA: Age, race, parity, G1: 11.74 P < 0.001 vs. G2 pregravid BMI, G2: 7.05 PIH, date of G3: 3.70 P < 0.001 vs. Read the entire page →
From page 608... ... 608 WEIGHT GAIN DURING PREGNANCY TABLE 36. Weight Change Relative to IOM Thresholds and Apgar Scores Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Quality (How Measured) Read the entire page →
From page 609... ... APPENDIX E 609 Confounders and Effect Modifiers Included Results in Analysis Maternal weight gain by IOM guidelines was None not not a signigicant predictor of Apgar scores (details -- none reported) Distribution of 1-minute Apgar score ≤ 4,%: None G1: 25.0 G2: 4.5 G3: 14.9 P = 0.02 for G1 vs. Read the entire page →
From page 610... ... 610 WEIGHT GAIN DURING PREGNANCY conducted among black adolescents and found a slow rate of weight gain (< 0.23 kg/week) to be associated with a 1-minute Apgar score of ≤ 4 compared to higher rates of weight gain (> 0.23 kg/week) Read the entire page →
From page 611... ... APPENDIX E 611 than the IOM guidelines (AOR, 1.38; 95% CI, 1.01-1.89) ; weight gains below the IOM were not associated with infant hypoglycemia. Read the entire page →
From page 612... ... 612 WEIGHT GAIN DURING PREGNANCY (Evidence Table 50) Read the entire page →
From page 613... ... APPENDIX E 613 TABLE 37. Weight Change Relative to IOM Thresholds and Breastfeeding Author, Year Pregravid Weight Country, Setting (How Measured) Confounders and Sample Size Total Weight Effect Modifiers Baseline BMI Gain (How Definition Included in Quality Measured) Read the entire page →
From page 614... ... 614 WEIGHT GAIN DURING PREGNANCY TABLE 37. Continued Author, Year Pregravid Weight Country, Setting (How Measured) Confounders and Sample Size Total Weight Effect Modifiers Baseline BMI Gain (How Definition Included in Quality Measured) Read the entire page →
From page 615... ... APPENDIX E 615 study used categories corresponding to the following cutpoints: < 8 kg, 8 to 15.9 kg (the reference group) , and ≥ 16 kg.166 Overview of results These studies (all fair quality) Read the entire page →
From page 616... ... 616 WEIGHT GAIN DURING PREGNANCY were associated with early termination of full breastfeeding Once the authors adjusted for pregravid BMI, however, this association was no longer significant. Detailed results on duration of any breastfeeding Shorter duration of any breastfeeding was associated with maternal obesity.166,167,169 In the two U.S. Read the entire page →
From page 617... ... APPENDIX E 617 study, changes in body fat from 14 to 37 weeks of gestation stratified by pregravid BMI showed that women who gained below the IOM guidelines had the lowest amount of fat gain; those within an intermediate level and those above had the highest fat gain.16 The investigators did not report significance tests. Among obese women who gained within the IOM guidelines, the percentage of body fat change (-0.6 kg) Read the entire page →
From page 618... ... TABLE 38. Weight Change Relative to IOM Thresholds and Short-Term Weight Retention 618 Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Confounders and Baseline BMI Total Weight Gain Effect Modifiers Quality (How Measured) Read the entire page →
From page 619... ... Stevens-Simon and Pregravid weight: Maternal weight gain Short term weight retention (2-11 weeks Age, pregravid McAnarney, 1992154 Self-report categories (kg/wk) : postpartum) Read the entire page →
From page 620... ... 620 WEIGHT GAIN DURING PREGNANCY TABLE 39. Weight Change Relative to IOM Thresholds and Weight Retention During the First Year Postpartum Author, Year Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 621... ... APPENDIX E 621 Confounders and Effect Modifiers Results Included in Analysis A mixed ANOVA with one repeated measures factor (weight before Pregravid BMI pregnancy, 6 months, 1, and 15 years) and one between-subjects factor (< IOM, within IOM, > IOM) Read the entire page →
From page 622... ... 622 WEIGHT GAIN DURING PREGNANCY TABLE 39. Continued Author, Year Country, Setting Pregravid Weight (How Sample Size Measured) Baseline BMI Total Weight Gain (How Quality Measured) Read the entire page →
From page 623... ... APPENDIX E 623 Confounders and Effect Modifiers Results Included in Analysis Mean weight retention at 6 months postpartum, lbs: Mode of delivery, G1: 0.4 infant sex, G2: 3.7 breastfeeding, G3: 13.5 infant birthweight, P < 0.001 pregravid BMI Maternal weight gain was significantly related to weight at 6 months postpartum: r = 0.60, P < 0.001 Mean weight retention at 18 months postpartum, lbs: G1, G2: 0.7 G3: 11.0 P < 0.01 Maternal weight gain was significantly related to weight at 18 months postpartum: r = 0.49, P < 0.001 Regression coefficient (SE) for weight change from early pregnancy to Exercise, 1 year postpartum (kg) Read the entire page →
From page 624... ... 624 WEIGHT GAIN DURING PREGNANCY the United States, and one was from Sweden.171 Five used a cohort design;158,171,172,174,175 one U.S. study was done in a representative sample of births.173 Overview of results The evidence from five fair studies158,171,172,174,175 and one poor study173 supports an association between excessive weight gain and weight retention within the first year postpartum. Read the entire page →
From page 625... ... TABLE 40. Weight Change Relative to IOM Thresholds and Long-Term Weight Retention Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Confounders and Effect Quality (How Measured) Read the entire page →
From page 626... ... TABLE 40. Continued 626 Author, Year Country, Setting Pregravid Weight Sample Size (How Measured) Baseline BMI Total Weight Gain Confounders and Effect Quality (How Measured) Read the entire page →
From page 627... ... Rooney et al., Pregravid weight: Maternal weight gain Average weight change between prepregnancy Duration of breastfeeding, 2002174 Measured at first categories: and ~8.5 years postpartum (kg) : postpartum aerobic exercise, visit G1: 4.1 weight loss by 6 months USA, hospital G1: < IOM G2: 6.5 Total weight gain: G2: Within IOM 540 G3: 8.4 Measured G3: > IOM P = 0.01 All weight/BMI (using IOM Regression coefficients (95% CI) Read the entire page →
From page 628... ... 628 WEIGHT GAIN DURING PREGNANCY In the other U.S. study, the incidence of overweight at the second pregnancy was statistically significantly higher among women who had gained above the IOM in the prior pregnancy than among those who gained within or below IOM recommendations.177 The adjusted odds of becoming overweight between baseline and the start of the second pregnancy was nearly threefold for women gaining above recommendations. Read the entire page →
From page 629... ... APPENDIX E 629 7. AA Hedley, CL Ogden, CL Johnson, MD Carroll, LR Curtin, and KM Flegal. Read the entire page →
From page 630... ... 630 WEIGHT GAIN DURING PREGNANCY 25. SR Devader, HL Neeley, TD Myles, and TL Leet. Read the entire page →
From page 631... ... APPENDIX E 631 42. L Tulman, KH Morin, and J Fawcett. Read the entire page →
From page 632... ... 632 WEIGHT GAIN DURING PREGNANCY 60. D Ogunyemi, S Hullett, J Leeper, and A Risk. Read the entire page →
From page 633... ... APPENDIX E 633 78. A Sherrard, RW Platt, D Vallerand, RH Usher, X Zhang, and MS Kramer. Read the entire page →
From page 634... ... 634 WEIGHT GAIN DURING PREGNANCY 97. NF Butte, KJ Ellis, WW Wong, JM Hopkinson, and EO Smith. Read the entire page →
From page 635... ... APPENDIX E 635 1 14. DK Steward and DK Moser. Read the entire page →
From page 636... ... 636 WEIGHT GAIN DURING PREGNANCY 1 32. NA Sowan and ML Stember. Read the entire page →
From page 637... ... APPENDIX E 637 150. PS Kaiser and RS Kirby. Read the entire page →
From page 638... ... 638 WEIGHT GAIN DURING PREGNANCY 168. KM Rasmussen, JA Hilson, and CL Kjolhede. Read the entire page →
From page 639... ... APPENDIX E 639 186. CS Johnston, FS Christopher, and LA Kandell. Read the entire page →

From page 389...

... appendix E Results from the Evidence-Based Report* on Outcomes of Maternal Weight Gain The purpose of this systematic evidence-based review, requested by the Agency for Healthcare Research and Quality (AHRQ)