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From page 641... ... appendix F Data Tables APPROACH TO GATHERING EVIDENCE In order to review the most relevant scientific literature available, the committee and staff conducted thorough searches of several online bibliographic databases, including Medline, Science Direct, and WorldCat/First Search. General searches on pregnancy, gestational weight gain, and outcomes of pregnancy were first conducted to identify primary literature. Read the entire page →
From page 642... ... 642 WEIGHT GAIN DURING PREGNANCY of Gestational Weight Gain for the Child. This table is not inclusive of all the literature covered in this report nor does the report address each of the studies listed in the table. Read the entire page →
From page 643... ... APPENDIX F 643 BOX F-1 Examples of Searches Using Key Words to Identify Relevant Literature (PubMed) General search (limited to English) Read the entire page →
From page 644... ... 644 WEIGHT GAIN DURING PREGNANCY STUDIES ON CONSEQUENCES OF GESTATIONAL WEIGHT GAIN FOR THE MOTHER AND CHILD TABLE F-1 Consequences of Gestational Weight Gain Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 645... ... APPENDIX F 645 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Maternal weight gain Women with low rate of modifiers: • Preterm delivery weight gain (< 0.27 kg/wk) • Dietary intake had a 60% higher risk for • Use of cigarettes, alcohol, spontaneous preterm birth and illicit drugs compared with those with • Pre-pregnancy weight/height average weight gain (0.27- • Age 0.52 kg/wk) Read the entire page →
From page 646... ... 646 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 647... ... APPENDIX F 647 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Total maternal weight Mean weight gain (kg) modifiers: gain G1: 14.3 • Race • Infant birth weight G2: 15.2 • Parity G3: 15.2 • Maternal age G4: 14.1 • Number of cigarettes smoked/day Birth weight (gm) Read the entire page →
From page 648... ... 648 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 649... ... APPENDIX F 649 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Risk factors associated The following risk factors modifiers: with preterm delivery carried the highest relative • Race/ethnicity risk for a preterm delivery: • Age Previous preterm (OR = • Marital status 29.8) • SES Antepartum hemorrhage • Age of menarche onset and placental abnormalities • Gravidity (OR = 25.9) Read the entire page →
From page 650... ... 650 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 651... ... APPENDIX F 651 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Preeclampsia with or Women with preeclampsia modifiers: without albuminuria tended to have an increased • Social class • Other hypertensive rate of gain as the • Height complications pregnancy progressed, and • Age was greater in all stages Infant and child confounders/ than in the normotensive effect modifiers: group. The incidence of NR preeclampsia also increases as the rate of gain increases. Read the entire page →
From page 652... ... 652 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 653... ... APPENDIX F 653 Outcomes/Results/Confounders Outcomes description: Results: Adequate GWG Maternal confounders/effect • Milk production 14.4 (3.3 kg) was a good modifiers: • Maternal dietary intake indicator of good nutritional • Education • Anthropometry status during pregnancy. Read the entire page →
From page 654... ... 654 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 655... ... APPENDIX F 655 Outcomes/Results/Confounders Outcomes description: Maternal confounders/effect Infant and child confounders/ • Neonatal and modifiers: effect modifiers: postneonatal mortality • Education level (defined • Birth defect and morbidity as appropriate or • Gestational age (< 32 wks, inappropriate for age) 32-36 weeks, ≥ 37 wks) Read the entire page →
From page 656... ... 656 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 657... ... APPENDIX F 657 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect Apgar score ≤ 6 at 5 min • Mean GWG modifiers: • Admission to NICU G1: 14.2 kg (± SD 6.9) • Maternal age • Birth weight (≤ 2,500 g G2: 11.2 kg (± SD 7.7) Read the entire page →
From page 658... ... 658 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 659... ... APPENDIX F 659 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Maternal anthropometrics No associations were seen modifiers: • Infant cardiac structure between maternal weight • Age gain during pregnancy • Height and LVM at 6 wks of age, • Prepregnancy weight however weight gain during • Prepregnancy BMI pregnancy was positively • Weight in late pregnancy correlated with postnatal Infant and child confounders/ LVM at 6 mos of age. effect modifiers: For each kg increase in • Gender weight during pregnancy, • Birth weight/length LVM at age 6 mos increased by 0.08 g (95% CI 0.02, 0.15) Read the entire page →
From page 660... ... 660 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 661... ... APPENDIX F 661 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Maternal weight Obese mothers had a higher modifiers: • Birth weight incidence of inadequate NR weight gain, as compared to Infant and child confounders/ nonobese mothers. effect modifiers: Massively obese mothers NR had a markedly higher risk of delivering an infant over 4 kg. Read the entire page →
From page 662... ... 662 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 663... ... APPENDIX F 663 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • GDM Gains of 1.1-2.2 kg/yr were modifiers: • Rate of weight gain associated with a small • Age increased risk of GDM (OR • Baseline BMI 1.63, 85% CI 0.95-2.81) Read the entire page →
From page 664... ... 664 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 665... ... APPENDIX F 665 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Low birth weight Mean total weight gain = modifiers: (< 2,500 g) 14.8 ± 6.1 kg (range -3.8 to • Age • Preterm delivery (before 43.9 kg) Read the entire page →
From page 666... ... 666 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 667... ... APPENDIX F 667 Outcomes/Results/Confounders Outcomes description: Results: Adjusted relative risks Preeclampsia, RR (95% CI) : Macrosomia, RR (95% CI) Read the entire page →
From page 668... ... 668 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 669... ... APPENDIX F 669 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Gestational weight gain BMI and GWG, but not modifiers: • Infant birth weight pre-pregnancy physical • Parity activity level, were linked to • Smoking status birth weight. GWG during • Education level gestational weeks 12 and 33 • Pregnancy physical activity was correlated with elevated level birth weight. Read the entire page →
From page 670... ... 670 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 671... ... APPENDIX F 671 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Breastfeeding initiation A higher percentage of modifiers: and duration mothers with increased • Parental age prepregnancy BMI or high • Education level of GWG failed to initiate population breastfeeding, as compared • Parental anthropometric to normal weight mothers. data • Parity With women who • Smoking and alcohol initiated breastfeeding, consumption during no significance differences pregnancy were seen in breastfeeding • Weight status before, during duration in women with and after pregnancy different gestational weight gains. Read the entire page →
From page 672... ... 672 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 673... ... APPENDIX F 673 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Pregravid weight for Mothers aged 10-16 years modifiers: height (normal or underweight • Parity • Net pregnancy weight before pregnancy) had • Gynecologic age gain, growth retarded infants • Cigarette smoking • Birth weight and length by comparison to older Infant and child confounders/ • Head circumference mothers. Read the entire page →
From page 674... ... 674 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 675... ... APPENDIX F 675 Outcomes/Results/Confounders Outcomes description: Maternal Outcomes Results: Neonatal Outcomes Results: Maternal outcomes: OR (95% CI) Read the entire page →
From page 676... ... 676 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 677... ... APPENDIX F 677 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Risk of prematurity (32nd The principle factors modifiers: wk of gestation) of prematurity and/or • Marital status • Length of gestation; intrauterine growth • Weight/height obstetric risks retardation were determined • Having more than two to be: children without domestic Pathology of the cervix help or isthmus, unfavorable • Age obstetrical and • Social class gynecological antecedent; • Factors of fatigue signs of imminent delivery; Infant and child confounders/ low eight gain; fatigue; effect modifiers: toxemia; short, thin women NR continued Read the entire page →
From page 678... ... 678 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 679... ... APPENDIX F 679 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Average weekly weight GWG outside of the IOM modifiers: gain (stratified by guidelines was not related • Smoking status during prepregnancy BMI) to ADHD symptoms (below pregnancy • ADHD symptoms recs: OR: 0.96, 95% CI • Weight gain 0.81,1.14; above recs: OR: • Education 0.98, 95% CI 0.82,1.16) Read the entire page →
From page 680... ... 680 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 681... ... APPENDIX F 681 Outcomes/Results/Confounders Outcomes description: Maternal confounders/effect • Preterm delivery modifiers: • Weight gain rate • Maternal age • Prepregnancy BMIs • Parity • Race/ethnicity • Marital status Results: There was an inverse • Education level There was no association association between early • Income between spontaneous pregnancy weight gain • Smoking status preterm delivery and BMI and spontaneous preterm • Prenatal vitamin use (before and after adjustment delivery (before and • Prior preterm delivery for age, race/ethnicity, and after adjustment for age, • Prepregnancy hypertension parity) (OR per 5 kg/m2 race/ethnicity, prepregnancy • Prepregnancy diabetes increase: 1.01, 95% CI BMI, and parity) Read the entire page →
From page 682... ... 682 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 683... ... APPENDIX F 683 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • SGA G1: modifiers: Mean maternal height: • Maternal height/weight 159.4 cm (prepregnancy) Read the entire page →
From page 684... ... 684 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 685... ... APPENDIX F 685 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Obstetrical outcomes Mean birth weight, 3,519 g modifiers: (infant birth weight, Macrosomic infants: 16.3% • Family history of diabetes LGA) LGA infants, 16.3% (type 2 DM) Read the entire page →
From page 686... ... 686 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 687... ... APPENDIX F 687 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Maternal weight gain Gestational hypertension: modifiers: • Complications of G1: 4.2% • Marital status pregnancy, labor, and G2: 2.6% • Age delivery G3: 4.1% • Race/ethnicity G4: 9.1% • Education level Preeclampsia: • Smoking status G1: 2.5% • Alcohol consumption G2: 1.8% • Gravidity G3: 4.3% • Prepregnant weight/height G4: 7.0% Infant and child confounders/ Vaginal bleeding: effect modifiers: G1:7.6% • Gestational age G2: 5.1% • Infant sex G3: 3.5% G4: 3.0% Cesarean delivery: G1: 17.0% G2:12.0% G3: 16.8% G4: 20.6% Infant birth weight: G1: ≤ 2,500 g: 1.7% 2,501-4,000 g: 94.9% > 4,000 g: 3.4% G2: ≤ 2,500 g: 1.1% 2,501-4,000 g: 90.0% > 4,000 g: 8.9% G3: ≤ 2,500 g: 0.4% 2,501-4,000 g: 86.2% > 4,000 g: 13.5% G4: ≤ 2,500 g: 1.2% 2,501-4,000 g: 77.6% > 4,000 g: 21.2% continued Read the entire page →
From page 688... ... 688 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 689... ... APPENDIX F 689 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Fetal and neonatal deaths Low weight gain categories modifiers: • Other deaths before age 5 had a higher percentage of • Maternal age • Cognitive development fetal and neonatal death • Race (Raven Colored than the high weight gain • Parity Progressive Matrices test categories (p < 0.001) Read the entire page →
From page 690... ... 690 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 691... ... APPENDIX F 691 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Gestational age Effects of Risk Factors, modifiers: • Birth weight/length Odds Ratio (p value) • Smoking • Head circumference Previous SGA infant: • Previous SGA infant Mild = 2.69 • Toxemia Severe = 5.39 (0.008) Read the entire page →
From page 692... ... 692 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 693... ... APPENDIX F 693 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Obstetric performance Obese gravidas had modifiers: • Pregnancy outcome significantly increased • Age • Lactational performance incidences of gestational • Height hypertension, inadequate • Parity pregnancy weight • Gestational age at first visit gain, cesarean section, Infant and child confounders/ postpartum infections, and effect modifiers: LGA infants. • Birth weight No significant increase • Age-weight classification of was seen on obese infant gravidas for incidence of • Postpartum infections diabetes, toxemia, breech • Mode of delivery presentation, postpartum hemorrhage, infant morbidity, or lactational failure. Read the entire page →
From page 694... ... 694 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 695... ... APPENDIX F 695 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Neonatal obesity Parameters of Infants Born modifiers: to Mothers • GWG Birth weight (gm) = • Parity G1: 3,471 ± 739; G2: 3,279 • Prepregnancy weight/height ± 494 (p value NS) Read the entire page →
From page 696... ... 696 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 697... ... APPENDIX F 697 Outcomes/Results/Confounders Outcomes description: Maternal confounders/effect • Total weight gain modifiers: • Maternal weight NR • Pregnancy complications Infant and child confounders/ • Mode of delivery effect modifiers: • Birth weight NR • Fetal status in labor (cardiotocographic tracing and fetal scalp pH) Results: Fetal distress in labor Preeclampsia G1: 12.1% G1: 8.8% G2: 5.1% G2: 5.9% G3: 4.1% G3: 9.7% G4: 4.9% G4: 9.7% G5: 6.3% G5: 10.3% G6: 6.3% G6: 11.1% Normal delivery Preexisting hypertension G1: 73.6% G1: 4.4% G2: 73.5% G2: 4.4% G3: 72.4% G3: 6.1% G4: 68.6% G4: 6.8% G5: 69.8% G5: 11.9% G6: 55.6% G6: 13.9% Forceps delivery IUGR G1: 13.2% G1: 29.7% G2: 14.7% G2: 14.7% G3: 13.1% G3: 5.8% G4: 16.9% G4: 7.0% G5: 17.4% G5: 6.3% G6: 27.8% G6: 6.9% C-Section Premature Labor G1: 13.2% G1: 8.8% G2: 11.8% G2: 4.4% G3: 14.5% G3: 2.5% G4: 14.4% G4: 2.5% G5: 15.1% G5: 2.4% G6: 16.6% G6: 4.1% Antepartum hemorrhage G1: 5.5% G2: 3.3% G3: 2.5% G4: 3.1% G5: 3.2% continued G6: 3.5% Read the entire page →
From page 698... ... 698 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 699... ... APPENDIX F 699 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Macrosomic infant Weight gain < 10.2 kg modifiers: (≥ 4,200 g) Univariate analyses: • Maternal BMI OR = 1.0 • Maternal subcutaneous fat Multivariate analyses: at visit one OR = 1.0 • Weight gain in pregnancy Weight gain ≥ 10.2 kg • Plasma glucose values (visit Univariate analyses: one and three) Read the entire page →
From page 700... ... 700 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 701... ... APPENDIX F 701 Outcomes/Results/Confounders Outcomes description: Maternal confounders/effect • Dietary intake and weight modifiers: development NR • Glucose metabolism Infant and child confounders/ • Birth outcome effect modifiers: NR Results: Placental weight (g) G1: Average GWG = 6.6 ± G1: 701 ± 131 5.5 kg G2: 771 ± 161 G2: Average GWG = 13.3 Head circumference (cm) Read the entire page →
From page 702... ... 702 WEIGHT GAIN DURING PREGNANCY TABLE F-1 Continued Protocol Including: Study Design/ Pregravid Weight (how measured) , Patient Population/ Total Weight Gain (how measured) Read the entire page →
From page 703... ... APPENDIX F 703 Outcomes/Results/Confounders Outcomes description: Results: Maternal confounders/effect • Offspring overweight Median GWG: 9.5 kg modifiers: status Median birth weight: 3,230 • Race • GWG g • Age Median gestational age: 40 • Prepregnancy BMI wks • Number of cigarettes Median BMI at 7 yr smoked/day assessment: 15.7 kg/m2 Infant and child confounders/ Overweight status at 7 effect modifiers: yr assessment (BMI at or • Sex above 95th percentile) : • First-born status 5.7% • Study site Adjusted Association • Gestational age between GWG and overweight at 7 yrs GWG by 1 kg of weight gain: OR 1.03 (95% CI 1.02, 1.05) Read the entire page →
From page 704... ... 704 WEIGHT GAIN DURING PREGNANCY REFERENCES Abrams B Read the entire page →
From page 705... ... APPENDIX F 705 Nohr E Read the entire page →

From page 641...

... appendix F Data Tables APPROACH TO GATHERING EVIDENCE In order to review the most relevant scientific literature available, the committee and staff conducted thorough searches of several online bibliographic databases, including Medline, Science Direct, and WorldCat/First Search. General searches on pregnancy, gestational weight gain, and outcomes of pregnancy were first conducted to identify primary literature.