Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes

Hein Stigum, Camilla Stoltenberg, Elisabeth Thiering, Carel Thijs, Maties Torrent, Thomas Trnovec, Marleen M H J van Gelder, Lenie van Rossem, Andrea von Berg, Martine Vrijheid, Alet H Wijga, Oleksandr Zwinchuk, Thorkild Ingvor Arrild Sørensen, Keith M Godfrey, Vincent W V Jaddoe, Romy Gaillard, LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Importance: Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all prepregnancy weight ranges.

Objectives: To examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories.

Design, Setting, and Participants: Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample). Optimal gestational weight gain ranges were estimated for each prepregnancy body mass index (BMI) category by selecting the range of gestational weight gain that was associated with lower risk for any adverse outcome. Individual participant-level data from 3505 participants within 4 separate hospital-based cohorts were used as a validation sample. Data were collected between 1989 and 2015. The final date of follow-up was December 2015.

Exposures: Gestational weight gain.

Main Outcomes and Measures: The main outcome termed any adverse outcome was defined as the presence of 1 or more of the following outcomes: preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, and small or large size for gestational age at birth.

Results: Of the 196 670 women (median age, 30.0 years [quartile 1 and 3, 27.0 and 33.0 years] and 40 937 were white) included in the main sample, 7809 (4.0%) were categorized at baseline as underweight (BMI <18.5); 133 788 (68.0%), normal weight (BMI, 18.5-24.9); 38 828 (19.7%), overweight (BMI, 25.0-29.9); 11 992 (6.1%), obesity grade 1 (BMI, 30.0-34.9); 3284 (1.7%), obesity grade 2 (BMI, 35.0-39.9); and 969 (0.5%), obesity grade 3 (BMI, ≥40.0). Overall, any adverse outcome occurred in 37.2% (n = 73 161) of women, ranging from 34.7% (2706 of 7809) among women categorized as underweight to 61.1% (592 of 969) among women categorized as obesity grade 3. Optimal gestational weight gain ranges were 14.0 kg to less than 16.0 kg for women categorized as underweight; 10.0 kg to less than 18.0 kg for normal weight; 2.0 kg to less than 16.0 kg for overweight; 2.0 kg to less than 6.0 kg for obesity grade 1; weight loss or gain of 0 kg to less than 4.0 kg for obesity grade 2; and weight gain of 0 kg to less than 6.0 kg for obesity grade 3. These gestational weight gain ranges were associated with low to moderate discrimination between those with and those without adverse outcomes (range for area under the receiver operating characteristic curve, 0.55-0.76). Results for discriminative performance in the validation sample were similar to the corresponding results in the main study sample (range for area under the receiver operating characteristic curve, 0.51-0.79).

Conclusions and Relevance: In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights. The estimates of optimal gestational weight gain may inform prenatal counseling; however, the optimal gestational weight gain ranges had limited predictive value for the outcomes assessed.

Original languageEnglish
JournalJAMA
Volume321
Issue number17
Pages (from-to)1702-1715
ISSN0098-7484
DOIs
Publication statusPublished - 7. May 2019

Fingerprint

Weight Gain
Mothers
Body Mass Index
Weights and Measures
ROC Curve
Meta-Analysis
Cohort Studies
Gestational Diabetes
Premature Birth
North America
Pre-Eclampsia
Gestational Age
Counseling
Outcome Assessment (Health Care)

Keywords

  • Adult
  • Birth Weight
  • Body Mass Index
  • Cesarean Section/statistics & numerical data
  • Diabetes, Gestational
  • Female
  • Gestational Weight Gain
  • Humans
  • Hypertension, Pregnancy-Induced
  • Infant, Newborn
  • Obesity
  • Pregnancy
  • Pregnancy Complications
  • Pregnancy Outcome
  • Premature Birth

Cite this

Stigum, H., Stoltenberg, C., Thiering, E., Thijs, C., Torrent, M., Trnovec, T., ... LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group (2019). Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes. JAMA, 321(17), 1702-1715. https://doi.org/10.1001/jama.2019.3820
Stigum, Hein ; Stoltenberg, Camilla ; Thiering, Elisabeth ; Thijs, Carel ; Torrent, Maties ; Trnovec, Thomas ; van Gelder, Marleen M H J ; van Rossem, Lenie ; von Berg, Andrea ; Vrijheid, Martine ; Wijga, Alet H ; Zwinchuk, Oleksandr ; Sørensen, Thorkild Ingvor Arrild ; Godfrey, Keith M ; Jaddoe, Vincent W V ; Gaillard, Romy ; LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group. / Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes. In: JAMA. 2019 ; Vol. 321, No. 17. pp. 1702-1715.
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title = "Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes",
abstract = "Importance: Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all prepregnancy weight ranges.Objectives: To examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories.Design, Setting, and Participants: Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample). Optimal gestational weight gain ranges were estimated for each prepregnancy body mass index (BMI) category by selecting the range of gestational weight gain that was associated with lower risk for any adverse outcome. Individual participant-level data from 3505 participants within 4 separate hospital-based cohorts were used as a validation sample. Data were collected between 1989 and 2015. The final date of follow-up was December 2015.Exposures: Gestational weight gain.Main Outcomes and Measures: The main outcome termed any adverse outcome was defined as the presence of 1 or more of the following outcomes: preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, and small or large size for gestational age at birth.Results: Of the 196 670 women (median age, 30.0 years [quartile 1 and 3, 27.0 and 33.0 years] and 40 937 were white) included in the main sample, 7809 (4.0{\%}) were categorized at baseline as underweight (BMI <18.5); 133 788 (68.0{\%}), normal weight (BMI, 18.5-24.9); 38 828 (19.7{\%}), overweight (BMI, 25.0-29.9); 11 992 (6.1{\%}), obesity grade 1 (BMI, 30.0-34.9); 3284 (1.7{\%}), obesity grade 2 (BMI, 35.0-39.9); and 969 (0.5{\%}), obesity grade 3 (BMI, ≥40.0). Overall, any adverse outcome occurred in 37.2{\%} (n = 73 161) of women, ranging from 34.7{\%} (2706 of 7809) among women categorized as underweight to 61.1{\%} (592 of 969) among women categorized as obesity grade 3. Optimal gestational weight gain ranges were 14.0 kg to less than 16.0 kg for women categorized as underweight; 10.0 kg to less than 18.0 kg for normal weight; 2.0 kg to less than 16.0 kg for overweight; 2.0 kg to less than 6.0 kg for obesity grade 1; weight loss or gain of 0 kg to less than 4.0 kg for obesity grade 2; and weight gain of 0 kg to less than 6.0 kg for obesity grade 3. These gestational weight gain ranges were associated with low to moderate discrimination between those with and those without adverse outcomes (range for area under the receiver operating characteristic curve, 0.55-0.76). Results for discriminative performance in the validation sample were similar to the corresponding results in the main study sample (range for area under the receiver operating characteristic curve, 0.51-0.79).Conclusions and Relevance: In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights. The estimates of optimal gestational weight gain may inform prenatal counseling; however, the optimal gestational weight gain ranges had limited predictive value for the outcomes assessed.",
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author = "Ellis Voerman and Susana Santos and Hazel Inskip and Pilar Amiano and Henrique Barros and Charles, {Marie Aline} and Leda Chatzi and Chrousos, {George P.} and Eva Corpeleijn and Sarah Crozier and Myriam Doyon and Merete Eggesb{\o} and Fantini, {Maria Pia} and Sara Farchi and Francesco Forastiere and Vagelis Georgiu and Davide Gori and Wojciech Hanke and Irva Hertz-Picciotto and Barbara Heude and Hivert, {Marie France} and Daniel Hryhorczuk and Carmen I{\~n}iguez and Karvonen, {Anne M.} and K{\"u}pers, {Leanne K.} and Hanna Lagstr{\"o}m and Lawlor, {Debbie A.} and Irina Lehmann and Per Magnus and Renata Majewska and Johanna M{\"a}kel{\"a} and Yannis Manios and Monique Mommers and Morgen, {Camilla S.} and George Moschonis and Nohr, {Ellen A.} and {Nybo Andersen}, {Anne Marie} and Emily Oken and Agnieszka Pac and Eleni Papadopoulou and Juha Pekkanen and Costanza Pizzi and Kinga Polanska and Daniela Porta and Lorenzo Richiardi and Rifas-Shiman, {Sheryl L.} and Nel Roeleveld and Luca Ronfani and Santos, {Ana C.} and Marie Standl and Hein Stigum and Camilla Stoltenberg and Elisabeth Thiering and Carel Thijs and Maties Torrent and Thomas Trnovec and {van Gelder}, {Marleen M H J} and {van Rossem}, Lenie and {von Berg}, Andrea and Martine Vrijheid and Wijga, {Alet H} and Oleksandr Zwinchuk and S{\o}rensen, {Thorkild Ingvor Arrild} and Godfrey, {Keith M} and Jaddoe, {Vincent W V} and Romy Gaillard and {LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group}",
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language = "English",
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Stigum, H, Stoltenberg, C, Thiering, E, Thijs, C, Torrent, M, Trnovec, T, van Gelder, MMHJ, van Rossem, L, von Berg, A, Vrijheid, M, Wijga, AH, Zwinchuk, O, Sørensen, TIA, Godfrey, KM, Jaddoe, VWV, Gaillard, R & LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group 2019, 'Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes', JAMA, vol. 321, no. 17, pp. 1702-1715. https://doi.org/10.1001/jama.2019.3820

Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes. / Stigum, Hein; Stoltenberg, Camilla; Thiering, Elisabeth; Thijs, Carel; Torrent, Maties; Trnovec, Thomas ; van Gelder, Marleen M H J; van Rossem, Lenie; von Berg, Andrea; Vrijheid, Martine; Wijga, Alet H; Zwinchuk, Oleksandr ; Sørensen, Thorkild Ingvor Arrild; Godfrey, Keith M; Jaddoe, Vincent W V; Gaillard, Romy; LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group.

In: JAMA, Vol. 321, No. 17, 07.05.2019, p. 1702-1715.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes

AU - Voerman, Ellis

AU - Santos, Susana

AU - Inskip, Hazel

AU - Amiano, Pilar

AU - Barros, Henrique

AU - Charles, Marie Aline

AU - Chatzi, Leda

AU - Chrousos, George P.

AU - Corpeleijn, Eva

AU - Crozier, Sarah

AU - Doyon, Myriam

AU - Eggesbø, Merete

AU - Fantini, Maria Pia

AU - Farchi, Sara

AU - Forastiere, Francesco

AU - Georgiu, Vagelis

AU - Gori, Davide

AU - Hanke, Wojciech

AU - Hertz-Picciotto, Irva

AU - Heude, Barbara

AU - Hivert, Marie France

AU - Hryhorczuk, Daniel

AU - Iñiguez, Carmen

AU - Karvonen, Anne M.

AU - Küpers, Leanne K.

AU - Lagström, Hanna

AU - Lawlor, Debbie A.

AU - Lehmann, Irina

AU - Magnus, Per

AU - Majewska, Renata

AU - Mäkelä, Johanna

AU - Manios, Yannis

AU - Mommers, Monique

AU - Morgen, Camilla S.

AU - Moschonis, George

AU - Nohr, Ellen A.

AU - Nybo Andersen, Anne Marie

AU - Oken, Emily

AU - Pac, Agnieszka

AU - Papadopoulou, Eleni

AU - Pekkanen, Juha

AU - Pizzi, Costanza

AU - Polanska, Kinga

AU - Porta, Daniela

AU - Richiardi, Lorenzo

AU - Rifas-Shiman, Sheryl L.

AU - Roeleveld, Nel

AU - Ronfani, Luca

AU - Santos, Ana C.

AU - Standl, Marie

AU - Stigum, Hein

AU - Stoltenberg, Camilla

AU - Thiering, Elisabeth

AU - Thijs, Carel

AU - Torrent, Maties

AU - Trnovec, Thomas

AU - van Gelder, Marleen M H J

AU - van Rossem, Lenie

AU - von Berg, Andrea

AU - Vrijheid, Martine

AU - Wijga, Alet H

AU - Zwinchuk, Oleksandr

AU - Sørensen, Thorkild Ingvor Arrild

AU - Godfrey, Keith M

AU - Jaddoe, Vincent W V

AU - Gaillard, Romy

AU - LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group

PY - 2019/5/7

Y1 - 2019/5/7

N2 - Importance: Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all prepregnancy weight ranges.Objectives: To examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories.Design, Setting, and Participants: Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample). Optimal gestational weight gain ranges were estimated for each prepregnancy body mass index (BMI) category by selecting the range of gestational weight gain that was associated with lower risk for any adverse outcome. Individual participant-level data from 3505 participants within 4 separate hospital-based cohorts were used as a validation sample. Data were collected between 1989 and 2015. The final date of follow-up was December 2015.Exposures: Gestational weight gain.Main Outcomes and Measures: The main outcome termed any adverse outcome was defined as the presence of 1 or more of the following outcomes: preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, and small or large size for gestational age at birth.Results: Of the 196 670 women (median age, 30.0 years [quartile 1 and 3, 27.0 and 33.0 years] and 40 937 were white) included in the main sample, 7809 (4.0%) were categorized at baseline as underweight (BMI <18.5); 133 788 (68.0%), normal weight (BMI, 18.5-24.9); 38 828 (19.7%), overweight (BMI, 25.0-29.9); 11 992 (6.1%), obesity grade 1 (BMI, 30.0-34.9); 3284 (1.7%), obesity grade 2 (BMI, 35.0-39.9); and 969 (0.5%), obesity grade 3 (BMI, ≥40.0). Overall, any adverse outcome occurred in 37.2% (n = 73 161) of women, ranging from 34.7% (2706 of 7809) among women categorized as underweight to 61.1% (592 of 969) among women categorized as obesity grade 3. Optimal gestational weight gain ranges were 14.0 kg to less than 16.0 kg for women categorized as underweight; 10.0 kg to less than 18.0 kg for normal weight; 2.0 kg to less than 16.0 kg for overweight; 2.0 kg to less than 6.0 kg for obesity grade 1; weight loss or gain of 0 kg to less than 4.0 kg for obesity grade 2; and weight gain of 0 kg to less than 6.0 kg for obesity grade 3. These gestational weight gain ranges were associated with low to moderate discrimination between those with and those without adverse outcomes (range for area under the receiver operating characteristic curve, 0.55-0.76). Results for discriminative performance in the validation sample were similar to the corresponding results in the main study sample (range for area under the receiver operating characteristic curve, 0.51-0.79).Conclusions and Relevance: In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights. The estimates of optimal gestational weight gain may inform prenatal counseling; however, the optimal gestational weight gain ranges had limited predictive value for the outcomes assessed.

AB - Importance: Both low and high gestational weight gain have been associated with adverse maternal and infant outcomes, but optimal gestational weight gain remains uncertain and not well defined for all prepregnancy weight ranges.Objectives: To examine the association of ranges of gestational weight gain with risk of adverse maternal and infant outcomes and estimate optimal gestational weight gain ranges across prepregnancy body mass index categories.Design, Setting, and Participants: Individual participant-level meta-analysis using data from 196 670 participants within 25 cohort studies from Europe and North America (main study sample). Optimal gestational weight gain ranges were estimated for each prepregnancy body mass index (BMI) category by selecting the range of gestational weight gain that was associated with lower risk for any adverse outcome. Individual participant-level data from 3505 participants within 4 separate hospital-based cohorts were used as a validation sample. Data were collected between 1989 and 2015. The final date of follow-up was December 2015.Exposures: Gestational weight gain.Main Outcomes and Measures: The main outcome termed any adverse outcome was defined as the presence of 1 or more of the following outcomes: preeclampsia, gestational hypertension, gestational diabetes, cesarean delivery, preterm birth, and small or large size for gestational age at birth.Results: Of the 196 670 women (median age, 30.0 years [quartile 1 and 3, 27.0 and 33.0 years] and 40 937 were white) included in the main sample, 7809 (4.0%) were categorized at baseline as underweight (BMI <18.5); 133 788 (68.0%), normal weight (BMI, 18.5-24.9); 38 828 (19.7%), overweight (BMI, 25.0-29.9); 11 992 (6.1%), obesity grade 1 (BMI, 30.0-34.9); 3284 (1.7%), obesity grade 2 (BMI, 35.0-39.9); and 969 (0.5%), obesity grade 3 (BMI, ≥40.0). Overall, any adverse outcome occurred in 37.2% (n = 73 161) of women, ranging from 34.7% (2706 of 7809) among women categorized as underweight to 61.1% (592 of 969) among women categorized as obesity grade 3. Optimal gestational weight gain ranges were 14.0 kg to less than 16.0 kg for women categorized as underweight; 10.0 kg to less than 18.0 kg for normal weight; 2.0 kg to less than 16.0 kg for overweight; 2.0 kg to less than 6.0 kg for obesity grade 1; weight loss or gain of 0 kg to less than 4.0 kg for obesity grade 2; and weight gain of 0 kg to less than 6.0 kg for obesity grade 3. These gestational weight gain ranges were associated with low to moderate discrimination between those with and those without adverse outcomes (range for area under the receiver operating characteristic curve, 0.55-0.76). Results for discriminative performance in the validation sample were similar to the corresponding results in the main study sample (range for area under the receiver operating characteristic curve, 0.51-0.79).Conclusions and Relevance: In this meta-analysis of pooled individual participant data from 25 cohort studies, the risk for adverse maternal and infant outcomes varied by gestational weight gain and across the range of prepregnancy weights. The estimates of optimal gestational weight gain may inform prenatal counseling; however, the optimal gestational weight gain ranges had limited predictive value for the outcomes assessed.

KW - Adult

KW - Birth Weight

KW - Body Mass Index

KW - Cesarean Section/statistics & numerical data

KW - Diabetes, Gestational

KW - Female

KW - Gestational Weight Gain

KW - Humans

KW - Hypertension, Pregnancy-Induced

KW - Infant, Newborn

KW - Obesity

KW - Pregnancy

KW - Pregnancy Complications

KW - Pregnancy Outcome

KW - Premature Birth

U2 - 10.1001/jama.2019.3820

DO - 10.1001/jama.2019.3820

M3 - Journal article

VL - 321

SP - 1702

EP - 1715

JO - J A M A: The Journal of the American Medical Association

JF - J A M A: The Journal of the American Medical Association

SN - 0098-7484

IS - 17

ER -

Stigum H, Stoltenberg C, Thiering E, Thijs C, Torrent M, Trnovec T et al. Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes. JAMA. 2019 May 7;321(17):1702-1715. https://doi.org/10.1001/jama.2019.3820