ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2018) 15 2.15 | DOI: 10.1530/ey.15.2.15


To read the full abstract: JAMA 2017 Jun 6;317(21):2207-2225

Excessive and insufficient gestational weight gain are associated with adverse pregnancy outcomes, including small for gestational age (SGA), large for gestational age (LGA), macrosomia, cesarean delivery, gestational diabetes mellitus (GDM), preeclampsia, postpartum weight retention, and offspring obesity. The Institute of Medicine (IOM; now known as the National Academy of Medicine) recommendations on gestational weight gain were developed in 1990 to guide clinical practice. These aimed to reduce the incidence of low-birth-weight babies and were based on a 1980 National Natality Survey of a largely white population. The updated IOM guidelines in 2009 incorporated World Health Organization (WHO) categories of maternal body mass index (BMI; for underweight, <18.5; normal weight, 18.5-24.9; overweight, 25-29.9; and obese, ≥30) and recommended less gestational weight gain for obese women. The 2009 guidelines identified maternal and infant relationships with gestational weight gain but were based on lower general population BMI with limited ethnic diversity. The 2009 IOM guidelines are endorsed by the American College of Obstetricians and Gynecologists, although they are not universally implemented.

This large metanalysis aimed to address the key question: what is the association between gestational weight gain above or below the Institute of Medicine guidelines and maternal and infant outcomes? The summary findings were that in 1.3 million pregnancies, gestational weight gain below the recommendations (in 23% of women) was associated with higher risk of small for gestational age and preterm birth and lower risk of large for gestational age and macrosomia. Gestational weight gain above recommendations (47%) was associated with lower risk of small for gestational age and preterm birth and higher risk of large for gestational age, macrosomia, and cesarean delivery. There are several limitations, which the authors acknowledge. For example the metanalysis did not include studies from developing countries and excluded non-English-language articles and the metanalysis could not be performed for GDM because of inconsistent primary data.

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