American Journal of Epidemiology Advance Access originally published online on May 13, 2009
American Journal of Epidemiology 2009 170(2):173-180; doi:10.1093/aje/kwp101
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ORIGINAL CONTRIBUTIONS |
Associations of Gestational Weight Gain With Short- and Longer-term Maternal and Child Health Outcomes
Correspondence to Dr. Emily Oken, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, Boston, MA 02215 (e-mail: emily_oken{at}hphc.org).
Received for publication September 30, 2008. Accepted for publication April 2, 2009.
The authors investigated the rate of gestational weight gain associated with the lowest combined risk of 5 short- and longer-term maternal and child health outcomes for 2,012 mother-child pairs recruited in 1999–2002 into Project Viva, a prebirth cohort study in Massachusetts. Within each maternal prepregnancy body mass index (BMI, kg/m2) stratum, they performed a logistic regression analysis predicting all 5 outcomes, from which they determined the rate of gain at which average predicted prevalence of the adverse outcomes was the lowest. The mean rate of total gestational weight gain was 0.39 kg/week (standard deviation, 0.14). The prevalence of small for gestational age was 6%, large for gestational age was 14%, preterm delivery was 7%, substantial postpartum weight retention was 16%, and child obesity was 10%. The lowest predicted outcome prevalence occurred with a 0.28-kg/week gain for women whose BMI was 18.5–24.9, a 0.03-kg/week loss for a BMI of 25.0–29.9, and a 0.19-kg/week loss for a BMI of 
30.0 kg/m2—the lowest observed weight changes in overweight and obese women. For normal-weight and overweight women, lowest-risk gains varied modestly with adjustment for maternal characteristics and with different outcome weightings. For obese women, the lowest-risk weight change was weight loss in all models. Recommendations for gestational weight gain for obese women should be revised.
fetal development; obesity; pregnancy; premature birth; weight gain
Abbreviations: BMI, body mass index; LGA, large for gestational age; SGA, small for gestational age
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