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Research

Weight gain during pregnancy: Does the antenatal care provider make a difference? A retrospective cohort study

Beth Murray-Davis, Howard Berger, Nir Melamed, Haroon Hasan, Karizma Mawjee, Maisah Syed, Joel G. Ray, Michael Geary, Jon Barrett and Sarah D. McDonald; for the Diabetes, Obesity and Hypertension in Pregnancy Research Network and Southern Ontario Obstetrical Network investigators
April 23, 2019 7 (2) E283-E293; DOI: https://doi.org/10.9778/cmajo.20180116
Beth Murray-Davis
Midwifery Education Program (Murray-Davis, Syed), Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ont.; Division of Maternal–Fetal Medicine (Berger, Mawjee), Department of Obstetrics and Gynecology, St. Michael’s Hospital, University of Toronto; Division of Maternal–Fetal Medicine (Melamed, Barrett), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Better Outcomes Registry & Network (BORN) Ontario (Hasan), Children’s Hospital of Eastern Ontario, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynaecology (Ray), St. Michael’s Hospital, University of Toronto, Toronto, Ont.; Department of Obstetrics & Gynaecology (Geary), Rotunda Hospital, Dublin, Ireland; Division of Maternal–Fetal Medicine (McDonald), Department of Obstetrics and Gynecology, Department of Radiology (McDonald) and Department of Research Methods, Evidence and Impact (McDonald), McMaster University, Hamilton, Ont.
RM PhD
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Howard Berger
Midwifery Education Program (Murray-Davis, Syed), Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ont.; Division of Maternal–Fetal Medicine (Berger, Mawjee), Department of Obstetrics and Gynecology, St. Michael’s Hospital, University of Toronto; Division of Maternal–Fetal Medicine (Melamed, Barrett), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Better Outcomes Registry & Network (BORN) Ontario (Hasan), Children’s Hospital of Eastern Ontario, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynaecology (Ray), St. Michael’s Hospital, University of Toronto, Toronto, Ont.; Department of Obstetrics & Gynaecology (Geary), Rotunda Hospital, Dublin, Ireland; Division of Maternal–Fetal Medicine (McDonald), Department of Obstetrics and Gynecology, Department of Radiology (McDonald) and Department of Research Methods, Evidence and Impact (McDonald), McMaster University, Hamilton, Ont.
MD
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Nir Melamed
Midwifery Education Program (Murray-Davis, Syed), Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ont.; Division of Maternal–Fetal Medicine (Berger, Mawjee), Department of Obstetrics and Gynecology, St. Michael’s Hospital, University of Toronto; Division of Maternal–Fetal Medicine (Melamed, Barrett), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Better Outcomes Registry & Network (BORN) Ontario (Hasan), Children’s Hospital of Eastern Ontario, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynaecology (Ray), St. Michael’s Hospital, University of Toronto, Toronto, Ont.; Department of Obstetrics & Gynaecology (Geary), Rotunda Hospital, Dublin, Ireland; Division of Maternal–Fetal Medicine (McDonald), Department of Obstetrics and Gynecology, Department of Radiology (McDonald) and Department of Research Methods, Evidence and Impact (McDonald), McMaster University, Hamilton, Ont.
MD
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Haroon Hasan
Midwifery Education Program (Murray-Davis, Syed), Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ont.; Division of Maternal–Fetal Medicine (Berger, Mawjee), Department of Obstetrics and Gynecology, St. Michael’s Hospital, University of Toronto; Division of Maternal–Fetal Medicine (Melamed, Barrett), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Better Outcomes Registry & Network (BORN) Ontario (Hasan), Children’s Hospital of Eastern Ontario, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynaecology (Ray), St. Michael’s Hospital, University of Toronto, Toronto, Ont.; Department of Obstetrics & Gynaecology (Geary), Rotunda Hospital, Dublin, Ireland; Division of Maternal–Fetal Medicine (McDonald), Department of Obstetrics and Gynecology, Department of Radiology (McDonald) and Department of Research Methods, Evidence and Impact (McDonald), McMaster University, Hamilton, Ont.
MPH
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Karizma Mawjee
Midwifery Education Program (Murray-Davis, Syed), Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ont.; Division of Maternal–Fetal Medicine (Berger, Mawjee), Department of Obstetrics and Gynecology, St. Michael’s Hospital, University of Toronto; Division of Maternal–Fetal Medicine (Melamed, Barrett), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Better Outcomes Registry & Network (BORN) Ontario (Hasan), Children’s Hospital of Eastern Ontario, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynaecology (Ray), St. Michael’s Hospital, University of Toronto, Toronto, Ont.; Department of Obstetrics & Gynaecology (Geary), Rotunda Hospital, Dublin, Ireland; Division of Maternal–Fetal Medicine (McDonald), Department of Obstetrics and Gynecology, Department of Radiology (McDonald) and Department of Research Methods, Evidence and Impact (McDonald), McMaster University, Hamilton, Ont.
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Maisah Syed
Midwifery Education Program (Murray-Davis, Syed), Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ont.; Division of Maternal–Fetal Medicine (Berger, Mawjee), Department of Obstetrics and Gynecology, St. Michael’s Hospital, University of Toronto; Division of Maternal–Fetal Medicine (Melamed, Barrett), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Better Outcomes Registry & Network (BORN) Ontario (Hasan), Children’s Hospital of Eastern Ontario, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynaecology (Ray), St. Michael’s Hospital, University of Toronto, Toronto, Ont.; Department of Obstetrics & Gynaecology (Geary), Rotunda Hospital, Dublin, Ireland; Division of Maternal–Fetal Medicine (McDonald), Department of Obstetrics and Gynecology, Department of Radiology (McDonald) and Department of Research Methods, Evidence and Impact (McDonald), McMaster University, Hamilton, Ont.
MPH
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Joel G. Ray
Midwifery Education Program (Murray-Davis, Syed), Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ont.; Division of Maternal–Fetal Medicine (Berger, Mawjee), Department of Obstetrics and Gynecology, St. Michael’s Hospital, University of Toronto; Division of Maternal–Fetal Medicine (Melamed, Barrett), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Better Outcomes Registry & Network (BORN) Ontario (Hasan), Children’s Hospital of Eastern Ontario, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynaecology (Ray), St. Michael’s Hospital, University of Toronto, Toronto, Ont.; Department of Obstetrics & Gynaecology (Geary), Rotunda Hospital, Dublin, Ireland; Division of Maternal–Fetal Medicine (McDonald), Department of Obstetrics and Gynecology, Department of Radiology (McDonald) and Department of Research Methods, Evidence and Impact (McDonald), McMaster University, Hamilton, Ont.
MD
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Michael Geary
Midwifery Education Program (Murray-Davis, Syed), Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ont.; Division of Maternal–Fetal Medicine (Berger, Mawjee), Department of Obstetrics and Gynecology, St. Michael’s Hospital, University of Toronto; Division of Maternal–Fetal Medicine (Melamed, Barrett), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Better Outcomes Registry & Network (BORN) Ontario (Hasan), Children’s Hospital of Eastern Ontario, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynaecology (Ray), St. Michael’s Hospital, University of Toronto, Toronto, Ont.; Department of Obstetrics & Gynaecology (Geary), Rotunda Hospital, Dublin, Ireland; Division of Maternal–Fetal Medicine (McDonald), Department of Obstetrics and Gynecology, Department of Radiology (McDonald) and Department of Research Methods, Evidence and Impact (McDonald), McMaster University, Hamilton, Ont.
MD
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Jon Barrett
Midwifery Education Program (Murray-Davis, Syed), Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ont.; Division of Maternal–Fetal Medicine (Berger, Mawjee), Department of Obstetrics and Gynecology, St. Michael’s Hospital, University of Toronto; Division of Maternal–Fetal Medicine (Melamed, Barrett), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Better Outcomes Registry & Network (BORN) Ontario (Hasan), Children’s Hospital of Eastern Ontario, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynaecology (Ray), St. Michael’s Hospital, University of Toronto, Toronto, Ont.; Department of Obstetrics & Gynaecology (Geary), Rotunda Hospital, Dublin, Ireland; Division of Maternal–Fetal Medicine (McDonald), Department of Obstetrics and Gynecology, Department of Radiology (McDonald) and Department of Research Methods, Evidence and Impact (McDonald), McMaster University, Hamilton, Ont.
MD
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Sarah D. McDonald
Midwifery Education Program (Murray-Davis, Syed), Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ont.; Division of Maternal–Fetal Medicine (Berger, Mawjee), Department of Obstetrics and Gynecology, St. Michael’s Hospital, University of Toronto; Division of Maternal–Fetal Medicine (Melamed, Barrett), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.; Better Outcomes Registry & Network (BORN) Ontario (Hasan), Children’s Hospital of Eastern Ontario, Ottawa, Ont.; Departments of Medicine (Ray) and Obstetrics and Gynaecology (Ray), St. Michael’s Hospital, University of Toronto, Toronto, Ont.; Department of Obstetrics & Gynaecology (Geary), Rotunda Hospital, Dublin, Ireland; Division of Maternal–Fetal Medicine (McDonald), Department of Obstetrics and Gynecology, Department of Radiology (McDonald) and Department of Research Methods, Evidence and Impact (McDonald), McMaster University, Hamilton, Ont.
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Article Figures & Tables

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  • Figure 1:
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    Figure 1:

    Flow chart showing cohort selection. Note: BMI = body mass index.

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    Figure 2:

    Proportions of pregnancies with weight gain below, within and above recommended levels, by antenatal health care provider.

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    Figure 3:

    Adjusted relative risk (RR) of being small for gestational age, being large for gestational age, preterm birth and cesarean delivery among pregnancies with a weight below that recommended relative to those with a weight gain within recommended levels, stratified according to antenatal health care provider. Note: CI = confidence interval. *Adjusted for maternal age, parity, gestational age at birth, prepregnancy body mass index (BMI), income quintile, education quintile, smoking, depression, preexisting diabetes, preexisting hypertension and gestational diabetes mellitus. †Adjusted for maternal age, parity, gestational age at birth, prepregnancy BMI, income quintile, education quintile, smoking, preexisting diabetes, preexisting hypertension, gestational diabetes, drug exposure, alcohol consumption, mental illness, previous cesarean delivery, previous term birth, previous preterm birth, previous vaginal birth, previous stillbirth, previous abortion, nonvertex presentation and male infant.

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    Figure 4:

    Adjusted relative risk (RR) of being small for gestational age, being large for gestational age, preterm birth and cesarean delivery among pregnancies with a weight gain above that recommended relative to those with a weight gain within recommended levels, stratified according to antenatal health care provider. Note: CI = confidence interval. *Adjusted for maternal age, parity, gestational age at birth, prepregnancy body mass index (BMI), income quintile, education quintile, smoking, depression, preexisting diabetes, preexisting hypertension and gestational diabetes mellitus. †Adjusted for maternal age, parity, gestational age at birth, prepregnancy BMI, income quintile, education quintile, smoking, preexisting diabetes, preexisting hypertension, gestational diabetes, drug exposure, alcohol consumption, mental illness, previous cesarean delivery, previous term birth, previous preterm birth, previous vaginal birth, previous stillbirth, previous abortion, nonvertex presentation and male infant.

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    Figure 5:

    Population attributable fractions of being small for gestational age, being large for gestational age, preterm birth and cesarean delivery for weight gain above that recommended relative to weight gain within recommended levels, stratified according to antenatal health care provider. Note: CI = confidence interval, RR = relative risk.

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    Figure 6:

    Population attributable fractions of being small for gestational age, being large for gestational age, preterm birth and cesarean delivery for weight gain below that recommended relative to weight gain within recommended levels, stratified according to antenatal health care provider. Note: CI = confidence interval, RR = relative risk.

Tables

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    Table 1:

    Characteristics of women with a singleton hospital birth in Ontario, April 2014–March 2016,* by antenatal health care provider

    CharacteristicAntenatal health care provider; no. (%) of women
    All
    n = 231 697
    Family physician
    n = 26 043
    Obstetrician
    n = 136 994
    Midwife
    n = 32 362
    Family physician + obstetrician
    n = 36 298
    Maternal age, yr
     ≤ 2430 896 (13.3)5014 (19.2)16 215 (11.8)3663 (11.3)6004 (16.5)
     25–2964 476 (27.8)8140 (31.3)35 950 (26.2)9487 (29.3)10 899 (30.0)
     30–3484 644 (36.5)8713 (33.5)50 335 (36.7)12 995 (40.2)12 601 (34.7)
     ≥ 3551 681 (22.3)4176 (16.0)34 494 (25.2)6217 (19.2)6794 (18.7)
    Prepregnancy body mass index†
     < 18.5 (underweight)14 018 (6.0)1440 (5.5)9086 (6.6)1608 (5.0)1884 (5.2)
     18.5 – < 25 (normal weight)120 434 (52.0)13 337 (51.2)70 883 (51.7)18 401 (56.9)17 813 (49.1)
     25 – < 30 (overweight)55 712 (24.0)6485 (24.9)32 820 (24.0)7551 (23.3)8856 (24.4)
     ≥ 30 (obese)41 533 (17.9)4781 (18.4)24 205 (17.7)4802 (14.8)7745 (21.3)
    Weight gain during pregnancy‡
     Inadequate31 804 (13.7)3567 (13.7)19 936 (14.6)3742 (11.6)4559 (12.6)
     Within recommended levels71 777 (31.0)7768 (29.8)43 270 (31.6)10 405 (32.2)10 334 (28.5)
     Excess128 116 (55.3)14 708 (56.5)73 788 (53.9)18 215 (56.3)21 405 (59.0)
    Preexisting diabetes2149 (0.9)115 (0.4)1544 (1.1)83 (0.3)407 (1.1)
    Preexisting hypertension1875 (0.8)146 (0.6)1293 (0.9)92 (0.3)344 (0.9)
    Gestational diabetes mellitus14 849 (6.4)1143 (4.4)10 245 (7.5)1270 (3.9)2191 (6.0)
    Nulliparous100 347 (43.3)11 536 (44.3)57 781 (42.2)15 359 (47.5)15 671 (43.2)
    Gravidity
     Primigravid74 634 (32.2)8706 (33.4)42 540 (31.0)11 708 (36.2)11 680 (32.2)
     Multigravid155 619 (67.2)17 165 (65.9)93 187 (68.0)20 652 (63.8)24 615 (67.8)
     Missing1444 (0.6)172 (0.7)1267 (0.9)2 (< 0.1)3 (< 0.1)
    Income quintile
     1 (lowest)48 414 (20.9)5769 (22.2)30 324 (22.1)5560 (17.2)6761 (18.6)
     246 243 (20.0)5041 (19.4)28 116 (20.5)6199 (19.2)6887 (19.0)
     346 908 (20.2)5255 (20.2)27 270 (19.9)6594 (20.4)7789 (21.5)
     448 916 (21.1)5227 (20.1)28 128 (20.5)7402 (22.9)8159 (22.5)
     5 (highest)37 207 (16.1)4339 (16.7)20 683 (15.1)6063 (18.7)6122 (16.9)
     Missing4009 (1.7)412 (1.6)2473 (1.8)544 (1.7)580 (1.6)
    Education quintile
     1 (lowest)45 156 (19.5)6479 (24.9)21 450 (15.7)6808 (21.0)10 419 (28.7)
     245 027 (19.4)5675 (21.8)23 799 (17.4)6651 (20.6)8902 (24.5)
     344 908 (19.4)4794 (18.4)27 549 (20.1)6093 (18.8)6472 (17.8)
     444 646 (19.3)3756 (14.4)29 796 (21.7)5857 (18.1)5237 (14.4)
     5 (highest)44 294 (19.1)3671 (14.1)30 088 (22.0)6273 (19.4)4262 (11.7)
     Missing7666 (3.3)1668 (6.4)4312 (3.1)680 (2.1)1006 (2.8)
    Mental illness35 271 (15.2)4832 (18.6)16 291 (11.9)6867 (21.2)7281 (20.1)
    Depression17 196 (7.4)2502 (9.6)7591 (5.5)3246 (10.0)3857 (10.6)
    Alcohol consumption during pregnancy5665 (2.4)899 (3.4)2772 (2.0)846 (2.6)1148 (3.2)
    Smoking during pregnancy
     Yes23 342 (10.1)4063 (15.6)12 065 (8.8)1880 (5.8)5334 (14.7)
     Missing9079 (3.9)979 (3.8)7668 (5.6)202 (0.6)230 (0.6)
    Drug exposure during pregnancy4542 (2.0)954 (3.7)2202 (1.6)407 (1.3)979 (2.7)
    Prenatal classes
     Yes51 293 (22.1)6127 (23.5)26 951 (19.7)10 120 (31.3)8095 (22.3)
     Missing16 810 (7.3)1943 (7.5)10 928 (8.0)2460 (7.6)1479 (4.1)
    Previous preterm birth12 256 (5.3)1034 (4.0)8075 (5.9)1305 (4.0)1842 (5.1)
    Previous cesarean delivery34 652 (15.0)2283 (8.8)23 543 (17.2)2842 (8.8)5984 (16.5)
    Previous abortion75 100 (32.4)8134 (31.2)45 102 (32.9)9947 (30.7)11 917 (32.8)
    Previous term birth124 036 (53.5)13 905 (53.4)74 108 (54.1)16 352 (50.5)19 671 (54.2)
    Previous vaginal birth96 788 (41.8)12 132 (46.6)55 108 (40.2)14 366 (44.4)15 182 (41.8)
    Previous stillbirth3097 (1.3)226 (0.9)2241 (1.6)280 (0.9)350 (1.0)
    Nonvertex presentation
     Yes9190 (4.0)707 (2.7)5536 (4.0)1270 (3.9)1677 (4.6)
     Missing16 179 (7.0)1655 (6.4)13 189 (9.6)328 (1.0)1007 (2.8)
    Male infant118 794 (51.3)13 331 (51.2)70 254 (51.3)16 713 (51.6)18 496 (51.0)
    • ↵* Women with plausible body mass index and weight gain during pregnancy available.

    • ↵† Categories reflect the World Health Organization classification. (17)

    • ↵‡ Total weight gain recommended for singleton pregnancies based on prepregnancy body mass index (adapted from reference (5)).

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Weight gain during pregnancy: Does the antenatal care provider make a difference? A retrospective cohort study
Beth Murray-Davis, Howard Berger, Nir Melamed, Haroon Hasan, Karizma Mawjee, Maisah Syed, Joel G. Ray, Michael Geary, Jon Barrett, Sarah D. McDonald
Apr 2019, 7 (2) E283-E293; DOI: 10.9778/cmajo.20180116

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Weight gain during pregnancy: Does the antenatal care provider make a difference? A retrospective cohort study
Beth Murray-Davis, Howard Berger, Nir Melamed, Haroon Hasan, Karizma Mawjee, Maisah Syed, Joel G. Ray, Michael Geary, Jon Barrett, Sarah D. McDonald
Apr 2019, 7 (2) E283-E293; DOI: 10.9778/cmajo.20180116
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