Original research
Weight gain in women of normal weight before pregnancy: complications in pregnancy or delivery and birth outcome

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Abstract

OBJECTIVE:

To investigate the relation between gestational weight gain in women of normal prepregnant weight and complications during pregnancy and delivery in a population with high gestational weight gain and birth weight.

METHODS:

Healthy women (n = 615) of normal weight before pregnancy (body mass index 19.5–25.5 kg/m2) were randomly selected. Maternity records gave information on age, height, prepregnant weight, gestational weight gain, parity, smoking, gestational hypertension and diabetes, preeclampsia, delivery complications, and infants’ birth size and health.

RESULTS:

The mean weight gain in pregnancy was 16.8 ± 4.9 kg (mean ± standard deviation). A total of 26.4% of the women had complications, either in pregnancy (9.1%) or delivery (17.3%). Women gaining weight according to the recommendation of the Institute of Medicine (11.5–16.0 kg) had lower frequency of pregnancy-delivery complications than women gaining more than 20.0 kg (P = .017), but did not differ significantly from those gaining 16–20 kg (P > .05). When dividing weight gain in pregnancy into quintiles, a relative risk of 2.69 (95% confidence interval 1.01, 7.18, P = .048) was found for complications in pregnancy in the fourth quintile (17.9–20.8 kg), using the second quintile as reference (12.5–15.5 kg). The mean birth weight was 3778 ± 496 g. A low weight gain in pregnancy (less than 11.5 kg) was associated with an increased frequency of infants weighing less than 3500 g at birth (P < .01).

CONCLUSION:

A gestational weight gain of 11.5–16.0 kg (Institute of Medicine recommendation) for women of normal prepregnant weight is related to the lowest risk for pregnancy-delivery complications. In the population studied, the upper limit might be higher (up to 18 kg), and low weight gain should be avoided to optimize birth outcome.

Section snippets

Materials and methods

The target group included women with normal weight before pregnancy (n = 615) who were randomly selected within 1 year (1998), according to the study participation criteria, for information on prepregnancy, pregnancy, and delivery factors as well as birth outcome. All were healthy before pregnancy and had no history of diabetes, hypertension, cardiovascular disease, or thyroid problems. They were 20–40 years old, had a prepregnant body mass index of 19.5–25.5 kg/m2 and delivered singleton

Results

Table 1 gives maternal and neonatal characteristics. Of the women, 61% were parous, 9% were single, and 17% were smokers. There were 162 women (26.4%) who developed complications, of whom one-third in pregnancy (n = 56) and two-thirds at delivery (n = 106). Figure 1 shows the proportion of women with pregnancy-delivery complications within 2-kg intervals of weight gain. Table 2 shows characteristics and neonatal size among women without complications and in three groups: complications in

Discussion

The frequency of pregnancy-delivery complications for women of normal weight before pregnancy, in a population with high gestational weight gain and birth weight, was highest among women gaining more than 20.0 kg in pregnancy. On average, the women gained 16.8 kg, which is just above the upper limit of weight gain recommended by the IOM for women of normal weight before pregnancy (11.5–16.0 kg).26 The average weight gain, as a proportion of the women’s weight before pregnancy, was 27%. These

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    Supported by the Fund for Research and Education, the Research Fund at the University of Iceland, and the Icelandic Ministry of Agriculture.

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