The Effect Of Gestational Weight Gain By Body Mass Index On Obstetric And Neonatal Outcomes

AND NEONATAL OUTCOMES JOAN CRANE, JOANNE WHITE, DONNA HUTCHENS, LORRAINE BURRAGE, PHILLIP MURPHY, Memorial University, Eastern Health, St. John’s, Newfoundland, Canada, Eastern Health, Provincial Perinatal Program, St. John’s, Newfoundland, Canada OBJECTIVE: To evaluate the effects of gestational weight gain, in different body mass index(BMI) classes, on obstetric and neonatal outcomes. STUDY DESIGN: A population-based cohort study using the Newfoundland and Labrador Perinatal Database April 2001-April 2007 (5377 women) compared obstetric and neonatal outcomes, based on gestational weight gain (Health Canada guidelines), in underweight, normal weight, overweight, obese and morbidly obese (BMI 40.00) women. Univariate and multivariate logistic regression analyses controlling for maternal age, parity, smoking, partnered status and gestational age were performed, and ORs and 95% CIs were calculated. RESULTS: Only 30.6% women gained the recommended amount of weight, with 52.3% gaining more than recommended(excess weight gain) and 17.1% less than recommended(poor weight gain). In women with normal BMI, excess weight gain was associated with increased risks of gestational hypertension(1.27,95%CI1.08-1.49), augmentation of labour(1.09,95%CI1.011.18), length of stay 5days(2.49,95%CI1.19-5.23), neonatal metabolic problems(1.32,95%CI0.99-1.76) and birthweight(BW) 4.0kg(1.21,95%CI 1.101.34). In overweight women, excess weight gain was associated with increased rates of gestational hypertension(1.31,95%CI1.10-1.55), induction(1.11,95%CI1.001.23) and BW 4.0kg(1.86, 95%CI1.02-3.40). In obese and morbidly obese women combined, excess weight gain was associated with increased rates of Cesarean delivery(1.00,95%CI1.00-1.20), BW 4kg(1.20,95%CI1.07-1.34) and neonatal metabolic problems(1.31,95%CI1.00-1.70). In morbidly obese women, poor weight gain was associated with lower rates of induction(0.44,95%CI0.19-1.01) and epidural use(0.34,95%CI 0.12-0.95). In overweight, obese and morbidly obese women combined, as well as in normal and overweight women, poor weight gain was associated with BW 2.5kg. CONCLUSION: The effects of gestational weight gain depend on the woman’s BMI. A weight gain of 15-25lb appears appropriate for obese and morbidly obese women, in order to minimize the risk of Cesarean delivery and optimize neonatal outcomes.