The risk for excess gestational weight gain is increased for women who gain more weight before pregnancy regardless of initial weight status, according to study findings published in Obesity.
“Our study confirms the excess risk of high gestational weight gain among women with overweight or obesity, and there was evidence that higher prepregnancy weight gain is associated with higher gestational weight gain evaluated on a continuous scale,” Janet M. Catov, PhD, MS, associate professor in the department of obstetrics, gynecology and reproductive sciences and the department of epidemiology at the University of Pittsburgh, and colleagues wrote. “High prepregnancy weight gain is also associated with higher gestational weight gain evaluated as a continuous or clinical outcome among women without overweight or obesity. This finding is important, as almost half of women without overweight or obesity have high gestational weight gain.”
Researchers analyzed data from 1,126 women (51% Black) participating in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Women aged 18 to 30 years living in four U.S. metropolitan areas were enrolled in the study in 1985 and 1986 and attended nine in-person follow-up exams for up to 30 years after baseline. Those who had at least one singleton birth after baseline and reported gestational weight gain were included. Current pregnancy status and the number of pregnancies and births since the last exam were reported at each follow-up. For women who gave birth, the length of gestation, date of delivery and total gestational weight gain were reported. National Academy of Medicine guidelines were used to determine whether participants had a high, average or low amount gestational weight gain. Prepregnancy BMI was calculated based on weight, height and waist circumference at each visit.
Of the study cohort, 56% had high gestational weight gain above recommendations, 28% had average gestational weight gain and 17% had low gestational weight gain. Women with high gestational weight gain gained a mean of 4.8 kg of body weight from baseline to their last prepregnancy exam, whereas the average gestational weight gain group gained a mean of 3.6 kg and women with low gestational weight gain added 2.5 kg of body weight before pregnancy.
Each 0.16 kg/m2 increase in prepregnancy BMI per year was associated with a 17% greater risk for high gestational weight gain. Women without overweight or obesity had an increased risk for high gestational weight gain with prepregnancy weight gain (RR = 1.71; 95% CI, 1.38-2.13), but no increased risk was found for those with overweight or obesity.
Researchers calculated a gestational weight gain z score accounting for prepregnancy BMI. Each one standard deviation in prepregnancy weight change was associated with a 0.19-point increase in gestational weight gain z score. Women with normal weight and prepregnancy weight gain above the cohort mean had a 0.24 higher gestational weight gain z score compared with those with a below average prepregnancy weight gain. Similarly, women with overweight or obesity and a high prepregnancy weight gain had a 0.28 higher gestational weight gain z score than women with overweight or obesity and a low prepregnancy weight gain.
“Our findings raise the possibility that the drivers of gestational weight gain are, in part, related to prepregnancy factors that are more complex than weight status at the time of conception,” the researchers wrote. “Therefore, efforts to achieve a healthy weight gain during pregnancy may need to be initiated prior to pregnancy and focus on assessments of weight changes in all women, not only those with overweight and obesity.”
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