Dataset Information

A systematic approach for establishing the range of recommended weight gain in pregnancy.

ABSTRACT:

Background

Current approaches for establishing public health guidelines on the recommended range of weight gain in pregnancy are subjective and nonsystematic.

Objective

In this article, we outline how decision-making on gestational weight-gain guidelines could be aided by quantitative approaches used in noninferiority trials.

Design

We reviewed the theoretical application of noninferiority margins to pregnancy weight-gain guidelines. A worked example illustrated the selection of the recommended range of pregnancy weight gain in women who delivered at the Magee-Womens Hospital, Pittsburgh, PA, in 2003-2010 by identifying weight-gain z scores in which risk of unplanned cesarean delivery, preterm birth, small-for-gestational-age infant, and large-for-gestational-age infant were not meaningfully increased (based on noninferiority margins of 10% and 20%).

Results

In normal-weight women, lowest risk of adverse perinatal outcome was observed at a weight-gain z score of -0.2 SDs. With a noninferiority margin of 20%, risks of adverse outcome were not meaningfully increased from the -0.2-SD reference value between z scores of -0.97 and +0.33 SDs (which corresponded to 11.3-18.4 kg). In overweight women, the recommended range was much broader: -2.11 to +0.29 SDs (4.4-18.1 kg).

Conclusion

The new approach illustrated in this article has a number of advantages over current methods for establishing pregnancy weight-gain guidelines because it is systematic, it is reproducible, and it provides a tool for policy makers to derive guidelines that explicitly reflect values at which risk of adverse outcome becomes meaningfully increased.

SUBMITTER: Hutcheon JA

PROVIDER: S-EPMC4095666 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature

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Publications

A systematic approach for establishing the range of recommended weight gain in pregnancy.

Hutcheon Jennifer A JA Bodnar Lisa M LM

The American journal of clinical nutrition 20140625 2

<h4>Background</h4>Current approaches for establishing public health guidelines on the recommended range of weight gain in pregnancy are subjective and nonsystematic.<h4>Objective</h4>In this article, we outline how decision-making on gestational weight-gain guidelines could be aided by quantitative approaches used in noninferiority trials.<h4>Design</h4>We reviewed the theoretical application of noninferiority margins to pregnancy weight-gain guidelines. A worked example illustrated the selecti ...[more]

PMID: 24965305

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Project description:BackgroundPrevention of weight gain outside recommendations is a challenge for health services, with several barriers to best practice care identified. The aim of this pragmatic implementation study with a historical control was to examine the impact of implementing a service wide education program, and antenatal care pregnancy weight gain chart combined with brief advice on women's knowledge of recommended gestational weight gain (GWG), the advice received and actual GWG.MethodsThe PRECEDE PROCEED Model of Health Program planning guided intervention and evaluation targets and an implementation science approach facilitated service changes. Pregnant women < 22 weeks' gestation attending the antenatal clinic at a metropolitan birthing hospital in Australia were recruited pre (2010, n = 715) and post (2016, n = 478) implementation of service changes. Weight measurements and questionnaires were completed at recruitment and 36 weeks' gestation. Questionnaires assessed advice received from health professionals related to healthy eating, physical activity, GWG, and at recruitment only, pre-pregnancy weight and knowledge of GWG recommendations.ResultsWomen who correctly reported their recommended GWG increased from 34% (pre) to 53% (post) (p < 0.001). Between pre and post implementation, the advice women received from midwives on recommended GWG was significantly improved at both recruitment- and 36-weeks' gestation. For normal weight women there was a reduction in GWG (14.2 ± 5.3 vs 13.3 ± 4.7 kg, p = 0.04) and clinically important reduction in excess GWG between pre and post implementation (31% vs 24%, p = 0.035) which remained significant after adjustment (AOR 0.53 [95%CI 0.29-0.96]) (p = 0.005).ConclusionsService wide changes to routine antenatal care that address identified barriers to supporting recommended GWG are likely to improve the care and advice women receive and prevent excess GWG for normal weight women.

Project description:BackgroundGestational weight gain (GWG) has important health implications for both the mother and offspring. Maternal diet during pregnancy may play an important role in achieving adequate GWG, although its precise role is unclear.ObjectivesAssociations between maternal dietary components (fruits and vegetables, added sugar, percentage energy from fat, dairy) and GWG were examined in 327 pregnant women from the Archive for Research on Child Health cohort.MethodsSelf-reported usual dietary intake was assessed with validated dietary screening tools at the first prenatal visit. GWG was obtained from the birth certificate and was categorized as inadequate, adequate, or excessive according to the Institute of Medicine recommendations. Associations between dietary components and GWG were assessed using multivariable regression models, stratified by maternal prepregnancy BMI category.ResultsOnly 31.5% of women had adequate GWG, with 24.8% gaining insufficient weight and 43.7% gaining excessively. Women who consumed more fruits and vegetables were suggestively less likely to have excessive GWG (OR: 0.86; 95% CI: 0.75, 1.00) in the minimally adjusted model, but the association became nonsignificant after adjusting for covariates (OR: 0.89; 95% CI: 0.77, 1.03). In stratified models, higher fruit and vegetable intake was linked to lower likelihood of excessive GWG among women with obesity (OR: 0.77; 95% CI: 0.60, 0.97), whereas higher added sugar intake was linked to a slight reduction in likelihood of excessive GWG (OR: 0.91; 95% CI: 0.84, 0.99) among women with a prepregnancy BMI in the normal range. Other dietary components were not significantly associated with GWG.ConclusionsThese results suggest that consuming fruits and vegetables during pregnancy may reduce risk of excessive GWG among women with obesity. With the rising prevalence of obesity among women of reproductive age, interventions to increase fruit and vegetable intake during pregnancy may have broad public health impact by improving maternal and child health outcomes.

Project description:Importance:Gestational weight gain is a determinant of infant birth weight, but it is unclear whether its timing in pregnancy may hold implications in this regard. Previous studies have yielded conflicting findings on the association of maternal weight gain in early pregnancy with birth weight. However, as these studies have typically recruited women during the first trimester, they are inherently limited by a reliance on self-reported pregravid weight. Objective:To evaluate the associations of directly measured maternal pregravid weight and the timing of subsequent weight gain across pregnancy with infant birth weight. Design, Setting, and Participants:In this prospective, preconception, observational cohort study, 1164 newly married women in Liuyang, China, underwent pregravid evaluation at a median of 19.9 weeks before a singleton pregnancy during which they underwent serial weight measurements. The study was conducted from February 1, 2009, to November 4, 2015. Data analysis was performed between September 1, 2016, and May 6, 2017. Exposure:Maternal weight gain was calculated for the following 10 gestational intervals: from pregravid to less than 14, 14 to 18, 19 to 23, 24 to 28, 29 to 30, 31 to 32, 33 to 34, 35 to 36, 37 to 38, and 39 to 40 weeks. Main Outcomes and Measures:Associations of pregravid weight and weight gain within each of the 10 gestational intervals with the outcome of infant birth weight. Results:The mean (SD) age of the 1164 women included in the study was 25.3 (3.1) years. Pregravid weight was consistently associated with infant birth weight. However, among the 10 gestational intervals, only weight gain from pregravid to 14 weeks and from 14 to 18 weeks was associated with birth weight. Birth weight increased by 13.6 g/kg (95% CI, 3.2-24.1 g/kg) of maternal weight gain from pregravid to 14 weeks and by 26.1 g/kg (95% CI, 3.8-48.4 g/kg) of maternal weight gain from 14 to 18 weeks. Conclusion and Relevance:Maternal weight only in the first half of gestation is a determinant of infant birth weight. Before pregnancy and early gestation may be a critical window for intervention to affect subsequent birth weight.

Dataset Information

A systematic approach for establishing the range of recommended weight gain in pregnancy.

Background

Objective

Design

Results

Conclusion

Publications

A systematic approach for establishing the range of recommended weight gain in pregnancy.

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