Trends in weight gain during pregnancy: A population study across 16 years in North Carolina

doi:10.1016/j.ajog.2006.01.025

American Journal of Obstetrics and Gynecology

Volume 194, Issue 5, May 2006, Pages e32-e34

https://doi.org/10.1016/j.ajog.2006.01.025 Get rights and content

Objective

This study was undertaken to examine the proportion of women meeting established weight gain recommendations during pregnancy.

Study design

Retrospective cohort using χ² and logistic regression analysis of 1,463,936 registered North Carolina births from 1988 to 2003.

Results

The percentage of pregnant women achieving recommended weight gain decreased significantly (down 6.3%) between 1988 and 2003.

Conclusion

Despite Institute of Medicine guidelines and a Healthy People 2010 goal aimed at improving the health of women and infants by optimizing weight gain during pregnancy, the proportion of women in North Carolina with inappropriately low or excessive weight gain increased. We need to reexamine interventions designed to support appropriate weight gain during pregnancy.

Section snippets

Methods

We compiled data for 1,756,207 births registered in North Carolina⁶ for the years 1988 through 2003 when the variable “pounds gained during pregnancy” was available. Secondary analysis of publicly available data is exempt from Institutional Review Board approval (Title 45 CFR 46 Subpart A 46.101 b4).

We categorized 1,463,936 (83%) singleton, term (≥37 weeks) deliveries based on IOM recommendation limits¹ (Table I): inadequate gain (<15 lbs), recommended gain (15-40 lbs), and excessive gain (>40

Results

We found significant differences in all categories over the 16-year span (P = .0001; Figure 1). The proportion making recommended gains decreased steadily from 76.9% in 1988 to 70.6% in 2003. The proportion making inadequate weight gains increased from 7.3% to approximately 10% in the early 2000s; approximately 25 additional women per 1000 did not achieve minimum recommended weight gains by the 2000s (Figure 2). The proportion gaining excessive weight increased from 15.5% in 1988 to 19.5% in

Comment

Over the past 16 years in North Carolina, a decreasing proportion of women achieved recommended weight gain goals during pregnancy. This is consistent with national trends for excessive pregnancy gain,⁷ which may be the result of a general societal trend toward increased obesity. Surprisingly, however, the proportion of pregnant women gaining inadequate weight has increased also. The reasons for this bidirectional shift are unknown and concerning.

The hypothetical issues associated with this

References (8)

C.A. Hickey et al.
Prenatal weight gain patterns and birth weight among non-obese black and white women
Obstet Gynecol
(1996)
Institute of Medicine
National Academy of Sciences, Subcommittee on Nutritional Status and Weight Gain during Pregnancy
(1990)
National Center for Health Statistics
Healthy People 2000 Review, 1997
(1997)
Maternal, Infant and Child Health, Healthy People 2010, 2000:16-36. Available at http://www.healthypeople.gov/....

There are more references available in the full text version of this article.

Cited by (48)

Excessive gestational weight gain in first trimester is a risk factor for exacerbation of asthma during pregnancy: A prospective study of 1283 pregnancies
2018, Journal of Allergy and Clinical Immunology
Acute exacerbation during pregnancy is the most important risk factor for an unfavorable outcome of pregnancy in women with asthma.
We sought to identify pregnancy-related risk factors for acute exacerbations of asthma during pregnancy.
Since 2007, all pregnant women referred to give birth at Hvidovre Hospital, Denmark, have been offered participation in the prospective Management of Asthma during Pregnancy (MAP) program. Women were included in the present analysis if they fulfilled the following criteria: (1) diagnosed with asthma, (2) prescribed at least rescue bronchodilator, and (3) had the first visit to the respiratory outpatient clinic within the first 18 weeks of pregnancy. Data were analyzed using multiple logistic regression models with backward stepwise elimination (Proc Logistic procedure in SAS).
Over an 8-year study period, a total of 1283 pregnancies in 1208 women fulfilled the criteria for inclusion in the MAP cohort. Women with asthma exacerbation(s) had larger gestational weight gain (GWG) in the first trimester of pregnancy (P < .001) and increased total GWG (P < .001) compared with women without exacerbation. More than 5 kg first-trimester weight gain was associated with an increased risk of asthma exacerbation (odds ratio, 9.35; 95% CI, 6.39-13.68; P < .001), and the risk increased in a dose-dependent manner with additional weight gain in excess of 5 kg.
Excessive GWG in the first trimester is a risk factor for asthma exacerbation during pregnancy and the risk increases in a dose-dependent manner with increasing GWG.
Understanding maternal dietary choices during pregnancy: The role of social norms and mindful eating
2017, Appetite
Serious health complications associated with excessive weight have been documented for pregnant women and their babies during pregnancy, birth and beyond. Whilst research has focused on identifying particular foods that can be either detrimental or essential for the developing baby, pregnant women's food choices are likely determined by broader considerations. This study examined social influences as represented in reports of descriptive and injunctive social norms related to healthy eating during pregnancy, and individual differences in mindfulness while eating, as important potential correlates of pregnant women's self-reported diet.
Pregnant women (N = 139) completed a questionnaire that measured self-reported consumption of healthy and unhealthy foods, descriptive and injunctive norms related to healthy eating during pregnancy and the Mindful Eating Questionnaire (MEQ). Hierarchical multiple regressions were conducted to assess the extent to which norms and mindful eating accounted for variance in consumption of both foods.
No significant associations were observed between perceived social norms related to diet during pregnancy and self-reported dietary behaviour. Mindful eating was found to play a role in pregnant women's eating behaviour, with the awareness subscale of the MEQ significantly associated with healthy eating and the emotional subscale associated with unhealthy eating. Age was also associated with consumption of unhealthy foods; younger pregnant women reported consuming more unhealthy snacks and fast food meals.
The associations between mindful eating and dietary behaviour suggests that improving mindfulness related to food consumption before and during pregnancy may provide a strategy to address excessive gestational weight gain.
Does dose matter in reducing gestational weight gain in exercise interventions? A systematic review of literature
2016, Journal of Science and Medicine in Sport
Citation Excerpt :
Evidence suggests that maternal physical activity (PA) has decreased substantially over the past half century,1,2 in concert with a significant increase in the prevalence of excessive gestational weight gain (GWG) during pregnancy.3,4
The purpose of this review was to examine the relationship between exercise dose and reductions in weight gain during pregnancy in exercise interventions.
Systematic literature review.
Four electronic research databases (PubMed, Web of Science, CINAHL, and Academic Search Premiere) were used to identify exercise interventions conducted with pregnant women. Eligible articles must have satisfied the following criteria: inclusion of a control condition, exercise as a major intervention component, weight gain measured and reported for each experimental condition, description of exercise dose (frequency, intensity and duration), and utilized an adequate number of control conditions to assess independent effects of exercise on weight gain.
The literature search identified 4837 articles. Of these, 174 abstracts were screened and 21 intervention studies (18 exercise-only, 3 exercise/diet) were eligible for review. Only 38% of the interventions achieved statistically significant reductions in gestational weight gain. Successful interventions possessed higher adherence and lower attrition rates and were predominantly conducted among normal weight populations. No clear patterns or consistencies of exercise dose and reductions in weight gain were evident.
An exercise dose associated with reductions in weight gain was unquantifiable among these interventions. Adherence and retention rates were strong contributors to the success of exercise interventions on gestational weight gain. It is strongly suggested that future researchers investigate methods to increase adherence and compliance, especially among overweight and obese women, and utilize objective measurement tools to accurately evaluate exercise dose performed by the participants and the impact on body composition and weight gain.
The childhood obesity epidemic as a result of nongenetic evolution: The maternal resources hypothesis
2015, Mayo Clinic Proceedings
Citation Excerpt :
Recent work suggests that by the 1990s, women and mothers allocated more time to screen-based media use (eg, watching TV) than to all forms of PA combined.68 In concert with progressive increments in sedentarism, inactivity, and PAEE were progressive decrements in population-level metabolic control73-75 and substantial increases in maternal pregravid obesity,76 gestational weight gain,77 and gestational diabetes.78 Skeletal muscle activation via PA is an absolute requirement for metabolic health.79
Over the past century, socioenvironmental evolution (eg, reduced pathogenic load, decreased physical activity, and improved nutrition) led to cumulative increments in maternal energy resources (ie, body mass and adiposity) and decrements in energy expenditure and metabolic control. These decrements reduced the competition between maternal and fetal energy demands and increased the availability of energy substrates to the intrauterine milieu. This perturbation of mother-conceptus energy partitioning stimulated fetal pancreatic β-cell and adipocyte hyperplasia, thereby inducing an enduring competitive dominance of adipocytes over other tissues in the acquisition and sequestering of nutrient energy via intensified insulin secretion and hyperplastic adiposity. At menarche, the competitive dominance of adipocytes was further amplified via hormone-induced adipocyte hyperplasia and weight-induced decrements in physical activity. These metabolic and behavioral effects were propagated progressively when obese, inactive, metabolically compromised women produced progressively larger, more inactive, metabolically compromised children. Consequently, the evolution of human energy metabolism was markedly altered. This phenotypic evolution was exacerbated by increments in the use of cesarean sections, which allowed both the larger fetuses and the metabolically compromised mothers who produced them to survive and reproduce. Thus, natural selection was iatrogenically rendered artificial selection, and the frequency of obese, inactive, metabolically compromised phenotypes increased in the global population. By the late 20th century, a metabolic tipping point was reached at which the postprandial insulin response was so intense, the relative number of adipocytes so large, and inactivity so pervasive that the competitive dominance of adipocytes in the sequestering of nutrient energy was inevitable and obesity was unavoidable.
Gestational Weight Gain and Birth Outcome in Relation to Prepregnancy Body Mass Index and Ethnicity
2011, Annals of Epidemiology
Citation Excerpt :
We found stronger evidence for an enhanced risk of preterm birth with high GWG among overweight and obese women, which also was found by investigators (14–16), but not observed by Rudra et al. (18) in a study focused on pregnancy weight gain before 22 weeks’ gestation. Given that the number of women with both elevated BMI and excessive GWG is substantial and appears to be increasing over time (19), the high end of the U-shaped association warrants at least as much concern as the lower part. The marked enhancement of the increased risk of preterm birth among high GWG women for medically indicated preterm births is consistent with the reduction in association for high GWG found by Dietz et al. (16) when births with hypertension or diabetes were excluded.
The obesity epidemic raises concerns about the impact of excessive and insufficient weight gain during pregnancy.
We examined the association between gestational weight gain (GWG) and preterm birth, term small- and large-for-gestational-age (SGA and LGA), term birthweight, and term primary Cesarean delivery, considering prepregnancy body mass index (BMI) and ethnicity in a cohort of 33,872 New York City residents who gave birth between 1995 and 2003 and delivered in hospitals elsewhere in New York State.
Preterm birth (<37 weeks’ gestation) showed a modest U-shaped relationship, with projected GWG of <10 kg and 20+ kg associated with odds ratios of 1.4 and 1.3, respectively, relative to 10 to 14 kg. The pattern was stronger for preterm birth <32 weeks’ and for underweight women with low GWG and overweight/obese women with high GWG. Term SGA decreased and term LGA and birthweight increased monotonically with increasing GWG. Primary Cesarean delivery followed the same pattern as LGA, but less strongly.
Although the study is limited by potential selection bias and measurement error, our findings support the contention that GWG may be a modifiable predictor of pregnancy outcome that warrants further investigation, particularly randomized trials, to assess whether the relation is causal.
Perspectives of Pregnant Women and Antenatal Service Providers Regarding Gestational Weight Gain and Nutritional Needs: Systematic Review
2023, Amerta Nutrition

View all citing articles on Scopus

View full text

Residents' PaperTrends in weight gain during pregnancy: A population study across 16 years in North Carolina

Objective

Study design

Results

Conclusion

Section snippets

Methods

Results

Comment

Obstet Gynecol

National Academy of Sciences, Subcommittee on Nutritional Status and Weight Gain during Pregnancy

Healthy People 2000 Review, 1997

Residents' Paper
Trends in weight gain during pregnancy: A population study across 16 years in North Carolina