title: Gestational weight gain and adverse neonatal outcome among term infants.
abstract: OBJECTIVE
  To examine the relationship between gestational weight gain and adverse neonatal outcomes among infants born at term (37 weeks or more).
  
  
  METHODS
  This was a retrospective cohort study of 20,465 nondiabetic, term, singleton births. We performed univariable and multivariable analyses of the associations between gestational weight gain and neonatal outcomes. We categorized gestational weight gain by the Institute of Medicine guidelines as well as extremes of gestational weight gain (less than 7 kg and more than 18 kg).
  
  
  RESULTS
  Gestational weight gain above the Institute of Medicine guidelines was more common than gestational weight gain below (43.3% compared with 20.1%). In multivariable analyses, gestational weight gain above guidelines was associated with a low 5-minute Apgar score (adjusted odds ratio [AOR] 1.33, 95% confidence interval [CI] 1.01-1.76), seizure (AOR 6.50, 95% CI 1.43-29.65), hypoglycemia (AOR 1.52, 95% CI 1.06-2.16), polycythemia (AOR 1.44, 95% CI 1.06-1.94), meconium aspiration syndrome (AOR 1.79, 95% CI 1.12-2.86), and large for gestational age (AOR 1.98, 95% CI 1.74-2.25) compared with women within weight gain guidelines. Gestational weight gain below guidelines was associated with decreased odds of neonatal intensive care unit admission (AOR 0.66, 95% CI 0.46-0.96) and increased odds of small for gestational age (SGA; AOR 1.66, 95% CI 1.44-1.92). Gestational weight gain less than 7 kg was associated with increased risk of seizure, hospital stay more than 5 days, and SGA. Gestational weight gain more than 18 kg was associated with assisted ventilation, seizure, hypoglycemia, polycythemia, meconium aspiration syndrome, and large for gestational age.
  
  
  CONCLUSIONS
  Gestational weight gain above guidelines was common and associated with multiple adverse neonatal outcomes, whereas gestational weight gain below guidelines was only associated with SGA status. Public health efforts among similar populations should emphasize prevention of excessive gestational weight gain.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco General Hospital, San Francisco, California 94110, USA. stotlandn@obgyn.ucsf.edu
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Stotland
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Cheng
authors.forename: Linda M
authors.initials: LM
authors.lastname: Hopkins
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D000704:Analysis of Variance; D001034:Apgar Score; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology* / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007902:Length of Stay; D009017:Morbidity; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications*; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D018570:Risk Assessment; D013851:Thinness / Q000150:complications*; D015430:Weight Gain