title: How should gestational weight gain be assessed? A comparison of existing methods and a novel method, area under the weight gain curve.
abstract: BACKGROUND
  Gestational weight gain is important to assess for epidemiological and public health purposes: it is correlated with infant growth and may be related to maternal outcomes such as reproductive health and chronic disease risk. Methods commonly used to assess weight gain incorporate assumptions that are usually not borne out, such as a linear weight gain, or do not account for differential length of gestation.
  
  
  METHODS
  We introduce a novel method to assess gestational weight gain, the area under the weight gain curve. This is easily interpretable as the additional pound-days carried due to pregnancy and avoids many flaws in alternative assessments. We compare the performance of the simple difference, weekly gain, Institute of Medicine categories and the area under the weight gain curve in predicting birthweight and maternal weight retention at 6, 12, 24 and 36 months postpartum. The analytic sample comprises 2016 participants in Project Viva, an observational prospective cohort study of pregnant women in Massachusetts.
  
  
  RESULTS
  For birthweight outcomes, none of the weight gain measures is a meaningfully superior predictor. For 6-month postpartum weight retention the simple difference is superior, while for 12-, 24- and 36-month weight retention the area under the weight gain curve is superior.
  
  
  CONCLUSIONS
  These findings are plausible biologically: the same amount of weight gained early vs later in the pregnancy may reflect increased maternal fat stores. The timing of weight gain is reflected best in the area under the weight gain curve. Different methods of measuring gestational weight gain may be appropriate depending on the context.
authors: Obesity Prevention Program, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA. Ken_Kleinman@hms.harvard.edu
authors: Ken P
authors: KP
authors: Kleinman
authors: Emily
authors: E
authors: Oken
authors: Jenny S
authors: JS
authors: Radesky
authors: Janet W
authors: JW
authors: Rich-Edwards
authors: Karen E
authors: KE
authors: Peterson
authors: Matthew W
authors: MW
authors: Gillman
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001724:Birth Weight; D015992:Body Mass Index; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D049590:Postpartum Period / Q000502:physiology; D011247:Pregnancy / Q000502:physiology*; D011264:Pregnancy Trimesters; D015430:Weight Gain
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