title: Misperceived pre-pregnancy body weight status predicts excessive gestational weight gain: findings from a US cohort study.
abstract: BACKGROUND
  Excessive gestational weight gain promotes poor maternal and child health outcomes. Weight misperception is associated with weight gain in non-pregnant women, but no data exist during pregnancy. The purpose of this study was to examine the association of misperceived pre-pregnancy body weight status with excessive gestational weight gain.
  
  
  METHODS
  At study enrollment, participants in Project Viva reported weight, height, and perceived body weight status by questionnaire. Our study sample comprised 1537 women who had either normal or overweight/obese pre-pregnancy BMI. We created 2 categories of pre-pregnancy body weight status misperception: normal weight women who identified themselves as overweight ('overassessors') and overweight/obese women who identified themselves as average or underweight ('underassessors'). Women who correctly perceived their body weight status were classified as either normal weight or overweight/obese accurate assessors. We performed multivariable logistic regression to determine the odds of excessive gestational weight gain according to 1990 Institute of Medicine guidelines.
  
  
  RESULTS
  Of the 1029 women with normal pre-pregnancy BMI, 898 (87%) accurately perceived and 131 (13%) overassessed their weight status. 508 women were overweight/obese, of whom 438 (86%) accurately perceived and 70 (14%) underassessed their pre-pregnancy weight status. By the end of pregnancy, 823 women (54%) gained excessively. Compared with normal weight accurate assessors, the adjusted odds of excessive gestational weight gain was 2.0 (95% confidence interval [CI]: 1.3, 3.0) in normal weight overassessors, 2.9 (95% CI: 2.2, 3.9) in overweight/obese accurate assessors, and 7.6 (95% CI: 3.4, 17.0) in overweight/obese underassessors.
  
  
  CONCLUSIONS
  Misperceived pre-pregnancy body weight status was associated with excessive gestational weight gain among both normal weight and overweight/obese women, with the greatest likelihood of excessive gain among overweight/obese underassessors. Future interventions should test the potential benefits of correcting misperception to reduce the likelihood of excessive gestational weight gain.
authors.affiliation: Obesity Prevention Program, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA. Sharon_Herring@post.harvard.edu
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Herring
authors.forename: Emily
authors.initials: E
authors.lastname: Oken
authors.forename: Jess
authors.initials: J
authors.lastname: Haines
authors.forename: Janet W
authors.initials: JW
authors.lastname: Rich-Edwards
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Rifas-Shiman
authors.forename: Ken P
authors.initials: KP
authors.lastname: Kleinman ScD
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
mesh_terms: D000328:Adult; D001828:Body Image; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D009765:Obesity / Q000453:epidemiology / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000523:psychology*; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013851:Thinness / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D015430:Weight Gain