title: Newborn size among obese women with weight gain outside the 2009 Institute of Medicine recommendation.
abstract: OBJECTIVE
  To estimate risk of delivering macrosomic, large-for-gestational-age and small-for-gestational-age neonates in obese women with gestational weight gain outside the 2009 Institute of Medicine recommendation (11-20 pounds).
  
  
  METHODS
  In a retrospective cohort study, we evaluated 2,080 obese women (body mass index 30 or higher) with singleton pregnancies that resulted in term live births within one health maintenance organization between 2000 and 2005; women with diabetes or hypertensive disorders were excluded. Gestational weight gain was categorized as less than 0, 0 to less than 11, 11-20 (referent), greater than 20-30, greater than 30-40, and greater than 40 pounds and as above, below, or within Institute of Medicine recommendations. We conducted multivariable logistic regression to estimate the odds of large for gestational age and small for gestational age (birth weights greater than the 90th percentile and less than the 10th percentile for gestational age, respectively) and macrosomia (greater than 4,500 g) adjusting for potential confounders.
  
  
  RESULTS
  Eighteen percent gained below, 25% within, and 57% above Institute of Medicine recommendations. Prevalence of macrosomia, large for gestational age, and small for gestational age were 4.3%, 19.8%, and 4.3%, respectively. Compared with weight gain of 11-20 pounds, weight gain above recommendations did not significantly decrease small-for-gestational-age risk but was associated with increased odds of macrosomia (adjusted odds ratio [OR] 3.36; 95% confidence interval [CI] 1.74-6.51; 6.0% compared with 2.1%) and large for gestational age (adjusted OR 1.80; 95% CI 1.36-2.38; 23.8% compared with 16.6%). Weight gain below recommendations was associated with increased odds of small for gestational age (adjusted OR 3.94; 95% CI 2.04-7.61; 8.8% compared with 2.7%) and decreased odds of large for gestational age (adjusted OR 0.56; 95% CI 0.37-0.84; 11.2% compared with 16.6%).
  
  
  CONCLUSIONS
  Regarding small for gestational age and large for gestational age, there is no benefit of weight gain above Institute of Medicine recommendations. Weight gain below recommendations decreases large for gestational age but increases small-for-gestational-age risk.
  
  
  METHODS
  II.
authors.affiliation: From The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon; and the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Kimberly K
authors.initials: KK
authors.lastname: Vesco
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Sharma
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Dietz
authors.forename: Joanne H
authors.initials: JH
authors.lastname: Rizzo
authors.forename: William M
authors.initials: WM
authors.lastname: Callaghan
authors.forename: Lucinda
authors.initials: L
authors.lastname: England
authors.forename: F Carol
authors.initials: FC
authors.lastname: Bruce
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Bachman
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Stevens
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
mesh_terms: D001724:Birth Weight; D015992:Body Mass Index; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology*; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000592:standards; D012189:Retrospective Studies; D018570:Risk Assessment; D015430:Weight Gain / Q000502:physiology*