title: Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index.
abstract: OBJECTIVE
  To determine the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on large-for-gestational-age (LGA) birth weight (≥90th % ile).
  
  
  METHODS
  We examined 4321 mother-infant pairs from the Ottawa and Kingston (OaK) birth cohort. Multivariate logistic regression (controlling for gestational and maternal age, pre-pregnancy weight, parity, smoking) were performed and odds ratios (ORs) calculated.
  
  
  RESULTS
  Prior to pregnancy, a total of 23.7% of women were overweight and 16.2% obese. Only 29.3% of women met GWG targets recommended by the Institute of Medicine (IOM), whereas 57.7% exceeded the guidelines. Adjusting for smoking, parity, age, maternal height, and achieving the IOM's recommended GWG, overweight (OR 1.99; 95%CI 1.17-3.37) or obese (OR 2.64; 95% CI 1.59-4.39) pre-pregnancy was associated with a higher rate of LGA compared to women with normal BMI. In the same model, exceeding GWG guidelines was associated with higher rates of LGA (OR 2.86; 95% CI 2.09-3.92), as was parity (OR 1.49; 95% CI 1.22-1.82). Smoking (OR 0.53; 95%CI 0.35-0.79) was associated with decreased rates of LGA. The adjusted association with LGA was also estimated for women who exceeded the GWG guidelines and were overweight (OR 3.59; 95% CI 2.60-4.95) or obese (OR 6.71; 95% CI 4.83-9.31).
  
  
  CONCLUSIONS
  Pregravid overweight or obesity and gaining in excess of the IOM 2009 GWG guidelines strongly increase a woman's chance of having a larger baby. Lifestyle interventions that aim to optimize GWG by incorporating healthy eating and exercise strategies during pregnancy should be investigated to determine their effects on LGA neonates and down-stream child obesity.
authors.affiliation: Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ontario, Canada.
authors.forename: Z M
authors.initials: ZM
authors.lastname: Ferraro
authors.forename: N
authors.initials: N
authors.lastname: Barrowman
authors.forename: D
authors.initials: D
authors.lastname: Prud'homme
authors.forename: M
authors.initials: M
authors.lastname: Walker
authors.forename: S W
authors.initials: SW
authors.lastname: Wen
authors.forename: M
authors.initials: M
authors.lastname: Rodger
authors.forename: K B
authors.initials: KB
authors.lastname: Adamo
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005320:Fetal Macrosomia / Q000209:etiology*; D017408:Guidelines as Topic; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity; D016017:Odds Ratio; D050177:Overweight / Q000150:complications; D010349:Patient Compliance; D011247:Pregnancy; D011248:Pregnancy Complications; D015430:Weight Gain; D055815:Young Adult