title: Association of second and third trimester weight gain in pregnancy with maternal and fetal outcomes.
abstract: OBJECTIVE
  To investigate the association between weekly weight gain, during the second and third trimesters, classified according to the 2009 Institute of Medicine (IOM/NRC) recommendations, and maternal and fetal outcomes.
  
  
  METHODS
  Gestational weight gain was evaluated in 2,244 pregnant women of the Brazilian Study of Gestational Diabetes (Estudo Brasileiro do Diabetes Gestacional--EBDG). Outcomes were cesarean delivery, preterm birth and small or large for gestational age birth (SGA, LGA). Associations between inadequate weight gain and outcomes were estimated using robust Poisson regression adjusting for pre-pregnancy body mass index, trimester-specific weight gain, age, height, skin color, parity, education, smoking, alcohol consumption, gestational diabetes and hypertensive disorders in pregnancy.
  
  
  RESULTS
  In fully adjusted models, in the second trimester, insufficient weight gain was associated with SGA (relative risk [RR] 1.72, 95% confidence interval [CI] 1.26-2.33), and excessive weight gain with LGA (RR 1.64, 95% CI 1.16-2.31); in third trimester, excessive weight gain with preterm birth (RR 1.70, 95% CI 1.08-2.70) and cesarean delivery (RR 1.21, 95% CI 1.03-1.44). Women with less than recommended gestational weight gain in the 2nd trimester had a lesser risk of cesarean deliveries (RR 0.82, 95% CI 0.71-0.96) than women with adequate gestational weight gain in this trimester.
  
  
  CONCLUSIONS
  Though insufficient weight gain in the 3rd trimester was not associated with adverse outcomes, other deviations from recommended weight gain during second and third trimester were associated with adverse pregnancy outcomes. These findings support, in part, the 2009 IOM/NRC recommendations for nutritional monitoring during pregnancy.
authors: Graduate Studies Program in Epidemiology, Department of Social Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. michele.drehmer@gmail.com
authors: Michele
authors: M
authors: Drehmer
authors: Bruce Bartholow
authors: BB
authors: Duncan
authors: Gilberto
authors: G
authors: Kac
authors: Maria Inês
authors: MI
authors: Schmidt
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001938:Brazil; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D012307:Risk Factors; D015430:Weight Gain; D055815:Young Adult
references: Int J Gynaecol Obstet. 2007 May;97(2):100-4
references: 17376448
references: Obstet Gynecol. 2009 Feb;113(2 Pt 1):305-12
references: 19155899
references: Am J Obstet Gynecol. 2009 Oct;201(4):339.e1-14
references: 19788965
references: Am J Clin Nutr. 2008 Jun;87(6):1750-9
references: 18541565
references: Obstet Gynecol. 2006 Nov;108(5):1153-61
references: 17077237
references: Obstet Gynecol. 1995 Aug;86(2):170-6
references: 7617345
references: Diabetes Care. 2001 Jul;24(7):1151-5
references: 11423494
references: Am J Epidemiol. 2011 Jul 15;174(2):136-46
references: 21633118
references: Obstet Gynecol. 2007 Jun;109(6):1309-15
references: 17540802
references: BMC Pregnancy Childbirth. 2011 Oct 26;11:81
references: 22029725
references: Obstet Gynecol. 2006 Sep;108(3 Pt 1):635-43
references: 16946225
references: Am J Obstet Gynecol. 2010 Jun;202(6):574.e1-8
references: 20132923
references: J Nutr. 1999 May;129(5):988-93
references: 10222390
references: Obstet Gynecol. 2007 Oct;110(4):745-51
references: 17906004
references: Matern Child Nutr. 2008 Jan;4(1):1-13
references: 18171403
references: Am J Public Health. 1997 Dec;87(12):1984-8
references: 9431288
references: Obstet Gynecol. 2010 Jan;115(1):152-155
references: 20027048
references: Am J Obstet Gynecol. 1995 Feb;172(2 Pt 1):705-12
references: 7856711
references: BJOG. 2008 Jan;115(1):44-50
references: 17970795
references: World Health Organ Tech Rep Ser. 1994;844:1-100
references: 7941615
references: Epidemiology. 1999 Mar;10(2):141-7
references: 10069249
references: Obstet Gynecol. 1994 Oct;84(4):565-73
references: 8090394
references: Cad Saude Publica. 2010 May;26(5):1024-34
references: 20563402
references: Obstet Gynecol. 2007 Oct;110(4):752-8
references: 17906005
references: Obstet Gynecol. 2001 Jan;97(1):39-43
references: 11152904
references: Obstet Gynecol. 2004 Oct;104(4):671-7
references: 15458884
references: Am J Clin Nutr. 2000 May;71(5 Suppl):1233S-41S
references: 10799396
references: Rev Saude Publica. 1993 Aug;27(4):271-6
references: 8209159
references: Obstet Gynecol. 1996 Oct;88(4 Pt 1):490-6
references: 8841205
references: Obes Rev. 2011 Jul;12(7):e602-20
references: 21521451
references: Cad Saude Publica. 2001 Nov-Dec;17(6):1367-74
references: 11784897
references: Lancet. 2011 May 28;377(9780):1863-76
references: 21561656
references: Epidemiology. 2006 Mar;17(2):170-7
references: 16477257