title: Should obese women gain less weight in pregnancy than recommended?
abstract: BACKGROUND
  Previous research on inadequate gestational weight gain among obese women and adverse outcomes has been mixed. The objective of this study was to examine associations between inadequate gain among obese women and antepartum, intrapartum, and infant outcomes.
  
  
  METHODS
  Obese women from the U.S. Collaborative Perinatal Project were divided into obesity classes I (30.0-34.9 kg/m(2)) and II/III (> 35.0 kg/m(2)) and three weight gain categories (inadequate: < 5 kg, adequate: 5-9 kg, excessive: > 9 kg) as defined by the U.S. Institute of Medicine. Associations between 1-kg increments of inadequate gain (< 5 kg) and outcomes were examined. Women with inadequate gain were also compared with women gaining normal (5-9 kg) and excessive (> 9 kg) weight.
  
  
  RESULTS
  Each fewer 1-kg of weight gain increased small-for-gestational age (SGA) risk and reduced large-for-gestational age (LGA) risk by similar magnitude. Compared with excessive gain, inadequate gain reduced the odds of preeclampsia (OR: 0.56, CI: 0.37, 0.84), gestational hypertension (OR: 0.66, CI: 0.47, 0.92), and LGA (OR: 0.48, CI: 0.38, 060) and increased the odds of SGA (OR: 2.26, CI: 1.52, 3.35). Inadequate gain offered fewer advantages over adequate weight gain: lower odds of LGA (OR: 0.75, CI: 0.57, 0.99); increased odds of SGA (OR: 1.86, CI: 1.18, 2.91). Most associations applied to obesity class I but not class II/III women.
  
  
  CONCLUSIONS
  Inadequate weight gain poses benefits and risks to mothers and infants, but is preferable to excessive gain. The risks and benefits apply differently to class I versus class II/III obese women, indicating the need for weight gain recommendations by obesity class.
authors.affiliation: Principal Investigators at the Research Institute at Nationwide Children's Hospital, Columbus, and Assistant Professors in the Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
authors.forename: Reena
authors.initials: R
authors.lastname: Oza-Frank
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Keim
mesh_terms: D000328:Adult; D001724:Birth Weight; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology*; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D009765:Obesity; D009767:Obesity, Morbid; D017410:Practice Guidelines as Topic; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D015430:Weight Gain; D055815:Young Adult
keywords: Collaborative Perinatal Project; gestational weight gain; infant; obesity; pre-pregnancy body mass index