title: Gestational weight gain among American Samoan women and its impact on delivery and infant outcomes.
abstract: BACKGROUND
  As obesity has increased worldwide, so have levels of obesity during pregnancy and excess gestational weight gain (GWG). The aim of this paper was to describe GWG among American Samoan women and examine the association between GWG and four adverse pregnancy and infant outcomes: cesarean delivery, small- and large-for-gestational age (SGA/LGA), and infant overweight/obesity.
  
  
  METHODS
  Data were extracted from prenatal care records of 632 Samoan women. Mixed-effects growth models were used to produce individual weight-for-gestational week curves from which second and third trimester weight gain was estimated. Binary logistic regression was used to examine associations between GWG and the outcomes of interest.
  
  
  RESULTS
  Most women were overweight/obese in early pregnancy (86%) and 78% exceeded the Institute of Medicine GWG guidelines. Greater GWG in the second trimester and early pregnancy weight were independently associated with increased odds of a c-section (OR 1.40 [95% CI: 1.08, 1.83]) and OR 1.51 [95% CI: 1.17, 1.95], respectively). Risk of delivering a LGA infant increased with greater third trimester weight gain and higher early pregnancy weight, while second trimester weight gain was negatively associated with SGA. Risk of infant overweight/obesity at 12 months increased with early pregnancy weight (OR: 1.23 [95% CI: 1.01, 1.51]) and infant birthweight.
  
  
  CONCLUSIONS
  The high levels of pregnancy obesity and excessive GWG in American Samoa suggest that it is important for physicians to encourage women into prenatal care early and begin education about appropriate GWG and the potential risks of excess weight gain for both the mother and baby.
authors: Department of Chronic Disease Epidemiology, School of Public Health, Yale University, P.O. Box 208034, New Haven, CT, 06520-8034, USA. nicola.hawley@yale.edu.
authors: Nicola L
authors: NL
authors: Hawley
authors: MRC Human Nutrition Research Unit, Cambridge, UK. William.Johnson@mrc-hnr.cam.ac.uk.
authors: William
authors: W
authors: Johnson
authors: Center for Obesity Research and Education & the Department of Public Health, Temple University, Philadelphia, USA. chantelle.hart@temple.edu.
authors: Chantelle N
authors: CN
authors: Hart
authors: Department of Epidemiology, School of Public Health, Brown University, Providence, USA. elizabeth_triche@brown.edu.
authors: Elizabeth W
authors: EW
authors: Triche
authors: LBJ Tropical Medical Center, Pago Pago, American Samoa, USA. ahchingjohn@yahoo.com.
authors: John
authors: J
authors: Ah Ching
authors: LBJ Tropical Medical Center, Pago Pago, American Samoa, USA. bethel.musasu@lbj.as.
authors: Bethel
authors: B
authors: Muasau-Howard
authors: Department of Epidemiology, School of Public Health, Brown University, Providence, USA. stephen_mcgarvey@brown.edu.|International Health Institute, School of Public Health, Brown University, Providence, USA. stephen_mcgarvey@brown.edu.
authors: Stephen T
authors: ST
authors: McGarvey
mesh_terms: D000328:Adult; D018948:American Samoa / Q000453:epidemiology; D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015430:Weight Gain; D055815:Young Adult
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