title: Weight gain in healthy pregnant women in relation to pre-pregnancy BMI, diet and physical activity.
abstract: OBJECTIVE
  to explore gestational weight gain in healthy women in relation to pre-pregnancy Body Mass Index, diet and physical activity.
  
  
  METHODS
  a cross-sectional survey was conducted among 455 healthy pregnant women of all gestational ages receiving antenatal care from an independent midwife in the Netherlands. Weight gain was assessed using the Institute of Medicine (IOM) guidelines and classified as below, within, or above the guidelines. A multinomial regression analysis was performed with weight gain classifications as the dependent variable (within IOM-guidelines as reference). Independent variables were pre-pregnancy Body Mass Index, diet (broken down into consumption of vegetables, fruit and fish) and physical activity (motivation to engage in physical activity, pre-pregnancy physical activity and decline in physical activity during pregnancy). Covariates were age, gestational age, parity, ethnicity, family income, education, perceived sleep deprivation, satisfaction with pre-pregnancy weight, estimated prepregnancy body mass index, smoking, having a weight gain goal and having received weight gain advice from the midwife.
  
  
  RESULTS
  forty-two per cent of the women surveyed gained weight within the guidelines. Fourteen per cent of the women gained weight below the guidelines and 44 per cent gained weight above the guidelines. Weight gain within the guidelines, compared to both above and below the guidelines, was not associated with pre-pregnancy Body Mass Index nor with diet. A decline in physical activity was associated with weight gain above the guidelines (OR 0.54, 95 per cent CI 0.33-0.89). Weight gain below the guidelines was seen more often in women who perceived a greater sleep deprivation (OR 1.20, 95 per cent CI 1.02-1.41). Weight gain above the guidelines was seen less often in Caucasian women in comparison to non-Caucasian women (OR 0.22, 95 per cent CI 0.08-0.56) and with women who did not stop smoking during pregnancy (OR 0.49, 95 per cent CI 0.25-0.95).
  
  
  CONCLUSIONS
  a decline in physical activity was the only modifiable factor in our population associated with weight gain above the gain recommended by the guidelines. Prevention of reduced physical activity during pregnancy seems a promising approach to promoting healthy weight gain. Interventions to promote healthy weight gain should focus on all women, regardless of pre-pregnancy body mass index.
authors.affiliation: Research Centre for Midwifery Science, Maastricht, Zuyd University, PO Box 1256, 6201 BG Maastricht, Universiteitsingel 60, 6229ER Maastricht, The Netherlands; CAPHRI, School for Public Health and Primary Care Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: a.merkx@av-m.nl.
authors.forename: Astrid
authors.initials: A
authors.lastname: Merkx
authors.affiliation: Research Centre for Midwifery Science, Maastricht, Zuyd University, PO Box 1256, 6201 BG Maastricht, Universiteitsingel 60, 6229ER Maastricht, The Netherlands.
authors.forename: Marlein
authors.initials: M
authors.lastname: Ausems
authors.affiliation: Research Centre for Midwifery Science, Maastricht, Zuyd University, PO Box 1256, 6201 BG Maastricht, Universiteitsingel 60, 6229ER Maastricht, The Netherlands.
authors.forename: Luc
authors.initials: L
authors.lastname: Budé
authors.affiliation: Research Centre for Midwifery Science, Maastricht, Zuyd University, PO Box 1256, 6201 BG Maastricht, Universiteitsingel 60, 6229ER Maastricht, The Netherlands; CAPHRI, School for Public Health and Primary Care Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Raymond
authors.initials: R
authors.lastname: de Vries
authors.affiliation: Research Centre for Midwifery Science, Maastricht, Zuyd University, PO Box 1256, 6201 BG Maastricht, Universiteitsingel 60, 6229ER Maastricht, The Netherlands.
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Nieuwenhuijze
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D039382:Maternal Nutritional Physiological Phenomena; D008880:Midwifery; D009426:Netherlands; D011247:Pregnancy / Q000502:physiology*; D011264:Pregnancy Trimesters; D012016:Reference Values; D011795:Surveys and Questionnaires; D015430:Weight Gain
keywords: BMI; Diet; Gestational weight gain; Health promotion; IOM-guidelines; Physical activity