title: Patterns and trajectories of gestational weight gain: a prospective cohort study.
abstract: BACKGROUND
  Gestational weight gain in excess of or below Health Canada's guidelines is known to increase the risk of adverse outcomes for both the woman and her baby. This study describes patterns and trajectories of total and rate of gestational weight gain in a large prospective cohort of pregnant women and adolescents in the Alberta Pregnancy Outcomes and Nutrition study.
  
  
  METHODS
  We collected weight and height data for 1541 pregnant adolescents and women (mean age 31 years, < 27 weeks' gestation) recruited through advertisements and physicians' offices in Calgary and Edmonton between May 2009 and November 2012. Data were collected once during each trimester following enrolment and once at about 3 months post partum. The participants were categorized according to their prepregnancy body mass index (BMI) as underweight, of normal weight, overweight or obese. We calculated distributions of total and weekly rates of weight gain and determined trajectories of weight gain for each prepregnancy BMI category.
  
  
  RESULTS
  Of the 1541 participants, 761 (49.4%) exceeded Health Canada's guidelines for total gestational weight gain, and 272 (17.6%) gained less weight than recommended. A total of 63 (19.2%) and 38 (23.6%) participants categorized as overweight or obese, respectively, exceeded the recommended upper limit by 5 to less than 10 kg, and 53 (16.2%) and 27 (16.8%), respectively, exceeded the upper limit by at least 10 kg. Ninety-five participants (30.3%) in the overweight group and 59 (39.6%) of those in the obese group gained weight at more than double the recommended rate between the second and third trimesters. The median weight gain for participants in the normal, overweight and obese categories had exceeded recommended upper limits by about 30, 20 and 18 weeks' gestation, respectively.
  
  
  CONCLUSIONS
  Adherence to Health Canada's guidelines for gestational weight gain was low. Excess gestational weight gain was most marked among those with a prepregnancy BMI in the overweight or obese category. The findings suggest that weight management in pregnancy is challenging and complex. Messages and supports that are tailored for women in different prepregnancy BMI categories may help to improve guideline-concordant gestational weight gain.
authors.affiliation: Department of Agricultural, Food and Nutritional Science (Jarman, Pakseresht, Robson, Bell) and School of Public Health (Yuan, Shi), University of Alberta; Cancer Measurement, Outcomes, Research and Evaluation (C-MORE) (Robson), Cancer Control Alberta, Alberta Health Services, Edmonton, Alta.
authors.forename: Megan
authors.initials: M
authors.lastname: Jarman
authors.affiliation: Department of Agricultural, Food and Nutritional Science (Jarman, Pakseresht, Robson, Bell) and School of Public Health (Yuan, Shi), University of Alberta; Cancer Measurement, Outcomes, Research and Evaluation (C-MORE) (Robson), Cancer Control Alberta, Alberta Health Services, Edmonton, Alta.
authors.forename: Yan
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Agricultural, Food and Nutritional Science (Jarman, Pakseresht, Robson, Bell) and School of Public Health (Yuan, Shi), University of Alberta; Cancer Measurement, Outcomes, Research and Evaluation (C-MORE) (Robson), Cancer Control Alberta, Alberta Health Services, Edmonton, Alta.
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Pakseresht
authors.affiliation: Department of Agricultural, Food and Nutritional Science (Jarman, Pakseresht, Robson, Bell) and School of Public Health (Yuan, Shi), University of Alberta; Cancer Measurement, Outcomes, Research and Evaluation (C-MORE) (Robson), Cancer Control Alberta, Alberta Health Services, Edmonton, Alta.
authors.forename: Qian
authors.initials: Q
authors.lastname: Shi
authors.affiliation: Department of Agricultural, Food and Nutritional Science (Jarman, Pakseresht, Robson, Bell) and School of Public Health (Yuan, Shi), University of Alberta; Cancer Measurement, Outcomes, Research and Evaluation (C-MORE) (Robson), Cancer Control Alberta, Alberta Health Services, Edmonton, Alta.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Robson
authors.affiliation: Department of Agricultural, Food and Nutritional Science (Jarman, Pakseresht, Robson, Bell) and School of Public Health (Yuan, Shi), University of Alberta; Cancer Measurement, Outcomes, Research and Evaluation (C-MORE) (Robson), Cancer Control Alberta, Alberta Health Services, Edmonton, Alta.
authors.forename: Rhonda C
authors.initials: RC
authors.lastname: Bell